Definition used in the consensus guidelines ASCCP +24 organizations 2013
Colposcopy
Colposcopy is the examination of the cervix , vagina and, in some instances the vulva, with the colposcope after the application of a 3--5% acetic solution coupled with obtaining colposcopically – directed biopsies of all lesions suspected of representing neoplasia
Given the availability of a colposcope and a trained colposcopist this method is an essential tool for effective secondary prevention of female reproductive organ diseases. Colposcopic guided procedures enable a preceise diagnostic and consequent treatments with eventually organ preserving means. This power point presentation highlights the range of opportunities offered by Colposcopy.
Given the availability of a colposcope and a trained colposcopist this method is an essential tool for effective secondary prevention of female reproductive organ diseases. Colposcopic guided procedures enable a preceise diagnostic and consequent treatments with eventually organ preserving means. This power point presentation highlights the range of opportunities offered by Colposcopy.
Advance in diagnosis & treatment of cancers has led to high cure rate & longer survival.
Nearly 1 in 12 cases detected before 40 years age.
Survivors have to face infertility or early menopause.
Hysteroscopic procedures are getting refined and with the advent of miniature scopes , doing these procedures in he office is getting better and more comfortable.
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Endometrial hyperplasia - irregular proliferation of the endometrial glands with an increase in the gland to stroma ratio when compared with proliferative endometrium
Endometrial Ca - most common gynaecological maglinancy in the western country, endometrial hyperplasia as the precursor
Incidence of endometrial hyperplasia 3 folds higher than endometrial Ca
Fourth most common cancer in women in Peninsular Malaysia
Advance in diagnosis & treatment of cancers has led to high cure rate & longer survival.
Nearly 1 in 12 cases detected before 40 years age.
Survivors have to face infertility or early menopause.
Hysteroscopic procedures are getting refined and with the advent of miniature scopes , doing these procedures in he office is getting better and more comfortable.
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Endometrial hyperplasia - irregular proliferation of the endometrial glands with an increase in the gland to stroma ratio when compared with proliferative endometrium
Endometrial Ca - most common gynaecological maglinancy in the western country, endometrial hyperplasia as the precursor
Incidence of endometrial hyperplasia 3 folds higher than endometrial Ca
Fourth most common cancer in women in Peninsular Malaysia
this lecture for undergraduates, GP & gynecologists
it includes full simple explanation of CIN (cervical intraepithelial neoplasia)
how to do screening for cervical cancer
methods of screening that include pap smear and HPV testing
it also includes the diagnostic method for the cervical cancer by taking biopsy directed by colposcopy
colposcopy and its rule
how to deal with CIN different grades
follow up after CIN treatment
1. Breast Ductography:Evaluation and Surgical Planning
2.INTRODUCTION: Breast ductography, sometimes referred to as galactography, is an imaging modality used to assess lesions resulting in discharge from the breasts. It offers helpful information for surgical approach and planning and aids in accurately finding the lump within breast tissue.
3. ANATOMY
4. Indications:If a single duct has a discharge, breast ductography is recommended.
Contraindications: When there are two or more discharging ducts, breast ductography is not recommended since the cause is either physiological or systemic.
5. Surgery: It helps locate the mass within breast tissue and provides useful information for surgical planning.
Excision of lesions: Surgery for breast ductography involves excising the majority of lesions found in ducts, such as intraductal papillomas.
Ultrasound-Guided Percutaneous Biopsy: For smaller lesions, ultrasound-guided percutaneous biopsy can be used.
Duct Excision with Dye: The duct is excised after it is filled with dye.
6. Procedure : A blunt-tipped sialogram needle is used in breast ductography procedure to perform the ductogram.
Once the aberrant duct has been located and cannulated, 1-2 mL of contrast agent is administered.
Images taken from standard mammography are obtained.
7. The tip of the cannula is inserted into the duct opening once the duct causing the discharge has been located.
The cannula is then carefully straightened. The cannula typically falls in the duct to the hub in patients. There is no force applied. Cannulation shouldn't cause any pain for the patient.
