Better life of Cancer patients during childhood and age reproductive period regarding fertility, fertility preservation and pregnancy outcome is the main concern.concentrating upon different safe diagnostic modalities, management and outcome.
Increase incidence of cancer during the reproductive age. Survival and cure rates of cancer are improving. Resulting in Increasing demand for fertility preserving interventions.
http://cancer-treatment-madurai.com Breast cancer is a type of cancer that starts in the tissues of the breast. Dr.S.G.Balamurugan is one of the best cancer doctor in India, offers low cost breast cancer diagnosis, breast cancer treatments and breast cancer care at Guru Cancer Hospital, Madurai.
Increase incidence of cancer during the reproductive age. Survival and cure rates of cancer are improving. Resulting in Increasing demand for fertility preserving interventions.
http://cancer-treatment-madurai.com Breast cancer is a type of cancer that starts in the tissues of the breast. Dr.S.G.Balamurugan is one of the best cancer doctor in India, offers low cost breast cancer diagnosis, breast cancer treatments and breast cancer care at Guru Cancer Hospital, Madurai.
obstetric and gynaecological management with breast cancer .pptxWafaa Benjamin
Obstetric & Gynaecological Management with Breast Cancer
Breast cancer is the most common cancer in females worldwide. It increasingly affects women through their reproductive age. The prognosis of breast cancer is improving, with 5-year survival 80% ( >50years(. As a result, obstetrician and gynaecologists are nowadays facing more women who are:
◦ Diagnosed with breast cancer during pregnancy
◦ Coming for Pre-pregnancy counselling following breast cancer treatment
◦ Asking for fertility preservation with breast cancer
◦ Having a Genetic predisposition to breast cancer
On this presentation I am going to address those problems in clinical case scenarios in line with latest evidences.
Fertility, Pregnancy, Contraception, Lactation And Endocrine Therapy In Breas...Mamdouh Sabry
Discussing every detail concerning gynaecologist and obstetrician in breast cancer. As fertility, pregnancy outcome, contraception, lactation, adjuvant hormone therapy and prevention.
Discussing sexually transmissible diseases, body defense, resistance to infection, susceptibility of infection, prevention and possible management and conclusion.
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!
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
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
Fertility And Pregnancy Outcome In Cancer Patients
1. Fertility And Pregnancy Outcome
In Cancer Patients
Dr. Mamdouh Sabry
MD. Ain Shams, Ph.D. France
Consultant Ob. & Gyn.
EL Mataria Teaching Hospital, Nasser Institute
Cairo, Egypt
2. BETTER LIFE OF CANCER,
ORGAN TRANSPLANTED, AND
CRITICALLY ILL PATIENTS,
REGARDING FERTILITY,
PREGNANCY OUTCOME AND
SEXUALITY IS THE TARGET OF
OUR TEAM IN Nasser Institute,
Pediatric Oncology Gp. And Hemato-
oncology Gp.
3. What created the situation ?
The increase In :
• Malignancy among children and during age
reproductive period (EBC)…
• Technology for early detection & treatment.
• Survivors from cancer during reproductive
age and childhood.
• Technology of fertility preservation
techniques.
• Delay age of marriage & increase cancer
rate with age.
4. Two Items
( 1 ) Fertility preservation for men,
women and children.
( 2 ) Pregnancy in cancer patients; that
detected before, during and after this
pregnancy.
5. Data Collection
WAS NOT EASY
Data from ASCO (am. Soc. Cl. On.)
Up to date.com, ESMO guidelines, Medscape……
Evaluation of more than 70 publications, obser., cohort,
case rep. and few clinical trials.
Cochrane Collaboration Library.
Our experience in N. In. , Hema. On. Gp., Ped. On. Gp.
6. Fertility Preservation for Men
• Sperm cryopreservation, effective, has to be divided.
• Hormonal gonadal suppression not recommended !!??
• Testicular tissue preservation and reimplantation or
grafting of testicular tissue is performed as clinical trials
or approved experimental protocol.
• Post chemotherapy sperm collection holds high risk of
genetic or morphologic sperm damage.
7. Fertility Preservation for Women
• Embryo cryopreservation is an established routine method.
• Oocyte cryopreservation is considered a good option
recently in experienced centers with application of flexible
protocols for ova collection and induction with AI. Specially
for estrogen sensitive breast or gynecol. malignancy .
