Implementation of the trend marker protocol results in a unique graphical presentation when a hormone and a symptom are plotted as per the day of menstrual cycle. This presentation will indicate behavior of the hormone in relation to the disease independent of whether the hormone levels are normal or abnormal as per the set laboratory limits.
The document discusses developing a healthy lifestyle. It covers factors that influence health like genetics and environment. It also discusses concepts like life expectancy in the US, leading causes of death for women, dimensions of wellness, theories of health behavior change, and planning lifestyle changes. Key points are that health is influenced by both controllable and uncontrollable factors, average US life expectancy is 77.5 years, and developing a healthy lifestyle involves assessing behaviors, setting goals, and evaluating progress.
This document discusses diabetes, including the different types and causes. Some key points:
- Diabetes is a group of metabolic diseases where a person has high blood glucose due to inadequate insulin production or cells not responding properly to insulin.
- There are an estimated 347 million people worldwide with diabetes, and it is predicted to become the 7th leading cause of death by 2030.
- The main types of diabetes are type 1, where the body does not produce insulin, and type 2, where the body does not produce enough insulin or cells do not respond properly to insulin.
- Risk factors for type 2 diabetes include family history, age, weight, and physical inactivity. Prevention focuses on maintaining a healthy weight and
https://docs.google.com/document/edit?id=1jnhQnFIQuMOgJdMGDoZFhVo1e5ByfOzkG6mjduTq5pY&hl=en#; Look for the text in another presentation by same author, same title
This document summarizes key aspects of women's health, including leading causes of death and conditions that disproportionately affect women. It discusses health issues specific to women like reproductive health and cancers. It also explains how some common conditions like heart disease, lung cancer, and diabetes present differently and may be more severe for women. Ensuring women receive appropriate diagnosis and treatment requires addressing gaps in understanding these gender differences and improving access to women-centered healthcare.
On Gestational Diabetes By Final Year Students Of KmdcZia Khan
The document summarizes a study that examined the relationship between gestational diabetes mellitus (GDM) and polycystic ovarian syndrome (PCOS) among pregnant women. The study found that 22% of women with GDM had a clinical history of PCOS, compared to only 4.6% of women without GDM. Additionally, women with both GDM and PCOS tended to be older, more obese, and have higher rates of family history of diabetes compared to other groups. The study concluded that GDM was 5.9 times more associated with clinically diagnosed PCOS than the controls.
10 biggest health problems indian woman suffering fromGods Own Store
The document lists 10 of the most common health problems faced by Indian women. These include high blood pressure, breast cancer, PCOS/PCOD, hair loss, obesity, osteoporosis and arthritis, stress and depression, cardiac disease, Alzheimer's disease, and asthma. Many of these issues stem from lifestyle factors like poor diet, lack of exercise, pollution, smoking, and stress from work and family responsibilities. Negligence of health needs and lack of priority given to women's health also contribute to these problems.
The document discusses developing a healthy lifestyle. It covers factors that influence health like genetics and environment. It also discusses concepts like life expectancy in the US, leading causes of death for women, dimensions of wellness, theories of health behavior change, and planning lifestyle changes. Key points are that health is influenced by both controllable and uncontrollable factors, average US life expectancy is 77.5 years, and developing a healthy lifestyle involves assessing behaviors, setting goals, and evaluating progress.
This document discusses diabetes, including the different types and causes. Some key points:
- Diabetes is a group of metabolic diseases where a person has high blood glucose due to inadequate insulin production or cells not responding properly to insulin.
- There are an estimated 347 million people worldwide with diabetes, and it is predicted to become the 7th leading cause of death by 2030.
- The main types of diabetes are type 1, where the body does not produce insulin, and type 2, where the body does not produce enough insulin or cells do not respond properly to insulin.
- Risk factors for type 2 diabetes include family history, age, weight, and physical inactivity. Prevention focuses on maintaining a healthy weight and
https://docs.google.com/document/edit?id=1jnhQnFIQuMOgJdMGDoZFhVo1e5ByfOzkG6mjduTq5pY&hl=en#; Look for the text in another presentation by same author, same title
This document summarizes key aspects of women's health, including leading causes of death and conditions that disproportionately affect women. It discusses health issues specific to women like reproductive health and cancers. It also explains how some common conditions like heart disease, lung cancer, and diabetes present differently and may be more severe for women. Ensuring women receive appropriate diagnosis and treatment requires addressing gaps in understanding these gender differences and improving access to women-centered healthcare.
On Gestational Diabetes By Final Year Students Of KmdcZia Khan
The document summarizes a study that examined the relationship between gestational diabetes mellitus (GDM) and polycystic ovarian syndrome (PCOS) among pregnant women. The study found that 22% of women with GDM had a clinical history of PCOS, compared to only 4.6% of women without GDM. Additionally, women with both GDM and PCOS tended to be older, more obese, and have higher rates of family history of diabetes compared to other groups. The study concluded that GDM was 5.9 times more associated with clinically diagnosed PCOS than the controls.
10 biggest health problems indian woman suffering fromGods Own Store
The document lists 10 of the most common health problems faced by Indian women. These include high blood pressure, breast cancer, PCOS/PCOD, hair loss, obesity, osteoporosis and arthritis, stress and depression, cardiac disease, Alzheimer's disease, and asthma. Many of these issues stem from lifestyle factors like poor diet, lack of exercise, pollution, smoking, and stress from work and family responsibilities. Negligence of health needs and lack of priority given to women's health also contribute to these problems.
Nutritional epidemiology combines the knowledge of nutritionists with epidemiological methodology to study diseases with multiple causes. It aims to monitor nutrient intake and nutritional status in populations and contribute to disease prevention and public health. Some goals are assessing community nutritional status, conducting nutritional and dietary surveys, and monitoring nutrition and growth. Major diseases related to nutrition include mineral deficiency, protein-energy malnutrition, anemia, and over-intake of nutrients.
The maternal mortality rate is the number of maternal deaths in a population divided by the number of women of reproductive age. It captures the likelihood of both becoming pregnant and dying during pregnancy (including deaths up to six weeks after delivery).
Determinants of Maternal mortality in SomaliaOmar Osman Eid
This document analyzes the determinants of maternal mortality in Somalia from 1990-2015. It finds that socioeconomic factors like poverty and lack of education, as well as cultural factors like gender inequality, contribute significantly to maternal deaths in Somalia. Physical barriers like limited transportation and long distances to health facilities also restrict access to prenatal and postnatal care. The document concludes that increasing GDP, lowering fertility rates, reducing HIV prevalence, expanding education for girls, discouraging early pregnancies, and increasing access to healthcare can help reduce Somalia's high maternal mortality ratio.
This document discusses inflammatory bowel disease (IBD) in pregnancy and covers several topics. It defines the two main types of IBD as ulcerative colitis and Crohn's disease. It discusses the prevalence and incidence of IBD, how pregnancy can affect disease course, and how active IBD may increase risks of adverse pregnancy outcomes like preterm birth. The document reviews common IBD medications including biologics, their safety in pregnancy, and considerations for use. It also discusses potential IBD complications and examines the question of whether aspirin has a role in preventing venous thromboembolism. Finally, it addresses considerations for mode of delivery for women with IBD.
58% of the households are food insecure.
18% of Women aged 15-49 years are under weight.
31% of children are underweight.
Nutrition status of <5 years children has shown no improvement from last 46 years
Anemia has worsened among both pregnant and non-pregnant women and pregnant women in urban areas are having more iron deficiency anemia.
Pakistan may be witnessing the double burden of under nutrition and obesity within rural and urban women of reproductive age.
