Dr Ayman Ewies - Topical Vaginal Oestrogen in the management of postmenopausa...AymanEwies
This document provides an overview of topical vaginal estrogen in managing postmenopausal vaginal atrophy. It discusses that vaginal atrophy is a common problem affecting over 60% of postmenopausal women, causing symptoms like dryness and pain. While systemic hormone therapy can help, it may have risks and up to 45% of users still experience dryness. Topical vaginal estrogen is effective at treating symptoms by restoring the vaginal lining, has minimal systemic absorption, and long-term studies show no increased endometrial risk without needing additional progestogen in non-hysterectomized women. The document reviews treatment options and safety of topical vaginal estrogen.
Dr Ayman Ewies - Principles of HysteroscopyAymanEwies
This document provides an overview of hysteroscopy procedures. It discusses the history and development of hysteroscopy, describes hysteroscope equipment and how it is used, outlines the steps for performing diagnostic and operative hysteroscopies, reviews indications and contraindications, and discusses techniques for performing hysteroscopy in an outpatient setting. The risks and complications of hysteroscopy are also reviewed. In summary, the document is a comprehensive guide to hysteroscopy procedures, equipment, techniques, and considerations for patient safety.
Dr Ayman Ewies - Prevalence of hyperplasia and cancer in endometrial polyps i...AymanEwies
This document summarizes a study that aimed to quantify the prevalence of hyperplasia and cancer in endometrial polyps among women with postmenopausal bleeding (PMB). The study conducted a systematic review and meta-analysis of 10 studies and found an overall prevalence of hyperplasia and cancer of 8.9%. However, there remains uncertainty around the exact prevalence due to heterogeneity in prior studies. There is also no consensus on whether polyps should be routinely removed or if expectant management could be adopted in some cases. Future research with large prospective studies is needed to help guide clinical practice.
Dr Ayman Ewies - Operative Hysteroscoy Practical TipsAymanEwies
This document discusses submucous fibroids (SMF) and their treatment. It provides background on the prevalence of SMF and their effects on infertility and recurrent pregnancy loss. It describes the classification of SMF and techniques for hysteroscopic myomectomy including using bipolar versus monopolar energy. Key steps in the procedure include differentiating type 1 and 2 fibroids, extracting tissue chips, and ensuring hemostasis. Long-term outcomes of hysteroscopic resection are generally good with high satisfaction rates. The document also briefly discusses techniques for endometrial ablation and hysteroscopic septum resection.
Dr Ayman Ewies - Mirena: why 50% of women dislike it?AymanEwies
1) The study found a high discontinuation rate of Mirena, with 50% of women stopping use before the recommended 5 years due to adverse effects like bleeding and pain.
2) Many women reported progestogenic side effects such as headaches, weight gain and depression, which led to early removal for 44% of participants.
3) Satisfaction with Mirena was low, with only 50% of women reporting being satisfied with the device.
Dr Mona Elshafie and Dr Ayman Ewies - The Effect Of Leptin On Maturation Of T...AymanEwies
1) Leptin administration to immature rats accelerated ovarian maturation, as seen in ultrastructural changes including enhanced folliculogenesis and development of corpora lutea.
2) It led to initiation of steroidogenesis in granulosa, theca and stroma cells, and premature ovulation between 26-30 days.
3) Histological analysis found increased numbers of growing and antral follicles and decreased primordial and atretic follicles in leptin-treated ovaries.
Dr Ayman Ewies - Endometrial Polyps in Postmenopausal WomenAymanEwies
1. The study examined endometrial polyps in 2625 postmenopausal women referred to a PMB clinic over 5 years.
2. It found that 17% of women had endometrial polyps, and of these polyps, 7.8% showed hyperplasia or cancer.
3. Higher BMI and thicker endometrium were independent predictors of hyperplasia and cancer in polyps. Women with both a BMI over 32.5 and endometrial thickness over 10.8mm had the highest risk.
