This document provides an overview of neuroendocrine tumors (NETs) that originate in the gastrointestinal tract (GIT). It discusses the classification, grading, epidemiology, pathophysiology, clinical features, and molecular biology of GIT-NETs. Some key points include:
- GIT-NETs are classified as well-differentiated or poorly-differentiated and further graded based on proliferation rate.
- The ileum is a common primary site. Symptoms vary depending on secretion of hormones.
- Carcinoid syndrome results from secretion of substances like serotonin that cause flushing, diarrhea, and heart disease.
- Molecular drivers include growth factors but causes are still not fully understood. Prognosis depends on
Updates on Electron Beam Therapy
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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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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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!
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
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NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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2. Outlines of presentation:
• Introduction
• NET-Distribution
-classification -Grade
-Epidemiology - Pathophysiology
-Molecular biology - Clinical features
3. Introduction
• Neuroendocrine cells are cells that receive
neuronal input (neurotransmitter) release
messaging molecules (hormone) to the blood.
• These hormones control many body functions.
• So they brings neural and endocrine
integration,a process know as neuroendocrine
integration.
4. Introduction…
• Pituitary gland, parathyroid glands and inner
layer of adrenal gland (adrenal medulla) are
almost made up of neuroendocrine cells.
• Other NEC are found scattered through out,
mainly GIT, Respiratory tract and pancreases.
• These NEC found scattered throughout these
organs are referred to as the diffuse
neuroendocrine system
6. • This diffuse neuroendocrine cells don’t form
an actual organ like the adrenal or thyroid
glands(Instead scattered)
• GIT has more neuroendocrine cells than any
other part of the body so is commonest origin
of NET(64% of NET cases).
7. Neuroendocrine tumors/NET
• Derived from the diffuse neuroendocrine system
that is composed of peptide- and amine-
producing cells which secrete different hormones
depending on the site of origin.
• NETs are composed of monotonous sheets of
small round cells with uniform nuclei and
cytoplasm.
• Traditionally classified based on their embryonic
divisions (foregut, midgut, or hindgut) of the
alimentary tract
8.
9. GIT-NET
• Gastroenteropancreatic NENs has evolved
over the past two decades & divided into two
major categories:
I) Well-differentiated neuroendocrine tumors
(NET)
II) Poorly differentiated neuroendocrine
carcinomas (NEC)
10. GIT-NET…Well differentiated
• Show a solid, trabecular, with fairly uniform
nuclei, coarsely stippled chromatin, and finely
granular cytoplasm.
• Traditionally referred to as carcinoid tumors in
GIT and pancreatic NETs (islet cell tumors) in
pancreases.
11. GIT-NET…Poorly differentiated
• Are high-grade carcinomas that resemble
small cell or large cell NEC of the lung.
• Often associated with a rapid clinical course,
so bad prognosis compared to well-
differentiated NET.
12. • Well-differentiated NETs, are further
subdivided into low grade and intermediate
grade based on proliferative rate.
13. Grading GIT-NET
• WHO classification of GIT-NET is based on
proliferative rate ,divided in to:
- Low-grade(G1) well-
-Intermediate-grade(G2) differentiated
-High-grade tumor(G3) poorly differentiated
Proliferative rate is measured using either
mitotic counts or Ki-67 labeling index.
14.
15. GIT-NET
• progression from a lower grade (G1 or G2)
well-differentiated NET to a G3 NET can occur.
• Evidence of progression can be:
-increase in the proliferative rate
-change in tumor morphology(↑ nuclear
atypia, or development of significant necrosis)
16. Molecular pathogenesis
• Little is known about the induction & growth of
carcinoid tumors.
• Gastric NET ↑ hypergastrinemia conditions (pernicious
anemia, atrophic gastritis, ZES).
• other growth factors in some carcinoid tumors are :
- transforming growth factor-alpha
-insulin like growth factor- 1
-VEGF
-acidic and basic fibroblast growth factor
-epidermal growth factor
17. Epidemiology
• Generally GIT-NET are uncommon, but GIT
common primary site NETs(6.2/100,000)
• Incidence is increasing due to multifactorial
-increased awareness (if you don’t suspect
NET you will not Dx it!)
-improved endoscopic methods detection
Small bowel NETs (midgut carcinoids) are more
common than both foregut and hindgut
18. Esophageal NET
• Rare (<1% of GI NET)
• Common in men >60 yrs
• Seen in distal esophagus, proximal to GEJ
• On EUS they are sub mucosal mass, dimple
the mucosa.
19. Stomach-NET
• Subdivided into three categories which have different
biologic behavior and prognosis
• Type 1 -70-80 % all gastric NETs
-associated with chronic atrophic gastritis
-more common in women
-derived from enterochromaffin-like (ECL) cells
-non functioning
- Endoscopically →<1 cm
→multiple
→ polypoid lesions
→ small central ulceration
20.