RESEARCH
Women’s Health Issues You Should Watch Out ForIsabella
Although both men and women share similar health concerns, some issues specifically threaten women’s health. In view of the male and female biological differences, some health concerns like heart attacks and depression are higher in women than in men.
Breast cancer is the most commonly diagnosed cancer in women. Over 1.7 million cases were diagnosed worldwide in 2007, with 465,000 deaths. The risk increases with age and certain lifestyle factors like obesity, alcohol consumption, and not having children. Screening and early detection can help prevent breast cancer and increase 5-year survival rates to 98%.
Obesity obesity and mental health 11-may-2015WALID SARHAN
Obesity is often associated with stigma and considered undesirable, while leanness is viewed as beautiful. There is a complex relationship between physical health and mental health in relation to obesity. Several studies have found that obese individuals have a higher risk of developing mental illnesses like depression and anxiety compared to normal weight individuals, and the relationship between obesity and mental illness appears to go both ways. Certain antidepressants and antipsychotic medications are also known to cause weight gain, which can further exacerbate the issue.
The well being of breast cancer patient: can nutrition help?Nilly Shams
The document discusses the potential links between diet, lifestyle, and breast cancer risk and prognosis. It notes that malnutrition is common in cancer patients, occurring in 31-87% depending on cancer stage and type. Several studies found links between excess body weight, dietary patterns high in carbohydrates and animal fats, and lack of exercise with increased breast cancer risk. One-third of breast cancer cases may be preventable through a diet high in fruits/vegetables, olive oil and low in alcohol, as well as increased physical activity. Certain nutrients like vitamin E, B-carotene, and soy have been associated with reduced breast cancer risk in some studies.
Prevalence of anemia among teenage pregnant girls attending antenatal clinic ...Alexander Decker
The study found that the prevalence of anemia among teenage pregnant girls in Bungoma District, Western Kenya was 61%. Nearly half (48.3%) had mild anemia, 31.2% had moderate anemia, and 20.5% had severe anemia. Factors associated with anemia included parasitic infections like hookworm, which were linked to inadequate calcium intake, and malaria parasites, which affected folate intake. Food intake and socioeconomic factors also played a role, as iron intake was associated with perceived food shortage and over 65% of participants had a monthly income below $100. The high rates of anemia found indicate the need for deworming and anemia treatment programs for pregnant teenage girls in the region
The document discusses principles of self-healing technology based on physical and thermodynamic theories. It proposes that health and disease are functions of positive and negative information respectively, received through nutrition, climate, social interactions and other means. Negative information can alter cell programming and characteristics, potentially causing illness, while positive information facilitates self-regulation and healing through neutralizing negative energy and restoring healthy cell functions and properties. The document outlines several proposed self-healing techniques utilizing the body's natural energy and information processes.
The document discusses several key points about women's health:
1) Women make most health care decisions for their families and spend a significant amount on health care costs.
2) Women's health needs are different than men's due to biological and hormonal differences.
3) A woman's health is influenced by her family genetics, culture, social norms, economics, physical environment, and daily habits and thoughts.
4) There are gaps in health care access and outcomes between men and women due to factors like income, insurance coverage, and childcare responsibilities.
This document provides guidelines for preventive screening tests and immunizations for women based on their age. It includes recommendations for general health checkups, tests related to heart health, diabetes, breast health, reproductive health, colorectal health, eye and ear health, oral health, and recommended immunizations. The guidelines are meant to help women work with their doctors to determine which screenings and tests are right for them based on their individual risk factors and health profiles. Preventive care including screenings and immunizations can help detect diseases early and promote long and healthy lives.
This document discusses various topics related to sexual health and sexuality. It covers definitions of sexual health, issues with body image and eating disorders, effects of aging and disability on sexuality, and impacts of cancer, drugs/alcohol, and other medical conditions on sexual functioning and well-being. The document provides information on common sexual health problems, screening tests, treatments, and how physical and mental health interact with sexuality.
- The document discusses an integrated approach to cancer prevention and treatment through lifestyle changes.
- It presents a model showing how lifestyle factors like nutrition, exercise, stress, and social support can affect cancer development over many years and influence whether cancer progresses or not.
- Evidence from studies on nutrition, exercise, stress management, and social support suggest that adopting a healthy lifestyle may reduce cancer risk and slow cancer progression. The Prostate Cancer Lifestyle Trial found significant benefits of lifestyle changes for men with early-stage prostate cancer.
This document discusses how medical nutrition therapy may improve survival rates for patients with spinal muscular atrophy (SMA). SMA is caused by a genetic mutation and results in progressive muscle weakness. Several studies have found that early nutrition intervention, such as feeding tubes, can help reduce complications of SMA like inadequate nutrition and aspiration pneumonia. Nutrition therapy may also help address metabolic issues and decreased bone density seen in SMA patients. The document concludes that improved pulmonary care and aggressive nutrition support have helped increase survival rates for those with the most severe type of SMA beyond the typical lifespan of two years.
This document discusses the effects of medical nutrition therapy (MNT) on survival rates for patients with spinal muscular atrophy (SMA). It summarizes several studies that show early nutrition intervention through feeding tubes can increase longevity and reduce complications for SMA patients by preventing inadequate nutrient intake and aspiration. MNT may also help reduce risks of bone loss, hyperglycemia, and obesity that can occur in SMA patients. The document concludes that while advancements in pulmonary care have increased SMA survival rates, nutrition support has also played an important role in improving quality of life and survival rates, especially for those with the most severe Type I SMA.
This chapter introduces key topics in women's health. It discusses that women's health issues need dedicated study as women have unique physiological and psychosocial needs compared to men. Promoting proactive health behaviors can help prevent disease. Women around the world face common challenges to their health, and concepts like sexism and misogyny have impacted women's healthcare. The women's health movement has advocated for women's health rights and access to medical information and care.
Immunology of Type I Diabetes: The Journey from Animal Models to Human Therap...Apollo Hospitals
Type I diabetes is primarily induced by an autoimmune process that destroys the pancreatic Beta cells. Genetic and environmental factors interplay to bring about an “insulitis”. Given that antibodies to GAD are detectable years before type I diabetes develops, there is a potential for treating and preventing the onset of this autoimmune process even before there is an irreversible pancreatic dysfunction.
When to Initiate RRT in Patients with AKI - Does Timing Matter?Apollo Hospitals
Acute kidney injury is a serious illness which occurs commonly in the renal units and also in the ICU setting. It is an independent risk factor of increased mortality and morbidity, particularly when RRT is needed. The wide variation in utilization of RRT contributes to a lack of consensus among clinicians regarding the parameters which should guide the decision to initiate RRT.
Nutritional epidemiology combines the knowledge of nutritionists with epidemiological methodology to study diseases with multiple causes. It aims to monitor nutrient intake and nutritional status in populations and contribute to disease prevention and public health. Some goals are assessing community nutritional status, conducting nutritional and dietary surveys, and monitoring nutrition and growth. Major diseases related to nutrition include mineral deficiency, protein-energy malnutrition, anemia, and over-intake of nutrients.
The maternal mortality rate is the number of maternal deaths in a population divided by the number of women of reproductive age. It captures the likelihood of both becoming pregnant and dying during pregnancy (including deaths up to six weeks after delivery).
Determinants of Maternal mortality in SomaliaOmar Osman Eid
This document analyzes the determinants of maternal mortality in Somalia from 1990-2015. It finds that socioeconomic factors like poverty and lack of education, as well as cultural factors like gender inequality, contribute significantly to maternal deaths in Somalia. Physical barriers like limited transportation and long distances to health facilities also restrict access to prenatal and postnatal care. The document concludes that increasing GDP, lowering fertility rates, reducing HIV prevalence, expanding education for girls, discouraging early pregnancies, and increasing access to healthcare can help reduce Somalia's high maternal mortality ratio.
