Berdasarkan analisis vegetasi gulma yang dilakukan pada 6 petak ukuran berbeda, ditemukan 11 jenis gulma. Gulma Elephantus scaber memiliki frekuensi dan dominansi tertinggi dibanding gulma lainnya. Asconopus compressus dan Elephantus spicatus juga memiliki frekuensi yang tinggi. Secara keseluruhan, gulma yang paling dominan di lahan tersebut adalah Elephantus scaber.
Colon cancer is the fourth most common cancer in the US. Approximately 96,830 new cases of colon cancer and 40,000 cases of rectal cancer occur each year. While incidence rates have decreased, it remains the second leading cause of cancer deaths. Approximately 20% of colon cancer cases are associated with hereditary factors like Lynch syndrome and Familial Adenomatous Polyposis. Universal genetic testing of tumors is recommended to identify hereditary cases so that at-risk family members can be identified. First line treatments for metastatic colon cancer include FOLFOX, CapeOx, and FOLFIRI combinations, often with added targeted therapies like bevacizumab, cetuximab, or panitumumab
The biopsy results showed poorly differentiated adenocarcinoma in the rectal biopsy and lymph nodes. Immunohistochemistry staining was positive for CK7 and CEA, and negative for CDX2 and other markers. This profile is consistent with anal gland carcinoma (AGC). For AGC lesions greater than 2 cm or not well differentiated, the treatment is neoadjuvant chemoradiation followed by surgery and adjuvant FOLFOX chemotherapy. Both squamous anal canal cancer and AGC are treated with approximately 5 weeks of chemoradiation, though the chemotherapies differ, and metastatic treatments also differ between the cancers.
A 67-year-old woman with poorly controlled type 2 diabetes and hypertension presented with severe muscle weakness and was found to have hyperglycemia, hyperkalemia, and elevated creatinine. Examination revealed facial hirsutism and signs of Cushing's syndrome. Laboratory testing, including a C-peptide measurement, should be performed to determine the cause of her diabetes.
This document discusses the approach to hypokalemia. It begins by distinguishing between renal and extrarenal causes of hypokalemia based on urinary potassium levels and the transtubular potassium gradient. It then reviews various endocrine causes of hypokalemia related to the renin-angiotensin-aldosterone system. Primary aldosteronism is discussed in more detail, including criteria for diagnosis, screening methods such as the aldosterone-renin ratio, and distinctions between forms with and without an adrenal tumor. Tests for evaluating renal tubular function like the urine anion gap and methods for diagnosing renal tubular acidosis are also summarized.
This document summarizes information about appendiceal adenocarcinoma. It discusses how the majority of patients present with acute appendicitis and describes the intestinal and mucinous tumor types. It also covers tumor classification, including mucinous tumors of uncertain malignant potential. Prognosis depends on factors like histologic type, T stage, and tumor grade. Treatment recommendations include simple appendectomy for early stage disease and hemicolectomy for more advanced tumors. Adjuvant chemotherapy and intraperitoneal hyperthermic chemotherapy are discussed as additional treatment options. Cytoreductive surgery can help palliate patients with peritoneal carcinomatosis.
Berdasarkan analisis vegetasi gulma yang dilakukan pada 6 petak ukuran berbeda, ditemukan 11 jenis gulma. Gulma Elephantus scaber memiliki frekuensi dan dominansi tertinggi dibanding gulma lainnya. Asconopus compressus dan Elephantus spicatus juga memiliki frekuensi yang tinggi. Secara keseluruhan, gulma yang paling dominan di lahan tersebut adalah Elephantus scaber.
