Secondary amenorrhoea by dr alka mukherjee dr apurva mukherjeealka mukherjee
The first step in the evaluation of any patient with secondary amenorrhea is a urine pregnancy test. Every contraceptive method has a failure rate, and anyone who is menstruating is potentially fertile, regardless of age. [5][6]
If the pregnancy test is negative, consider the clinical picture: hirsutism, acne, and a long history of infrequent and irregular menses suggest polycystic ovarian syndrome. By the Rotterdam criteria, a patient may be diagnosed with PCOS if she has two of the following: clinical or chemical hyperandrogenism, oligo- or amenorrhea, or polycystic ovaries on ultrasound. So if a patient has evidence of hirsutism and oligo- or amenorrhea, she can be diagnosed with PCOS without further laboratory testing or imaging.
If history and physical exam are not consistent with PCOS, a TSH should be ordered. Both hyper- and hypothyroidism can lead to menstrual dysfunction.
If TSH is normal, check a serum prolactin. Elevated serum prolactin suggests prolactinoma.
Benign ovarian masses include functional cysts and tumors; most are asymptomatic.Most functional cysts and benign tumors are asymptomatic. Sometimes they cause menstrual abnormalities. Hemorrhagic corpus luteum cysts may cause pain or signs of peritonitis, particularly when they rupture. Occasionally, severe abdominal pain results from adnexal torsion of a cyst or mass, usually > 4 cm. Treatment varies depending on the patient's reproductive status.
Secondary amenorrhoea by dr alka mukherjee dr apurva mukherjeealka mukherjee
The first step in the evaluation of any patient with secondary amenorrhea is a urine pregnancy test. Every contraceptive method has a failure rate, and anyone who is menstruating is potentially fertile, regardless of age. [5][6]
If the pregnancy test is negative, consider the clinical picture: hirsutism, acne, and a long history of infrequent and irregular menses suggest polycystic ovarian syndrome. By the Rotterdam criteria, a patient may be diagnosed with PCOS if she has two of the following: clinical or chemical hyperandrogenism, oligo- or amenorrhea, or polycystic ovaries on ultrasound. So if a patient has evidence of hirsutism and oligo- or amenorrhea, she can be diagnosed with PCOS without further laboratory testing or imaging.
If history and physical exam are not consistent with PCOS, a TSH should be ordered. Both hyper- and hypothyroidism can lead to menstrual dysfunction.
If TSH is normal, check a serum prolactin. Elevated serum prolactin suggests prolactinoma.
Benign ovarian masses include functional cysts and tumors; most are asymptomatic.Most functional cysts and benign tumors are asymptomatic. Sometimes they cause menstrual abnormalities. Hemorrhagic corpus luteum cysts may cause pain or signs of peritonitis, particularly when they rupture. Occasionally, severe abdominal pain results from adnexal torsion of a cyst or mass, usually > 4 cm. Treatment varies depending on the patient's reproductive status.
Abnormal uterine bleeding can occur when a woman experiences a change in menstrual loss, or the degree of loss or vaginal bleeding pattern differs from that experienced by the age-matched general female population
AUB is not restricted to menstrual bleeding that is abnormally heavy, but includes bleeding that is abnormal in TIMING
It is considerable cycle variability in the adolescent years. Regular ovulatory menstrual cycles occur every 21 to 35 days and last up to 7 days, with an average blood loss of 25 to 69 mL. Many patients complain of menstrual problems that actually fall within normal variations. In the first year after menarche, 50% of cycles are anovulatory, but 80% still fall in the normal range for duration. By the third year of menarche, 95% of menstrual cycles fall into this range. Charting the menstrual flow on a calendar can be helpful to clarify normal versus abnormal cycles. Cycles that fall outside of the norm should be evaluated for underlying pathology. There are multiple causes for abnormal uterine bleeding in adolescents, the most likely cause is dysfunctional uterine bleeding (DUB) due to an immature hypothalamic-pituitary-ovarian (HPO) axis, causing an ovulatory cycles and irregular bleeding
Abnormal uterine bleeding can occur when a woman experiences a change in menstrual loss, or the degree of loss or vaginal bleeding pattern differs from that experienced by the age-matched general female population
AUB is not restricted to menstrual bleeding that is abnormally heavy, but includes bleeding that is abnormal in TIMING
It is considerable cycle variability in the adolescent years. Regular ovulatory menstrual cycles occur every 21 to 35 days and last up to 7 days, with an average blood loss of 25 to 69 mL. Many patients complain of menstrual problems that actually fall within normal variations. In the first year after menarche, 50% of cycles are anovulatory, but 80% still fall in the normal range for duration. By the third year of menarche, 95% of menstrual cycles fall into this range. Charting the menstrual flow on a calendar can be helpful to clarify normal versus abnormal cycles. Cycles that fall outside of the norm should be evaluated for underlying pathology. There are multiple causes for abnormal uterine bleeding in adolescents, the most likely cause is dysfunctional uterine bleeding (DUB) due to an immature hypothalamic-pituitary-ovarian (HPO) axis, causing an ovulatory cycles and irregular bleeding
AMENORRHEA
Ludmila Barbakadze
Ivane Javakhishvili Tbilisi State University Assistant Professor Medical Doctor at Archil Khomassuridze Institute of Reproductology ,Tbilisi , Georgia.