21. • Type 2 — associated with Zollinger-Ellison
syndrome, in the setting of MEN-1
-6-8% gastric NETs
-Men=women
-develop in a hyperplasia-dysplasia-neoplasia
sequence
-arise from ECL cells
-stimulated by elevated serum gastrin
levels
22. Gastric NET
• Type 3
-sporadic, no association with hypergastrinemia.
-15-20% of gastric NETs
-solitary, and grow more rapidly.
-Present with metastasis at Dx
-M:F,3:1
23. Small bowel NETs
Small bowel NETs — incidence increased in part
due to increased detection on endoscopy and
imaging studies
• NETs surpassed adenocarcinomas as the most
common small bowel tumor.
• Patients usually present in their 60s or 70s.
• Commonly located in the ileum within 60 cm of
the ileocecal valve & 42% of GI-NETs
• 25% patients will have more than one small
bowel NET at the time of discovery.
24. Small bowel NET…
• Many are asymptomatic at presentation and
are found incidentally.
• If symptomatic ,abdominal pain(51%) followed
bowel obstruction(31%),abdominal
mass(17)and GI bleeding(11%).
• Metastases to LN/liver are common, even if
the primary tumor is <2 cm in size.
• Commonly presented with carcinoid
syndrome.
25. Small bowel NET…
• Pts with metastatic NET with unknown
primary, they can harbor occult primary in
the ileum.
• So exploration and palpation of the bowel
can allow detection of the sub mucosal
primary which feel like little pea in the bowel
wall.
26. • Appendix — NETs are the most common
neoplasms in the appendix.
• NET is discovered incidentally (1 in 300
appendectomies, commonly at the tip).
• Common at age of 40s or 50s
• more common in women
27. Hind gut NET
• Includes NET of transverse,descending colon &
rectum.
• Are non secretory(not associated with
carcinoid syndrome, even when metastatic)
• If symptomatic, it is same CR adenocarcinoma
( changes in bowel habits, bleeding)
28. • Colon — in pts at their 70s during evaluation
for abdominal pain, anorexia, or weight loss.
• Incidence of functioning tumors is very low.
• More on Rt side of colon.
29. • Rectum — majority are asymptomatic .
• Found incidentally on colonoscopy that is
performed for other reason.
• Accounts 27% of GIT-NETs,1-2% rectal tumors
• 75-85% are localized at diagnosis
30. METASTATIC TUMORS
• Regardless of primary site, NETs are
characterized by metastasize to the liver.
• Patients with liver metastases may experience
symptoms related to tumor burden (eg, pain,
jaundice, early satiety) or hormonal symptoms
(eg, flushing and diarrhea, the main symptoms
of carcinoid syndrome).
31.
32. PATHOPHYSIOLOGY
• Around 40 secretory products have been
identified in various NETs.
• The most prominent of these are:
-Serotonin - Tachykinins
-Histamine -Kallikrein
-Prostaglandin
33.
34. Tryptophan metabolism
• Altered metabolism of tryptophan occurs in
almost all patients with the carcinoid
syndrome.
• In normal subjects, approximately 1 % of
dietary tryptophan is converted to serotonin;
(↑ to 70% in pts with carcinoid syndrome).
• Serotonin is then metabolized to 5-
hydroxyindoleacetic acid (5-HIAA)
35.
36. Clinical features
• Can occur at any age, media age 63
• M:F, 48:52%
• Dx delayed for average 2yrs (can range for 20
yrs) due vague symptoms.
• The clinical presentation of carcinoid tumors far
underestimates their occurrence because many
are asymptomatic
• Symptoms are caused by local tumor growth,
metastatic spread or excess hormonal.
37. Carcinoid syndrome
• Symptoms mediated by various humoral factors.
Common in setting of liver metastasis b/c liver
failed to deactivate the products.
• Common mid gut, but lung & stomach NET
present with atypical carcinoid syndrome.
Flushing attack
Diarrhea
Cardiac manifestation
Wheezing and asthma like symptom
Retroperitoneal & intra-abdominal fibrosis
38. Cutaneous flushing
• Episodic flushing is the clinical hallmark of
carcinoid syndrome .
• occurs in 85 % of patients.
• Typical flush associated with midgut NET
• Begins suddenly and lasts for 30 sec to 30 min.
• Involves the face, neck, and upper chest,
which become red to violaceous or purple.
39. Cutaneous flush…
• Most episodes occur
spontaneously, but they
can be provoked by eating,
drinking alcohol, defecation,
emotional events, palpation
of the liver, and anesthesia.
• Carcinoid crisis:
40. Diarrhea
• present in 67% to 84%
• Occurs -with flushing(85% of cases)
-alone(15% of cases) .
• Described as watery and less commonly as
frothy bulky stool of steatorrhea.
• Number of stools ranges from 2 -30/day
• Most debilitating component of the syndrome
41. Cardiac valvular lesions
• occur i n 11-66%
• Carcinoid heart disease is characterized by
pathognomonic plaque-like deposits of fibrous
tissue.
• Common on right side of the heart because
inactivation of humoral substances by the lung
protects the left heart.
• Bronchospasm-10-20% of pts with the carcinoid
syndrome have wheezing and dyspnea, often
during flushing episodes.