This document discusses inflammatory bowel disease (IBD) in pregnancy and covers several topics. It defines the two main types of IBD as ulcerative colitis and Crohn's disease. It discusses the prevalence and incidence of IBD, how pregnancy can affect disease course, and how active IBD may increase risks of adverse pregnancy outcomes like preterm birth. The document reviews common IBD medications including biologics, their safety in pregnancy, and considerations for use. It also discusses potential IBD complications and examines the question of whether aspirin has a role in preventing venous thromboembolism. Finally, it addresses considerations for mode of delivery for women with IBD.
58% of the households are food insecure.
18% of Women aged 15-49 years are under weight.
31% of children are underweight.
Nutrition status of <5 years children has shown no improvement from last 46 years
Anemia has worsened among both pregnant and non-pregnant women and pregnant women in urban areas are having more iron deficiency anemia.
Pakistan may be witnessing the double burden of under nutrition and obesity within rural and urban women of reproductive age.
RESEARCH
Women’s Health Issues You Should Watch Out ForIsabella
Although both men and women share similar health concerns, some issues specifically threaten women’s health. In view of the male and female biological differences, some health concerns like heart attacks and depression are higher in women than in men.
Breast cancer is the most commonly diagnosed cancer in women. Over 1.7 million cases were diagnosed worldwide in 2007, with 465,000 deaths. The risk increases with age and certain lifestyle factors like obesity, alcohol consumption, and not having children. Screening and early detection can help prevent breast cancer and increase 5-year survival rates to 98%.
Obesity obesity and mental health 11-may-2015WALID SARHAN
Obesity is often associated with stigma and considered undesirable, while leanness is viewed as beautiful. There is a complex relationship between physical health and mental health in relation to obesity. Several studies have found that obese individuals have a higher risk of developing mental illnesses like depression and anxiety compared to normal weight individuals, and the relationship between obesity and mental illness appears to go both ways. Certain antidepressants and antipsychotic medications are also known to cause weight gain, which can further exacerbate the issue.
The well being of breast cancer patient: can nutrition help?Nilly Shams
The document discusses the potential links between diet, lifestyle, and breast cancer risk and prognosis. It notes that malnutrition is common in cancer patients, occurring in 31-87% depending on cancer stage and type. Several studies found links between excess body weight, dietary patterns high in carbohydrates and animal fats, and lack of exercise with increased breast cancer risk. One-third of breast cancer cases may be preventable through a diet high in fruits/vegetables, olive oil and low in alcohol, as well as increased physical activity. Certain nutrients like vitamin E, B-carotene, and soy have been associated with reduced breast cancer risk in some studies.
Prevalence of anemia among teenage pregnant girls attending antenatal clinic ...Alexander Decker
The study found that the prevalence of anemia among teenage pregnant girls in Bungoma District, Western Kenya was 61%. Nearly half (48.3%) had mild anemia, 31.2% had moderate anemia, and 20.5% had severe anemia. Factors associated with anemia included parasitic infections like hookworm, which were linked to inadequate calcium intake, and malaria parasites, which affected folate intake. Food intake and socioeconomic factors also played a role, as iron intake was associated with perceived food shortage and over 65% of participants had a monthly income below $100. The high rates of anemia found indicate the need for deworming and anemia treatment programs for pregnant teenage girls in the region
The document discusses principles of self-healing technology based on physical and thermodynamic theories. It proposes that health and disease are functions of positive and negative information respectively, received through nutrition, climate, social interactions and other means. Negative information can alter cell programming and characteristics, potentially causing illness, while positive information facilitates self-regulation and healing through neutralizing negative energy and restoring healthy cell functions and properties. The document outlines several proposed self-healing techniques utilizing the body's natural energy and information processes.
The document discusses several key points about women's health:
1) Women make most health care decisions for their families and spend a significant amount on health care costs.
2) Women's health needs are different than men's due to biological and hormonal differences.
3) A woman's health is influenced by her family genetics, culture, social norms, economics, physical environment, and daily habits and thoughts.
4) There are gaps in health care access and outcomes between men and women due to factors like income, insurance coverage, and childcare responsibilities.
This document provides guidelines for preventive screening tests and immunizations for women based on their age. It includes recommendations for general health checkups, tests related to heart health, diabetes, breast health, reproductive health, colorectal health, eye and ear health, oral health, and recommended immunizations. The guidelines are meant to help women work with their doctors to determine which screenings and tests are right for them based on their individual risk factors and health profiles. Preventive care including screenings and immunizations can help detect diseases early and promote long and healthy lives.
This document discusses various topics related to sexual health and sexuality. It covers definitions of sexual health, issues with body image and eating disorders, effects of aging and disability on sexuality, and impacts of cancer, drugs/alcohol, and other medical conditions on sexual functioning and well-being. The document provides information on common sexual health problems, screening tests, treatments, and how physical and mental health interact with sexuality.
- The document discusses an integrated approach to cancer prevention and treatment through lifestyle changes.
- It presents a model showing how lifestyle factors like nutrition, exercise, stress, and social support can affect cancer development over many years and influence whether cancer progresses or not.
- Evidence from studies on nutrition, exercise, stress management, and social support suggest that adopting a healthy lifestyle may reduce cancer risk and slow cancer progression. The Prostate Cancer Lifestyle Trial found significant benefits of lifestyle changes for men with early-stage prostate cancer.
This document discusses how medical nutrition therapy may improve survival rates for patients with spinal muscular atrophy (SMA). SMA is caused by a genetic mutation and results in progressive muscle weakness. Several studies have found that early nutrition intervention, such as feeding tubes, can help reduce complications of SMA like inadequate nutrition and aspiration pneumonia. Nutrition therapy may also help address metabolic issues and decreased bone density seen in SMA patients. The document concludes that improved pulmonary care and aggressive nutrition support have helped increase survival rates for those with the most severe type of SMA beyond the typical lifespan of two years.
This document discusses the effects of medical nutrition therapy (MNT) on survival rates for patients with spinal muscular atrophy (SMA). It summarizes several studies that show early nutrition intervention through feeding tubes can increase longevity and reduce complications for SMA patients by preventing inadequate nutrient intake and aspiration. MNT may also help reduce risks of bone loss, hyperglycemia, and obesity that can occur in SMA patients. The document concludes that while advancements in pulmonary care have increased SMA survival rates, nutrition support has also played an important role in improving quality of life and survival rates, especially for those with the most severe Type I SMA.
This chapter introduces key topics in women's health. It discusses that women's health issues need dedicated study as women have unique physiological and psychosocial needs compared to men. Promoting proactive health behaviors can help prevent disease. Women around the world face common challenges to their health, and concepts like sexism and misogyny have impacted women's healthcare. The women's health movement has advocated for women's health rights and access to medical information and care.
Immunology of Type I Diabetes: The Journey from Animal Models to Human Therap...Apollo Hospitals
Type I diabetes is primarily induced by an autoimmune process that destroys the pancreatic Beta cells. Genetic and environmental factors interplay to bring about an “insulitis”. Given that antibodies to GAD are detectable years before type I diabetes develops, there is a potential for treating and preventing the onset of this autoimmune process even before there is an irreversible pancreatic dysfunction.
When to Initiate RRT in Patients with AKI - Does Timing Matter?Apollo Hospitals
Acute kidney injury is a serious illness which occurs commonly in the renal units and also in the ICU setting. It is an independent risk factor of increased mortality and morbidity, particularly when RRT is needed. The wide variation in utilization of RRT contributes to a lack of consensus among clinicians regarding the parameters which should guide the decision to initiate RRT.
