The document discusses the cervix and cervical intraepithelial neoplasia (CIN). Some key points:
1) The cervix contains two types of epithelium that meet at the squamocolumnar junction (SCJ), which shifts locations throughout life. The transformation zone (TZ) is the area at risk for developing pre-cancerous and cancerous lesions.
2) CIN is characterized by abnormal cell growth in the cervix and is graded from I to III based on severity. Left untreated, some CIN lesions can progress to cervical cancer over many years.
3) Human papillomavirus (HPV) infection is required for cervical cancer but most infections clear on
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
Seminar presentation by student under supervision of endocrinology specialist from HRPZ. References as mentioned in the slides. Mostly from Malaysia CPG.
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
Seminar presentation by student under supervision of endocrinology specialist from HRPZ. References as mentioned in the slides. Mostly from Malaysia CPG.
endometrial stromal tumours review article
These tumours are very less in number. They are classified into endometrial stromal tumour, low grade endometrial stromal sarcoma, high grade stromal sarcoma and undifferentiated uterine sarcoma according to the 2014 WHO classification.
http://basur.name.tr/
Basur nedir?
Basur veya tıpta kullanılan ismi ile hemoroid halk arasında basur dışında mayasıl ya da babasıl gibi isimlerle de anılır. Hemoroid nedir sorusunun basit cevabına değinirsek, makattan dışarı doğru sarkan toplardamar, atardamar ve bağ dokusu yumrularıdır diyebiliriz. Basur normalde ağrı yapmaz fakat şiştiğinde, sert dışkı ve benzeri durumlarla zarar gördüğünde ya da iltihaplandığında hastalar için çok sorunlu bir hal alırlar.
A brief discussion over CA Cervix. All newest updates in management protocol and revised by reknowned gynecologistts. Very much helpful for both under and post graduate students/Doctors.
premalignant lesions of pelvis and cervix
cervical intra epithelial neoplasia
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cervical intra epithelial neoplasia
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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
- 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
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
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2. The cervix is a tubular structure. It is
composed of stromal tissue which is lined by
sequamous epithelium in the vagina
(ectocervix) and columnar epithelium within
the cervical canal (endocervix).
The meeting of the two types of the
epithelium is called squamocolumnar
junction SCJ and this is usually at the
ectocervix.
3. The position of the SCJ changes throughout the
reproductive years.
In children it lies at the ectocervix that is
just at the external os.
At puberty and during pregnancy it extends
outwards as the cervix enlarges and in adult
life it returns to the ectocervix through the
process of metaplasia
4. isan important area on the cervix which is
defined as the area where the original SCJ
was to the current SCJ and it includes areas
of metaplasia.
Occasionally, when the mucous columnar
epithelium is covered by the squamous
epithelium there is retention of the mucus-
this is called a nabothian follicle.
The transformation zone TZ is the site where
pre-malignancy and
malignancy develop.
5. CIN: cervical intraepithelial neoplasia,
Dysplasia: a histological term describing
architectural abnormalities within the tissue.
Dyskaryosis: a cytological term describing
the nuclear abnormalities- not synonymous
with dysplasia
6. CIN I: minimal dysplasia.
CIN II: moderate dysplasia.
CIN III: sever dysplasia or CIS carcinoma in
situ ( CIN III, sever dysplasia and CIS are all
different names for the same thing that is
early cervical cancer)
7. Metaplasia: a physiological process whereby
columnar epithelium is replaced by squamous
tissue in response to the acid environment of
the vagina.
Squamocolumnar junction SCJ: where
squamous and columnar tissue meets, this is
not fixed, but is affected by metaplasia.
8. Paps smear: or cervical smear- cytological
test described by Papanicolaou.
9. CIN is a condition characterized by new
cellular growth (neoplasia) in a normal tissue
Once CIN is diagnosed this alarm us that an
abnormal tissue has been diagnosed in the
cervix of that lady.
