- Hot flashes are characterized by excessive vasodilatation of peripheral vasculature in response to a small increase in core body temperature, resulting in sensations of heat. They can be managed through lifestyle changes like diet modification, exercise, and stress relief techniques.
- For mild cases, avoiding triggers and lifestyle changes may be sufficient. For moderate to severe cases, herbal medications like black cohosh can be tried. If ineffective, SSRIs/SNRIs like escitalopram are first-line pharmacological options. Gabapentin or clonidine may be used if SSRIs/SNRIs provide inadequate relief or side effects.
- Management involves identifying triggers, incorporating
OSCE REVISION IN OBSTETRICS AND GYNECOLOGY 2015,NEARLY COVERING COURSE CURRICULUM .Prepared by Dr Manal Behery.Professor of OB&Gyne .Faculty of medicine,Zagazig University
Colposcopy training part 1 ,DR. SHARDA JAIN Dr. Jyoti Agarwal / Dr. Jyoti Bha...Lifecare Centre
Definition used in the consensus guidelines ASCCP +24 organizations 2013
Colposcopy
Colposcopy is the examination of the cervix , vagina and, in some instances the vulva, with the colposcope after the application of a 3--5% acetic solution coupled with obtaining colposcopically – directed biopsies of all lesions suspected of representing neoplasia
Contracted pelvis, CEPHALOPELVIC DISPROPORTION, PELVIC ABNORMALITY, CPD, TYPES OF PELVIS , TYPES OF PELVIS AND ITS OUT COME, MECHANISM OF LABOUR IN CONTRACTED PELVIS, DIAGNOSIS OF CPD, DIAGNOSIS and MANAGEMENT OF CONTRACTED PELVIS, PELVIMETRY, PELVIC ASSESSMENT, TRIAL OF LABOUR
OSCE REVISION IN OBSTETRICS AND GYNECOLOGY 2015,NEARLY COVERING COURSE CURRICULUM .Prepared by Dr Manal Behery.Professor of OB&Gyne .Faculty of medicine,Zagazig University
Colposcopy training part 1 ,DR. SHARDA JAIN Dr. Jyoti Agarwal / Dr. Jyoti Bha...Lifecare Centre
Definition used in the consensus guidelines ASCCP +24 organizations 2013
Colposcopy
Colposcopy is the examination of the cervix , vagina and, in some instances the vulva, with the colposcope after the application of a 3--5% acetic solution coupled with obtaining colposcopically – directed biopsies of all lesions suspected of representing neoplasia
Contracted pelvis, CEPHALOPELVIC DISPROPORTION, PELVIC ABNORMALITY, CPD, TYPES OF PELVIS , TYPES OF PELVIS AND ITS OUT COME, MECHANISM OF LABOUR IN CONTRACTED PELVIS, DIAGNOSIS OF CPD, DIAGNOSIS and MANAGEMENT OF CONTRACTED PELVIS, PELVIMETRY, PELVIC ASSESSMENT, TRIAL OF LABOUR
Psycotropics, anti psycotics 1st and second generation,anti parkinsons, anti depressants mood stabilizers, sedative hypnotics side effects, management of side effects
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.
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
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.
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
- 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
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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.
2. Symptoms
• Hot flashes can occur day or night; when they
occur at night, they are called night sweats.
• Each episode lasts 3–10 minutes and can recur
with varying frequency .
• Some women experience hot flashes hourly or
daily, whereas for others they may occur
occasionally.
• Furthermore, the majority of women have hot
flashes for 1–2 years, but ∼15% may have
persistent hot flashes for up to 30 years.
3. The Japanese experience (hotto furasshu)
• They asked the Japanese women (and their physicians) how they would describe this time of life
and the symptoms they experienced.
• The respondents used a combination of 3 terms :
Sudden feeling of heat
Feeling hot or flushed
Rush of blood to the head
4. PATHOPHYSIOLOGY
• Hot flashes (HFs) are characterized by excessive vasodilatation of peripheral vasculature to lose heat in
setting of abnormal hypothalamic thermoneutral zone.
• While normal women initiate mechanisms of heat loss, once core body temperature increases by 0.4°C,
women with HFs initiate vasodilatory response with a much smaller increase in core body temperature. It
is peripheral vasodilatory response that results in profuse sweating and sensation of intense heat.
• During HFs, the peripheral vasodilation results in loss of heat with lowering of core body temperature
and abolition of flush. The chills which accompany HFs are a compensatory response to bring lowered
core body temperature to normal.
5. Management (Non-hormonal)
• The management of HFs is guided by their frequency and severity.