Dr Ayman Ewies - Topical Vaginal Oestrogen in the management of postmenopausa...AymanEwies
This document provides an overview of topical vaginal estrogen in managing postmenopausal vaginal atrophy. It discusses that vaginal atrophy is a common problem affecting over 60% of postmenopausal women, causing symptoms like dryness and pain. While systemic hormone therapy can help, it may have risks and up to 45% of users still experience dryness. Topical vaginal estrogen is effective at treating symptoms by restoring the vaginal lining, has minimal systemic absorption, and long-term studies show no increased endometrial risk without needing additional progestogen in non-hysterectomized women. The document reviews treatment options and safety of topical vaginal estrogen.
Dr Ayman Ewies - Principles of HysteroscopyAymanEwies
This document provides an overview of hysteroscopy procedures. It discusses the history and development of hysteroscopy, describes hysteroscope equipment and how it is used, outlines the steps for performing diagnostic and operative hysteroscopies, reviews indications and contraindications, and discusses techniques for performing hysteroscopy in an outpatient setting. The risks and complications of hysteroscopy are also reviewed. In summary, the document is a comprehensive guide to hysteroscopy procedures, equipment, techniques, and considerations for patient safety.
Dr Ayman Ewies - Prevalence of hyperplasia and cancer in endometrial polyps i...AymanEwies
This document summarizes a study that aimed to quantify the prevalence of hyperplasia and cancer in endometrial polyps among women with postmenopausal bleeding (PMB). The study conducted a systematic review and meta-analysis of 10 studies and found an overall prevalence of hyperplasia and cancer of 8.9%. However, there remains uncertainty around the exact prevalence due to heterogeneity in prior studies. There is also no consensus on whether polyps should be routinely removed or if expectant management could be adopted in some cases. Future research with large prospective studies is needed to help guide clinical practice.
Dr Ayman Ewies - Operative Hysteroscoy Practical TipsAymanEwies
This document discusses submucous fibroids (SMF) and their treatment. It provides background on the prevalence of SMF and their effects on infertility and recurrent pregnancy loss. It describes the classification of SMF and techniques for hysteroscopic myomectomy including using bipolar versus monopolar energy. Key steps in the procedure include differentiating type 1 and 2 fibroids, extracting tissue chips, and ensuring hemostasis. Long-term outcomes of hysteroscopic resection are generally good with high satisfaction rates. The document also briefly discusses techniques for endometrial ablation and hysteroscopic septum resection.
Dr Ayman Ewies - Mirena: why 50% of women dislike it?AymanEwies
1) The study found a high discontinuation rate of Mirena, with 50% of women stopping use before the recommended 5 years due to adverse effects like bleeding and pain.
2) Many women reported progestogenic side effects such as headaches, weight gain and depression, which led to early removal for 44% of participants.
3) Satisfaction with Mirena was low, with only 50% of women reporting being satisfied with the device.
Dr Mona Elshafie and Dr Ayman Ewies - The Effect Of Leptin On Maturation Of T...AymanEwies
1) Leptin administration to immature rats accelerated ovarian maturation, as seen in ultrastructural changes including enhanced folliculogenesis and development of corpora lutea.
2) It led to initiation of steroidogenesis in granulosa, theca and stroma cells, and premature ovulation between 26-30 days.
3) Histological analysis found increased numbers of growing and antral follicles and decreased primordial and atretic follicles in leptin-treated ovaries.
Dr Ayman Ewies - Endometrial Polyps in Postmenopausal WomenAymanEwies
1. The study examined endometrial polyps in 2625 postmenopausal women referred to a PMB clinic over 5 years.
2. It found that 17% of women had endometrial polyps, and of these polyps, 7.8% showed hyperplasia or cancer.
3. Higher BMI and thicker endometrium were independent predictors of hyperplasia and cancer in polyps. Women with both a BMI over 32.5 and endometrial thickness over 10.8mm had the highest risk.