The most important causative factor is HPV
which could cause other combined genital
and anal cancer.
10. However, CIN is much more common than
the other types of genital neoplasia.
The tissue changes associated with CIN
signify presence of premalignant or
precancerous condition i.e. CIN is essentially
a precursor to invasive cervical cancer and is
collectively composed of cells that have
undergone abnormal individual changes that
is with abnormal mitotic activity and leads to
formation of a lesion in the cervix.
11. A revised classification has been introduced:
Low – grade lesion CIN I and HPV associated
changes with unknown but a likely low
progressive potential.
High-grade lesion CIN II and CIN III that is likely
to behave as cancer precursors.
Simpler classification is according to Bethesda
divided to:
Low grade squamous intraepithelial lesion (LSIL)
= CIN I.
High grade squamous intraepithelial lesion (HSIL)
= CIN II and CIN III
12.
13. Human papillomavirus HPV infection is the
essential prerequisite for the development of
cervical malignancy.
HPV infection is extremely common with up
to 80% of sexually active women being HPV
positive at some point during their lifetime.
14. Using the incidence of genital wart as a
marker, the incidence appears to be raising
five fold in the female population and eight
fold in male population with approximately
15% prevalence of the oncogenic HPV types
16 and 18.
However most infections are usually
transient with 90% of women clearing the
infection within 2 year and young competent
women are able to eliminate the infection.
15. Smoking reduces local cervical immunity.
Multiple sexual partners.
Having a partner with multiple sexual
partners or with sexually transmitted
disease.
Presence of other sexually transmitted
disease like HIV and genital herpes.
16. Long term use of contraceptive pill.
Immunosupression or use of anticancer
drugs.
Being born to mother used diethylstilbestrol.
17. Often it’s a symptomatic and diagnosed
during routine annual Pap smear,
non-specific:
Genital lesion (wart)
Abnormal lower genital bleeding.
Abnormal vaginal discharge.
Vague lower abdominal pain.
18. Metaplasia is a normal finding but this may
be disrupted by some factors like HPV,
smoking or immunosupression and etc.. And
lead to development of disorder squamous
epithelium called dysplasia which
characterized by:
Lack of normal maturation of cell as they
move from basal layer to superficial layer.
Large nuclei more available in size and
shape.
High mitotic activity means more rapidly
dividing cell.
19.
20. Severity of atypia.
Thickness of the epithelium involved.
CIN I means 1/3 of the epithelium from the
basal layer is involved.
CIN II means 2/3 of the epithelium from the
basal layer is involved.
CIN III means no maturation throughout the
full thickness.
21. Regression and progression of CIN may occur. Spontaneous
regression of low grade disease is common and is likely to
occur through the patient’s own cell mediated immunity.
High grade lesion is less likely to regress spontaneously
and requires treatment as there is risk of progression to
cancer.
22. 1 year Up to 5 years Up to 20 years
Persistent
infection CIN* 2/3
Initial
HPV
infection
CIN* 1
CANCER
CLEARED HPV INFECTION
*cervical intraepithelial neoplasia
23. If left untreated 20% of patients with high grade
abnormalities may develop cancer of cervix.
Reasons for this remain unclear but may include
reduced host immunity, oncogenic HPV and
smoking.
24. . Even the most sever CIN III take several many
years to change to cancer, this mean we can
apply screening test to do early detection of
premalignant condition and do appropriate
treatment and follow up.
25. Since 1988, the UK has offered population
based cervical screening for women. Women
aged 25 and 64 are tested routinely as
follow:
25 first test
25-49 every 3 years
50-64 every 5 years
64+ only screen those who have not
screened since age 50 or has recent
abnormal test
26. Originallythe “Pap” smear was introduced
by Papanicolou, where cell removed from the
cervix using a wooden spatula and placed on
glass slide and fixed. This was then examined
by a cytologist for the immature squamous
cells sheds from the area of the CIN.
