Global Medical Cures™| STROKE SCALE
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Short 10 Min Presentation on Speech Audiogram & Audiometry. Delivered by Abubakkar Raheel (4th Year Mbbs)
Frontier Medical College, Abbottabad, Pakistan.
ATLS is two days course for those who manage trauma patients. These protocols have been followed by hospitals all over the world to treat trauma patients quickly and efficiently.
Global Medical Cures™ | Womens Health- ORAL HEALTH
Caring for your oral health, understanding oral health issues specific to women, and learning how to recognize oral health problems.
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Short 10 Min Presentation on Speech Audiogram & Audiometry. Delivered by Abubakkar Raheel (4th Year Mbbs)
Frontier Medical College, Abbottabad, Pakistan.
ATLS is two days course for those who manage trauma patients. These protocols have been followed by hospitals all over the world to treat trauma patients quickly and efficiently.
Global Medical Cures™ | Womens Health- ORAL HEALTH
Caring for your oral health, understanding oral health issues specific to women, and learning how to recognize oral health problems.
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Sun Safety for America's Youth Toolkit (Skin Cancer P...Global Medical Cures™
Global Medical Cures™ | Sun Safety for America's Youth Toolkit (Skin Cancer Prevention)
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | COLORECTAL CANCER TESTS SAVE LIVES
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | African American Men & High Blood Pressure ControlGlobal Medical Cures™
Global Medical Cures™ | African American Men & High Blood Pressure Control
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Lactose Intolerance & Osteoporosis
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | New York State Disability Chartbook
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Helping your Overweight Child
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Medicines for Rheumatoid Arthritis
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Health and Retirement Study
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | What I Need to Know about CONSTIPATION
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Your Guide to Lowering High Blood Pressure
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Configuration Manager: zero-touch & Windows 8.1 (WinDays14)Tomica Kaniski
Presentation about zero-touch Windows 8.1 deployment using System Center 2012 R2: Configuration Manager product, delivered at Microsoft WinDays14 conference in Croatia.
Global Medical Cures™ | Womens Health- HEALTHY AGING
Dealing with menopause, understanding common signs of aging, and living with chronic health conditions.
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Older Americans- Key Indicators of Well Being Global Medical Cures™
Global Medical Cures™ | Older Americans- Key Indicators of Well Being
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Global Medical Cures™ | Womens Health- HEART DISEASE
Understanding risk factors of this number one killer of women, as well as heart attack signs, common tests, treatments, and living with heart disease.
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | AGING- Concerned about CONSTIPATION ?
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Sun Safety & Precautions to Minimize Skin CancerGlobal Medical Cures™
Global Medical Cures™ | Sun Safety & Precautions to Minimize Skin Cancer
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Crestor- Post Marketing Adverse Event ReviewGlobal Medical Cures™
Global Medical Cures™ | Crestor- Post Marketing Adverse Event Review
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Is my Child at risk for KIDNEY DISEASE?
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Lipid Screening in Childhood for Detection of Multifactorial DyslipidemiaGlobal Medical Cures™
Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Skin Cancer Screening
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Global Medical Cures™ | USA Chartbook on HealthCare for Blacks
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Global Medical Cures™ | Staggering Increase in Generic Drugs PricingGlobal Medical Cures™
Global Medical Cures™ | Staggering Increase in Generic Drugs Pricing
Disclaimer
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Dangers & Consequences of Marijuana Abuse
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Harmful Interactions
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Medicines for Treating Depression
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Women & Depression
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | National Strategy for Combating Antibiotic Resistant ...Global Medical Cures™
Global Medical Cures™ | National Strategy for Combating Antibiotic Resistant Bacteria
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | PCAST Report- Combating Antibiotic ResistanceGlobal Medical Cures™
Global Medical Cures™ | PCAST Report- Combating Antibiotic Resistance
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Physical Activity Guidelines for Americans
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Dietary Guidelines for Americans
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Aging and your Eyes
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Help your Child gain control over Asthma
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Drugs approved for Bone Cancer
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Drugs approved for Breast Cancer
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™| Drugs approved for Head and Neck Cancer
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Drugs approved for Non Hodgkin Lymphoma
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™| Drugs approved for Pancreatic Cancer
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Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Global Medical Cures™ | Drugs approved for LUNG CANCER
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
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.
