Endometrial cancer is the most common female genital tract malignancy, with a lifetime risk of developing it being 2.5%. It mostly occurs in women in their 6th-7th decades. Obesity is a major risk factor, accounting for 40% of cases. Diagnosis is usually through post-menopausal bleeding. Treatment involves a total hysterectomy with bilateral salpingo-oophorectomy and surgical staging for high-risk cases. The role of lymphadenectomy is controversial, with some advocating for it only in high-risk cases. Adjuvant radiotherapy decreases pelvic recurrence rates. Prognosis is generally good, with an 80% 5-year survival rate.
Cancer that
forms in the tissue lining the uterus (the small, hollow, pear-shaped
organ in a woman's pelvis in which a fetus develops). Most endometrial
cancers are adenocarcinomas (cancers that begin in cells that make and
release mucus and other fluids).
NCI
Cancer that
forms in the tissue lining the uterus (the small, hollow, pear-shaped
organ in a woman's pelvis in which a fetus develops). Most endometrial
cancers are adenocarcinomas (cancers that begin in cells that make and
release mucus and other fluids).
NCI
a nice presentation about the Ovarian Cancer its include an introduction with brief notes about the epidemiology and risk factors then shift to pathology and pathogenesis and diagnosis with signs , symptoms and lab tests with imaging modules , screening , management
Endometrial Cancer is a malignancy that arises from the lining of the uterus, endometrium.
It is the most common gynaelogical cancer in developing countries, while in developed countries it is the second most common cancer, behind cervical cancer.
• In year 2012 a total of 320,000 new cases were recorded.
• Globally, it is the sixth most common cancer in women, fourteenth most common overall.
• In Peninsular Malaysia, it is the seventh most common cancer in women, according to Malaysian cancer Registry 2006.
• It is rare among women younger than 40 years.
• Peak incidence occurring at age 60-69.
• Majority are of Chinese ethnicity (47.5%), followed by Malays (41.6%) and Indian (10.9%).
a nice presentation about the Ovarian Cancer its include an introduction with brief notes about the epidemiology and risk factors then shift to pathology and pathogenesis and diagnosis with signs , symptoms and lab tests with imaging modules , screening , management
Endometrial Cancer is a malignancy that arises from the lining of the uterus, endometrium.
It is the most common gynaelogical cancer in developing countries, while in developed countries it is the second most common cancer, behind cervical cancer.
• In year 2012 a total of 320,000 new cases were recorded.
• Globally, it is the sixth most common cancer in women, fourteenth most common overall.
• In Peninsular Malaysia, it is the seventh most common cancer in women, according to Malaysian cancer Registry 2006.
• It is rare among women younger than 40 years.
• Peak incidence occurring at age 60-69.
• Majority are of Chinese ethnicity (47.5%), followed by Malays (41.6%) and Indian (10.9%).
Dr. Patty Tenofsky of Via Christi Clinic spoke at the Via Christi Women's Connection luncheon about breast cancer statistics, screening for breast cancer, treatment options, radiation therapy and chemotherapy.
A lecture on endometrial hyperplasia and carcinoma, exploring the etiology, clinical features, types, investigations, management and treatment options and prognosis.
This was presented to undergraduate medical students at Livingstone Central Teaching Hospital, Livingstone, Zambia, department of Obstetrics and Gynecology by Nghitukuhamba T.E Kalipi (final year student) Cavendish University Zambia, School of Medicine.
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
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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!
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
- 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
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
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
3. Epidemiology…
Mostly in the 6-7th decades of life, 75 - 85%
Lifetime risk of developing endometrial carcinoma is 2.5%
Incidence is rising due to
increased life expectancy,
obesity epidemic
fewer hysterectomies performed for benign diseases
4. Pathology…
Type 1 Type 2
80% 20%
endometrioid adenocarcinoma serous, clear cell, squamous and
undifferentiated carcinomas, carcinosarcoma
on a background of atypical hyperplasia
up to 50% of cases of severe atypical
hyperplasia
not associated with the risk factors
hyper-oestrogenic environment
PTEN tumour suppressor gene; k-ras
oncogene, E & P receptors
p53 tumour suppressor gene,
Trans-peritoneal dissemination
good prognosis poor prognosis
5. Spread…
In rare cases may be metastatic from other tumours
Breast, ovary, lung, stomach, colorectal, and melanoma
Direct extension - cervix, vagina, myometrium
Haematogenous spread- Vaginal metastases (drop-lesions)
Lymphatic spread- Illiac, obturator, para-aortic nodes
Involvement of para-aortic nodes is less common if the pelvic
nodes are not involved
Trans-tubal spread- to the ovaries and peritoneal cavity
6. Risk factors…
accounts for about 40%
The first malignancy to be recognized as being linked to obesity
Obese women have 2-4 times greater risk of developing E. Ca than do
women of a healthy weight,regardless of their menopausal status
Avoiding weight gain lowers the risk of endometrial and
postmenopausal breast CA.
