Medulloblastoma is the most common malignant brain tumor in children that arises in the cerebellum. It typically presents between ages 4-8 with symptoms of increased intracranial pressure and cerebellar dysfunction. Treatment involves surgery, radiation therapy, and chemotherapy in a multimodal approach. Prognosis is generally better in adults compared to children due to differences in tumor biology and treatment tolerance. Relapse can occur in up to 30% of patients within 3 years after initial treatment.
Historically, brain tumors have been treated with neurosurgical resection and radiation therapy. Demonstration of the efficacy of chemotherapy has lagged behind that for most other types of tumors, but currently chemotherapy is being employed more frequently. Recognition of the chemo-sensitivity of many types of brain tumors, in conjunction with the still relatively guarded prognoses of many of these patients, has also logically led to exploration of the use of hematopoietic cell support as a means of increasing dose intensity.
Historically, brain tumors have been treated with neurosurgical resection and radiation therapy. Demonstration of the efficacy of chemotherapy has lagged behind that for most other types of tumors, but currently chemotherapy is being employed more frequently. Recognition of the chemo-sensitivity of many types of brain tumors, in conjunction with the still relatively guarded prognoses of many of these patients, has also logically led to exploration of the use of hematopoietic cell support as a means of increasing dose intensity.
Gliomas are the commonest tumor of brain arising from the supportive cells of the brain with diverse form and presentation the treatment of which is surgical and demands adjuvant therapy for most of circumstances.
Gliomas are the commonest tumor of brain arising from the supportive cells of the brain with diverse form and presentation the treatment of which is surgical and demands adjuvant therapy for most of circumstances.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
Embryonal Brain tumours in children
1. EMBRYONAL BRAIN TUMORS IN
CHILDREN
Dr. Evith Pereira
Dr. Amruta Padhye
Moderator – Dr. D.B.Borkar
2. • Cancer in childhood is rare with only 1:600 children developing
malignancy by the age of 15 years.
• 20 -25% of childhood tumors are of CNS origin
• This equates to 2.4 cases / 100,000 children per year
3. Introduction
• The origin of Medulloblastoma is from medulla (Latin for marrow), blastos
(Greek word for germ) and oma (Greek for tumor);
means “tumor of primitive undeveloped cells located inside the cerebellum”.
• Most common malignant primary brain tumor of child age group.
• First described by Harvey Cushing and Percival Bailey in 1930.
• Initially described as “spongioblastoma cerebelli” - a soft, suckable tumor
usually arising in the vermis of cerebellum.
• In 1925, changed name to medulloblastoma - from “medulloblast” - a
hypothetical multipotent cell.
4. Origin
• A highly malignant primary brain tumor that originates in the
cerebellum vermis or posterior fossa.
• Arise in cerebellum and projects into 4th
ventricle.
• Originate from embryonal cells k/a medulloblast of cerebellar stem
cells. The exact cell of origin, or “medulloblast” has yet to be
identified.
• It is currently thought that it arises from Germinative neuroepithelial
cells in the external granular layer of cerebellum.
5. Epidemiology
• Overall account ~ 7% all brain
tumors
• 10-20% of brain tumors in pediatric
age group
• 0.4%–1% of all adult central
nervous system tumors
• 40% of tumors of the posterior
fossa
• Peak incidence at the age of 5 –6
yrs In children and 25 yrs in adults
• Approximately 20% of
Medulloblastoma present in infants
younger than 2 years old;.
• male : female (3:2)
Figure: Distribution of pediatric central nervous
system (CNS) tumors by location in the CNS and by
tumor type.
6. Adult vs. Paediatric Medulloblastoma
Child Adult
Usual age ~ 4 - 8 yrs Median age ~ 24 - 30 yrs
Shorter clinical History (~ 3 months) Longer history ( ~ 5 months)
Classical type predominates Desmoplastic type relatively
commoner
Median cerebellar syndrome
predominates
Lateral cerebellar syndrome seen
Biologically more agressive Biologically less aggressive
Poorer resectability - median location Greater resectability - lateral location
Higher surgical morbidity and
mortality
Lower surgical morbidity and mortality -
impact of location and age
Poorer RT tolerance Better RT tolerance
Poorer long term survival Better long term survival
7. Natural History
Arising in the midline
cerebellar vermis (roof
of the 4th
ventricle)
Arising in the midline
cerebellar vermis (roof
of the 4th
ventricle)
Grows into the 4th
ventricle
Grows into the 4th
ventricle
Fills into the 4th
ventricle
Fills into the 4th
ventricle
Spread around the
4th
ventricle
Spread around the
4th
ventricle
Invasion of
ventricular floor
Invasion of
ventricular floor
Invasion of brain
stem
Invasion of brain
stem
Invasion of
brachium pontis
Invasion of
brachium pontis
CSF SpreadCSF Spread
Extra neural spread :Young age, males and diffuse subarachnoid diseaseExtra neural spread :Young age, males and diffuse subarachnoid disease
8. Mode of Spread
• Contagiously-
cerebellar peduncle
Floor of forth ventricle
Ant-brain stem
Inf –cervical spine
Sup- above tentorium
• CSF(30%) –
Intracranially
Leptomeninges
Spinal cord
• Extraneural (5%) Most common CNS tumor to spread
Hematogenous
MC sites are Long Bones and Ribs(10-15%)
LN(4-6%)
9.