• Oophoropexy before pelvic radiation >> technique not
always successful due to many factors.
• Ovarian suppression >> insufficient evidence on its
effectiveness.
• Ovarian tissue cryopreservation and transplantation>> only
method in children>> experimental and performed only in
centers with good experience.
8.
9. Pregnancy and Malignancy
• Diagnosed in (1/ 1000- 2000 ) pregnancy.
• Breast, hematologic (lymphoma & leukemia),
melanoma, cervix, ovary, thyroid, bone and soft
tissue cancers.
• Newly detected cases or pregnancy detected
during cancer ttt or planned pregnancy in cancer
patient and or recurrence during pregnancy.
• Diagnostic techniques, Therapeutic options, fetal
safety, termination, mode of delivery and lactation
are all questionable and in debate ??
• Breast lump, atypical vag. Discharge, enlarging L.N
,rectal bleeding or others should attract attention.
10. DIAGNOSTIC MODALITY
( Investigations For ):
• Screening.
• Diagnosis.
• Confirmation of the diagnosis.
• Staging.
• Pre-operative.
• Excision Biopsy.
11. X-rays
-Measured in several types of units.
-Radiation-absorbed dose (rad), US measurement.
-Gray (Gy) international measurement.
-Both represent a single-time exposure and radiation
absorbed dose (as diagnostic procedures).
-The measurement units; roentgen equivalent man
(rem) and Sievert (Sv) used to quantify radiation
exposure over time and radiologic effective dose (as
environmental releases).
-1 Gy equals 100 rad & 1 Sv equals 100 rem.
-Dose calculation depends on study type, machine
type, distance from machine, organ penetrated and
method of study.
12. X-ray, follow.
-X-rays have deterministic and stochastic effects.
-Deterministic effects are usually intrauterine, involving
damage to growing cells, it has a dose response curve
and a threshold effect, either all or non, the damage
threshold begins at 0.1-o.15 Gy (10-15 rad) which
causes abortion or no implantation and extends to 1Gy
(100rad) which causes fetal death in-utero at term.
-Stochastic effects appears in the later years of
exposed persons, not needing threshold? (0.05 Gy)
relative risk documented in multiple case-control
studies, others considered this to be theoretical.
-Dose< 5 rad not associated with fetal hazards.
13. X-ray follow.
CT scanning
-New generations more
sensitive and accurate.
-0.17-0.35 rad are fetal
exposure in abdominal or
pelvic CT.
Fluoroscopy/Angiography
-Cerebral angiography
exposes to <10 mrad
-Risk benefit ratio.
Plain Films
-In chest radiograph,
exposure for 2 views
<0.07 mrad
-To bone, ribs, skull and
lower limb deliver lower
doses due to fetal
distance from target
organ, but hip and
pelvis X-ray deliver
about 200 mrad.
14. X-ray, Conclusion
SO, Concern about possible effects of
high-dose ionizing radiation exposure
should not prevent medically indicated
diagnostic x-ray procedures from being
performed on a pregnant woman.
During pregnancy, other imaging
procedures not associated with ionizing
radiation (ultrasonography and MRI)
should be considered instead of x-rays
when appropriate.
15. X-ray, Conclusion
“Women should be counseled that x-ray
exposure from a single diagnostic procedure
does not result in harmful fetal effects.
Specifically, exposure to less than 5 rad has
not been associated with an increase in fetal
anomalies or pregnancy loss.”
American College of Obstetricians and Gynecologists,
Committee on Obstetric Practice;
Guidelines for Diagnostic Imaging During Pregnancy.
ACOG Committee Opinion No. 299.
ACOG, September 2004.
16. Nuclear Medicine Exams
-Most of the radiopharmaceuticals used will
cross the placental barrier.
-In general, the effective dose from most
diagnostic nuclear medicine exams, other
than the radioiodines, will be less than 10
mSv (1 rem).
-The fetal absorbed dose represents the
combined effect of both external radiation
from maternal tissues and placental transfer
and fetal uptake of radiopharmaceuticals.
17. Magnetic Resonance Imaging (MRI)
“Although there have been no documented adverse fetal
effects reported, the National Radiological Protection
Board arbitrarily advises against its use in the first
trimester.”
