ENDOMETRIOSIS STILL AN ENIGMATIC DISEASE
Endometriosis: The Pain That Keeps on Giving
“Endometriosis remains a riddle wrapped in a mystery inside an enigma”
Endometriosis an overview by dr. sharda Jain, Dr. Jyoti Agarwal , Dr. Jy...Lifecare Centre
Endometriosis :An Overview
Presented in Endometriosis update in Delhi June (2016) Hotel Leela
EB Guidelines
RCOG: Evidence-based Clinical, 1999
Endometriosis and infertility. ASRM, 2004.
ACOG. Endometriosis in adolescents, 2005.
ESHRE guideline for the diagnosis and treatment of endometriosis, 2005.
Endometriosis and infertility. ASRM, 2006.
Endometriosis: diagnosis and management.
Fertility: Assessment and Treatment for People with Fertility Problems. NICE, 2013.
ESHRE guideline: management of women with endometriosis,2014.
Endometriosis still an enigmatic disease dr. sharda jainLifecare Centre
ENDOMETRIOSIS STILL AN ENIGMATIC DISEASE : Introduction DR. SHARDA JAIN DR. JYOTI AGARWAL
DR. JYOTI BHASKER
“Endometriosis remains a riddle wrapped in a mystery inside an enigma”
ENDOMETRIOSIS: THE BITTER TRUTH
Understand the history and pathophysiology of endometriosis
Understand the critical need for timely diagnosis and effective intervention
Understand the considerable effects and cost burdens of this chronic disease and employ best-practice techniques to mitigate them
Endometriosis an overview by dr. sharda Jain, Dr. Jyoti Agarwal , Dr. Jy...Lifecare Centre
Endometriosis :An Overview
Presented in Endometriosis update in Delhi June (2016) Hotel Leela
EB Guidelines
RCOG: Evidence-based Clinical, 1999
Endometriosis and infertility. ASRM, 2004.
ACOG. Endometriosis in adolescents, 2005.
ESHRE guideline for the diagnosis and treatment of endometriosis, 2005.
Endometriosis and infertility. ASRM, 2006.
Endometriosis: diagnosis and management.
Fertility: Assessment and Treatment for People with Fertility Problems. NICE, 2013.
ESHRE guideline: management of women with endometriosis,2014.
Endometriosis still an enigmatic disease dr. sharda jainLifecare Centre
ENDOMETRIOSIS STILL AN ENIGMATIC DISEASE : Introduction DR. SHARDA JAIN DR. JYOTI AGARWAL
DR. JYOTI BHASKER
“Endometriosis remains a riddle wrapped in a mystery inside an enigma”
ENDOMETRIOSIS: THE BITTER TRUTH
Understand the history and pathophysiology of endometriosis
Understand the critical need for timely diagnosis and effective intervention
Understand the considerable effects and cost burdens of this chronic disease and employ best-practice techniques to mitigate them
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)Lifecare Centre
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
MODERATOR
DR SHARDA JAIN
DR JYOTI AGARWAL
DR ILA GUPTA
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
Endometriosis is known to have a remarkably negative effect on the Quality of Life of the women. Surgery is considered when medical therapy is unsuccessful or in the setting of infertility. A high recurrence rate is reported in advanced stages of endometriosis. Thus, Complete excision and prevention of recurrence is particularly important.
Free Information Session 8th May 2013: Endometriosis and InfertilityFertility SA
Dr Louise Hull presented the facts about Endometriosis and its impact on fertility.
Dr Louise Hull has worked in fertility services since she graduated as a doctor 15 years ago. She became Obstetrician and Gynaecologist (FRANZCOG) after gaining clinical experience in New Zealand and Cambridge and Somerset in the UK. Louise has a strong interest in reproductive medicine and has worked in IVF units in New Zealand, England and Australia, including Bourn Hall, the fertility centre where the first IVF baby was born. For more information about Dr Hull, please follow this link: http://www.fertilitysa.com.au/dr-m.-louise-hull-specialist.html
Recurrence of endometriosis is fairly common; some studies suggest the rate of recurrence to be as high as 40%. Most common cause of recurrence is incomplete resection in primary surgery and microscopic foci which escapes detection.
Recurrent Pregnancy Loss Sharing Personal Experience (10 years) Lifecare Centre
Complete over view of the causes diagnosis management of Recurrent Pregnancy Loss
it is a personal experience of treating recurrent miscarriages with excellent result
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)Lifecare Centre
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
MODERATOR
DR SHARDA JAIN
DR JYOTI AGARWAL
DR ILA GUPTA
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
Endometriosis is known to have a remarkably negative effect on the Quality of Life of the women. Surgery is considered when medical therapy is unsuccessful or in the setting of infertility. A high recurrence rate is reported in advanced stages of endometriosis. Thus, Complete excision and prevention of recurrence is particularly important.
Free Information Session 8th May 2013: Endometriosis and InfertilityFertility SA
Dr Louise Hull presented the facts about Endometriosis and its impact on fertility.
