This document discusses the history and scientific evidence around hormone replacement therapy (HRT) and its relationship to breast cancer. It notes that while early studies found HRT improved quality of life and reduced fractures, the large Women's Health Initiative studies from the 1990s-2000s found HRT increased risks of breast cancer, heart disease, and blood clots. However, sub-analysis indicated lower risks for younger women using HRT short-term. Current recommendations are that HRT may be used at lowest effective dose for shortest time to treat menopausal symptoms.
Advance in diagnosis & treatment of cancers has led to high cure rate & longer survival.
Nearly 1 in 12 cases detected before 40 years age.
Survivors have to face infertility or early menopause.
Panel Discussion on Post Menopausal Bleeding Lifecare Centre
Panel Discussion on Post Menopausal Bleeding
Moderator
Dr Jyoti Agarwal
Dr Meenakshi Sharma
Panelists
Dr Uma Rai
Dr Raj Bokaria
Dr Ila Gupta
Dr Vandana Gupta
Dr Renu Chawla
Dr Manju Barik
Dr Krishna Gopa
Dr Sharda Jain
Fertility preservation in Cancer patientsArunSharma10
The need for fertility preservation
Chemotherapeutic drugs according to gonadotoxicity level
Fertility preservation: subject of continuous review by experts
Non-oncological conditions requiring fertility preservation
Delayed childbearing
AVAILABLE PROCEDURES FOR FP
Embryo and oocyte cryopreservation
Advance in diagnosis & treatment of cancers has led to high cure rate & longer survival.
Nearly 1 in 12 cases detected before 40 years age.
Survivors have to face infertility or early menopause.
Panel Discussion on Post Menopausal Bleeding Lifecare Centre
Panel Discussion on Post Menopausal Bleeding
Moderator
Dr Jyoti Agarwal
Dr Meenakshi Sharma
Panelists
Dr Uma Rai
Dr Raj Bokaria
Dr Ila Gupta
Dr Vandana Gupta
Dr Renu Chawla
Dr Manju Barik
Dr Krishna Gopa
Dr Sharda Jain
Fertility preservation in Cancer patientsArunSharma10
The need for fertility preservation
Chemotherapeutic drugs according to gonadotoxicity level
Fertility preservation: subject of continuous review by experts
Non-oncological conditions requiring fertility preservation
Delayed childbearing
AVAILABLE PROCEDURES FOR FP
Embryo and oocyte cryopreservation
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
HPV Vaccination, Cerviocal Cancer : Do we need it
for Prevention of cervical cancer &
other HPV related diseasesm,
Presentation Outlines
Cervical cancer disease burden
Prevention with HPV vaccination
Vaccination of sexually active women
Opportunity of Postpartum HPV vaccination
Importance of genital warts prevention
Real world effectiveness data
Safety of HPV vaccine
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)Sujoy Dasgupta
Dr Sujoy Dasgupta invited to deliver a lecture on "RPL- ESHRE Guideline" in the Annual Conference of RCOG (Royal College of Obstetricians and Gynaecologists) IRC (International Representative Committee) India East held on 20-21 May, 2023
this presentation highlights the principles of uterine and ovarian transplantation. It explores the past and examines the current status for uterine and ovarian factor infertility.
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
Increase incidence of cancer during the reproductive age. Survival and cure rates of cancer are improving. Resulting in Increasing demand for fertility preserving interventions.
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
HPV Vaccination, Cerviocal Cancer : Do we need it
for Prevention of cervical cancer &
other HPV related diseasesm,
Presentation Outlines
Cervical cancer disease burden
Prevention with HPV vaccination
Vaccination of sexually active women
Opportunity of Postpartum HPV vaccination
Importance of genital warts prevention
Real world effectiveness data
Safety of HPV vaccine
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)Sujoy Dasgupta
Dr Sujoy Dasgupta invited to deliver a lecture on "RPL- ESHRE Guideline" in the Annual Conference of RCOG (Royal College of Obstetricians and Gynaecologists) IRC (International Representative Committee) India East held on 20-21 May, 2023
this presentation highlights the principles of uterine and ovarian transplantation. It explores the past and examines the current status for uterine and ovarian factor infertility.