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
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
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
2. Administer stroke scale items in the
order listed. Record performance in
each category after each subscale exam.
Do not go back and change scores.
Follow directions provided for each
exam technique. Scores should reflect
what the patient does, not what the
clinician thinks the patient can do.
The clinician should record answers while
administering the exam and work quickly.
Except where indicated, the patient
should not be coached (i.e., repeated
requests to patient to make a
special effort).
Instructions
Level of Consciousness:
The investigator must choose a response
if a full evaluation is prevented by such
obstacles as an endotracheal tube, language
barrier, orotracheal trauma/bandages. A 3 is
scored only if the patient makes no movement
(other than reflexive posturing) in response to
noxious stimulation.
Scale Definition
Level of Consciousness
0 Alert; keenly responsive.
1
Not alert; but arousable by minor
stimulation to obey, answer,
or respond.
2
Not alert; requires repeated
stimulation to attend, or is
obtunded and requires strong
or painful stimulation to make
movements (not stereotyped).
3
Responds only with reflex motor
or autonomic effects, or totally
unresponsive, flaccid, and areflexic.
1aInstructions
Score
3. LOC Questions:
The patient is asked the month and his/her
age. The answer must be correct — there is
no partial credit for being close. Aphasic and
stuporous patients who do not comprehend
the questions will score 2. Patients unable
to speak because of endotracheal intubation,
orotracheal trauma, severe dysarthria from any
cause, language barrier, or any other problem
not secondary to aphasia are given a 1. It
is important that only the initial answer be
graded and that the examiner not “help” the
patient with verbal or non-verbal cues.
Scale Definition
Level of Consciousness
0 Answers both questions correctly.
1 Answers one question correctly.
2 Answers neither question correctly.
1bInstructions
LOC Commands:
The patient is asked to open and close
the eyes and then to grip and release
the non-paretic hand. Substitute
another one-step command if the hands
cannot be used. Credit is given if an
unequivocal attempt is made but not
completed due to weakness. If the
patient does not respond to command,
the task should be demonstrated to
him or her (pantomime), and the result scored
(i.e., follows none, one, or two commands).
Patients with trauma, amputation, or
other physical impediments should be
given suitable one-step commands.
Only the first attempt is scored.
Scale Definition
Level of Consciousness
0 Performs both tasks correctly.
1 Performs one task correctly.
2 Performs neither task correctly.
1cInstructions
Score Score
4. Best Gaze:
Only horizontal eye movements will be tested.
Voluntary or reflexive (oculocephalic) eye
movements will be scored, but caloric testing
is not done. If the patient has a conjugate
deviation of the eyes that can be overcome
by voluntary or reflexive activity, the score
will be 1. If a patient has an isolated
peripheral nerve paresis (CN III, IV, or VI),
score a 1. Gaze is testable in all aphasic
patients. Patients with ocular trauma,
bandages, pre-existing blindness, or other
disorder of visual acuity or fields should be
tested with reflexive movements, and a choice
made by the investigator. Establishing eye
contact and then moving about the patient
from side to side will occasionally clarify the
presence of a partial gaze palsy.
Scale Definition
Best Gaze
0 Normal.
1
Partial gaze palsy; gaze is abnormal
in one or both eyes, but forced
deviation or total gaze paresis is
not present.
2
Forced deviation, or total
gaze paresis is not overcome by the
oculocephalic maneuver.
2Instructions
Visual:
Visual fields (upper and lower quadrants) are
tested by confrontation, using finger counting
or visual threat, as appropriate. Patients may
be encouraged, but if they look at the side of
the moving fingers appropriately, this can
be scored as normal. If there is unilateral
blindness or enucleation, visual fields in the
remaining eye are scored. Score 1 only if a
clear-cut asymmetry, including quadrantanopia,
is found. If patient is blind from any cause,
score 3. Double simultaneous stimulation is
performed at this point. If there is extinction,
patient receives a 1, and the results
are used to respond to item 11.