Dr Ayman Ewies - What makes an effective e-tutorial?AymanEwies
This document discusses what makes an effective e-tutorial. It notes that e-learning is great because it is comprehensive, accessible, responsive, up-to-date, and greener than traditional learning. Effective e-tutorials should be engaging and interesting through the use of case studies, interactive tasks, assessment questions, videos, animations and graphics. They should also be comprehensive, highlight advanced content, include key points and user feedback. Support is provided to authors through guidelines, templates and incentives. Challenges include ensuring quality through updating, copyright issues, and plagiarism.
Dr Ayman Ewies and Dr Seu Gunasekera Best Oral PresentationAymanEwies
The document announces the 27th annual congress of the European Society of Gynaecological Endoscopy (ESGE) to be held from October 7-10, 2018 in Vienna, Austria. The congress will take a holistic approach to women's health, focusing on quality assurance and innovation. Seuvandhi Gunasekera of the United Kingdom, along with co-authors Ahmed Ghoubara and Ayman Ewies, will receive an award for their scientific work titled "Rate of hysterectomy following 419 Novasure procedures - real-life experience of a teaching hospital in the UK", which was selected for an oral presentation during the plenary sessions of the congress.
The Sandwell and West Birmingham Hospitals NHS Trust provides healthcare services to over 300,000 people living in the Sandwell and West Birmingham areas. It operates two main hospital sites, Sandwell General Hospital in West Bromwich and City Hospital in Birmingham. The Trust employs over 5,000 staff and provides a wide range of acute medical and surgical services including A&E, maternity, outpatients, and diagnostic imaging.
Dr Ayman Ewies - Doctors versus nurses in managing women with PMBAymanEwies
The Sandwell and West Birmingham Hospitals NHS Trust provides healthcare services to over 300,000 people living in the Sandwell and West Birmingham areas. It operates two main hospital sites, Sandwell General Hospital in West Bromwich and City Hospital in Birmingham. The Trust employs over 5,000 staff and provides a wide range of acute medical and surgical services including A&E, maternity, outpatients, and diagnostic and therapy services.
Dr Ayman Ewies - Body fat percentage in women with PMBAymanEwies
The Sandwell and West Birmingham Hospitals NHS Trust operates two main hospitals in the West Midlands region of England - Sandwell General Hospital in West Bromwich and City Hospital in Birmingham. The trust provides a range of acute hospital services including accident and emergency, medicine, surgery, maternity, and outpatient care to over 350,000 people living in Sandwell and parts of western Birmingham.
Dr Ayman Ewies - Thickened Endometrium in absence of PMBAymanEwies
The Sandwell and West Birmingham Hospitals NHS Trust operates two hospitals in the West Midlands region of England - Sandwell General Hospital in West Bromwich and City Hospital in Birmingham. The trust provides a range of acute hospital services including accident and emergency, medicine, surgery, maternity, and outpatient care to over 350,000 people living in Sandwell and parts of western Birmingham.
Dr Ayman Ewies - Are animal laboratory models superior to virtual reality sim...AymanEwies
The document discusses different models for training in advanced hysteroscopic surgery procedures, which have a slow learning curve. It evaluates animal models using cattle uteruses versus virtual reality simulation. Trainees provided feedback over two years of training courses. The cattle uterus model scored the highest with a 94.65% overall score, replicating tissue properties better than virtual simulators which averaged 83.88%. While virtual simulators have limitations like cost and lack of realism, animal models provide a realistic environment for developing skills before clinical training. The cattle uterus is concluded to be a superior model for its similarity to the human uterus and ability to practice resection techniques.
This study evaluated an office hysteroscopy service with 700 annual cases. A retrospective review of 141 women undergoing NovaSure endometrial ablation from 2011-2015 found 79% did not require further treatment, while 21% received additional care including 10% who had a hysterectomy. A survey of 100 women in the office hysteroscopy service from 2015-2016 found high satisfaction, with 93 women scoring overall acceptability ≥8 and stating they would repeat the procedure. While 17 women reported severe pain during treatment, staff were found to be supportive and privacy was maintained.