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
Increase incidence of cancer during the reproductive age. Survival and cure rates of cancer are improving. Resulting in Increasing demand for fertility preserving interventions.
Menopausal can be a difficult transition for women, affecting their quality of life, relationships & health objectives. Learn how hormone replacement therapy can aid in this process.
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
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.
- 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.
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
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.
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
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
9. HRT
• MEDICAL TREATMENT IN
• SURGICALLY MENOPAUSAL
• PERIMENOPAUSAL
• POSTMENOPAUSAL
• AIM: TO MITIGATE DISCOMFORT CAUSED BY DIMINISHED CIRCULATING
ESTROGEN AND PROGESTERONE HORMONES IN MENOPAUSE
12. HISTORY.... TIMELINE
• 1821- French physician de Gardanne invented the term
menopause to describe the phenomenon of transition phase in
a woman’s life and the problems thereof
• doctors start to experimented with testicular extracts for men
and ovarian extracts for women
• Research leads to identifying estrogen and other hormones
13. HRT...TIMELINE
• 1941 – FDA approves estrogen for treatment of menopausal
symptoms
• First estrogen pill (Premarin) was introduced in US
14. HRT ...TIMELINE
In the 1950s, Ayerst Laboratories funded a massive campaign to educate doctors on menopause,
menopausal symptoms, and the consequences of estrogen loss—and on the use of its product
Premarin to treat menopausal symptoms
Emminen, the first replacement therapy to contain conjugated estrogens, was extracted in Ayerst
Laboratories from the urine of pregnant women and became commercially available in 1933
1942 Premarine (PREgnant MARes’s urINe) available in US
1980 Progestin developed to balance estrogen
15. 1950's Robert Wilson (Brooklyn gynecologist) published his best seller “Feminine Forever”
Robert Wilson argued in his book “Feminine Forever” that menopause was not natural age-related
condition and estrogen become long-term treatment for chronic ills of aging
16. SCIENTIFIC EVIDENT.....
• 1970 's New England Journal of Medicine published two articles that
found an increase risk of endometrial cancer
• Few studies show HRT prevents Osteoporosis
• 1976 Nurses’ Health Study showed a protective effect of HRT on CVD
• 1991 – Meta-Analysis of the effect of estrogen replacement therapy
showed increase risk of breast cancer
• 1998 (JAMA) – Results of Heart and Estrogen/Progestin Replacement
Study (HERS) published-
• 2002 (JAMA) – Risk and Benefits of Estrogen Plus Progestin in Healthy
Postmenopausal Women-Women’s Health Initiative (WHI)
17. WOMAN HEALTH INITIATIVES
• 15 YEARS STUDY 1991-2010
• 3 COMPONENT : RANDOMISED CLINICAL TRIAL
• 68,132 POSTMENOPAUSAL WOMEN AGE BETWEEN 50-79
• HORMONE THERAPY
• EFFECT OF HT ON PREVENTION OF HEART DISEASES AND OSTEOPOROSIS AND ANY ASSOCIATED
RISK OF BREAST CANCER.
• WOMEN TOOK EITHER HORMONE PILL OR PLACEBO (INACTIVE PILL)
• DIETARY MODIFICATION
• effect of low fat,high fruit,vegetable and grain diet on prevention on breast and colorectal cancer
and heart disease
• women either taking usuall diet or low-fat eatimg program
• CALCIUM /VITAMIN D
• effect of calcium and vitamin D supplementation on the prevention of osteoporosis related
fractures and colorectal. Women took calcium and vitamin D or placebo
18. WHI.....
• OBSERVATIONAL STUDY
• examine the relationship between life style,health and risk fators and specific
diseases outcome.
• COMMUNITY PREVENTION STUDY
19.