27. Now Pap smear is superseded by liquid based
cytology where a small brush is used to
sample cells from the transformation zone
and the brush head placed in the fixative.
This is then spun down and read by
cytologist.
Normal cervical cell has small nuclei that is
flattened and pyknotic but abnormal cell has
large nuclei, cytological atypia and high N/C
28. An abnormal smear can show cells in
different degree of maturity (dyskaryosis)
and is divided into:
Mild dyskaryosis and borderline changes (low
grade)
Moderate and sever dyskaryosis (high grade)
Abnormal smears act as a mean of referring
the patient to the colposcopic clinic for
further assessment.
29. The sensitivity of cervical smear in picking
up women with CIN is around 70 percent,
however, as there is slow progression for
most women with CIN to cancer, if a lesion is
missed then this should be picked up on
subsequent smear. The specifity is 90%.
If the test is negative the patient is re-placed
on routine recall.
30. Ifthe smear shows low grade changes the
patient offered repeated test in next 3-6
months and managed accordingly and if test
shows high grade lesion the patient is
urgently referred to colposcopy.
31. Patient in lithotomy position under good
light,
start by inspection (spread labia and look for
any discharge or abnormal growth and ulcer)
then
insert warm vaginal speculum (not too hot),
do not use any lubricant , Vaseline or K-Y
jelly. The blades of speculum is kept closed
until is fully inserted.
32. Identify the SCJ that is the junction of pink
cervical skin and red endocervical canal then
use Ayres spatula is used to sample the
cervix
33. the concave end is used to fit the cervix and
should be rotated 360 degree
do not use too much force as it may cause
bleeding and pain
or too little force as it may lead to in
adequate sample).
The smear should be as thin as possible,
properly labeled,
allow fully drying before packaging and
spraying with fixative within 10-15 seconds.
34. Colposcopy is the outpatient examination of
the magnified cervix using a light source. It
is used for both diagnosis and treatment.
After inserting a speculum the cervix is
examined using Binocular operative
microscope under magnification (5-20 time).
35. 5% acetic acid is applied, as it causes
nucleoproteins within the cells to coagulate.
Therefore areas of increased cell turnover,
for example CIN will appear white.
36. Schiller’stest: by application of iodine,
areas of CIN lack the presence of
intracellular glycogen and therefore are stain
yellow as opposed to normal which stain
brown when iodine is applied.
37. Abnormal vascular pattern like punctuate or
mosiasim.
Biopsy is taken from the most abnormal site.
Colposcopy is deemed unsatisfactory if TZ is
not viewed adequately.
38. AsHPV is the main causative factor of CIN
and cervical cancer, recently detection of
HPV DNA in serum has been introduced to
screening program but this is still used under
research.
39. The aim of treatment is to make the post-
treatment test negative while minimizing
harm to the patient.
Low grade lesion will regress spontaneously
in over 60% of cases and usually they require
no treatment but careful follow up by with
colposcopy and cytology in next six month
after initial diagnosis.
If CIN is not resolve on follow up tests or
progress to high grade then treatment is
needed to avoid development of active
disease.
40. Could be out patient or in patient
Excisional methods like:
Loop electrosurgical excision (LEEP) and
large loop excision of TZ (LLETZ)
Laser TZ excision
Knife, laser or loop cone biopsy.
Hysterectomy.
42. Thefavored method is LLETZ which is done
as outpatient under local anesthesia and
take 15 minutes and should go 10 mm deep
down cervical stroma,
43. theadvantage is that its effective (95% test
negative post treatment), cost-effective and
provide specimen for histology. The
disadvantage may lead to poor obstetric
outcome as it may weaken the cervix
44. Cone biopsy or conization is both treatment
and diagnosis and done under anesthesia.
If hysterectomy is performed (usually after
completion of family), annual vault smears
should be performed.
45. Closefollow up after initial treatment by
regular cervical smear is needed after six
month then yearly for ten year, as the risk of
recurrence and cancer is remains.