Scale Definition
Visual
0 No visual loss.
1 Partial hemianopia.
2 Complete hemianopia.
3 Bilateral hemianopia (blind including
cortical blindness).
3Instructions
Score Score
5. Facial Palsy:
Ask — or use pantomime to encourage — the
patient to show teeth or raise eyebrows and
close eyes. Score symmetry of grimace in
response to noxious stimuli in the poorly
responsive or non-comprehending patient.
If facial trauma/bandages, orotracheal tube,
tape, or other physical barriers obscure
the face, these should be removed to the
extent possible.
Scale Definition
Facial Palsy
0 Normal symmetrical movements.
1 Minor paralysis (flattened nasolabial
fold, asymmetry on smiling).
2 Partial paralysis (total or near-total
paralysis of lower face).
3
Complete paralysis of one or both
sides (absence of facial movement in
the upper and lower face).
4Instructions
Motor Arm:
The limb is placed in the appropriate position:
extend the arms (palms down) 90 degrees
(if sitting) or 45 degrees (if supine). Drift is
scored if the arm falls before 10 seconds. The
aphasic patient is encouraged using urgency
in the voice and pantomime, but not noxious
stimulation. Each limb is tested in turn,
beginning with the non-paretic arm. Only
in the case of amputation or joint fusion at
the shoulder, the examiner should record the
score as untestable (UN) and clearly write the
explanation for this choice.
Motor Arm
5Instructions Scale Definition
Score
5a
5b Score
Score
Left Arm
Right Arm
0 No drift; limb holds 90 (or 45) degrees
for full 10 seconds.
1
Drift; limb holds 90 (or 45) degrees,
but drifts down before full 10 seconds;
does not hit bed or other support.
2
Some effort against gravity; limb
cannot get to or maintain (if cued) 90
(or 45) degrees, drifts down to bed,
but has some effort against gravity.
3 No effort against gravity; limb falls.
4 No movement.
Amputation or joint fusion, explain:
UN
6. Motor Leg:
The limb is placed in the appropriate position:
hold the leg at 30 degrees (always tested
supine). Drift is scored if the leg falls before
5 seconds. The aphasic patient is encouraged
using urgency in the voice and pantomime but
not noxious stimulation. Each limb is tested
in turn, beginning with the non-paretic leg.
Only in the case of amputation or joint fusion
at the hip, the examiner should record the
score as untestable (UN) and clearly write the
explanation for this choice.
Motor Leg
6Instructions
Limb Ataxia:
This item is aimed at finding evidence of a
unilateral cerebellar lesion. Test with eyes
open. In case of visual defect, ensure testing
is done in intact visual field. The finger-
nose-finger and heel-shin tests are performed
on both sides, and ataxia is scored only if
present out of proportion to weakness. Ataxia
is absent in the patient who cannot under-
stand or is paralyzed. Only in the case of
amputation or joint fusion, the examiner
should record the score as untestable (UN)
and clearly write the explanation for this
choice. In case of blindness, test by having
the patient touch nose from extended arm
position.
Scale Definition
Limb Ataxia
0 Absent.
1 Present in one limb.
2 Present in two limbs.
Amputation or joint fusion, explain:
7InstructionsScale Definition
Score
6a
6b Score
Score
Left Leg
Right Leg
0 No drift; leg holds 30-degree position
for full 5 seconds.
1 Drift; leg falls by the end of the 5-
second period but does not hit the bed.
2
Some effort against gravity; leg falls
to bed by 5 seconds but has some
effort against gravity.
3 No effort against gravity; leg falls to
bed immediately.
4 No movement.
Amputation or joint fusion, explain:
UNUN
7. Sensory:
Sensation or grimace to pinprick when tested,
or withdrawal from noxious stimulus in the
obtunded or aphasic patient. Only sensory
loss attributed to stroke is scored as abnormal
and the examiner should test as many body
areas [arms (not hands), legs, trunk, face]
as needed to accurately check for hemisensory
loss. A score of 2, “severe or total sensory
loss,” should only be given when a severe
or total loss of sensation can be clearly
demonstrated. Stuporous and aphasic patients
will, therefore, probably score 1 or 0. The
patient with brainstem stroke who has bilateral
loss of sensation is scored 2. If the patient
does not respond and is quadriplegic, score 2.
