This document discusses breast cancer management from diagnosis through treatment and follow-up. It covers breast cancer subtypes, staging, guidelines for workup and determining estrogen receptor, progesterone receptor and HER2 status. Treatment options are discussed for early, locally advanced and metastatic breast cancer including surgery, radiation, chemotherapy regimens and targeted therapies. Main toxicities of common breast cancer drugs are also summarized. The goal is to provide an overview of the usual management of breast cancer patients.
Presentación realizada por la Dra. Pilar Escudero del HCU Lozano Blesa, en el marco de la I Jornada de actualización e innovación en Oncología que tuvo lugar en el CIBA en enero de 2015.
Presentación realizada por la Dra. Pilar Escudero del HCU Lozano Blesa, en el marco de la I Jornada de actualización e innovación en Oncología que tuvo lugar en el CIBA en enero de 2015.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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 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
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
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!
3. Objetivo
Obtener un conocimiento GENERAL del manejo USUAL de pacientes con las patologías a
discutir desde la sospecha diagnóstica, hasta el las pautas de seguimiento post-
tratamiento, pasando por los aspectos más relevantes de tratamientos con intención
curativa.
19. TNM
N1:
movable LN
N2:
Fixed Matted LN
N3:
Infraclavicular LN, or
Supraclavicular LN, or
Axillary + internal mammary LN
T1: up to 2 cm
More than 2,
less than 5 cm
T3: more than
5 cm
M0: No distant
metastasis
M1: Distant
metastasis
T4: Chest wall or
Skin involvement
LN: Lymph nodes
CLINICAL
Enough tnm to guide
therapy for breast cancer
20. TNM
N1:
1-3 axillary ln
N2:
4-9 axillary ln
N3:
More than 10 axillary LN
Infraclavicular LN, or
Supraclavicular LN, or
Axillary + internal mammary LN
T1: up to 2 cm
More than 2,
less than 5 cm
T3: more than
5 cm
M0: No distant
metastasis
M1: Distant
metastasis
T4: Chest wall or
Skin involvement
LN: Lymph nodes
PATHOLOGICAL
Enough tnm to guide
therapy for breast cancer
38. Mastectomía radical modificada
A.Resección de la mama (en rosado)
B.Disección de ganglios axilares – Nivel I
C.Disección de ganglios axilares – Nivel II
D.Disección de ganglios axilares – Nivel III
Lumpectomía
(cuadrantectomía) – Cirugía
preservadora de mama
QUIRÚRGICO
61. Workup – Stages I-IIB Comments
H&P
Diagnostic bilateral mammogram
Breast ultrasound
Pathologic review
Determination ER / PR
Determination Her2
Genetic counseling High risk for hereditary cancer
Breast MRI Optional
Counseling for fertility In premenopausal; pregnancy test
Further workup as needed Complete blodd count, liver function tests
Bone scan if symptoms or high alk-phosphatase
Abdomen CT in high alk-phosphatase or symptoms
Chest CT if pulmonary symptoms
Breast cancer
https://www.nccn.org
62. Workup – Stages IIIA T3, N1, MO Comments
H&P
Diagnostic bilateral mammogram
Breast ultrasound
Pathologic review
Determination ER / PR
Determination Her2
Genetic counseling High risk for hereditary cancer
Breast MRI Optional
Counseling for fertility In premenopausal; pregnancy test
Complete blood count
Liver function tests, alk-phosphatase
Chest / abdomen +/- pelvis CT
Bone scan
PET-CT Optional
Breast cancer
https://www.nccn.org
63. Workup – Prior to preoperative
systemic therapy
Comments
H&P
