THIS PRESENTATION IS FOCUSSES ON CONGENITAL HYPERPLASIA, ITS DEFINITION, EPIDEMIOLOGY, ITS TYPES, PATHOGENESIS DIAGNOSIS AND MANAGEMENT OPTIONS IT DESCRIBES HOW CAH AFFECTS ON BODY, AND HOW BODY RESPONSES TO THIS CONDITION THIS IS THE CONDITION IN WHICH ADRENOMEGALY IS SEEN
Congenital Adrenal Hyperplasia (CAH)
For 5th Year Medical Students and Endocrinology Modules and Master and MD Degree Internal Medicine and Endocrinology
By Dr Usama Ragab Youssif
References: Oxford Handbook of Endocrinology & Diabetes
Congenital Adr Hyperplasia (CAH) can appear at any age from birth to puberty where it can lead to ambiguous genitalia. It is due to absolute or relative deficiency of 17 Hydroxylase or 21 Hydroxylase enzyme.
Congenital Adrenal Hyperplasia (CAH)
For 5th Year Medical Students and Endocrinology Modules and Master and MD Degree Internal Medicine and Endocrinology
By Dr Usama Ragab Youssif
References: Oxford Handbook of Endocrinology & Diabetes
Congenital Adr Hyperplasia (CAH) can appear at any age from birth to puberty where it can lead to ambiguous genitalia. It is due to absolute or relative deficiency of 17 Hydroxylase or 21 Hydroxylase enzyme.
precocious puberty is one of the grey areas for pediatricians and gyenecologists. this is an attempt to answer some of the questions the content is references taken from authorative textbooks
AIS is a genetic condition where affected people have male chromosomes and male gonads with complete or partial feminization of the external genitals
An inherited X-linked recessive disease with a mutation in the Androgen Receptor (AR) gene resulting in:Functioning Y sex chromosome and abnormality on X chromosome
precocious puberty is one of the grey areas for pediatricians and gyenecologists. this is an attempt to answer some of the questions the content is references taken from authorative textbooks
AIS is a genetic condition where affected people have male chromosomes and male gonads with complete or partial feminization of the external genitals
An inherited X-linked recessive disease with a mutation in the Androgen Receptor (AR) gene resulting in:Functioning Y sex chromosome and abnormality on X chromosome
(medical explanation) Emily rose, exorcism of Anneliese Michel.pptxalok hridaya
(medical explanation) case study of the story of anneleise michel aka emily rose, died at young age of 24, was considered to be possessed by demon, actually thought to have multiple psychotic disorders which ultimately cause her death.FAMILY HAD A VERY STRONG BELIEF IN RELIGION,
AND SHE KNEW ABOUT LATIN AND ROMAN (LANGUAGE & CULTURE)
Holy objects like CROSS, HOLY WATER drive her mad.
She heard voices:- that she is damned, and she will rot in hell.
And she began to see faces of demons on people and things around her.
she told she saw colors, and experienced Euphoria, heard sounds and had a grimacing face.
She used to do disturbing things,
Peeing on the floor and then licking it
Tearing her clothes
Eating insects (flies, cockroach)
Barking
Screaming through walls
Scratching the floor
Arguing in different demonic voices
Priest claimed (father ARNOLD RENZ, Pastor ERNST ALT)
that she was possessed by 6 demons:
LUCIFER (voice:- lucifer, devil in the flesh)
JUDAS ISCARIOT
NERO
CAIN
HITLER (voice:- people are stupid pigs)
VALENTINE FLEISCHMAN (DISGRACED FRANKISH PRIEST)
AND PROBABLY A FEW MORE (BELIAL),
She suffered from torn ligaments due to genuflexion due to falling on one or both knees.
Had multiple episodes of vomiting, she refused to eat, bcoz Annaleise said she wasn’t allowed to, thus was Anorexic and weighted around 30Kg.