Patients in a coma (item 1a=3) are automati-
cally given a 2 on this item.
Scale Definition
Sensory
0 Normal; no sensory loss.
1
Mild-to-moderate sensory loss;
patient feels pinprick is less sharp
or is dull on the affected side; or
there is a loss of superficial pain
with pinprick, but patient is aware
of being touched.
2
Severe or total sensory loss; patient
is not aware of being touched in the
face, arm, and leg.
8Instructions
Best Language:
A great deal of information about
comprehension will be obtained during the
preceding sections of the examination. For
this scale item, the patient is asked to
describe what is happening in the attached
picture, to name the items on the attached
naming sheet, and to read from the attached
list of sentences. Comprehension is judged
from responses here, as well as to all of the
commands in the preceding general neurological
exam. If visual loss interferes with the tests,
ask the patient to identify objects placed in
the hand, repeat, and produce speech. The
intubated patient should be asked to write.
The patient in a coma (item 1a=3) will
automatically score 3 on this item. The examiner
must choose a score for the patient with stupor
or limited cooperation, but a score of 3 should
be used only if the patient is mute and follows
no one-step commands.
Best Language
9Instructions Scale Definition
Score Score
0 No aphasia; normal.
1
Mild-to-moderate aphasia; some obvious
loss of fluency or facility of comprehension,
without significant limitation on ideas
expressed or form of expression. Reduction
of speech and/or comprehension, however,
makes conversation about provided materials
difficult or impossible. For example, in
conversation about provided materials,
examiner can identify picture or naming card
content from patient’s response.
2
Severe aphasia; all communication is
through fragmentary expression; great need
for inference, questioning, and guessing by
the listener. Range of information that can
be exchanged is limited; listener carries
burden of communication. Examiner cannot
identify materials provided from patient
response.
3 Mute, global aphasia; no usable speech
or auditory comprehension.
8. Dysarthria:
If patient is thought to be normal, an
adequate sample of speech must be obtained
by asking patient to read or repeat words from
the attached list. If the patient has severe
aphasia, the clarity of articulation of
spontaneous speech can be rated. Only if the
patient is intubated or has other physical
barriers to producing speech, the examiner
should record the score as untestable (UN) and
clearly write the explanation for this choice.
Do not tell the patient why he/she is being
tested.
Scale Definition
Dysarthria
0 Normal.
1
Mild-to-moderate dysarthria;
patient slurs at least some words
and, at worst, can be understood
with some difficulty.
2
Severe dysarthria; patient’s speech
is so slurred as to be unintelligible
in the absence of or out of
proportion to any dysphasia, or is
mute/anarthric.
Intubated or other physical barrier,
explain:
10Instructions
Extinction and Inattention (formerly Neglect):
Sufficient information to identify neglect may
be obtained during the prior testing. If the
patient has a severe visual loss preventing
visual double simultaneous stimulation, and
the cutaneous stimuli are normal, the score is
normal. If the patient has aphasia but does
appear to attend to both sides, the score is
normal. The presence of visual spatial neglect
or anosagnosia may also be taken as evidence
of abnormality. Since the abnormality is
scored only if present, the item is never
untestable.
Scale Definition
Extinction and Inattention
0 No abnormality.
1
Visual, tactile, auditory, spatial, or
personal inattention, or extinction to
bilateral simultaneous stimulation in
one of the sensory modalities.
2
Profound hemi-inattention or extinction
to more than one modality; does not
recognize own hand or orients to only one
side of space.
11Instructions
Score Score
UN
9.
10. You know how.
Down to earth.
I got home from work.
Near the table in the dining room.
They heard him speak on the
radio last night.
MAMA
TIP – TOP
FIFTY – FIFTY
THANKS
HUCKLEBERRY
BASEBALL PLAYER