Menstrual irregularities are the problems with a girl's normal monthly menses. For example, missed periods, have them too frequently, having painful periods, or have excessively heavy flow. Menstrual irregularities can sometimes be a sign of an underlying health problem.
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
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
12. Once Pregnancy and cryptomenorrhea are excluded: The patient is a bioassay for Endocrine abnormalities Four categories of patients are identified 1. Amenorrhea with absent or poor secondary sex Characters 2. Amenorrhea with normal 2ry sex characters 3. Amenorrhea with signs of androgen excess 4. Amenorrhea with absent uterus and vagina
13. FSH Serum level Low / normal High Hypogonadotropic hypogonadim Gonadal dysgenesis
14.
15. FSH Low / normal High Hypothalamic-pituitary Failure Ovarian failure If < 25 yrs or primary amenorrhea karyoptype If < 35 yrs R/O autoimmune disease ?? Ovarian biopsy head CT- scan or MRI - Severe hypothalamic dysfunction - Intracranial pathology
16. Amenorrhea Utero-vaginal absence Karyotype 46- XX Mullerian Agenesis (MRKH syndrome) Andogen Insenitivity (TSF syndrome) . Gonadal regressioon . Testocular enzyme defenciecy . Leydig cell agenisis 46- XY Normal breasts & sexual hair Normal breasts & absent sexual hair Absent breasts & sexual hair
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19. Amenorrhea Signs of androgen excess Testosterone, DHEAS, FSH, and LH DHEAS 500-700 mug/dL DHEAS >700 mug/dL TEST. >200 ng/dL Serum 17-OH Progesterone level Late CAH Adrenal hyperfunction U/S ? MRI or CT Ovarian Or adrenal tumor Lower elevations PCOS (High LH / FSH)
47. How would you evaluate this patient? Total testosterone: 134 ng/dL (176-781) Luteinizing hormone (LH): 26.3 mIU/mL (1.3-13.0) What is the initial diagnosis? Primary hypogonadism What is the next step in work up?
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49. Confirmed low testosterone Check LH+FSH (SA if infertility) High gonadotropins – 1 o Low/low nl gonadotropins – 2 o Karyotype Prolactin, other pituitary hormones, iron studies, sella MRI
50. How would you evaluate this patient? Total testosterone: 134 ng/dL (176-781) Luteinizing hormone (LH): 26.3 mIU/mL (1.3-13.0) What is the initial diagnosis? Primary hypogonadism What is the next step in work up? Karyotype: 47 XXY
51.
52. Gordon DL et al. Arch Intern Med (1972) 130:720 Abnormality Frequency (%) Abnormal testicular histology 100 Decreased testicular length 99 Azoospermia 93 Low testosterone 79 Decreased facial hair 77 Increased gonadotropins 75 Decreased sexual function 68 Gynecomastia 55 Decreased axillary hair 49 Decreased penis length 41
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57. Case 1 Answer: Full physical examination Serum endocrinology: FSH, LH, prolactin, thyroid function pregnancy test Ultrasound scan of the pelvis (uterus and ovaries)
58. Case 1 Results FSH of 2.2 iu/L LH 15.0 iu/L normal prolactin and thyroid function The ultrasound scan demonstrated the presence of polycystic ovaries and an endometrial thickness of 15 mm.