8. Before injecting contrast, watch the tubing for a short while after cannulation.
Since the duct is cannulated and the tubing is now part of a closed system, it is occasionally possible to view the contents of the duct refluxing into the tubing. This indicates that the duct producing the discharge has been cannulated if it is observed.
9. When contrast is injected into the cannula, duct contents occasionally form a droplet (arrow) around the cannula if they do not reflux into the tubing. Duct contents are displaced by the contrast. Observing this verifies that the duct causing the discharge has been cannulated.
10. Following the injection of 0.2 to 0.4 mL of contrast, the cannula is secured to the nipple with two pieces of paper tape. Leaving the cannula in situ allows for additional contrast injections when duct evaluation is required. Additionally, the cannula lessens the quantity of contrast that compression forces out of the duct.
11. Intraductal Abnormalities
Filling defects. Fusiform or tubular dilatation of ducts
Abrupt ductal cut off.
Causes of Abnormalities
The intraductal abnormalities observed on mammography can have both pathological and artifactual causes.
12. Complications: Duct Perforation, Pain or Burning Sensation, Infection.
13. It matters more how a patient perceives the discharge than what kind of discharge it is.
Cervix Anatomy
Lowermost part of uterus
Cylindrical shape
Diameter and length are 2.5 cm.
Parts Supravaginal
Infravaginal
Extends from histological internal os to anatomical external os.
Nulliparous - Pin hole cervix
Parous - Bilateral slit
Cervical Biopsy
Punch Biopsy
Wedge Biopsy
Ring Biopsy
Whole of squamo-columnar junction area of the cervix is excised with a special knife.
The tissue is subjected to serial section to detect cervical intraepithelial neoplasia (CIN) or early invasive carcinoma.
Cone Biopsy - Conization
Complications
Thank you
The Newer Concepts In Endometriosis Management : Dr Sharda JainLifecare Centre
The Newer Concepts In
Endometriosis Management
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DELEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
The Newer Concepts forReduced Surgery to preserve fertility in Endometrios...Lifecare Centre
The Newer Concepts forReduced Surgery to preserve fertility in Endometriosis
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DILEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Strategies for Improving Success Rates in ART PARTLifecare Centre
Strategies for Improving Success Rates in ART
Part - 2
Strategies for Improving Success Rates in ART
Tailoring Controlled Ovarian Stimulation
Strategies for Luteal Phase in ART cycles
Endometrial Receptivity Array
How to optimize success rates in ART? : Dr Sharda JainLifecare Centre
How to optimize success rates in ART? : Dr Sharda Jain
How to improve success rates in ART?
The big debate कार्य में आनंद
Evolution of In-vitro Fertilization (IVF)
Factors Influencing IVF Success Ist Part
Strategies for Improving Success Rates in ART Second Part
Innovations & Breakthroughs in IVF Part Three
OPEN DEBATE
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda JainLifecare Centre
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
Introduction
Social egg freezing (oocyte cryopreservation for non-medical reasons) has evolved as a proactive option for women looking to extend their reproductive possibilities past their peak childbearing years
It is the process of saving or protecting eggs, or reproductive tissues so that a person can use them to have biological children in future
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
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.
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
3. Colposcopy
Colposcopy is the examination of the
cervix , vagina and, in some instances
the vulva, with the colposcope after the
application of a 3--5% acetic solution
coupled with obtaining colposcopically
– directed biopsies of all lesions
suspected of representing neoplasia .
4. Endocervical Sampling
Includes obtaining a specimen
for either histopathological
evaluation using an
endocervical curette or a
cytobrush or for cytological
evaluation using a cytobrush
5. Endocervical assessment
Is the process of evaluating the
endocervical canal for the
presence of neoplasia using
either a colposcope or
endocervical sampling
6. Diagnostic excisional procedure
Is the process of obtaining a speciman
from the transformation zone and
endocervical canal for
histopathological evaluation and
includes laser conization, cold – knife
conization, loop electrosurgical
excision procedure (leep), and loop
electrosurgical conization
7. Adequate colposcopy
Indicates that the entire
squamocolumner junction and
the margin of any visible lesion
can be visualized with the
colposcope .