Dr Louise Hull has worked in fertility services since she graduated as a doctor 15 years ago. She became Obstetrician and Gynaecologist (FRANZCOG) after gaining clinical experience in New Zealand and Cambridge and Somerset in the UK. Louise has a strong interest in reproductive medicine and has worked in IVF units in New Zealand, England and Australia, including Bourn Hall, the fertility centre where the first IVF baby was born. For more information about Dr Hull, please follow this link: http://www.fertilitysa.com.au/dr-m.-louise-hull-specialist.html
Recurrence of endometriosis is fairly common; some studies suggest the rate of recurrence to be as high as 40%. Most common cause of recurrence is incomplete resection in primary surgery and microscopic foci which escapes detection.
Recurrent Pregnancy Loss Sharing Personal Experience (10 years) Lifecare Centre
Complete over view of the causes diagnosis management of Recurrent Pregnancy Loss
it is a personal experience of treating recurrent miscarriages with excellent result
Endometriosis: an invisible and neglected disease that affects 180 million women. Celebrities and famous women over the years have been known to be affected by this Queen Victoria to Marilyn Monroe to Katrina Kaif who had surgery for endometriosis.
Endometriosis: an invisible and neglected disease that affects 180 million women. Celebrities and famous women over the years have been known to be affected by this Queen Victoria to Marilyn Monroe to Katrina Kaif who had surgery for endometriosis. The old theories of Endometriosis such as Sampsons Theory Angiogenesis, Lymphogenesis theory are no longer acceptable. The Epigenetic/ Genetic theorey has been postulated. ROle of biomarkers in diagnosis Risk factrs affecting Endometriosis and Risk of Cancer is discussed
this slide helps a physician in understanding the basics of miscarriages(definition, types/classification, causes, clinical presentation, investigations and complications. In understanding the basics, this helps a physician to able to treat or manage abortions.
Dr Sujoy Dasgupta was invited to deliver a lecture at the Conference of IMA (Indian Medical Association), held at July 2019 in Kolkata. This session was sponsored by Meyer Organic.
Endometriosis and fertility how and when to treatDr Aditya Keya
Endometriosis can influence fertility in several ways: distorted anatomy of the pelvis, adhesions, scarred fallopian tubes, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy, and altered egg quality.
Intrahepatic Cholestasis of Pregnancy - Prof Surekha TayadeSurekhaTayade4
This presentation is for undergraduates, postgraduates, consultants and nurses and describes incidence, etiology, pathophysiology, complications and management of intrahepatic cholestasis of pregnancy /obstetric cholestasis
The Newer Concepts In Endometriosis Management : Dr Sharda JainLifecare Centre
The Newer Concepts In
Endometriosis Management
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DELEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
The Newer Concepts forReduced Surgery to preserve fertility in Endometrios...Lifecare Centre
The Newer Concepts forReduced Surgery to preserve fertility in Endometriosis
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DILEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Strategies for Improving Success Rates in ART PARTLifecare Centre
Strategies for Improving Success Rates in ART
Part - 2
Strategies for Improving Success Rates in ART
Tailoring Controlled Ovarian Stimulation
Strategies for Luteal Phase in ART cycles
Endometrial Receptivity Array
How to optimize success rates in ART? : Dr Sharda JainLifecare Centre
How to optimize success rates in ART? : Dr Sharda Jain
How to improve success rates in ART?
The big debate कार्य में आनंद
Evolution of In-vitro Fertilization (IVF)
Factors Influencing IVF Success Ist Part
Strategies for Improving Success Rates in ART Second Part
Innovations & Breakthroughs in IVF Part Three
OPEN DEBATE
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda JainLifecare Centre
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
Introduction
Social egg freezing (oocyte cryopreservation for non-medical reasons) has evolved as a proactive option for women looking to extend their reproductive possibilities past their peak childbearing years
It is the process of saving or protecting eggs, or reproductive tissues so that a person can use them to have biological children in future
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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
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
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.
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
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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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).
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
5. ENDOMETRIOSIS: THE BITTER TRUTH
Prevalence rate – no: body knows !!
35%–50% in women experiencing pain or infertility
Elusive Pathogenesis
Healthcare costs are estimated to exceed
$70 billion every year- underestimated
Acien P, Velasco I. Endometriosis: A Disease That Remains Enigmatic. ISRN Obstetrics and
Gynecology. 2013; http://dx.doi.org/10.1155/2013/242149
Donnez J. Endometriosis: enigmatic in the pathogenesis and controversial in its therapy. (Fertil
Steril. 2012;98:509–10 …Caring hearts, healing hands
6. Remains Controversial Despite…..
Existence of a journal and various regular
international congresses & dedicated forums / societies
specifically to the disease
Current scientific and technological advances
Publication of a large number of manuscripts
Acien P, Velasco I. Endometriosis: A Disease That Remains Enigmatic. ISRN Obstetrics and Gynecology.
2013; http://dx.doi.org/10.1155/2013/242149
Donnez J. Endometriosis: enigmatic in the pathogenesis and controversial in its therapy. (Fertil Steril.
2012;98:509–10 …Caring hearts, healing hands
9. • Age: common in reproductive period
• True Incidence Unknown: ?
• Does NOT Discriminate by Race.