Diagnostic bilateral mammogram
Breast ultrasound
Pathologic review
Axillary assessment Physical exam, ultrasound or other imaging as necessary,
and percutaneous biopsy of suspecious nodes
Determination ER / PR
Determination Her2
Genetic counseling High risk for hereditary cancer
Breast MRI Optional
Counseling for fertility In premenopausal; pregnancy test
Further workup as needed Complete blodd count, liver function tests
Bone scan if symptoms or high alk-phosphatase
Abdomen CT in high alk-phosphatase or symptoms
Chest CT if pulmonary symptoms
Breast cancer
https://www.nccn.org
64. Clinical suspicion
Suspiscious
mammo…
Breast skin changes Nipple abnormalities
Core-needle biopsy
(ie US-guided)
Breast mass
TNM/Stage/Biology
Stage I Stage II
Resectable stage
III
Unresectable
stage III
Metastatic
65. Luminal Her2+ TNBC
Stage I LRT (RT if BCS)
Genomic (Chemo if HR)
Hormonal
LRT (RT if BCS)
Paclitaxel + Trastuzumab
Hormonal if HR+
LRT (RT if BCS)
Adjuvant chemotherapy
Stage II LRT (RT if BCS)
Genomic (Chemo if HR)
Hormonal
LRT (RT if BCS)
AC, followed by Paclitaxel + Trastuzumab
Hormonal if HR+
RT if LN+
LRT (RT if BCS)
Adjuvant chemotherapy
RT if LN+
Stage III Neoadjuvant AC-Paclitaxel
Surgery – RT
Hormonal
Neoadjuvant AC-Paclitaxel + Trastuzumab
Surgery – RT
If not-pCR: T-DM1; else, Trastuzumab
Hormonal if HR+
Neoadjuvant AC-Paclitaxel +/-
Carboplatin
Surgery – RT
If not-pCR: Capecitabine
Low-Risk Metastatic (Bone
and soft tissue metastases,
only)
Ovarian ablation (premenopausal) + AI +
cdk4/6 inhibitor + Denosumab
CLEOPATRA: Docetaxel + Trastuzumab + Pertuzumab +
Denosumab
Single-agent paclitaxel
Visceral crises Single/combined chemo, followed by
hormone
CLEOPATRA Single/combined chemo
Breast cancer pattern of care
LRT: Loco-regional therapy (ie, surgery +/- radiation); RT: radiation therapy; BCS: breast-conserving surgery, HR: Estrogen or progesteron receptor positive, AC: Doxorubicin +
Cyclophosphamide; LN+: positive regional lymph-nodes; pCR: pathologic complete response, T-DM1: Trastuzumab emtansine; AI: Aromatase inhibitor
66.
67. Drug MOA Included in Main toxicities
Doxorubicin Topoisomerase II inhibitor
(anti DNA agent)
A in AC Alopecia
Nausea/Vomiting
Myelosuppression
Mucositis
Cardiac toxicity, 2ry leukemias
Cyclophosph
amide
Alkilating agent (anti DNA
agent)
C in AC Myelossuppression
… See doxorubicin
Paclitaxel Anti microtubule agent
(mitosis poison)
Paclitaxel, alone or in combination Muscle and joint pain
Myelosuppression
Peripheral neuropathy
Capecitabine Antimetabolite (anti
Thymidilate synthase)
Capecitabina, alone or in combination Diarrhea
Hand-foot syndrome
Myelosuppression
Trastuzumab Anti HER-2 monoclonal
antibody
In many Her2+ settings Cardiac toxicity (reversible)
T-DM1 Anti Her2 - Antibody-drug
conjugate
In many Her2+ settings Neuropathy
Thrombocytopenia
Cardiac toxicity
68. Drug MOA Included in Main toxicities
Tamoxifen Selective estrogen
receptor modulator
Anti estrogen for both premenopausal, and post
menopausal women
Hot flashes
Weight gain
Thromboembolic complications
Corpus uteri neoplasms
AI Anti-estrogen through
aromatase inhibition
Alone, or in combination (Anastrozol, Letrozol,
Exemestane)
Hot flashes
Joint pain
Osteoporosis
Dyslipidemia
Fulvestrant ER inactivator Alone, or in combination Hot flashes
Injection-site reaction
Cdk4/6
inhibitor
Cell-cycle inhibitor Alone (abemaciclib) In combination with AI or
Fulvestrant (ribociclib or palbociclib)
Neutropenia
Prolongued QT
Diarrhea, etc.