A Question and Answer session was held during a Tweetinar on
Spine Problems – Symptoms and Cure,
conducted on the 30th of October 2012.
It was a live discussion with Doctor Sajan K Hegde -Senior Consultant, Spine Surgeon, Apollo Hospitals, Chennai
Predonated Autologous Blood Transfusion in Elective OrthopaedicApollo Hospitals
The use of homologous blood carries significant risk of viral infections and immune-mediated reactions.
Preoperative autologous blood donation is an attractive alternative to homologous transfusion and has become common
in elective orthopaedic surgery.
When to Initiate RRT in Patients with AKI - Does Timing Matter?Apollo Hospitals
Acute kidney injury is a serious illness which occurs commonly in the renal units and also in the ICU setting. It is an independent risk factor of increased mortality and morbidity, particularly when RRT is needed. The wide variation in utilization of RRT contributes to a lack of consensus among clinicians regarding the parameters which should guide the decision to initiate RRT. This problem is confounded by a paucity of high quality evidence in the current literature. This review examines the role of usual biochemical parameters as well as conventional clinical indications for commencing RRT. It also discusses the potential role of biomarkers as predictors for the need of RRT in AKI. Initiating dialysis in AKI should be based on dynamic clinical criteria and not only on specific biochemical values.
Minimally invasive spine surgeries (MISS) since its inception around 15 years ago has undergone rigorous changes with ever evolving technologies. Minimally invasive spine surgeries with “percutaneous” and “tubular” approaches is based on novel concept of minimizing collateral soft tissue damage, while achieving surgical goal in various spinal pathologies. MISS has been applied to simple spinal procedures of discectomy, decompression and fusion to even complex surgeries like deformity correction. MISS vis a vis “conventional open techniques” has benefits in terms of postoperative pain, concurrent tissue damage, disruption of spinal stabilizing structures, estimated blood loss, need of blood transfusion, length of hospital stay, surgical site infections, time to ambulation and functional recovery.
Neurocritical Care Triad - Focused Neurological Examination, Brain Multimodal...Apollo Hospitals
Intensive care is rightly described as “an art of managing intense intricacy” and this situation is further complicated in the care of patients with critical neurological illness. Brain
damage directly related to an insult is primary brain injury (PBI). The cascade of pathobiological events following PBI is known as secondary brain injury (SBI). PBI is most often
irreversible so, the focus of neurocritical care is to prevent, detect and manage SBI.
Arthroscopic Anterior Cruciate Ligament Reconstruction Using Four-Strand Hams...Apollo Hospitals
In this study, we analyzed the clinical outcomes at two years following reconstruction of the anterior cruciate ligament with use of a four-strand hamstring tendon autograft in patients who had presented with a symptomatic torn anterior cruciate ligament.
This document discusses several reproductive disorders in women including menopause, premenstrual syndrome, dysmenorrhea, amenorrhea, menorrhagia, metrorrhagia, abortion, spontaneous abortion, and habitual abortion. It describes the symptoms, causes, medical management, and nursing care considerations for each condition. Key points covered include the hormonal changes that occur during menopause and how it is signaled, common symptoms of premenstrual syndrome, painful menstruation associated with dysmenorrhea, and definitions and types of abortion.
Some women get through their monthly periods easily with few or no concerns. Their periods come like clockwork, starting and stopping at nearly the same time every month, causing little more than a minor inconvenience.
Những dấu hiệu trong thời kì tiền mãn kinh | Venus GlobalVENUS
Tiền mãn kinh là thời kỳ mà bất kỳ phụ nữ nào cũng phải trải qua. Tiền mãn kinh là gì? Triệu chứng tiền mãn kinh thường gặp? Cách điều trị rối loạn tiền mãn kinh như thế nào? Bài viết dưới đây sẽ cung cấp cho bạn những thông tin chi tiết nhất về vấn đề này.
Trích: Nguồn https://venusglobal.com.vn/dau-hieu-tien-man-kinh/
#triệu_chứng_tiền_mãn_kinh
#nguyên_nhân_tiền_mãn_kinh
#triệu_chứng_tiền_mãn_kinh_và_cách_điều_trị
#dấu_hiệu_thời_kỳ_tiền_mãn_kinh
#những_dấu_hiệu_của_thời_kỳ_tiền_mãn_kinh
1. Amenorrhea, or the absence of menstrual periods, can be either primary or secondary. Primary amenorrhea refers to the lack of menses by age 15, while secondary amenorrhea is the absence of periods for 3 months after menarche.
2. A thorough history and physical exam is important to evaluate the potential causes of amenorrhea, which can include pregnancy, eating disorders, medical conditions, or anatomical abnormalities.
3. Laboratory tests and imaging may be needed to diagnose endocrine disorders, such as hypothalamic, pituitary, ovarian, or thyroid issues, which can cause amenorrhea. Genetic testing may be considered if Turner syndrome is suspected.
The document discusses various women's reproductive disorders and the menstrual cycle. It describes the internal female genital organs and the two phases of the menstrual cycle. It then discusses menstrual disorders like amenorrhea, dysfunctional uterine bleeding, and dysmenorrhea. It provides information on the causes and treatments of these disorders. The document also covers other topics related to women's health issues like infertility, early pregnancy loss, menopause, and premenstrual syndrome.
This document discusses the earliest signs and symptoms of menopause transition. It summarizes that:
1) In addition to vasomotor symptoms like hot flashes and night sweats, mood changes, sleep difficulties, and changes in sexual functioning often increase early in the menopause transition, before irregular periods occur.
2) Vasomotor symptoms are the most common symptom, experienced by up to 80% of women, usually starting before the final menstrual period and continuing for several years after.
3) Depressed mood is also common in the menopause transition, with the likelihood of depression being 30-300% greater than in the premenopausal stage, and highly associated with vasomotor symptoms
This document discusses using phytoestrogens from asparagus and soybeans to treat menstrual disorders. It provides background on common menstrual problems and their impact. Studies show asparagus helps regulate the menstrual cycle, increases libido, and treats inflammation of sexual organs. Asparagus balances hormones and moistens tissues. Soybeans are rich in protein, fat, and iron and help balance hormones. The proposed study will give supplements to women aged 18-23 with menstrual issues and women aged 43-53 with pre/post-menopausal symptoms to see if the supplements improve symptoms. Data on menstrual problems, irregularities, and health issues will be collected. The study expects the supplements may help cure some menstrual disorder symptoms.
Primary amenorrhea is diagnosed by performing labs to evaluate hormone levels and imaging tests to identify anatomical abnormalities. Secondary amenorrhea is also diagnosed through hormone level evaluation to discover the underlying cause such as a hypothalamic disorder. Treatment depends on the cause but may include birth control, hormone therapy, or surgery. Dysmenorrhea is diagnosed through a medical history and physical exam. Treatment includes over-the-counter medications and oral contraceptives.
Female sexual dysfunction (FSD) is defined as any distress that is the result of sexual pain, orgasm
difficulties, and/or altered sexual interest or arousal.
The document discusses dysmenorrhea (painful menstruation), which affects at least 50% of menstruating women. It is classified as primary (without underlying pathology) or secondary (with a pathological cause). Primary dysmenorrhea is likely due to hormonal factors and increased uterine activity/prostaglandins. Secondary dysmenorrhea has causes like endometriosis, adenomyosis, pelvic inflammatory disease, intrauterine adhesions, and fibroids. Treatment involves analgesics, oral contraceptives, and treating any underlying causes. Premenstrual syndrome involves physical and emotional symptoms before menstruation and affects 20-40% of women. Causes are unknown but may involve hormonal im
This document provides clinical practice guidelines for menopause. It defines menopause and related terms like peri-menopause. It describes the evaluation and assessment of patients, including history, examinations, and recommended lab tests. It also outlines the stages of menopause based on the STRAW+10 criteria and discusses common menopausal symptoms like vasomotor symptoms, genitourinary symptoms, and menstrual problems.