20. WHI.....
Estrogen +Progestin VS placebo
• Increased risk of heart attack
stroke & blood clots
• Increased risk of breast cancer
• Reduced resik of colorectal ca
• Fewer fractures
• No protectio against mild
cognitive impairment and
increased risk of dementia
Estrogen VS Placebo
• No difference in risk of heart
attack
• Increased risk of blood clots &
stroke
• Uncertain effect for breast
cancer
• No difference risk in colorectal ca
• Reduce risk of fracture
21.
22.
23. • Not differentiate for different types of synthetic progesterones used-
only MPA (medroxyprogesterone acetate).
• There are reseach paper showing significantly better outcomes in
brain,breast and cardiovascular parameters with estradiol plus
progesterone instead of MPA
'MPA : Contributes to much poor advice for Women' Bethea CL (Feb 2011).
Endocrinology.152(2):343-345.PMC 3037166.
24. AFTER WHI.. SUBANALYSIS...
• HRT AND CVD
• WOMEN HEALTH INITIATIVE (WHI) (Rossouw et al,JAMA 2007;297:1465-77)
• Younger women (50-59) taking HRT over a period of 10 years have shown no increased in
developing CVD
• THE WOMEN INTERNATIONAL STUDY OF LONG DURATION OF ESTROGEN AND
PROGESTIN AFTER MENOPAUSE (WISDOM)
• Women starting or restarting combined HRT have increased cardiovascular and
thromboembolic risk when treatment begins many years after menopause.
• Vickers et al,BMJ July 2007,doi:10.1136/bmj.39266.425069.AD
• Decreased risk of osteoporotic fracture and no difference in the risk of stroke or cancers
25. HRT & BREAST CANCER
• Studies have shown an association between E+P with breast cancer-
BUT it related to certain types of HRT and types of breast CA for a
women of a particular age group.
• The recorded risk are statistically small and appear to be linked with the
duration of therapy
Ravdin et al,NEJM 2007;356:1670-4
• Postmenopausal women who take E+P for at least 5 years are increasing
risk of breast ca. The risk is reduce once HRT is stop.
Chlebowski et al, NEJM 2009; 360 (6)573- 587
• Women should be aware that only a small percentage of combined E+P
users continue use for more than 5 years
Brett & Rueben,Obstet Gynecol 2003;102:1240-9
26. HRT & BREAST CANCER
• Risk factors for breaast cancer,such as hormones should be evaluated
in light of equally important risk factors related to lifestyle
Reid et al, JOGC 2009;31(1):S5-S8
• 34% of breast cancers could be avoided by making lifestyle changes at
the time of menopause
Sprague et al, Am J Epidemiol 2008:168(4):404-11
27.
28. HRT & UROGYNAE &SEXUAL HEALTH
• 50 % of postmenopausal women will suffer urogenital atrophy.Locally
applied hormone therapy generally more effective than systemic HRT
for urogenital symptoms, including dyspareunia, which can be critical
determinant of women interest in sex
Nappi RE,Davis SR. Climateric 2012 June 15(3) 267-74
• E+P is effective for relief of urinary tract symptoms related to
estrogen deficiency
• In postmenopausal women with urinary incontinence, HRT alone are
not beneficial
29. • The used of androgens in HRT.
Ziaei S,Moghasemi M & Faghihzadeh S (2010)
• Comparative effects of conventional hormone replacement therapy
and tibolone on climacteric symptoms and sexual dysfuction in
postmenopausal women
Climateric.13,147-156 doi:10.1016/j.maturitas.2006.04014
30. HRT & QUALITY OF LIFE....
• IN WHI- HRT use led to minimal improvement in QoL
• WHI study was not designed to look at women going through
menopause- underestimate the real extent of effect HRT on QoL-
hence suffering to many women
• Some studies indicates that HRT improves many domain of QoL -
mental health ,depressive symptoms,physical functioning,bodily pain
and sleep.
31. The WHI trial and related studies: 10 years later: A clinician
view.
