This document discusses the diagnosis of growth hormone deficiency (GHD). It begins by outlining the objectives which are an introduction to short stature, indications for GHD investigations, GH testing methods including physiological and pharmacological tests, and international criteria for GHD diagnosis. It then provides details on the GH gene and physiological GH secretion patterns controlled by GHRH and somatostatin. The functions of GH and IGF/IGFBP systems are described. Various GH stimulation tests including pharmacological tests using insulin, L-dopa, arginine and GHRH are outlined. International criteria for GHD diagnosis incorporate auxological parameters, biochemical markers, and subnormal responses to provocative tests.
Congenital Adr Hyperplasia (CAH) can appear at any age from birth to puberty where it can lead to ambiguous genitalia. It is due to absolute or relative deficiency of 17 Hydroxylase or 21 Hydroxylase enzyme.
Liver function tests (LFT’s) are groups of laboratory blood assays designed to give information about the state of patients liver
They include
Liver enzymes (SGOT, SGPT, ALP, GGT etc.,)
Bilirubin(Direct and indirect)
Albumin
Prothrombin time / INR
Approach to Hypoglycemia in Children.pptxJwan AlSofi
Introduction
DEFINITION
Symptoms and Signs of Hypoglycemia
Sequelae of Hypoglycemia
Hormonal Signal
Regulation of serum glucose
Disorders of Hypoglycemia
Classification of Hypoglycemia in Infants and Children
DIAGNOSIS
EMERGENCY MANAGEMENT
What is achondroplasia, definition , etiology ,types of dwarfism , genetic background,clinical presentations ,history and clinical examination , differential diagnosis ,diagnostic tests ,radiological findings ,CT scan and MRI , Medical care and role of growth hormone ,Surgical care and consultation,
Congenital Adr Hyperplasia (CAH) can appear at any age from birth to puberty where it can lead to ambiguous genitalia. It is due to absolute or relative deficiency of 17 Hydroxylase or 21 Hydroxylase enzyme.
Liver function tests (LFT’s) are groups of laboratory blood assays designed to give information about the state of patients liver
They include
Liver enzymes (SGOT, SGPT, ALP, GGT etc.,)
Bilirubin(Direct and indirect)
Albumin
Prothrombin time / INR
Approach to Hypoglycemia in Children.pptxJwan AlSofi
Introduction
DEFINITION
Symptoms and Signs of Hypoglycemia
Sequelae of Hypoglycemia
Hormonal Signal
Regulation of serum glucose
Disorders of Hypoglycemia
Classification of Hypoglycemia in Infants and Children
DIAGNOSIS
EMERGENCY MANAGEMENT
What is achondroplasia, definition , etiology ,types of dwarfism , genetic background,clinical presentations ,history and clinical examination , differential diagnosis ,diagnostic tests ,radiological findings ,CT scan and MRI , Medical care and role of growth hormone ,Surgical care and consultation,
Crianças com baixa estatura que querem crescer mais devem efetuar exames bem ...Van Der Häägen Brazil
Considerações similares são relacionadas aos testes fisiológicos, como exercícios monitorados e amostras sequenciais noturnas (que dependem de internamento). Ainda mais, a pouca especificidade destes testes, a falta de padronização e os valores diagnósticos aceitos, além da extrema variabilidade entre os testes laboratoriais para a dosagem do GH faz com que estes testes tenham baixa efetividade, para uma grande percentagem de pacientes
Growth Hormone Deficiency (GHD) can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. Growth harmone (GH) therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.
Ovarian stimulation for assisted reproductive technology(ART) cycle aims to provide multiple pre-ovulatory follicles for oocyte collection.
The components of a conventional ART cycle-
Induction of multi-follicular growth with exogenous gonadotropins.
Prevention of endogenous leutinizing hormone (LH) surge by using Gonadotropin releasing hormone(GnRH) analogs.
inducing endogenous LH surge or mimicking it with exogenous human chorionic gonadotropin(hCG) for oocyte maturation.
This concept is known as “CONTROLLED OVARIAN STIMULATION”
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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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
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
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.
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.
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.
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
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
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
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
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Growth hormone testing
1. Diagnosis of GH
deficiency
Abdulmoein Al-Agha,
FRCPCH (UK)
Professor & Head of
Pediatric Endocrinology,
King Abdulaziz University
Hospital,
www.aagha.kau.edu.sa
2. Objectives
• Introduction of short stature.
• Indications of GHD investigations?
• GH testing:
• Physiological.
• Pharmacological.