8. Endometrial sampling
Include obtaining a specimen
for histopathological evaluation
using an endometrial aspiration
or biopsy device a “dilatation
and curettage oh hysteroscopy
15. Indications for COLPOSCOPY….
• Abnormal PAP Smear
• Persistent vaginal discharge
• Long standing foul smelling vaginal
discharge
• Unhealthy Cervix
• Bleeding- post coital/ Postmenopausal
• HPV positive / external vulval warts
• Post treatment follow up
16. Basic Satisfactory Requirements of
Colposcopic Exam
Adequate Visualization
Entire TZ Zone seen
Abnormal areas seen in entirety
Endocervical Canal free of Dysplasia
No Evidence of Invasive Cancer
Abnormal Areas Biopsied
ECC Completed (Non-Pregnant patients)
17. Colposcopy - Objectives
Determines the presence of invasive cancer
Localizes the squamocolumnar junction
Identifies the most severe disease for biopsy
Evaluates the extent of disease
18. Accesibility of CERVIX……..
• seen instantly after putting speculum inside the vagina
and becomes apparent.
• The success of colposcopy lies in visualising the
cervical epithelia in the region of transformation zone
in its entirely.
19. Benefits of Colposcopy…….
• Non invasive, no anaethesia for pain
• Helps in precise examination of cervix and
TZ
• Guide to locate the biopsy, improve accuracy
of early diagnosis
• Reduce over-treatment
• Easy for follow up
• This is an outpatient procedure
• It takes only a few minutes
24. TZ lies between the original squamo-columner junction
and the new (or the present ) squamo-columner junction.
This is a highly active zone of metaplastic tissues in
which the single layered columnar epithelium is transformed
by metaplastic cellular divisions into multilayered squamous
epithelium.
34. STEPS FOR PERFORMING VIDEO
COLPOSCOPY….
• Normal Inspection after cleaning with
normal saline
• Inspection through Green filter
• Inspection after application of acetic acid
• Inspection after application of lugols Iodine
• Examination of Vagina
• Directed Biopsy.
35. NORMAL INSPECTION AFTER CLEANING
WITH NORMAL SALINE….
• To make the tissues and vascular details
more clear.
36. VIEW WITH GREEN FILTER
• For vascular pattern of cervix.
• This absorbs the red color and makes the
appearance of blood vessels black
• Black blood vessels can be viewed clearly.
37.
38. ACETIC ACID TEST
• Coagulation of cell protein seen an interval of 1 mint.
• If white layer is very thick (opaque) that area becomes
area of concern.
• The impact of acetic acid fades away normally in 1-3 mints,
So repeated application is recommended for proper
visualization of pathological lesions.
39. Aceto white lesion
• Intensity
• Duration of stay
• speed of Appearance
• speed of disappearance
• margins Relation to SCJ
Inside TZ/ outside TZ
40. Grading of Colposcopy Findings….
• Grade I: Flat acetowhite epithelium, snow white,
regular pattern of fine calibre vessels . CIN I , HPV
• Grade II: Flat but whiter acetowhite epithelium, gray
white, irregular blood vessel often coarse. CIN I to
carcinoma-in-situ.
• Grade-III dull oyster white, gray acetowhite
epithelium with irregular surface contour and
irregular coarse and coiled blood vessel. Carcinoma-
in-situ early invasive carcinoma.
47. LUGOL’S
IODINE TEST
• Rich glycogen area appears dark brown
• Areas which do not stain are considered iodine negative
and needs attention.
• Iodine doesn’t stain columnar, immature matalplastic,
regenerating squamous epithelium after surgical trauma,
intra epithelial neoplasia and invasive carcinoma.
• Staining is superficial and fades off in 8-10 mints.
60. IMMATURE METAPLASIA
Step I = Loss of tranlucency,
Grape like configuration +
Step II = Loss of grape like
configuration
Step III = villus pattern is lossed
69. EXAMINATION OF VAGINA
& BIOPSY
• The vault of vagina should be carefully
examined for evidence of vaginitis,
leucoplakia and any growth while
withdrawing the speculum
• Colposcopy directed biopsy should be
taken whenever necessary
70. COLPOSCOPY DIRECTED
• Biopsy forceps: Punch biopsy forcep is preferred
• Tissue specimen is sent to Lab for testing further.