THIS PRESENTATIONS COVERS THE TOPIC ON LUNG CANCER and its epidemiology among different age groups, its incidence and fatality rate, types of lung cancer andpathogenesis of lung cancer, diagnosis, treatment, complication and prognosis of lung caner
THIS CONTENT WILL HELP YOU TO LEARN HOW ALPHA 1 ANTITRYPSIN DEFCIENCY AFFECT LUNGS AND LIVER
ANDN MULTI ORGAN SYSTEM GIVING OFF DIFFERENT MANIFESTATION IN BODY
Everything about Pulmonary embolism- PPTalok hridaya
the sudden blockage of pulmonary artery or its branches by an embolus called PULMONARY EMBOLISM.
embolus can be of different types
thrombus is most common arising from deep veins
thus DEEP VEINS THROMBOSIS leads to PULMONARY EMBOLISM
Covid 19 (variants+Ro value+when pandemic will over+ how it effects body+its ...alok hridaya
corona virus disease 2019 or covid19 is a critical conditon affecting the whole body, primarily targeting lungs by causing patholoigies such as ARDS and Pneumonia. there are different variants presented till date and most recent one is omicron with Ro=7 while delta variant has the Ro=6.
ultimately it affect the alveolar sac causing the inflammation followed by consolidation, during the whole process different other organ system also get affected due to ventilation perfusion mismatch thus leads to tachycardia followed by multiple organ damage which ultimately causes MOF (multiple organ failure), COVID19 is diagnosed according to history and physical examination of patient presented by the given symptoms, and provided vitals. Nasopharyngeal swab test as well as RT-PCR is counted as Gold standard, though sensitivity is less than NAAT (nucleic acid amplification test) which has more sensitivity but is very expensive for the population. diagnosis is then followed by general blood test to rule out other condition and and critical scenario of the body, finally imaging technique such as CXR, CT-chest or US can be done to find and evaluate lungs and its functioning. finally this presentation will guide you to know the current prevention and treatment option.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. INCREASE IN SIZE OCCUR BY
HYPERTROPHY
HYPERPLASIA
METAPLASIA
!! MUST KNOW BASICS !!
ONE OF THE PATHOLOGY THAT
LEADS TO ADRENOMEGALY
OTHER THAN CAH CAN BE
“CUSHING DISEASE”
4. INTRODUCTION
• Congenital adrenal hyperplasia (CAH) refers to a group of genetic
disorders that affect the adrenal glands, a pair of walnut-sized organs
above the kidneys. The adrenal glands produce important hormones,
including:
• Cortisol, which regulates the body's response to illness or stress
• Mineralocorticoids, such as aldosterone, which regulate sodium and
potassium levels
• Androgens, such as testosterone, which are male sex hormones
• In people who have CAH, a genetic problem results in a lack of one of the
enzymes needed to make these hormones.
• Although there is no cure, with proper treatment, most people who have
congenital adrenal hyperplasia can lead normal lives.
•
5. EPIDEMIOLOGY
• The classic form, also known as the severe form, occurs in
1:15,000 births worldwide, while the nonclassic or mild form
occurs in approximately 1:1,000 births worldwide and is much
more common (up to 1:20) in certain ethnic groups.
• People with a mutation in only one of the CAH-related genes do
not have symptoms of CAH. But they're called CAH
carriers because they can pass the CAH-causing gene to
their children
• Factors that increase the risk of having CAH include:
• Parents who both have CAH or are both carriers of the genetic
defect for the disorder
• Certain ethnic heritages, such as Ashkenazi Jew, but also
Hispanic, Italian, Yugoslav and Yupik Inuit
6. TYPES
• There are two major types of congenital adrenal
hyperplasia:
21 hydroxylase deficiency (>90%)
• Classic CAH. This form is rarer and is usually
detected in infancy. Approximately two-thirds of
people who have classic CAH have what's known
as the salt-losing form, while one-third have what's
referred to as the simple-virilizing form.