• Newer strategies for assessment of GH status (using GHRH).
• Sex – steroid priming for GH provocative tests.
• The IGF/ IGFBP system in childhood.
• International Criteria for the diagnosis of GHD.
3. GH Gene
• The human genome contains five GH-related genes:
• human growth hormone (hGH).
• human chorionic growth prolactin-A.
• human chorionic growth prolactin-B.
• human chorionic growth prolactin-like.
• human auxin variant.
• They have the same transcriptional direction but are separated by a 6-13 kb
long gene interval.
• The five genes have about 90- 99% sequence homology, and each gene
contains 5 exons and 4 introns.
• The five genes are grouped together to form a gene cluster, which is located
on the long arm q22-24 of chromosome 17.
4. Physiological secretion of GH
• GH is secreted in a pulsating manner, and its secretion has fluctuation, with
the largest change range at night and the most vigorous secretion at
puberty, and then gradually decreases with the increase of age.
• The secretion of growth hormone in pituitary gland is controlled by two
hypothalamic peptides: GH releasing hormone (GHRH) and somatotropin
release inhibiting factor (SRIF).
• GHRH is the main regulatory factor of GH, which promotes the transcription
and release of GH gene.
• Somatostatin inhibits the secretion of growth hormone by inhibiting the
growth nutrition response of growth hormone to GHRH.
• The third factor is Ghrelin, which stimulates growth hormone secretion,
although its role in physiological regulation of growth hormone secretion is
controversial.
5. Growth Hormone Functions
• Human growth hormone has a wide range of physiological functions.
• HGH mainly affects the growth, metabolism and differentiation of cells by affecting the growth
axis of GH-IGF1, promotes protein synthesis.
• Increase Muscle Strength.
• The release of growth hormones is crucial to regulating bone growth, especially during puberty.
• Increased height in childhood is one of the most important roles of growth hormone.
• GH activates the MAPK/ERK pathway by binding to receptors on target cells and stimulates the
division and proliferation of chondrocytes.
• Human growth hormone speeds bone regeneration, making it a key part of bone healing.
• HGH can promote the breakdown of fat in animals.
• Impaired secretion of human growth hormone will result in loss of lipolytic function.
• Insulin resistance and visceral/abdominal obesity are common in adults with hormonal growth
defects.
• Human growth hormone can play a therapeutic role in helping obese people lose weight.
6. Growth Hormone Functions
• Studies have shown that growth hormone deficiency can alter lipoprotein
metabolism and increase the risk of cardiovascular disease.
• Growth hormone plays a vital role in mental and emotional health and
maintaining high energy levels.
• Adults with growth hormone deficiency are more likely to suffer from depression.
• Studies have shown that growth hormone therapy in adults with growth hormone
deficiency can improve their cognitive function and mood.
• Growth hormone can regulate immune function, increase thymocyte activity,
affect B cell development and function, and enhance NK killing activity.
• Growth hormone is involved in the development, differentiation and functional
integration of brain neurons.
• Numerous studies have shown that growth hormone can stimulate the
regeneration of neurons, astrocytes, endothelial cells and oligodendrocytes, as
well as the formation of myelin sheath and dendritic diversity.
7. Indications of GH stimulation test
• Standing height > 2 SD below the mean for chronological age, sex &
ethnic background.
• Growth velocity < 5 cm / year.
• Children with decelerating growth even they are still on normal percentiles.
• Children with delayed BA.
• Children who have hypothalamic-pituitary dysfunction (e.g.,
microphallus, septo-optic dysplasia, intracranial tumor, history of
cranial irradiation).
• Children who have deficits in other hypothalamic- pituitary hormones
(congenital or acquired).
9. Growth Hormone physiological secretion
• GH is a single chain polypeptide of 191 amino acid residues with two
disulphide bridges.
• Secreted by the anterior pituitary gland under the control of GHRH,
somatostatin & Ghrelin.
• GH is secreted in approximately 8 peaks /day with low basal levels in
between these pulses.
• Nearly 50 % of the daily GH secretion occurs during the early hours of the
night following the onset of deep sleep.
• Various pharmacological & physiological factors are potent stimulators of
GH secretion:
• Exercise, stress, high protein meal & prolonged fasting.
10. The IGF system in childhood
• The IGFs are related GH-dependent peptide factors believed to
mediate many of the anabolic and mitogenic actions of GH.
• The serum level of the major GH-dependent peptide IGF-1 is stable
during the day, due mainly to the complexing of IGF peptides with a
family of IGF-binding proteins (IGFBPs).