This document discusses hormone replacement therapy (HRT) and aims to break stigmas around its use. It summarizes recent research showing that for healthy women under 60, the benefits of HRT generally outweigh the risks when initiated soon after menopause. While some studies linked oral HRT to increased breast cancer and heart risks, newer options like transdermal estrogen and bioidentical micronized progesterone may not carry these risks. HRT can help reduce risks of conditions like dementia and osteoporosis linked to estrogen loss. However, risks likely outweigh benefits for some women with hormone-receptive cancer histories. Overall, the document advocates that HRT use should be considered on a case-by-case basis.
Rối loạn kinh nguyệt: nguyên nhân và cách điều trị tại nhà | Venus GlobalVENUS
Kinh nguyệt không đều là tình trạng bất cứ phụ nữ nào cũng từng mắc phải. Có nhiều nguyên nhân dẫn tới kinh nguyệt không đều, bạn đọc cần nắm chắc để phòng tránh. Hãy cùng Venus global tìm hiểu 18 nguyên nhân chủ yếu khiến kinh nguyệt không đều.
Nguồn: Trích https://venusglobal.com.vn/kinh-nguyet-khong-deu/
#kinh_nguyệt_không_đều
#chu_kỳ_kinh_nguyệt_không_đều
#làm_sao_để_điều_hòa_kinh_nguyệt
#điều_hòa_kinh_nguyệt_bằng_cách_nào
#làm_thế_nào_để_điều_hòa_kinh_nguyệt
assignment manpreet mam.power point presentationKittyTuttu
The document discusses menopause and its psychological and social impacts. It defines menopause and outlines its phases. It then examines common psychological changes like headaches, irritability and fatigue. Social factors like relationships, education and culture are also explored. Finally, the document summarizes research on management approaches, including hormone replacement therapy, antidepressants, lifestyle modifications and social support.
Primary and secondary amenorrhea and dysmenorrhea are common gynecological disorders that are diagnosed through a medical history, physical exam, and lab tests. Treatment depends on the underlying cause but may include medications, surgery, or lifestyle changes. Routine screening is generally not recommended unless symptoms are present.
Prediction of the Syndrome Premature Ovarian Insufficiencyijtsrd
Premature ovarian failure syndrome is a symptom complex characterized by hypergonodotropic amenorrhea in women under 40. Known causes include 1. Genetic aberrations that can affect the X chromosome or autosomes. 2. Autoimmune damage to the ovaries, as evidenced by the observed association of POF with other autoimmune disorders. 3. Iatrogenic after surgery, radiotherapy or chemotherapy, as in malignant neoplasms. 4. Environmental factors such as viral infections and toxins, the mechanism of action of which is not known. Tangirova Yulduz Alimovna | Yusupov Shokhruh "Prediction of the Syndrome Premature Ovarian Insufficiency" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-3 , April 2022, URL: https://www.ijtsrd.com/papers/ijtsrd49766.pdf Paper URL: https://www.ijtsrd.com/biological-science/other/49766/prediction-of-the-syndrome-premature-ovarian-insufficiency/tangirova-yulduz-alimovna
The Role of Estradiol in Idiopathic Anterior Uveitis during the Eumenorrheic ...CrimsonpublishersMSOR
Women with idiopathic anterior uveitis do not appear to relapse while pregnant. Relapses are reported more frequently and more intensely during premenstrual and menstrual stages. These observations suggest that uveitis may be related to fluctuations of sex steroid hormones.
3. Content of grant proposal_rev3_R.docxadhanefendi
The document discusses stress and energy expenditure monitoring in pregnant women. It proposes developing a wearable device called "MomiCare" consisting of various biosensors connected to a microcontroller and using machine learning. Data from sensors measuring ECG, GSR, PPG, skin temperature, respiration, and acceleration would be collected. Machine learning algorithms would analyze these parameters to predict stress levels and energy expenditure, providing warnings to maintain mother and fetus health. The focus is on designing accurate and comfortable sensors, collecting data, and processing it to comprehensively monitor stress and energy expenditure in pregnant women.
This document discusses various women's health issues and disorders and how yoga can help address them. It covers:
1) Common health disorders women face such as PMS, dysmenorrhea, amenorrhea, and issues related to pregnancy, menopause, and infertility.
2) How stress physically and psychologically impacts the body.
3) Yoga practices like Surya Namaskar and meditation that aim to relax the body, slow the breath, and calm the mind for stress management.
The document provides information on yoga techniques for treating various women's health disorders and menstrual issues. It outlines integrated yoga modules involving breathing practices, yoga poses, relaxation techniques, and meditation/pranayama that can help with conditions like heavy or painful periods, irregular cycles, PMS, infertility, menopause, and incontinence. The modules are designed to stimulate, relax, and balance the body and mind.
Similar to Concept of trend markers for menstrual diseases (20)
Movement disorders: A complication of chronic hyperglycemia? A case reportApollo Hospitals
A 77-year-old man presented with bilateral choreic movements that had developed over the past month. He had a history of poorly controlled type 2 diabetes. At admission, he was found to have severe hyperglycemia without ketosis. A CT scan showed hyperdensity in the putamen and lenticular nucleus. Treatment with insulin, haloperidol, and glycemic control led to regression of the choreic movements within 4 days. Chorea secondary to nonketotic hyperglycemia is a rare complication of uncontrolled diabetes that is usually reversible with normalization of blood glucose levels and neuroleptic treatment. The pathophysiology is thought to involve metabolic disturbances from hyperglycemia impairing neurotransmission in basal ganglia structures and
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleApollo Hospitals
Malignant mixed mullerian tumors are very rare genital tumors. They are biphasic neoplasms composed of an admixture of malignant epithelial and mesenchymal elements. In descending order of frequency they originate in the uterus, ovaries, fallopian tubes, cervix and vagina. Also they arise denovo from peritoneum. They are highly aggressive and tend to occur in postmenopausal low parity women. Because of rarity, there is as such no treatment guidelines available. Multimodality treatment in the form of radical surgery followed by adjuvant chemotherapy or radiotherapy or combined chemoradiation gives a better prognosis & outcome. Two case reports of such tumors, one from ovary and other from penitoneum are presented along with the review of literature.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
This case report describes the successful treatment of an acardiac twin (TRAP sequence) via intra-fetal laser ablation of the umbilical vessels. The patient was a 26 year old pregnant woman at 18 weeks gestation with twins, one normal (Twin A) and one acardiac (Twin B). By 26 weeks, Twin A showed signs of cardiac failure so laser ablation was performed to interrupt blood flow from Twin B to A. This minimally invasive procedure used an Nd: YAG laser to coagulate the vessels under ultrasound guidance. The pregnancy continued successfully, with Twin A delivered via c-section at 35 weeks in good condition. This report demonstrates that intra-fetal laser ablation can safely
Improved Patient Satisfaction At Apollo – A Case StudyApollo Hospitals
1) Indraprastha Apollo Hospital utilized patient satisfaction surveys called Voice of Customer (VOC) tools to identify ways to improve various hospital departments and services.
2) Factors that contributed to an increasing trend in VOC scores over 1.5 years included leadership commitment to quality improvement, improved efficiency, superior clinical care, soft skills enhancement for staff, and improved patient information and complaint resolution.
3) Through consistent efforts such as staff training, improved processes, and addressing issues identified in VOC surveys, Apollo Hospitals achieved higher than target patient satisfaction scores, creating loyal patients with memorable hospital experiences.