Colon cancer is the fourth most common cancer in the US. Approximately 96,830 new cases of colon cancer and 40,000 cases of rectal cancer occur each year. While incidence rates have decreased, it remains the second leading cause of cancer deaths. Approximately 20% of colon cancer cases are associated with hereditary factors like Lynch syndrome and Familial Adenomatous Polyposis. Universal genetic testing of tumors is recommended to identify hereditary cases so that at-risk family members can be identified. First line treatments for metastatic colon cancer include FOLFOX, CapeOx, and FOLFIRI combinations, often with added targeted therapies like bevacizumab, cetuximab, or panitumumab
The biopsy results showed poorly differentiated adenocarcinoma in the rectal biopsy and lymph nodes. Immunohistochemistry staining was positive for CK7 and CEA, and negative for CDX2 and other markers. This profile is consistent with anal gland carcinoma (AGC). For AGC lesions greater than 2 cm or not well differentiated, the treatment is neoadjuvant chemoradiation followed by surgery and adjuvant FOLFOX chemotherapy. Both squamous anal canal cancer and AGC are treated with approximately 5 weeks of chemoradiation, though the chemotherapies differ, and metastatic treatments also differ between the cancers.
A 67-year-old woman with poorly controlled type 2 diabetes and hypertension presented with severe muscle weakness and was found to have hyperglycemia, hyperkalemia, and elevated creatinine. Examination revealed facial hirsutism and signs of Cushing's syndrome. Laboratory testing, including a C-peptide measurement, should be performed to determine the cause of her diabetes.
This document discusses the approach to hypokalemia. It begins by distinguishing between renal and extrarenal causes of hypokalemia based on urinary potassium levels and the transtubular potassium gradient. It then reviews various endocrine causes of hypokalemia related to the renin-angiotensin-aldosterone system. Primary aldosteronism is discussed in more detail, including criteria for diagnosis, screening methods such as the aldosterone-renin ratio, and distinctions between forms with and without an adrenal tumor. Tests for evaluating renal tubular function like the urine anion gap and methods for diagnosing renal tubular acidosis are also summarized.
This document summarizes information about appendiceal adenocarcinoma. It discusses how the majority of patients present with acute appendicitis and describes the intestinal and mucinous tumor types. It also covers tumor classification, including mucinous tumors of uncertain malignant potential. Prognosis depends on factors like histologic type, T stage, and tumor grade. Treatment recommendations include simple appendectomy for early stage disease and hemicolectomy for more advanced tumors. Adjuvant chemotherapy and intraperitoneal hyperthermic chemotherapy are discussed as additional treatment options. Cytoreductive surgery can help palliate patients with peritoneal carcinomatosis.
Acquired hemophilia A is a rare bleeding disorder caused by autoantibodies against factor VIII. It most commonly presents in older patients as severe bleeding and has a high mortality rate if not properly treated. Evaluation involves testing for prolonged aPTT and ruling out an inhibitor through mixing studies. Treatment focuses on controlling bleeding with bypassing agents or factor VIII while also using immunosuppressants to eliminate the autoantibody inhibitor. Proper management can reduce bleeding and inhibitor levels, but monitoring is needed due to the slow response to therapy.
1. Most common cardiac conduction abnormalities during CVC insertion are right bundle branch blocks and new left anterior and posterior fascicular blocks which result from overzealous advancement of the guide wire.
2. The most common site of catheter-related deep vein thrombosis is the internal jugular vein. Risk factors include history of DVT, subclavian insertion site, and improper catheter tip positioning.
3. Symptoms of venous air embolism during CVC insertion include chest pain, dyspnea, headache, EKG changes, and decreased cardiac output. Treatment involves stopping air entry, placing the patient in Trendelenburg and left lateral position, and
This document provides information about blood transfusion, including guidelines, components, and risks. It discusses:
1) Guidelines from 1988 and 2010 that multiple factors should be considered for red blood cell transfusion based on a patient's clinical status and oxygen needs.
2) Red blood cell transfusion is indicated for symptomatic anemia, life-threatening anemia, or restoring oxygen-carrying capacity after hemorrhage.
3) Potential transfusion reactions include febrile non-hemolytic reactions, acute hemolytic reactions, transfusion-related acute lung injury, and infections like HIV or hepatitis. Careful patient screening and component selection can reduce risks.