• Histology: Endometrial Glands with Stroma
+/- Inflammatory Reaction.
• Hereditary (↑↑ among sisters).
Epidemiology
10. Delay to Diagnosis of
8 to 10 years is the RULE
Delay of
• 10 years in Germany and Austria
• 8 years in the UK and Spain,
• 7 years in Norway, Italy
• 4–5 years in Ireland and Belgium
INDIA--- ?
15. RISK FACTORS (Odukoya & Cooke, 1996)
I- ASSOCIATED:
First or second degree
relation.
Menstrual cycle < 27 days.
Menstrual duration > 7 days.
Genital outflow obstruction.
II- INCONCLUSIVE:
Obesity,
Exercise,
Age at menarche,
uterine retroversion.
III- NOT ASSOCIATED:
Age
Race
Social class
duration of marriage
ICUD
Miscarriage
16. Predisposing Factors
1. Hyperoestrinism:
a) Fibroid & metropathia hemorrhagica.
b) Delayed marriage, infertility.
c) Oestrogen secreting tumours of the ovary e.g. granulosa
& theca cell tumours, or with prolonged oestrogen therapy.
2. Cervical Stenosis.
3. Insufflation ?
4. Curettage ?
20. DONNEZ ET AL (2003)
• Red lesions = Early endometriosis
• Black lesions = Advanced endometriosis
• White = Lesions are believed to be
- Healed endometriosis or
- Quiescent or latent lesions.
21. ASRM classification (1996)
• The only difference between the 1985 rAFS classification &
1996 ASRM classification is that the latter includes
information on the morphologic appearance of the disease.
• Red: red, red-pink & clear lesions
• White: white, yellow-brown, peritoneal defects, subovarian
adhesion
• Black: black & blue lesions.
• Denote percent of total described as
• R ….%, W ….% and B ….%.
• Total should equal 100%.
22. CLASSIFICATION
• The revised American Fertility Society (rAFS)
(1985)was produced to standardize the
documentation of findings in patients who
have pelvic pain & endometriosis.
• Staging Involves:
• 1. Location
• 2. Depth of Disease,
• 3. Extent of Adhesions.
23. REVISED AFS (1985)
• Stage I (minimal) 1 – 5.
• Stage II (mild) 6 – 15.
• Stage III (moderate) 16 – 40.
• Stage IV (severe) > 40.
25. IN WOMEN OF REPRODUCTIVE AGE WITH
NON-GYNAECOLOGICAL CYCLICAL SYMPTOMS
• Dyschezia
• Dysuria
• Haematuria
• Rectal bleeding
• Shoulder pain.
26. Pelvic examination may reveal:
1. Pelvic tenderness.
2. Fixed retroverted uterus.
3. Nodularity of the Douglas pouch and
uterosacral ligaments.
4. Ovaries may be enlarged and tender .
5.Ovarian cyst may be detected.
Signs
27. • It should include both-
• Per Abdomen
• Per Speculum
• Per Vaginum
• Highest predictive value
• -- Menstruation
In all women suspected of
endometriosis
28. For adolescents and/or women without
previous sexual intercourse
• Rectal examination can be helpful for the
diagnosis of endometriosis.
• Only after Counselling and Verbal
Consent
29. Suspect Deep Endometriosis
• Women with (painful) induration and/or
nodules of the Rectovaginal wall found
during clinical examination or
• Visible vaginal nodules in the posterior
vaginal fornix
34. Magnetic Resonance Imaging
????
• Clinicians should be aware that the
usefulness of magnetic resonance
imaging (MRI)
to diagnose Peritoneal Endometriosis
is not well established
35. Biomarkers ????
Clinicians are recommended not to use
biomarkers to diagnose endometriosis in
• endometrial tissue,
• menstrual or uterine fluids
• and/or immunological biomarkers, including
CA-125, in plasma, urine or serum
37. Treatment (Rationale)
• Recognize Goals:
– Pain Management
– Preservation / Restoration of Fertility
• Discuss with Patient:
– Disease may be Chronic and Not Curable
– Optimal Treatment Unproven or Nonexistent
38. When is Medical Treatment
Required ?
• First line treatment with chocolate cyst?
• First line treatment with superficial / deep
nodules?
• Role before surgery ?
• After surgery to prevent recurrence ?
• When surgery is not possible or refused ?
Full of
controversies
40. Limitations of surgery
Skill / Recurrence
LONG LEARNING CURVE
High risk of recurrence after surgery
25 % recurrence after 2 years
50 % at 5 years
40 – 80 % women have PAIN again
within 2 years of surgery
41. Endometriosis & IVF
• The presence of endometriosis does
not generally impair the results of
IVF but it increases the risk of
infection.
• It is preferable not to cauterize
ovarian endometrium if IVF or ICSI is
indicated for fear of destruction of
ovarian tissues.
43. • Endometriosis is a mystery for
gynaecologists as it requires decision
making at every stage by the Doctor and the
patient.
• Endometriosis still stand as one of the
most-investigated disorders in gynecology.
SO is one of the highest priorities for
research
TAKE HOME MESSAGE