Breast Cancer in Young Women and its Impact on Reproductive FunctionApollo Hospitals
Breast cancer is the most common cancer in women in developed countries. Chemotherapy for breast cancer is likely to negatively impact on reproductive function. We review current treatment; effects on reproductive function; breastfeeding and management of menopausal symptoms following breast cancer.
Turner syndrome (gonadal dysgenesis) is one of the most common chromosomal abnormalities occuring 1 in 2500 to 1 in 3000 live-born girls. It is an important cause of short stature in girls and primary amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This review briefly summarises the current knowledge about the syndrome and the management strategies.
Due to pregnancy thyroid economy is affected with changes in iodine metabolism, TBG and development of maternal goiter. The incidence of hypothyroidism in pregnancy is quite common with autoimmune hypothyroidism being the most important cause. Overt as well as subclinical hypothyroidism has a varied impact on maternal and neonatal outcome. After multiple studies also, routine screening in pregnancy for hypothyroidism can still not be recommended. Management mainly comprises of dosage adjustments as soon as pregnancy is diagnosed based on results of thyroid function tests. The aim should be to keep FT4 at the upper end of normal range.
Growth Hormone Deficiency (GHD) can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. Growth harmone (GH) therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.
Advances in the management of thalassemia have led to marked improvements in the life span and quality of life of children and young adults. This poses new challenges for the treating physicians. There is now increasing recognition that thalassemics have impaired bone health which is multifactorial in etiology. This paper aims to highlight the factors that predispose these patients to osteoporosis and suggests measures to minimise the impact on bone health.
A 34-year-old woman presented with accidental ingestion of mercury that was used in her household to preserve grains. She experienced abdominal radiopaque shadows on X-ray that cleared after two days. Mercury poisoning can result from inhalation, ingestion, or absorption and affects the neurological, gastrointestinal, and renal systems. Diagnosis involves determining exposure history and elevated mercury levels in blood and urine. Supportive treatment includes removal of contaminated materials, irrigation, activated charcoal, chelation agents, and hemodialysis in severe cases.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Occupational Blood Borne Infections: Prevention is Better than CureApollo Hospitals
Viral infections like HIV, hepatitis Band C virus pose a big risk to the contacts of individuals with high risk behaviour as well as to the attending health care workers. Blood, semen, vaginal and other potentially infectious materials can transmit the infection to the susceptible contacts. Universal precautions should be strictly implemented during clinical examination, laboratory work and surgical procedures to prevent transmission to the health care providers. Health care workers should receive vaccination for hepatitis B infection. An inadvertent exposure should be managed with proper first aid and infectivity of the source and severity of exposure should be assessed. Severity of exposure is based on the nature and area of exposed surface, mode of injury and volume of infective material. Post-exposure prophylaxis (PEP) should be started as soon as possible after a proper counseling about the effectiveness of post-exposure prophylaxis, side effects and risk of carrying the infection to his familial contacts and its prevention.
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...Apollo Hospitals
Storage of red cells causes a progressive increase in hemolysis. Inspite of the use of additive solutions for storage and filters for leucoreduction some amount of hemolysis is still inevitable. The extent of hemolysis however should not exceed the permissible threshold for hemolysis even on the 42nd day of storage.
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...Apollo Hospitals
Various drugs used to treat pemphigus can cause remission, but none can provide permanent remission as relapses are common. With the introduction of DCP in pemphigus in 1984, patients started being in prolonged/permanent remission. This study was done to compare the efficacy of DCP to oral corticosteroids and cyclophosphamide in combination.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Apollo Hospitals
This case report describes a 24-year-old man who presented with fever, rash, abdominal pain, and vomiting. He had been taking carbamazepine for seizures. His symptoms and lab results met the criteria for Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), also known as drug hypersensitivity syndrome. DRESS is caused by certain drugs and is characterized by fever, rash, eosinophilia, and involvement of internal organs like the liver or lungs. Carbamazepine was withdrawn and steroids were started, leading to improvement. The report reviews the characteristics, diagnosis, and treatment of DRESS, noting it is important to identify the causative drug and avoid re-
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Apollo Hospitals
Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration.
Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open.
With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
This document describes two cases of unusual manifestations of dengue fever. Case 1 is a 40-year-old man who presented with fever, headache, body aches, and a rash who developed hepatitis, thrombocytopenia, and respiratory distress from dengue hemorrhagic fever. Case 2 is a 24-year-old man who presented with fever and was found to have an intraocular hemorrhage, retinal detachment, ARDS, myocarditis, and hepatitis, also from dengue hemorrhagic fever. The document then reviews atypical neurological and gastrointestinal manifestations that have been reported with dengue infection.
A 71-year-old male presented in ENT department with dysphagia for last three weeks, more to solids than liquids. He had a hard bony bulge in the posterior pharyngeal wall on palpation and hence was referred for an Orthopaedic opinion. Lateral radiograph of the cervical spine revealed diffuse ossification of the anterior longitudinal ligament. This ossification was extending almost half the width of the cervical body from its anterior body at C1 and C2 vertebra level.
This document discusses pediatric liver transplantation. It begins by stating that pediatric liver transplantation is now an established treatment for end-stage liver failure from various causes, with excellent results due to improved immunosuppressive regimens, surgical techniques, and intensive care. It then discusses the historical development of liver transplantation, including the first attempts in the 1960s and key innovations like cyclosporine in the 1980s. The most common indications for pediatric liver transplantation are discussed as extrahepatic biliary atresia and acute liver failure. The document provides an overview of the pre-transplant evaluation process and post-transplant medical management and immunosuppression. It notes that living-related transplantation has helped address the shortage of donor l
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
2. a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 2 8 0 e2 8 4
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier.com/locate/apme
Review Article
Concept of trend markers for menstrual diseases
Shilpa Shah
Researcher, University of Mumbai, Fort, Mumbai 400032, Maharashtra, India
article info
abstract
Article history:
Background: For female patients with menstrual cycle related diseases, getting a proper
Received 25 September 2013
diagnosis and treatment is one of the most difficult challenges they face. Many get
Accepted 30 October 2013
incorrectly diagnosed with a variety of conditions due to unavailability of specific test or
Available online 21 November 2013
marker to confirm a diagnosis that can fit their symptoms.
Methods: Current article introduces concept of trend markers for menstrual diseases. It also
Keywords:
suggests methods for application of this concept in routine practice.
Female
Results: Implementation of the trend marker protocol results in a unique graphical presen-
Menstrual diseases
tation when a hormone and a symptom are plotted as per the day of menstrual cycle. This
Hormone
presentation will indicate behavior of the hormone in relation to the disease independent of
Trend markers
whether the hormone levels are normal or abnormal as per the set laboratory limits.
Conclusion: Menstrual diseases are ideal examples where despite of the established hormonal graphics for the three phases of menstrual cycle, there is a need for studying trend
in hormone levels for individual patients with respect to the disease conditions as
demanded by the complexity and variety of symptoms.
Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
1.
Introduction
Menstrual cycle is a biological marker of general health for
females from puberty till menopause. Menstruation is the
cyclic, orderly sloughing of the uterine lining on account of the
interactions of hormones produced by the hypothalamus,
pituitary, and ovaries.1 Almost any menstrual complaint understood in an appropriate vocabulary of suffering could be
labeled a menstrual disorder. The impact of menstruation on
women’s health manifests itself on different levels: living,
education, work and family.2 For female patients with menstrual cycle related diseases, it is a frightful condition. It is an
anticipated trouble that accompanies them every month.