Dr Ayman Ewies - Abnormal Uterine Bleeding in Pre-menopausal Women: When Shou...AymanEwies
This document summarizes a study on abnormal uterine bleeding in pre-menopausal women. The study examined 3006 endometrial samples from women aged 30 to 50 who presented with abnormal uterine bleeding. It found that the rate of atypical hyperplasia and carcinoma increased with each successive 5-year age group, with the highest rates occurring in women aged 45-50. Specifically, atypical hyperplasia was 3.85 times more likely and carcinoma was 4.03 times more likely in women aged 45-50 compared to those under 40. While abnormal growths can occur under age 40, the study supports guidelines recommending endometrial sampling for women over 45 presenting with abnormal uterine bleeding.
Dr Ayman Ewies - Colposcopy and STI SurveyAymanEwies
This document discusses a cross-sectional survey that was conducted to determine the prevalence of sexually transmitted infections (STIs) among women attending colposcopy clinics in order to inform screening policies. The survey found that the women attending colposcopy were not at higher risk of STIs than the general population. Current NHS guidelines state that asymptomatic patients do not need routine STI screening during colposcopy visits. The survey results support these guidelines and suggest that universal STI screening is not required for colposcopy patients.
Dr Ayman Ewies - Postcoital Bleeding National SurveyAymanEwies
This document discusses the inconsistent management of postcoital bleeding (PCB) by UK doctors and the need for evidence-based guidelines. A survey of UK gynecologists found wide variations in how they manage and investigate PCB. Despite links between PCB and cervical pathology, less than half repeat smear tests for women with a negative history and only 15% refer women directly to colposcopy clinics. The lack of consensus and guidelines on PCB management makes it important to standardize care based on the best evidence.
Dr Ayman Ewies - Managing Women with Postcoital BleedingAymanEwies
This study prospectively observed 120 women referred to a hospital with postcoital bleeding over one year. The study found that over 50% of women were under 35, over 90% had PCB for more than 4 weeks, and 19.2% had severe episodes. Significant pathology was found in 53.8% of women under 35, suggesting age alone may not determine pathology. None of the 11 women with cervical cancer or CIN3 had previous abnormal smears. The study recommends urgent referral for all women with PCB and evaluating all for infections, given the high rate of detected pathology.
The document summarizes a study on the continuation rate and reasons for early removal of the Mirena intrauterine device (IUD). The study reviewed medical records of 269 women who received Mirena implants between 2000-2003 at two UK hospitals. A questionnaire was sent to 151 women, with responses from 102 at one hospital and 49 at the other. The continuation rate after 3 years was 45%, significantly lower than a Finnish study. Common reasons for early removal included unscheduled bleeding (33 women), abdominal pain (16 women), and progestogenic side effects like mood changes (14 women). The authors conclude that Mirena has a lower continuation rate in the UK population compared to Finland, and that its progestogen
Dr Ayman Ewies - The Effect of Exogenous Leptin Administration on Folliculoge...AymanEwies
Exogenous leptin administration in immature albino rats was found to enhance folliculogenesis, increase ovarian weight, and reduce total body weight compared to controls. Specifically, leptin-treated rats had a higher median number of antral follicles, significantly higher ovarian weights, and significantly lower total body weights than control rats across various ages. The results suggest leptin may play a role in female reproduction and metabolism, warranting further study of its potential effects in obese women with impaired reproductive functions.
Dr Ayman Ewies - Advanced hysteroscopic Surgery workshop flyer 2015AymanEwies
This document summarizes an advanced hysteroscopic surgery workshop taking place from November 17-19, 2015 in Birmingham, UK. The workshop will be led by consultant gynaecologists and will provide intensive hands-on training in hysteroscopic techniques like endometrial resection. Over three days, participants will receive both theoretical lectures and practical training using simulators and models to practice procedures. The workshop aims to help participants achieve competency in hysteroscopic surgery.