Guidelines for Diagnostic Imaging During Pregnancy. ACOG
Committee Opinion
-USA, FDA labeling MRI devices to indicate, safety of MRI with
respect to the fetus not yet confirmed.
-Gadolinium is teratogenic in animals and does cross the
placenta.
- Pet MRI ???
.
18. Ultrasound Imaging
“There have been no reports of documented adverse
fetal effects for diagnostic ultrasound procedures,
including duplex Doppler imaging.”
“There are no contraindications to ultrasound
procedures during pregnancy, and this modality
has largely replaced x-ray as the primary method
of fetal imaging during pregnancy.”
American College of Obstetricians and Gynecologists,
Committee on Obstetric Practice;
Guidelines for Diagnostic Imaging During Pregnancy.
ACOG Committee Opinion No. 299.
ACOG, September, 2004.
20. Cancer Diagnosed During Pregnancy
• Pregnancy does not have a proven negative effect
on any cancer.
• Termination may be done early in pregnancy to
admit proper oncologic care, risk benefit value ???.
• Surgery never postponed if crucial in ttt plan.
• Surgery is performed safely with slight increase in
miscarriage risk in 1st trimester, increase morbidity
is noticed in major pelvic and abdominal surgery.
• Laparoscopy may be performed ( experience ).
• Chemotherapy is not recommended during first
trimester, 3 weeks before delivery and during
lactation, if lactated. ( IUGR or premature delivery)
21. • Contemporary research established that, breast
cancer does not imply a worse prognosis in
women seeking pregnancy after ttt. .
• Delay ttt for few weeks (1st trimester) not affect
outcome in breast cancer or many others. (Int.
cancer in pregnancy study, German breast gp.,
Ann. Oncol. Jun. 2013, RCOG guidelines 2011)
• Chemotherapy can be introduced during
pregnancy in hematologic malignancies and
others.
• Interleukins, monoclonal antibody and immune
therapy admission are trimester dependent.
22. Pregnancy after cancer Treatment
• Decrease fertility and pregnancy rate is higher
in women, 40% less than normals , 70% less in
breast cancer. But fertility is affected early in
men with genital cancer.
• Neonatal outcome in men or women with history
of cancer is comparable to general population.
• The timing of pregnancy is considered
regarding end of treatment and risk of relapse.
• Better wait 3-6 months after ttt.
• Wait after end of hormone dependent breast
cancer.
23. Pregnancies diagnosed during anti-cancer
Therapy
• Pre-menopausal females undergoing systemic anti-
cancer therapy (i.e. chemo., hormonal, immuno or
radiotherapy) should use active contraception,
sperm DNA integrity in men ?!
• Contraception use up to 3–6 months after the last
administered dose is advised.
• It depends on cancer origin, duration of pregnancy
and type of therapy.
• Some cases of hematologic malignancy are allowed
to be pregnant during therapy.
25. Fertility preservation
Indications:
• Cancer patients before gonadotoxic
treatment
• Other diseases before gonadotoxic
treatment
• Young patients with Turner syndrome,
Fragile X premutation (FMR 1),
Galactosemia
• Unmarried women in mid-thirties ?
26. Interference, staging and diagnostic
modality
• Avoid exposure to ionizing radiation.
• Ultrasound and MRI, Pet MRI (no contrast)
are considered safe. Pet CT is unsafe.
• Chest X-ray, spiral CT and mammography
with shielding may be done during pregnancy.
• CA125, HCG, CA15,3 and Alpha feto protein
not used as markers, ESR and leucocytes
• Biopsy and surgery can be performed during
pregnancy.
27. Conclusion, cont.
- In order to provide the best possible care,
a team approach involving an obstetrician,
fetologist, oncologist, radiologist, oncology
surgeon and neonatologist is required.
- The couple also should be involved in the
decision-making.
- It is equally important to share experience
as current recommendations are often
based on case series and expert views with
little high-quality research.
28. Conclusion, cont.
• Does chemotherapy and pelvic radiation
affect gonadal function? Yes.
• Can we protect them ? Yes.
• Is pregnancy safe after Breast cancer ttt?Yes.
• Does pregnancy worsen hematologic, other
tumors or breast cancer prognosis? NO.
• Is pathologic features different from matched
non-pregnant females ? No.
• Abnormal findings during pregnancy, might
hide malignancy or recurrence.
• Cancer breast may be preventable? ? Yes?