• The potential for assessing GH status with a single estimation of
the circulating IGF-1 level proved attractive and gave rise to the
hope that eventually dynamic GH provocation tests may become
unnecessary.
11. • Children & adolescents with variety of illnesses & metabolic disorders have
altered circulating IGF-1 & IGFBP levels.
• Exogenous obesity, anorexia nervosa, celiac disease, leukemia, other types of
cancer & GH deficiency, this axis can be altered.
• Some reported cases of children with non- detectable levels of circulating IGF-1
that yet normal height and growth velocity, or with non-detectable levels of GH
yet normal growth & IGF-1 levels, raises many questions marks.
• Additional problems remain, including lack of specificity.
• The IGF-1 level is influenced markedly by age & pubertal development.
• Use of age & puberty-corrected IGF-I values improves the diagnostic use of IGF-1.
• Low concentrations of IGF-I occur in normal children < 5 years of age.
• To have better use of IGF-1 in the screening test, should be done along with
IGFBP3.
12. IGFBPs
• Of the six known IGFBPs, IGFBP-3 is normally the major serum carrier
of IGF peptides.
• IGFBP-3 circulates as part of a ternary complex consisting of IGFBP-3,
IGF peptide & acid-labile subunit.
• Both acid-labile subunit & IGFBP-3 are GH dependent.
• Age dependency of IGFBP-3 is less striking than for IGF-1.
• Similarly, the influence of nutritional status on IGFBP-3 levels is less than
for IGF-1 level.
• Low IGF-1 & IGFBP-3 concentrations are reliable guides to the diagnosis
of severe GHD, providing the investigator the alternative possibilities of
malnutrition, hypothyroidism, liver disease & GH insensitivity.
13. GH secretion physiological assessment
• GH secretion assessment by physiological circumstances e.g., exercise
test, 24-h GH profiling & urinary GH estimation in the diagnosis of
GHD.
• The exercise test is safe, simple to perform as an outpatient
procedure and inexpensive.
• Unfortunately, an absent GH response to exercise may occur in
up to 1/3 of normal prepubertal children (i.e., 33% false
positive).
• The exercise test, however, is no longer used in clinical practice.
15. GH provocation testing
• There is considerable variability in the different types of assay used
to measure GH, so each laboratory needs to set its own threshold
for defining GHD.
• This adds to the difficulty & variability in the diagnosis of GHD
worldwide.
• Generally, a peak GH response of < 20 mU/L or < 10ng/ml is
considered evidence of GHD.
• There are also, false positive & negative results with any of these
tests so that "normal" children with normal growth patterns can fail
to have good GH response on single agent of pharmacological testing
16. • The first established pharmacological stimulus introduced for
assessment of GH status was insulin tolerance test (ITT).
• Advantages of this test include:
• ACTH-adrenal axis can be assessed at the same time.
• Considered to be a powerful stimulus to GH release.
• Induces moderate hypoglycemia, which is sufficient to elicit
maximal GH responses.
• The main disadvantages include:
• Lack of normative data in children, a characteristic it shares
with many other pharmacological tests.
• Unpleasant nature of the test, which in inexperienced hands is
frankly dangerous.
17. • Other pharmacological stimuli were introduced afterward including:
• L-dopa , Arginine , glucagon , propranolol, Clonidine , GHRH &
Pyridostigmine.
• A variety of combinations of these tests has been used.
• In some centers, two provocative stimuli are administered
sequentially or in combination.
• Combination approach may be time-saving & more economical.
• No evidence to suggest, the results are more meaningful if the
tests were performed in combination rather than individually.
18. Assessment of GH status (using GHRH)
• The effects of the commonly used provocative tests of GH release,
such as arginine, clonidine & ITT, are mediated through activation of
α- receptors in the hypothalamus.
• The availability of GHRH provides strong means of assessing the
secretory capacity of the pituitary somatotroph directly.
• The use of GHRH in combination with substances that act via
inhibition of endogenous somatostatin, such as pyridostigmine
(cholinesterase inhibitor) & arginine, has been explored to provoke a
much greater GH response than other agents used in GH combined
stimulation tests.
19. International Criteria of GHD
• Standing height >2 SD below the mean for chronological age,
sex & ethnicity.
• GV ≤ 4 cm/year (prepubertal).
• BA ≥ 2 years behind CA.
• Low IGF-1 & BP3.
• Subnormal GH secretion in response to at least two provocative
stimuli when sampled over several hours.
• Increased IGF1 levels after few days of GH treatment.
• Increased growth velocity after few months of GH treatment.