Dr Ayman Ewies - Advanced hysteroscopic surgery workshop agenda 2015AymanEwies
This document provides the agenda for the 2nd Annual Advanced Hysteroscopic Surgery Workshop held from November 17-19, 2015. The agenda includes lectures on hysteroscopic techniques, equipment, and safety aspects as well as practical stations where attendees can practice hysteroscopic procedures. The workshop aims to provide training to meet the requirements for advanced surgical skills certification and consists of lectures, demonstrations, and hands-on practice over the course of three days. Coffee breaks and lunches are provided each day to allow attendees to take breaks between sessions.
This document discusses vulvar disease, including vulvar intraepithelial neoplasia (VIN) and lichen sclerosus. It covers the classification, incidence and risk factors, malignancy potential, symptoms, signs, and treatment options for VIN and lichen sclerosus. It also discusses the role of colposcopy, vulvoscopy, and biopsy in assessing vulvar lesions.
Dr Ayman Ewies - Vaginal Colposcopy 2009AymanEwies
This document discusses vaginal abnormalities and the role of colposcopy in assessing dyskariosis, VAIN, and carcinoma. It notes that the true incidence of VAIN is unknown, but it is less common than CIN and VIN. Colposcopy is useful for examining the vagina to detect abnormal lesions, though vaginal assessment is more difficult than cervical assessment due to the large surface area and rugose folds. Biopsies of any atypical vaginal epithelium are important for diagnosis. Management depends on the grade of VAIN, with VAIN I often requiring only observation, while VAIN II and III should typically be treated through methods like topical therapies, ablation, or excision.
Glandular lesions of the cervix can be difficult to diagnose due to their small size, multifocal nature, and location away from the squamocolumnar junction. High grade glandular intraepithelial neoplasia (CGIN) and adenocarcinoma in situ (AIS) have malignant potential and are associated with HPV 18. Conservative treatment with loop electrosurgical excision procedure (LLETZ) is usually recommended for CGIN/AIS to preserve fertility in young women, with careful examination of margins and long-term cytological follow-up. Hysterectomy may be considered for positive margins, high grade cytology after LLETZ, or if fertility preservation is not a concern.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Dr Ayman Ewies - What makes an effective e-tutorial?AymanEwies
This document discusses what makes an effective e-tutorial. It notes that e-learning is great because it is comprehensive, accessible, responsive, up-to-date, and greener than traditional learning. Effective e-tutorials should be engaging and interesting through the use of case studies, interactive tasks, assessment questions, videos, animations and graphics. They should also be comprehensive, highlight advanced content, include key points and user feedback. Support is provided to authors through guidelines, templates and incentives. Challenges include ensuring quality through updating, copyright issues, and plagiarism.
Dr Ayman Ewies and Dr Seu Gunasekera Best Oral PresentationAymanEwies
The document announces the 27th annual congress of the European Society of Gynaecological Endoscopy (ESGE) to be held from October 7-10, 2018 in Vienna, Austria. The congress will take a holistic approach to women's health, focusing on quality assurance and innovation. Seuvandhi Gunasekera of the United Kingdom, along with co-authors Ahmed Ghoubara and Ayman Ewies, will receive an award for their scientific work titled "Rate of hysterectomy following 419 Novasure procedures - real-life experience of a teaching hospital in the UK", which was selected for an oral presentation during the plenary sessions of the congress.
The Sandwell and West Birmingham Hospitals NHS Trust provides healthcare services to over 300,000 people living in the Sandwell and West Birmingham areas. It operates two main hospital sites, Sandwell General Hospital in West Bromwich and City Hospital in Birmingham. The Trust employs over 5,000 staff and provides a wide range of acute medical and surgical services including A&E, maternity, outpatients, and diagnostic imaging.
Dr Ayman Ewies - Doctors versus nurses in managing women with PMBAymanEwies
The Sandwell and West Birmingham Hospitals NHS Trust provides healthcare services to over 300,000 people living in the Sandwell and West Birmingham areas. It operates two main hospital sites, Sandwell General Hospital in West Bromwich and City Hospital in Birmingham. The Trust employs over 5,000 staff and provides a wide range of acute medical and surgical services including A&E, maternity, outpatients, and diagnostic and therapy services.