Getting a proper diagnosis and treatment is one of the most
difficult challenges they face. Many get incorrectly diagnosed
with a variety of conditions due to unavailability of specific
test or marker to confirm a diagnosis that can fit their
symptoms. Symptoms of menstrual irregularities can be
similar to and confused with symptoms of other disease
conditions, such as pelvic inflammatory disease, ovarian
cysts, uterine cancer and others. Some of these conditions can
be very serious, even fatal, if left untreated. Further, as patients do not get diagnosed in the earliest stages of their illnesses, their sufferings multiply. In addition, untreated
menstrual irregularities can also lead to serious complications, such as infertility from lack of ovulation, anemia from
prolonged bleeding, endometrial cancer from prolonged build
up of the endometrial lining without menstrual bleeding.3,4
2.
Menstrual diseases
The functional (physiological) bleeding is differentiated
from dysfunctional (hormonal cause) bleeding such as
E-mail address: rescience_5@yahoo.co.in.
0976-0016/$ e see front matter Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.apme.2013.10.013
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amenorrhea, premenstrual syndrome, premenstrual asthma,
menstrual migraine, arthritis and others.3
2.1.
Amenorrhea
281
patients with cyclic variation in symptoms may have exacerbation at other times during a menstrual cycle, other terms
that have been used to describe this phenomenon include
“menstrual-linked asthma”, “menstrual associated asthma”,
and “perimenstrual asthma”. The fact that adult females are
more severely affected by asthma raises the possibility that
hormonal or biochemical differences related to sex may play a
role in the pathophysiology of asthma.9
Amenorrhea is absence of menses during the reproductive
years. Primary amenorrhea is defined as absence of menses by
age 14 with absence of growth and development of secondary
sexual characteristics or absence of menses by age 16 with
normal development of secondary sexual characteristics.
Possible causes of primary amenorrhea are extreme weight
gain or loss, congenital abnormalities of the reproductive
system, stress, excessive exercises, eating disorders (anorexia
nervosa), polycystic ovarian syndrome, thyroid imbalance,
turner syndrome, imperforated hymen, chronic illness, pregnancy, cystic fibrosis, congenital heart disease, and ovarian or
adrenal tumors.
Secondary amenorrhea is the absence of menses for 3 cycles or 6 months in women who have previously menstruated
regularly. Possible causes of secondary amenorrhea are
pregnancy, post partum pituitary necrosis, breast-feeding,
emotional stress, malnutrition, depression, thyroid imbalance, hyperprolactinemia, rapid weight gain or loss, chemotherapy or radiotherapy, vigorous exercising, kidney failure,
colitis, use of tranquilizers or antidepressants, pituitary,
ovarian, or adrenal turners, and early menopause.
Assessment of amenorrhea is based on history of etiologic
factors, physical examination and related laboratory tests
such as sonogram, pregnancy test, thyroid function test, FSH
(follicle stimulating hormone) level, LH (luteinizing hormone)
level, prolactin level, and laparoscopy. Treatment depends on
the cause.5
Migraine headaches are more common in women and 60e70%
of women with migraines report some relationship with their
menstrual period. Usually there is an increased frequency
before, during and after menses. Menstrual migraine is
thought to occur in about 14% of women.10 There are two
types of menstrual migraine e menstrually related migraine
(MRM) and pure menstrual migraine (PMM). MRM is a headache of moderate-to-severe pain intensity that happens
around the time of a woman’s period and at other times of the
month as well. PMM is similar in every respect but only occurs
around the time of a woman’s period.11 The exact causes of
menstrual migraine are uncertain but evidence suggests there
may be a link between menstruation and migraine due to the
drop in estrogen levels that normally occurs right before the
period starts.12 Menstrual migraine has been reported to be
more likely to occur during a five-day window, from two days
before to two days after menstruation.13 When compared with
migraines that occur at other times of the month, menstrual
migraines have been reported to last longer, be more severe,
occur more often with nausea and vomiting, be more difficult
to treat and occur more frequently.14
2.2.
2.5.
Premenstrual syndrome (PMS)
Premenstrual syndrome (PMS) is a collection of physical, psychological, and emotional symptoms related to a woman’s
menstrual cycle.6 Such symptoms are usually predictable and
occur regularly during the two weeks prior to menses. Generally, symptoms may vanish either before or after the start of
menstrual flow. The combination of symptoms and their intensity vary from woman to woman. More than 200 different
symptoms have been identified, but the three most prominent
symptoms are irritability, tension, and dysphoria.7 Although
the causes of PMS are poorly documented, they probably are
multifactorial. Most women with premenstrual syndrome
experience only a few of the problems. The following symptoms can be attributed to PMS: abdominal bloating, abdominal
cramps, breast tenderness or swelling, stress or anxiety,
trouble falling asleep (insomnia), joint or muscle pain, headache, fatigue, acne, mood swings, worsening of existing skin
disorders, and respiratory (e.g., allergies, infection) or eye
(bulbar disturbances, conjunctivitis) problems.8
2.4.
Arthritis
Rheumatoid arthritis (RA), an inflammatory disease of autoimmune origin, is between two and four times more likely to
strike women than men. Among women, RA is more likely to
develop when reproductive hormonal levels are changing,
such as in the first few months following a pregnancy. A significant trend toward lower risk of RA with longer duration of
breast-feeding is observed. Women who experience irregular
menstrual cycles between the ages of 20 and 35 have an
increased risk of rheumatoid arthritis. The risk of rheumatoid
arthritis increases with age and demonstrates a peak risk at
the typical time of menopause.15
Assessment of premenstrual diseases focuses on detailed
history. Physical examination is necessary to find out if there
are any physical causes for the symptoms. Depending on the
symptom pattern, blood studies, including hormonal investigations are carried out.
3.
2.3.
Menstrual migraine
Hormonal diagnosis
Premenstrual asthma
It has been recognized that many asthmatic women have the
worst of their asthma just a few days before the menstrual
periods. This presentation of asthma in females has been
described as “premenstrual asthma”. However, as some
Suspected diagnosis of menstrual diseases can usually be
made through the type of the menstruation irregularity,
symptoms and the results of the gynecological examinations,
which can then either be confirmed or excluded through a
differentiated laboratory diagnosis. The type of menstrual
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irregularity is not necessarily indicative of the underlying
disorder so the examination of the levels of hormones is
indispensable. Perimenopause, menopause, or other hormone
related diseases such as hypothyroidism and adrenal
exhaustion, all exhibit similar and overlapping symptoms. So
making an accurate diagnosis based on symptoms alone is
very difficult. For example, if a woman presents with hot
flashes clinically one will assume that she requires estrogen
when in actual fact the hot flashes may be due to high cortisol
levels. Further treatment with estrogen in this case might
aggravate the hot flashes leading to excessively high levels of
estrogen which can result in a down regulation of estrogen
receptors. Assuming hormonal conditions in patients without
actual assessment of hormones can cause harm rather than
help. Depending on the assumed disease pattern, not all
hormones need to be examined; rather it can be limited to the
most relevant ones.
The following hormones are determined during the basic
hormone analysis.16
(i)
(ii)
(iii)
(iv)
(v)
(vi)
FSH (follicle stimulating hormone)
LH (luteinizing hormone)
E2 (estradiol)
Progesterone
Prolactin
Testosterone
(vii) Androstenedione
(viii) DHEAS (dehydroepiandrosterone sulfate)
(ix) 17-OH-Progesterone
(x) TSH (thyroid stimulating hormone)
4.
Variables for hormonal assessment
Assessing hormones within the framework of the menstrual
events involve the knowledge of the day of menstruation,
the length of menstruation, the sequential secretion of the
individual hormones (during the course of a menstrual
cycle) and their relationship to one another.17 Measuring
hormone levels in females has several related dependent
variables.