This document discusses anal carcinoma. It covers the overview, risk factors which include HPV and anal intercourse, and the strong association with HPV-16 and HPV-18. It also discusses risk reduction through treatment of high-grade anal intraepithelial neoplasia, a precursor to anal cancer. The anatomy of the anal region and canal is described. Sentinel nodes are the inguinal nodes. Primary treatment of non-metastatic anal cancer involves chemotherapy with radiotherapy to improve local control and reduce colostomies.
This document summarizes the results of a clinical trial investigating the efficacy and safety of pembrolizumab (anti-PD-1 antibody) in patients with advanced melanoma that progressed after treatment with ipilimumab. The overall response rate was 26% in the 2 mg/kg group and 10% in the 10 mg/kg group, with responses ongoing after 1 year. Pembrolizumab demonstrated a manageable safety profile, with grade 3-4 drug-related adverse events occurring in 12% of patients. This trial provides evidence that pembrolizumab is an effective treatment option for patients with advanced melanoma who have progressed on ipilimumab.
The document discusses several types of primary bone cancers. It focuses on chondrosarcoma, which arises from cartilage and most commonly affects the pelvis and femur in older adults. The document outlines diagnostic evaluation, staging, histologic grading, and treatment approaches including wide local excision and adjuvant therapies for chondrosarcoma. Prognosis depends on tumor grade and location. Ewing's sarcoma and osteosarcoma are also discussed as well as giant cell tumor of bone.
Acute Promyelocytic Leukemia (APL) is a subtype of AML characterized by the t(15;17) translocation resulting in the PML-RARA fusion gene. APL has a high cure rate with all-trans retinoic acid (ATRA) and chemotherapy due to its differentiation of promyelocytes. Complications include disseminated intravascular coagulation, ATRA syndrome, and pseudotumor cerebri. Modern treatment protocols using risk stratification and ATRA with chemotherapy have increased survival to over 80% for APL.
Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease characterized by airflow limitation that is usually progressive and associated with an abnormal inflammatory response in the lungs. The diagnosis of COPD requires two spirometric measures: FEV1 and its ratio to FVC (FEV1/FVC), which must be less than 0.7. Treatment involves smoking cessation, vaccinations, bronchodilators, corticosteroids, pulmonary rehabilitation, and oxygen therapy or lung transplantation for advanced cases.
The guideline recommends annual low-dose CT screening for lung cancer until age 79 for high-risk groups based on results from the National Lung Screening Trial. It received moderate ratings in the AGREE assessment due to lack of stakeholder involvement, uncertainty around harms and costs, and need for further validation. While screening high-risk groups could reduce mortality, the high false positive rate and risk of overdiagnosis require careful consideration in implementation.
This document discusses Superior Vena Cava Syndrome (SVCS), which occurs when the Superior Vena Cava (SVC) is compressed, reducing blood flow from the head and upper body. The document covers the case presentation of a patient with SVCS, including symptoms, imaging findings, and treatment. It then provides details on the anatomy, etiologies, clinical features, imaging and classification of SVCS. Treatment options for malignant causes of SVCS such as radiation therapy, chemotherapy and stenting are described. A grading system and treatment algorithm for SVCS are also presented.
Megakaryopoiesis and thrombopoiesis involve the production of megakaryocytes and platelets from hematopoietic stem cells in the bone marrow. Megakaryoblasts are early stage megakaryocytes that are 8-24 μm in size with minimal nuclear lobulation and scant cytoplasm. They express surface adhesion molecules like integrin αIIbβ3 and glycoprotein Ib-IX complex. Megakaryoblasts undergo endomitosis, replicating their DNA without cell division to become polyploid. Cytokines such as thrombopoietin are critical for megakaryoblast survival and proliferation.
Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults. It has an average incidence of 2.7 per 100,000 people in the US and is more common in older men. CLL accounts for about 0.8% of all cancers and 30% of leukemias. The neoplastic cells are typically B-cell lymphocytes. Farming exposure and hepatitis C may play a role in etiology. CLL has various genetic abnormalities that affect prognosis. Clinical features include lymphadenopathy, fatigue, infections. Diagnosis requires a sustained lymphocytosis above 5000/uL. Treatment is indicated for symptomatic disease, doubling time under 6 months, or disease complications. Prognostic factors
Hodgkin's lymphoma, also known as Hodgkin's disease, is a cancer that originates in the lymphatic system. It is characterized by the presence of Reed-Sternberg cells in the lymph nodes and other tissues. The disease has four main subtypes - nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte rich - which are distinguished based on the type of cells in the tissue around the Reed-Sternberg cells. The nodular sclerosis subtype, which involves bands of fibrosis dividing the lymph node tissue into nodules, accounts for about 40-70% of cases. Hodgkin's lymphoma most commonly presents with painless swelling of lymph nodes in the neck,
Acquired hemophilia A is a rare bleeding disorder caused by autoantibodies against factor VIII. It most commonly presents in older patients as severe bleeding and has a high mortality rate if not properly treated. Evaluation involves testing for prolonged aPTT and ruling out an inhibitor through mixing studies. Treatment focuses on controlling bleeding with bypassing agents or factor VIII while also using immunosuppressants to eliminate the autoantibody inhibitor. Proper management can reduce bleeding and inhibitor levels, but monitoring is needed due to the slow response to therapy.
1. Most common cardiac conduction abnormalities during CVC insertion are right bundle branch blocks and new left anterior and posterior fascicular blocks which result from overzealous advancement of the guide wire.
2. The most common site of catheter-related deep vein thrombosis is the internal jugular vein. Risk factors include history of DVT, subclavian insertion site, and improper catheter tip positioning.
3. Symptoms of venous air embolism during CVC insertion include chest pain, dyspnea, headache, EKG changes, and decreased cardiac output. Treatment involves stopping air entry, placing the patient in Trendelenburg and left lateral position, and
This document provides information about blood transfusion, including guidelines, components, and risks. It discusses:
1) Guidelines from 1988 and 2010 that multiple factors should be considered for red blood cell transfusion based on a patient's clinical status and oxygen needs.
2) Red blood cell transfusion is indicated for symptomatic anemia, life-threatening anemia, or restoring oxygen-carrying capacity after hemorrhage.
3) Potential transfusion reactions include febrile non-hemolytic reactions, acute hemolytic reactions, transfusion-related acute lung injury, and infections like HIV or hepatitis. Careful patient screening and component selection can reduce risks.
This document discusses anal carcinoma. It covers the overview, risk factors which include HPV and anal intercourse, and the strong association with HPV-16 and HPV-18. It also discusses risk reduction through treatment of high-grade anal intraepithelial neoplasia, a precursor to anal cancer. The anatomy of the anal region and canal is described. Sentinel nodes are the inguinal nodes. Primary treatment of non-metastatic anal cancer involves chemotherapy with radiotherapy to improve local control and reduce colostomies.
This document summarizes the results of a clinical trial investigating the efficacy and safety of pembrolizumab (anti-PD-1 antibody) in patients with advanced melanoma that progressed after treatment with ipilimumab. The overall response rate was 26% in the 2 mg/kg group and 10% in the 10 mg/kg group, with responses ongoing after 1 year. Pembrolizumab demonstrated a manageable safety profile, with grade 3-4 drug-related adverse events occurring in 12% of patients. This trial provides evidence that pembrolizumab is an effective treatment option for patients with advanced melanoma who have progressed on ipilimumab.
The document discusses several types of primary bone cancers. It focuses on chondrosarcoma, which arises from cartilage and most commonly affects the pelvis and femur in older adults. The document outlines diagnostic evaluation, staging, histologic grading, and treatment approaches including wide local excision and adjuvant therapies for chondrosarcoma. Prognosis depends on tumor grade and location. Ewing's sarcoma and osteosarcoma are also discussed as well as giant cell tumor of bone.
Acute Promyelocytic Leukemia (APL) is a subtype of AML characterized by the t(15;17) translocation resulting in the PML-RARA fusion gene. APL has a high cure rate with all-trans retinoic acid (ATRA) and chemotherapy due to its differentiation of promyelocytes. Complications include disseminated intravascular coagulation, ATRA syndrome, and pseudotumor cerebri. Modern treatment protocols using risk stratification and ATRA with chemotherapy have increased survival to over 80% for APL.
Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease characterized by airflow limitation that is usually progressive and associated with an abnormal inflammatory response in the lungs. The diagnosis of COPD requires two spirometric measures: FEV1 and its ratio to FVC (FEV1/FVC), which must be less than 0.7. Treatment involves smoking cessation, vaccinations, bronchodilators, corticosteroids, pulmonary rehabilitation, and oxygen therapy or lung transplantation for advanced cases.
The guideline recommends annual low-dose CT screening for lung cancer until age 79 for high-risk groups based on results from the National Lung Screening Trial. It received moderate ratings in the AGREE assessment due to lack of stakeholder involvement, uncertainty around harms and costs, and need for further validation. While screening high-risk groups could reduce mortality, the high false positive rate and risk of overdiagnosis require careful consideration in implementation.
This document discusses Superior Vena Cava Syndrome (SVCS), which occurs when the Superior Vena Cava (SVC) is compressed, reducing blood flow from the head and upper body. The document covers the case presentation of a patient with SVCS, including symptoms, imaging findings, and treatment. It then provides details on the anatomy, etiologies, clinical features, imaging and classification of SVCS. Treatment options for malignant causes of SVCS such as radiation therapy, chemotherapy and stenting are described. A grading system and treatment algorithm for SVCS are also presented.
Megakaryopoiesis and thrombopoiesis involve the production of megakaryocytes and platelets from hematopoietic stem cells in the bone marrow. Megakaryoblasts are early stage megakaryocytes that are 8-24 μm in size with minimal nuclear lobulation and scant cytoplasm. They express surface adhesion molecules like integrin αIIbβ3 and glycoprotein Ib-IX complex. Megakaryoblasts undergo endomitosis, replicating their DNA without cell division to become polyploid. Cytokines such as thrombopoietin are critical for megakaryoblast survival and proliferation.
Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults. It has an average incidence of 2.7 per 100,000 people in the US and is more common in older men. CLL accounts for about 0.8% of all cancers and 30% of leukemias. The neoplastic cells are typically B-cell lymphocytes. Farming exposure and hepatitis C may play a role in etiology. CLL has various genetic abnormalities that affect prognosis. Clinical features include lymphadenopathy, fatigue, infections. Diagnosis requires a sustained lymphocytosis above 5000/uL. Treatment is indicated for symptomatic disease, doubling time under 6 months, or disease complications. Prognostic factors
Hodgkin's lymphoma, also known as Hodgkin's disease, is a cancer that originates in the lymphatic system. It is characterized by the presence of Reed-Sternberg cells in the lymph nodes and other tissues. The disease has four main subtypes - nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte rich - which are distinguished based on the type of cells in the tissue around the Reed-Sternberg cells. The nodular sclerosis subtype, which involves bands of fibrosis dividing the lymph node tissue into nodules, accounts for about 40-70% of cases. Hodgkin's lymphoma most commonly presents with painless swelling of lymph nodes in the neck,
8. STORY
Ada seekor kelinci yang
mengumpulkan wortel dengan jumlah
yang ditentukan,jika kelinci tersebut
tidak mendaatkan wortel yang
jumlahnya ditentukan maka kelinci
tersebut akan dimakan serigala atau
akan mencari wortel yang belum di
ambil.Jika kelinci tersebut berhasil
mendapatkan wortelnya dia akan
lanjut ke stage berikutnya .
nyawa kelinci disini hanya 3 jika nyawa
10. WIN
-Jika berhasil lanjut ke stage
berikutnya
-Jika menjwab pertanyaan
dengan benar maka kelinci
dapat point 2
- Sampai di stage terakhir dia
mendapatkan wortel raksasa dan
piala
11. LOSE
-Dimakan serigala
- jika salah menjawab pertanyaan
skornya dikurangi 1
- Jika wortelnya kurang maka harus
mencarinya lagi atau di makan
serigala dan kalah