Dr Ayman Ewies - Body fat percentage in women with PMBAymanEwies
The Sandwell and West Birmingham Hospitals NHS Trust operates two main hospitals in the West Midlands region of England - Sandwell General Hospital in West Bromwich and City Hospital in Birmingham. The trust provides a range of acute hospital services including accident and emergency, medicine, surgery, maternity, and outpatient care to over 350,000 people living in Sandwell and parts of western Birmingham.
Dr Ayman Ewies - Thickened Endometrium in absence of PMBAymanEwies
The Sandwell and West Birmingham Hospitals NHS Trust operates two hospitals in the West Midlands region of England - Sandwell General Hospital in West Bromwich and City Hospital in Birmingham. The trust provides a range of acute hospital services including accident and emergency, medicine, surgery, maternity, and outpatient care to over 350,000 people living in Sandwell and parts of western Birmingham.
Dr Ayman Ewies - Are animal laboratory models superior to virtual reality sim...AymanEwies
The document discusses different models for training in advanced hysteroscopic surgery procedures, which have a slow learning curve. It evaluates animal models using cattle uteruses versus virtual reality simulation. Trainees provided feedback over two years of training courses. The cattle uterus model scored the highest with a 94.65% overall score, replicating tissue properties better than virtual simulators which averaged 83.88%. While virtual simulators have limitations like cost and lack of realism, animal models provide a realistic environment for developing skills before clinical training. The cattle uterus is concluded to be a superior model for its similarity to the human uterus and ability to practice resection techniques.
This study evaluated an office hysteroscopy service with 700 annual cases. A retrospective review of 141 women undergoing NovaSure endometrial ablation from 2011-2015 found 79% did not require further treatment, while 21% received additional care including 10% who had a hysterectomy. A survey of 100 women in the office hysteroscopy service from 2015-2016 found high satisfaction, with 93 women scoring overall acceptability ≥8 and stating they would repeat the procedure. While 17 women reported severe pain during treatment, staff were found to be supportive and privacy was maintained.
Dr Ayman Ewies - Abnormal Uterine Bleeding in Pre-menopausal Women: When Shou...AymanEwies
This document summarizes a study on abnormal uterine bleeding in pre-menopausal women. The study examined 3006 endometrial samples from women aged 30 to 50 who presented with abnormal uterine bleeding. It found that the rate of atypical hyperplasia and carcinoma increased with each successive 5-year age group, with the highest rates occurring in women aged 45-50. Specifically, atypical hyperplasia was 3.85 times more likely and carcinoma was 4.03 times more likely in women aged 45-50 compared to those under 40. While abnormal growths can occur under age 40, the study supports guidelines recommending endometrial sampling for women over 45 presenting with abnormal uterine bleeding.
Dr Ayman Ewies - Colposcopy and STI SurveyAymanEwies
This document discusses a cross-sectional survey that was conducted to determine the prevalence of sexually transmitted infections (STIs) among women attending colposcopy clinics in order to inform screening policies. The survey found that the women attending colposcopy were not at higher risk of STIs than the general population. Current NHS guidelines state that asymptomatic patients do not need routine STI screening during colposcopy visits. The survey results support these guidelines and suggest that universal STI screening is not required for colposcopy patients.
Dr Ayman Ewies - Postcoital Bleeding National SurveyAymanEwies
This document discusses the inconsistent management of postcoital bleeding (PCB) by UK doctors and the need for evidence-based guidelines. A survey of UK gynecologists found wide variations in how they manage and investigate PCB. Despite links between PCB and cervical pathology, less than half repeat smear tests for women with a negative history and only 15% refer women directly to colposcopy clinics. The lack of consensus and guidelines on PCB management makes it important to standardize care based on the best evidence.
Dr Ayman Ewies - Managing Women with Postcoital BleedingAymanEwies
This study prospectively observed 120 women referred to a hospital with postcoital bleeding over one year. The study found that over 50% of women were under 35, over 90% had PCB for more than 4 weeks, and 19.2% had severe episodes. Significant pathology was found in 53.8% of women under 35, suggesting age alone may not determine pathology. None of the 11 women with cervical cancer or CIN3 had previous abnormal smears. The study recommends urgent referral for all women with PCB and evaluating all for infections, given the high rate of detected pathology.