Limited evidence, intentional weight loss will lower risk
7. Tamoxifen…
Significantly increased (2-5 fold) incidence of endometrial pathology
Both endometrioid and non-endometrioid endometrial CA can develop
No evidence to support routine endometrial screening for asymptomatic women
Bleeding on tamoxifen, hysteroscopic guided biopsy
Future… aromatase inhibitors as a substitute in the adjuvant treatment of breast
CA
8. Hereditary..
Less than 5% of all endometrial CA
BRCA carriers who did not receive tamoxifen do not have a significant increase in
risk
HNPCC/Lynch II syndrome
50% of affected women, endometrial CA as index cancer (rather than bowel
cancer)
No uniform screening strategy
Risk-reducing hysterectomy, BSO are recommended for those who have
completed their family
9. Diagnosis…
Mostly presents as PMB - 90%
Only 10% of women with PMB will have CA
Persistent postmenopausal vaginal discharge, pyometra
Pre-menopausal- worsening in menstrual pattern, abnormal endometrial cells on
routine cervical cytology (25- 50%)
Pelvic examination - to exclude obvious lower genital tracts CA
Thin endometrium (<5 mm) in the postmenopausal woman has a high negative
predictive value (99%)
10. Pipelle sampling…
Detection rates for endometrial cancer in postmenopausal and premenopausal
women of 99.6% and 91%, respectively.
The sensitivity for the detection of endometrial hyperplasia is 81%, with a
specificity of 98%.
11. Imaging…
To identify metastatic disease and aid treatment decisions
Chest X-ray to all
CT of the thorax-
where the risk of lung metastases is higher e.g. carcinosarcoma
suspected upper abdominal metastatic disease
MRI - assess the depth of myometrial invasion and to identify extension into cervical
stroma ( sensitive in 92% )
12.
13. Management
Peritoneal fluid washings for cytologic evaluation
Total extra-fascial hysterectomy with BSO
Surgical staging in women considered at risk for extrauterine disease
Adjuvant therapy to prevent vaginal vault recurrence and to address disease in
lymph nodes
14. Controversies in lymphadenectomy…
Majority of women with endometrial carcinoma are low-risk for nodal disease at
presentation
Adjuvant treatment decisions can be based on final pathologic information
Confirms node-negative/ low-risk status
avoid pelvic radiation
recurrence risk is low
overall survival is high with no radiation or with the substitution of VBT
15. Rationales for routine lymphadenectomy
Inaccuracy of pre-operative or intraoperative assessments
Reducing adjuvant therapy use in node-negative women
Lack of significant morbidity associated with the procedure
16. ‘A Study in the Treatment of Endometrial
Cancer’ (ASTEC)
Women with stage I endometrial cancer were assigned to have a standard
TAH+BSO with or without lymphadenectomy
Systematic use of pelvic lymphadenectomy did not improve disease-free or overall
survival in women with early-stage endometrial cancer
Major complication rate of pelvic lymphadenectomy is approximately
2-6%,
Argued that the increased use of radiation in unstaged women may produce
similar outcomes to women who are staged and who avoid radiation therapy
17.
18.
19.
20. Drawbacks of ASTEC…
Utilized a second randomization for pelvic radiation for disease characteristics
Vaginal vault radiation was permitted as per institutional practice irrespective of the
assignment to pelvic radiation or not
It makes interpretation of results difficult
The number of lymph nodes resected was insufficient in many women,
21. An alternative approach for
lymphadenectomy …
Reserve nodal dissection for women with high risk of nodal disease
Depth of myometrial invasion is the most important factor
GOG 33 study- the risk of pelvic nodal disease is around 3% for all women with
grade 1 tumours, increasing to 11% with deeply invasive (outer one-third
myometrial invasion) tumours
Serous or clear cell histology also warrant nodal dissection, as 30%-50%will have
nodal disease
Lymphadenectomy improves the carcinoma related survival and the recurrence
free survival in high-risk
22. Extent of lymphadenectomy…
In full staging, bilateral pelvic and para-aortic lymphadenectomy is increasingly
advocated
Isolated para-aortic lymph nodes can occur in all grades
But majority after pelvic LN +
Para-aortic lymphadenectomy is advocated on all high-risk women, or in women
with two or more positive pelvic lymph nodes
But a major surgery, in women who are elderly, obese, with co-morbidities
23. Radiotherapy…
Pelvic radiotherapy (external beam radiotherapy (EBRT) or brachytherapy )
adjuvant treatment after surgery
as definitive treatment for women who are medically inoperable
local recurrence
Decreases the risk of pelvic recurrence
No overall survival advantage in women with low-risk endometrial cancer
25. Chemotherapy…
Adjuvant systemic chemotherapy in women with high-risk early-stage endometrial
cancer is still controversial
PORTEC-3 study
Two additional GOG studies
26. Predicting nodal disease…
Positron emission tomography (PET)
Accurate method for the pre-surgical evaluation of pelvic nodes metastases
High sensitivity, specificity and positive predictive value.
Sentinel node identification, data are scant
27. Advanced and recurrent disease…
Generally preferable to excise the uterus prior to radiotherapy or chemotherapy
particularly where there is troublesome vaginal bleeding and pelvic pain
Adjuvant external beam radiotherapy to the pelvis and vaginal vault brachytherapy
Adjuvant chemotherapy to prevent distant disease
Widespread nodal involvement at presentation is usually palliative
High-dose oral progestagens
28. Recurrent disease…
Managed according to the pattern of recurrence and overall fitness
MRI- evaluation of suspected pelvic recurrence
CT- abdomen and thorax for other metastases
Isolated vaginal vault recurrence - either surgery or radiotherapy
Radiotherapy can also be used with good effect to treat isolated bony metastases
29. Prognosis and follow-up…
5-year survival rate for all stages is approximately 80%
Factors that adversely affect prognosis include non-endometrioid histological sub-
type and lymphovascular space invasion
Recurrence may be suggested by vaginal bleeding, new onset of persistent
backache, significant weight loss or persistent pressure symptoms
Routine follow-up visit in detecting asymptomatic recurrence and improving
survival from recurrence is unproven