• Nonclassic CAH. This form is milder and more
common, and may not become evident until
childhood or early adulthood. (1 in 1000)
•
7. • MINOR TYPES:-
OR OTHERS
11-HYDROXYLASE DEFICIENCY
17ALPHA-HYDROXYLASE DEFICIENCY
3-HYRDROXYSTEROID DEHYDROGENASE
DEFICIENCY
10. CLINICAL FEATURES
• CLASSICAL
ENZYME DEFICIENCY IS COMPLETE
(11 HYDROXYLASE DEFICIECNY) SO
LOW ALDOSTERONE
LOW CORTISOL
HIGH TESTOSTERNE
DECREASED ALDOSTERONE MEANS DECREASE
SODIUM ABSORPTION AND WE KNOW WATER
FOLLOW SODIUM THUS LESS WATER RETENTION
AND MORE POTASSIUM IN BODY
11. • SO,
• HYPOVALEMIA
• HYPONATREMIA
• HYPERKALEMIA
• HYPOTENSION
• DEHYDRATION (SUNKEN EYES AND MUCOSA)
• IRREGULAR HR
• DIARRHEA
• SHOCK
Decreased BP will activate RAAS mechanism
ALSO, decrease amount of cortisol, thus stress hormone is less thus it won’t target liver to
release glucose thus
• HYPOGLYCEMIA
Though testosterone will increase,
This causes
• early puberty in boys
• female oligomenorrhea can be seen
• Clitoromegaly
• Growth of hair and muscles in female
SALT
WASTING
12. • NON CLASSIC:-
• DEFICIENCY OF ENZYME IS PARTIAL BUT STILL ENZYME IS LITTLE BIT
ACTIVE TO PRODUCE ALMOST NEAR NORMAL LEVEL OF ALDOSTERONE,
CORTISOL BUT THOUGH THERE IS STILL ACCUMULATION OF PRODUCTS
THERE IS HIGH LEVEL OF TESTOSTERONE
• SO THERE IS NO SALTWASTING, OR OTHER MANIFESTATION AS
CLASSIC ONE BUT HAVE FEW FEATURES DUE TO EXTRA
TESTOSTERONE:-
• ACNE
• EXCESS HAIR GROWTH
• MUSCLE GROWTH
• EARLY PUBERTY
• OLIGOMENORRHEA
• MOOD SWINGS
• BODY ODOR
• OILY HAIR AND SKIN
• INFERTILITY
13. DIAGNOSIS
Prenatal testing:-
• Tests used to diagnose CAH in fetuses include:
• Amniocentesis. This procedure involves using a
needle to withdraw a sample of amniotic fluid from
the womb and then examining the cells.
• Chorionic villus sampling. This test involves
withdrawing cells from the placenta for
examination.
Any organomegaly must not be neglected as it could be
cancerous too thus biopsy is must
14. Newborns, infants and children
• Doctors recommend that all newborns in the United States be
screened for genetic 21-hydroxylase deficiency during the first few
days of life. This test identifies the classic form of CAH but doesn't
identify the nonclassic form.
• Diagnosis of CAH in older children and young adults includes:
• Physical exam. If the doctor suspects CAH based on a physical exam
and symptoms, the next step is to confirm the diagnosis with blood and
urine tests.
• Blood and urine tests. These tests look for abnormal levels of
hormones produced by the adrenal glands.
• Gene testing. In older children and young adults, genetic testing may
be needed to diagnose CAH.
• Testing to determine a child's sex. In female infants who have
severe ambiguous genitalia, tests can be done to analyze
chromosomes to identify genetic sex. Also, pelvic ultrasound can be
15. MANAGEMENT
• THERE IS NO KNOWN WAY TO PREVENT CONGENITAL ADRENAL
HYPERPLASIA.
• ALSO THERE IS NO CURE
• Supportive therapies can be given thorughout the life
• Medications:-
• People who have the classic form of CAH can successfully manage the
condition by taking hormone replacement medications throughout their lives.
• People who have nonclassic CAH may not require treatment or may need only
small doses of corticosteroids.
• Corticosteroids to replace cortisol
• Mineralocorticoids to replace aldosterone to help retain salt and get rid of
excess potassium
• Salt supplements to help retain salt
• Classic CAH is treated with steroids that replace the low hormones, in
females
16. • Reconstructive surgery:-
In some female infants who have severe ambiguous genitalia as a result of
classic CAH, doctors may recommend reconstructive surgery to improve genital
function and make them look more feminine
• Prenatal treatment
• Synthetic corticosteroids that cross the placenta to the fetus are controversial
and considered experimental. More research is needed to determine the long-
term safety and the effect of this treatment on fetal brain development.
Very important Is :-
Psychological support is important to the emotional health and social adjustment of
female children who have genital abnormalities.