The document summarizes a study on the continuation rate and reasons for early removal of the Mirena intrauterine device (IUD). The study reviewed medical records of 269 women who received Mirena implants between 2000-2003 at two UK hospitals. A questionnaire was sent to 151 women, with responses from 102 at one hospital and 49 at the other. The continuation rate after 3 years was 45%, significantly lower than a Finnish study. Common reasons for early removal included unscheduled bleeding (33 women), abdominal pain (16 women), and progestogenic side effects like mood changes (14 women). The authors conclude that Mirena has a lower continuation rate in the UK population compared to Finland, and that its progestogen
Dr Ayman Ewies - The Effect of Exogenous Leptin Administration on Folliculoge...AymanEwies
Exogenous leptin administration in immature albino rats was found to enhance folliculogenesis, increase ovarian weight, and reduce total body weight compared to controls. Specifically, leptin-treated rats had a higher median number of antral follicles, significantly higher ovarian weights, and significantly lower total body weights than control rats across various ages. The results suggest leptin may play a role in female reproduction and metabolism, warranting further study of its potential effects in obese women with impaired reproductive functions.
Dr Ayman Ewies - Advanced hysteroscopic Surgery workshop flyer 2015AymanEwies
This document summarizes an advanced hysteroscopic surgery workshop taking place from November 17-19, 2015 in Birmingham, UK. The workshop will be led by consultant gynaecologists and will provide intensive hands-on training in hysteroscopic techniques like endometrial resection. Over three days, participants will receive both theoretical lectures and practical training using simulators and models to practice procedures. The workshop aims to help participants achieve competency in hysteroscopic surgery.
Dr Ayman Ewies - Advanced hysteroscopic surgery workshop agenda 2015AymanEwies
This document provides the agenda for the 2nd Annual Advanced Hysteroscopic Surgery Workshop held from November 17-19, 2015. The agenda includes lectures on hysteroscopic techniques, equipment, and safety aspects as well as practical stations where attendees can practice hysteroscopic procedures. The workshop aims to provide training to meet the requirements for advanced surgical skills certification and consists of lectures, demonstrations, and hands-on practice over the course of three days. Coffee breaks and lunches are provided each day to allow attendees to take breaks between sessions.
This document discusses vulvar disease, including vulvar intraepithelial neoplasia (VIN) and lichen sclerosus. It covers the classification, incidence and risk factors, malignancy potential, symptoms, signs, and treatment options for VIN and lichen sclerosus. It also discusses the role of colposcopy, vulvoscopy, and biopsy in assessing vulvar lesions.
Dr Ayman Ewies - Vaginal Colposcopy 2009AymanEwies
This document discusses vaginal abnormalities and the role of colposcopy in assessing dyskariosis, VAIN, and carcinoma. It notes that the true incidence of VAIN is unknown, but it is less common than CIN and VIN. Colposcopy is useful for examining the vagina to detect abnormal lesions, though vaginal assessment is more difficult than cervical assessment due to the large surface area and rugose folds. Biopsies of any atypical vaginal epithelium are important for diagnosis. Management depends on the grade of VAIN, with VAIN I often requiring only observation, while VAIN II and III should typically be treated through methods like topical therapies, ablation, or excision.
Glandular lesions of the cervix can be difficult to diagnose due to their small size, multifocal nature, and location away from the squamocolumnar junction. High grade glandular intraepithelial neoplasia (CGIN) and adenocarcinoma in situ (AIS) have malignant potential and are associated with HPV 18. Conservative treatment with loop electrosurgical excision procedure (LLETZ) is usually recommended for CGIN/AIS to preserve fertility in young women, with careful examination of margins and long-term cytological follow-up. Hysterectomy may be considered for positive margins, high grade cytology after LLETZ, or if fertility preservation is not a concern.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.