10. Pathological Features
Highly cellular tumor
High N:C ratio
Cells arranged in typical
Homer - Wright rosettes
Multiple histological subtypes
1. Classic medulloblastomas- 70-80%
2. Desmoplastic/nodular- 7%
3. Medulloblastoma with extensive nodularity
(MBEN) - 3%
4. Anaplastic
5. Large Cell
WHO classification -2007
large cell / anaplastic
(LCA) 10% to 22%.
11. • Gross
• Well circumscribed, gray-pink, soft/friable.
well-circumscribed
soft, fleshy tumor with
areas of softening & necrosis
in the center.
12. • M/E-
• Highly cellular
• sheets of anaplastic cells with scanty cytoplasm,
• hyperchromatic nuclei,
that are often elongated &
cresent shaped
• Mitoses- abundant
• Occasional
Homer-Wright rosettes
13. • Homer-Wright rosettes (groups of tumor cells arranged in a circle around a fibrillary
center). Similar rosettes are seen in adrenal neuroblastoma.
14. • Positive stains
• NSE, synaptophysin
• Focal GFAP
• Molecular / cytogenetics description
• Isochromosome (17q) or 17p-
• 5-30% overexpress c-myc or N-myc;
• C-myc overexpression is associated with poor prognosis
15. • Differential diagnosis
• Lymphoma: diffusely infiltrates CNS until it mixes with normal and reactive
fibrillar cells
• PNET
• Ependymoma
16. • Desmoplasmic/nodular medulloblastoma
• nodular b/c of its architecture
• desmoplastic because it is permeated by (reticulin) fibers that give it a firm
consistency
• M/E-
17. • Round pale nodules of tumor separated by zones of darker tumor cells.
• Paler tumor nodules showing a population of uniform round to oval cells on
a pale pink fibrillary background.
• The cells have a more mature neuronal appearance and are less active
mitotically.
• The surrounding darker tumor cells are more primitive appearing with brisk
mitotic activity.
•
• Desmoplastic medulloblastoma has a better prognosis than the classic form
18. • Medulloblastoma with extensive nodularity
• M/E-
• Low power view numerous pale islands
• The nodules are composed of a uniform population of tumor cells. The background
is reticulin-free & rich in neuropil-like tissue. Mitosis is not significantly increased.
The cells often show streaming in parallel rows
20. • Anaplastic Medulloblastoma
• M/E-
• Highly anaplasticnuclei
• with high rate of mitosis &
apoptosis.
• Primitive looking cells
with nuclear molding.
• Some are
composed of large cells
with rounded vesicular nuclei
(i.e. no nuclear molding).
• Poor prognosis.
23. GORLIN SYNDROME
The most common syndrome associated with MB (3-5 %).
Autosomal dominant → germline mutation in patched-1(PTCH-
1).
PTCH-1 → over activate SHH pathway.
characterized by nevoid basal cell carcinoma & skeletal
abnormalities.
24. TURCOT SYNDROME
Brain tumour (MB)&familial adenomatous polyposis
(FAP).
FAB caused by autosomal dominant→ inactivation
adenomatous polyposis coli (APC) gene on chromosome
5.
APC is part of protein complex in the WNT signaling
pathway→ control cell proliferation and differentiation.
26. MOLECULAR SUBGROUPS
MB divided into 4 groups based on:
DNA copy number,
mRNA expression profiles and
Somatic copy number aberrations.
1.SONIC HEDGEHOG (SHH) pathway
2.WINGLESS (WNT) pathway
3. TP 53 mutations
4. MYC / MYCN amplification.
27. SONIC HEDEHOG (SHH) pathway
Abnormalities in SHH pathway are present
in 30% of MB cases.
MB pathology usually desmoplastic.
SHH up-regulate MYCN gene.
Tp53 mutations are present in 10-20 % of
SHH tumours.
28.
WINGLESS (WNT) pathway
WNT tumours are seen in children and adults.
Rarely in infants.
It associated with the most favourable
prognosis
WNT protein binds to its receptor→
destabilizes APC protein.
Loss chromosome 6.
29. TP 53 MUTATIONS are present in 10-20% of
WNT and SHH MB and very rarely in the other
subtypes.
MYC / MYCN - amplification of MYC group
genes is associated with a worse prognosis.
30. Symptoms & signs
MB patients present with symptoms and signs of:
1. Increased intra cranial tension.
2. Cerebellar dysfunction
Weeks→ few months
32. A combination of surgery, radiotherapy and chemotherapy
Multi modal approach
Difference in treatment between child & adult
Measures to alleviate increased ICP.
Specific therapy directed against the tumour.
Complications
Follow up
Treatment at relapse
33. Child Adult
Usual age ~ 4 - 8 yrs Median age ~ 24 - 30 yrs
Shorter History (~ 3 months) Longer history ( ~ 5 months)
Classical type predominates Desmoplastic type relatively
commoner
Median cerebellar syndrome
predominates
Lateral cerebellar syndrome seen
Biologically more aggressive Biologically less aggressive
Poorer resectability
(median location)
Greater resectability
(lateral location)
Higher surgical morbidity and
mortality
Lower surgical morbidity and
mortality
Poorer RT tolerance Better RT tolerance
Poorer long term survival Better long term survival
Difference in treatment between child & adult
34. Treatment at relapse
Relapse occurs in 20 - 30 % following initial treatment.
Site of relapse:
Local→ 1/3
Disseminated (brain and spine)→ 1/3
Both local and disseminated (brain and spine)→ 1/3
Time: within 3 years (children) but late relapse in (adults).