60. Case 1 Endometrial hyperplasia is a risk factor for oligo / amenorrhoeic women with PCOS because of unopposed oestrogen stimulating progressive hyperplasia and potentially malignancy / adenocarcinoma. Regular withdrawal bleeds should be induced either with cyclical progestogens or the COC pill. If fertility is required then ovulation induction should be instituted with clomifene citrate followed by gonadotrophin therapy if this is unsuccessful. If the patient is overweight she should be encouraged to lose weight. Women with polycystic ovary syndrome have insulin resistance and at an increased of cardiovascular disease and type II diabetes.
61. Case 2 An 18 year old woman presents with primary amenorrhoea (she has never had a period). She has developed small breasts and has some pubic hair. She is very overweight with a body mass index of 39 kg/m 2 . What investigations should be performed in order to make the diagnosis?
62. Case 2 Answer: Full physical examination Serum endocrinology: FSH, LH, prolactin, thyroid function ( pregnancy test) Ultrasound scan of the pelvis (uterus and ovaries)
63. Case 2 Results FSH of 0.5 iu/L LH of 0.5 iu/L normal prolactin and thyroid function The ovaries appear small on ultrasound scan, as does the uterus. What is the diagnosis?
64. Case 2 Hypogonadotrophic hypogonadism Usually of hypothalamic origin and may be congenital, such as Kallmann's Syndrome (association with lack of smell) The low gonadotrophin concentrations have failed to stimulate ovarian development and adequate puberty. The small amount of breast development and pubic hair can be explained by oestrogen being produced in the peripheral fat and adrenal androgen secretion. Overall this patient will be oestrogen deficient and bone mineral densitometry should be performed to exclude osteoporosis.
66. Case 2 If the patient wishes to be pregnant, first line treatment would be pulsatile GnRH or gonadotrophin stimulation of the ovaries with a preparation that contains both FSH and LH bio-activity (ie, one of the traditional hMG preparations rather than recombinant FSH). Otherwise HRT should be given.
67. Case 2 Do you need to image the pituitary / hypothalamus?
68. Case 2 Do you need to image the pituitary / hypothalamus? Yes in adults with secondary amenorrhoea and hypog/hypog or hyperPRL, but tumours less common in adolescents if no other symptoms and normal PRL
69. Case 2 The patient was administered HMG at increasing high doses, but failed to produce any demonstrable follicular growth as assessed both by ultrasound scan and persistently low serum oestradiol concentrations. Can you explain?
70. Case 2 This patient appears to have a second pathology and may well have primary ovarian failure combined with hypothalamic hypogonadotrophic hypogonadism, thus explaining the combination of ovarian failure with low gonadotrophin concentrations.
71. Case 3 An 18 year old woman presents with primary amenorrhoea (she has never had a period). She has a normal body mass index and no other obvious problems. What investigations should be performed in order to make the diagnosis?
72. Case 3 Answer: Full physical examination Serum endocrinology: FSH, LH, prolactin, thyroid function (pregnancy test) Ultrasound scan of the pelvis (uterus and ovaries)
73. Case 3 Results FSH of 0.5 iu/L LH of 0.5 iu/L serum prolactin concentration: 5,000 mu/L What is the diagnosis? What further investigations should be done?
74. Case 3 Hyperprolactinaemia A repeat prolactin should be measured. The diagnosis is likely to be that of a macro-adenoma of the pituitary gland and therefore either MRI or CT imaging of pituitary should be performed. What treatment should be provided?
75. Case 3 Dopamine agonists: Bromocriptine or Cabergoline Check visual fields
76. Case 4 An 18 year old woman presents with primary amenorrhoea (she has never had a period). She has a normal body mass index and no other obvious problems. What investigations should be performed in order to make the diagnosis?
77. Case 4 Answer: Full physical examination Serum endocrinology: FSH, LH, prolactin, thyroid function (pregnancy test) Ultrasound scan of the pelvis (uterus and ovaries)
78. Case 4 Results FSH of 40 iu/L LH of 30 iu/L What is the diagnosis? What further investigations should be done?
79. Case 4 Primary ovarian failure / premature ovarian failure What further investigations should be performed?
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