(a) Age: While for teenage patients’ age and time of puberty
are important determinants, for post-puberty females
menstrual phase must be taken into consideration when
investigating the hormone levels. This further can get
affected by history of pregnancy, hormonal therapy for
contraception and pre-ponding or post-ponding the menstrual cycle with help of hormones. For senior females the
related possibility of perimenopause or menopause needs
to be kept in mind.
(b) Day of menstrual cycle: Sex hormone levels do indeed
fluctuate as per the day of menstrual cycle. So the normal
limits for each three phase of menstrual cycle are
different. To determine if the assessed value of hormone is
normal or not, it is mandatory to know that in which phase
of cycle the test is carried out e follicular phase, mid-cycle
peak or the luteal phase. For females suffering from
menstrual diseases it could be difficult at times to quote
their first day of last menstruation period (LMP). For
varying length of menstrual cycle or missed periods these
patient may not be able to inform for sure about the day of
cycle.
(c) Technique: Blood tests, saliva test or urine test can be used
to determine hormone levels. It is important to distinguish
inactive form of the hormone, from its free and biologically
active form. As quite often total hormone levels are within
normal limits but once the free and active levels are tested
deficiencies are identified.
(d) Interpretation: A major problem with hormone testing is
the interpretation of test results. Practitioners with little
experience in hormonal matters often observe results that
lie at the low end of the so called “normal range” and
determine that no hormone imbalance or deficiency exists
thus determine no action is required. A major problem is
that laboratory test “normal” ranges are defined and
standardized according to statistical norms instead of
physiological optimal levels. That is, mathematics rather
than patient symptoms define “normal” hormone levels.
Instead of using “normal” laboratory ranges it would be
ideal to use optimal ranges which as a general rule lie
within the upper one third of the normal laboratory range.
This general rule is only a guide as it does not take the
appropriate balance between certain hormones into account which is also very important. Therefore it is
important that someone with experience and knowledge
on appropriate hormone balance views the test results for
an accurate diagnosis. Often there is a significant
improvement in symptoms when levels at the low end of
the normal range are increased to the upper end of the
normal range with treatment. It should be clarified that
test results must be used in conjunction with signs and
symptoms and not be totally relied upon 100% for a diagnosis and latter on to determine appropriate dosages.
There is always a general optimal physiological level that
can be tried to achieve, however these levels can vary in
some patients and this must be taken into account and can
only be done so by also using symptoms as a guideline.18
It is due to the above variables and wide variety of
symptoms along with enumerable causes that there are no
standard protocols for diagnosis and management of menstrual diseases. Many times the patients suffering from
menstrual diseases are subjected to a great number of
available investigation techniques to know the cause. The
investigative efforts are often a wasted attempt as what is
found at end of detailed investigations is that all the parameters were normal. These patients are often not even
medically registered as being diseased. It is important to
realize that investigating a patient for once may not always
be enough. Even if all investigations appear to be within the
reported normal limits, if the patient continues to complain
and the cause is unidentified, periodic testing and reevaluation of the concerned parameters should be performed before dismissal i.e. their trend should be observed.
Research is required to develop techniques for application of
hormonal investigations in a fashion that would help diagnose the menstrual disorders that more accurately reflect
women’s complaints. Chief objective of such techniques can
be to mark trends in menstruation related hormonal levels
5. a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 2 8 0 e2 8 4
283
versus clinical symptoms and to provide trend markers for
the menstrual diseases.
temperature graph which indicates ovulation simply highlights the ‘trend marker’ concept. This concept can be applied
in individual patient-oriented ways as under.
5.
(1) In patients having chronic disease complaints which vary
as per the day of menstrual cycle the simple way is to take
detailed history of the patient, correlating the symptoms
for a probable diagnosis, choosing the related hormone/s
and then investigating the patient for that hormone.
Plotting the hormone and a symptom as per the day of
menstrual cycle will produce a unique graphical presentation indicating behavior of the hormone in relation to the
disease. It is important to realize that this understanding
will be independent of whether the hormone levels are
normal or abnormal as per the set laboratory limits.
(2) In patients suffering from intermittent menstrual symptoms the trend marker can be a two-test procedure. Based
on the detailed clinical history and probable diagnosis
choice of hormone/s can be made. Once the hormone selection is done, first estimation can be done immediately
when patient gets diseased and the second estimation of
the same hormone can be made during the disease free
period. Comparison of these two estimations can indicate
the difference in hormone/s with and without disease
irrespective of whether the values are normal or abnormal
as per the set laboratory normal limits. Additionally such
two time estimation is also independent of the day of cycle
or bothering of the menstrual phase. This helps the patient
a lot as diagnostic attempt can start right when the
symptoms are ongoing, rather than waiting for the recommended day of cycle as is usually done during the
standard medical practice.
(3) In patients having amenorrhea plus other symptoms of
menstrual disease the trend marker concept can be applied
after inducing and regularizing the menstrual cycle.
(4) In patients having known hormonal imbalance and menstrual disease the trend markers concept can be applied to
interpret the effectiveness of therapy. For these patients
the therapeutic intervention can be plotted against a
health or disease parameter along with the hormone
which is selected based on the clinical history and probable diagnosis.
(5) Anticipatory application of the trend marker concept
would be ideal for the subjects having family history of the
disease in question or to the subjects who have got
pending undiagnosed disease conditions and who are
being treated for symptoms rather than root cause of the
disease.
Trend markers
A disease marker can be defined as an efficient diagnostic
indication that a specific disease may develop. Post development of a disease, such a marker can assist in confirmation of
its diagnosis. It also helps to differentiate between identical
presentations of disease symptoms which is essential for an
appropriate treatment. A disease marker needs to be a characteristic, measurable and quantifiable biological parameter
that can be objectively measured and evaluated as an indicator of either a normal or pathogenic process or pharmacologic responses to a therapeutic intervention.19
In the current scenario of medicine, disease markers are
routinely used mainly for predicting and diagnosing a disease
as well as for post treatment follow-up of patients. These
straight applications of disease markers are possible when
there is a single marker in question for a distinct set of
symptoms and a unique disease. But, in practice there are
varied situations possible. (1) There could be a single marker
predicting more than one distinct set of clinical symptoms or
getting affected by more than one disease conditions or (2)
there could be multiple parameters indicative of a particular
disease condition or (3) there is a possibility of multiple parameters resulting in several different presentations of the
same disease or (4) there could be a particular trend of a single
parameter or multiple parameters that could be predictive or
diagnostic of a disease or syndrome. For such complexities a
onetime measurement of the disease markers may not always
be sufficient to predict or diagnose or provide therapeutic
guidance. For such situations it would be right to introduce the
concept of “Trend Markers”. A trend marker can either be a
single marker or a group of individual markers which need to
be studied for individual diseases or group of diseases or
syndromes. Menstrual disease conditions are the model illustrations indicating the need for trend markers. There is a
need for studying trend in hormone levels with respect to the
disease conditions as demanded by the complexity and variety of symptoms. Menstrual diseases are ideal examples
where despite of the established hormonal graphics for the
three phases of menstrual cycle. In Fig. 120 the basal body
Conflicts of interest
The author has none to declare.
Acknowledgments
Fig. 1 e Menstrual cycle and hormones.
Special thanks to Dr. Atmaram Bandivdekar, National Institute of Research in Reproductive Health, Mumbai, India;
6. 284
a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 2 8 0 e2 8 4
Dr. Roby Russell, Roby Institute, Austin, TX, USA, Dr. Richard
Richardson and Dr. Patricia Richardson, University of Texas at
Austin, TX, USA, Dr. Gerhard Meisenberg, Ross University
School of Medicine, Roseau, Dominica, and Dr. William Simmons, Loyola University Stritch School of Medicine, Chicago,
IL, USA.
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