Gurney ED,Nachtiqall MJ. J.Steroid Biochem Mol Biol 2014.Jul 142:4-11
• HRT IS SAFE & EFFECTIVE IN NEWLY MENOPAUSAL WOMEN
• Subanalysis shows more benefit than risk for symptom
control,prevention of bone mineral loss and fracture when HRT
started < 60 years of age.
• In hysterectomized women with estrogen alone,reduction in breast
cancer risk noted in all age groups
32. CURRRENT RECOMMENDATION..
• THE RISKS ASSOCIATED WITH THE USE OF HRT ARE LOW AND
DURATION OF USE MAY,IF NECESSARY BE EXTENDED, AS THE USE OF
HRT FOR MANY WOMEN PROVIDES WELCOME RELIEF FROM
DISTRESSING POSTMENOPAUSAL SYMPTOMS
• GRADY & BARRETT-CONNOR,BMJ 2007:334;860-1
• START EARLY,USE LOWEST DOSE FOR THE SHORTEST PERIODS OF TIME
(BENEFIT OUTWEIGHT THE RISK)
33. CURRENT RECOMMENDATION...
• WINDOW OF OPPORTUNITY- BEFORE THE AGE OF 60 AND/OR
WITHIN 10 YEARS OF MENOPAUSE
• THIS REDUCES THE RISK OF CORONARY HEART DISEASES AND OVERALL
MORTALITY ( 30%). HRT MORE EFFECTIVE FOR THIS COMPARE TO STATINS
AND ASPIRIN AND COST EFFECTIVE - HODIS et al 2008
• ADVISED ON TYPE,DOSE,MODE OF DELIVERY AND DURATION
• TAILOR TREATMENT TO INDIVIDUAL PATIENTS
34. CURRENT RECOMMENDATION...
• NO LONGER RECOMMENDED AS PRIMARY PREVENTION OR
TREATMENT OF DISEASES
• BREAST CANCER RISK INCREASES WITH THE USE BEYOND 5 YEARS
35. • HRT taken during perimenopause or initial years of menopause,
carries significantly fewer risks than previously published and reduces
all cause mortality in most patient scenarios
Santen, RJ; Utian,WH (2010). “Executive Summary: Postmenopausal
Hormone Therapy : An Endocrine Society Scientific Statement”. J Clin
Endocrinol Metab. 95 S1-S66 (Supplement 1).
36. MENOPAUSE 2017-UPDATE
BY AC OF ENDOCRINE
Endocr Pract 2017:Jul,23(7) 869-880
• The use of HRT in symptomatic women should be based on
consideration of all risk factor for CVD,age and time of menopause.
• The use of TRANSDERMAL HRT as compared to oral estrogen may be
considered less likely to produce thrombotic risk,stroke and coronary
artery diseases.
• Bioidentical hormone therapy is not recommended
• In women who are at significant risk from the use of HRT,the use of
selective serotonin re-uptake inhibitors (SSR-I) and other non
hormonal agents offer significant symptoms relief.
37. WHAT TO TELL PATIENT...
• MAINTAIN HEALTHY LIFESTYLE
• DISCUSS WITH DOCTOR
• BE FLEXIBLE, SHOULD BE WILLING TO EXPERIENCE WITH TREATMENT
OPTION
• TRY CONSERVATIVE MEASURE AND LIFESTYLE MODIFICATION FIRST
• CONSIDER HRT OR ALTERNATIVE THERAPY
• UNDERSTOOD THE RISK BUT DO NOT LIFE IN FEAR
• REMEMBER...QUALITY OF LIFE IS IMPORTANT
38. ALTERNATIVE TREATMENT...
• ANTIDEPRESSION
• GABAPENTIN
• BIOPHOSPHONATE & SERM
• PHYTOESTROGEN
• BIOIDENTICAL HORMONES
• FROM PLANTS
• NOT AN ASSURANCE OF SAFETY OR EFFICACY
• NOT FDA APPROVED
• SIGNIFICANT COST
• ACOG COMMITTEEOPINION NO 332,AUGUST 2012
• ACOG PRACTICE BULLETIN JUNE 2013