• The severity of HFs can be graded as:
(a) mild (no interference with usual daily activities)
(b) moderate (interfere with usual daily activities to some extent)
(c) severe (when usual daily activities cannot be performed)
• In mild cases: Just avoid the triggers, diet modification and lifestyle changes.
• In moderate to severe cases: Start herbal medications If inadequate response Start SSRIs/SNRIs ( Be
familiar with one drug and always use it) If inadequate response Try another SSRIs/SNRIs If inadequate
response Try gabapentin alone or in combination with SSRIs If inadequate response Give a trial of
clonidine
6. Knowing the triggers of hot flashes
• Identify your own hot flashes triggers and avoid them. ( e.g. Some women notice hot flashes when
they eat a lot of sugar)
7. Diet Modification
• Avoid caffeine, spicy food, hot drinks and alcohol.
• Try to incorporate more plant estrogens into your diet.
• Plant estrogens, such as isoflavones, are thought to have weak estrogen-like effects that may reduce hot flashes.
• Examples of plant estrogens include:
Soybeans الصويا فول
Chickpeas الحمص
Lentils العدس
Flaxseed الكتان بذور
Grains, beans, fruits, red clover and vegetables.
8. Lifestyle changes (Behavioral modifications)
• Patients should maintain a low core body temperature through:
Reducing the temperature in your bedroom.
Dressing loose-fitting and light clothes.
Using a fan as needed.
Take a warm bath or shower at bedtime.
Consuming cool or cold food or drinks. (drinking small amounts of cold water or milk products before bed)
• Weight loss
• Relaxation techniques
Try deep, slow abdominal breathing (6 to 8 breaths per minute). Practice deep breathing for 15 minutes in the morning, 15 minutes
in the evening and at the onset of hot flashes.
These techniques may reduce overall sympathetic tone, thus reducing the frequency of hot flashes.
9. Medications
• Herbal (Over-the-counter) Medications
Black cohosh
Evening primrose oil
Soy (Phytoestrogens)
Vitamin E
• Neuroactive agents
SSRIs and SNRIs
Gabapentin and pregabalin
Clonidine
10. Black cohosh
• Native American women have used the extract of black cohosh (Actae racemosa or Cimicifugae racemosae) for
centuries as a phytotherapic cure for many different conditions. Nowadays, is used only for climacteric symptoms.
• The mechanism underlying the bioactivity of black cohosh is still unclear. Selective modulation of oestrogen
receptors (SERM), serotonin partial agonist mechanism, antioxidant and anti-inflammatory effects have been
suggested.
• Dose : 20-80 mg / day
• Side effects:
Mild stomach upset.
Safe up to 6 months only due to possible estrogen-like effects. ( Not recommended in women with breast cancer)
Liver toxicity has been reported.
12. Soy (Plant estrogen) (Phytoestrogens)
• Side effects:
Appears safe if consumed in foods. In supplement form, consistency of dose and quality can be a
concern.
Supplements are not recommended for breast cancer survivors.
13. Vitamin E
• Side effects:
13% increase risk of heart failure. Might increase death rate in those who use high doses for a
long time.
Excessive vitamin E intake can interfere with blood clotting and lead to fatal bleeding.
15. Selective serotonin-norepinephrine
reuptake inhibitors (SNRIs)
• Duloxetine 30-120 mg/ day (Tradename: Duloxeprin)
• Venlafaxine 37.5- 150 mg/ day (Tradename: Efexor)
• Desvenlafaxine 100-150 mg/ day (Tradename: Pristiq)
16. SSRIs dosing
• Start with a low dose, increasing gradually over 2-4 weeks as tolerated.
• Most SSRIs are taken in the morning to minimize insomnia, but if it makes the patient sleepy, it can be taken at
night.
• When SSRIs are to be discontinued, gradually reduce the dose over 2 weeks to minimize symptoms that con occur
from withdrawing.
• Start with dose 10 mg (a half of a tablet) daily for one week, and then increase to 20 mg daily.
• Take tablets with or without food, once a day and at the same time each day.
• If after 4-6 weeks there is no benefit or significant side effects, treatment should be stopped.
• When changing from one SSRI to another SSRI or SNRI, wait for SSRI free period to prevent side effects due to
drug interactions.
17. SNRIs dosing
• Venlafaxine (Efexor)
Available in 37.5,75,and 150mg capsules,
Start the dose at 37.5mg daily.
The dose can be increased every week until the recommended dose is reached, which is 75mg
daily.
Take with food to decrease any nausea feeling, at the same time everyday.
Gradually withdraw over 2 weeks to avoid withdrawal symptoms.
18. SSRIs and SNRIs
• SSRIs and SNRIs act rapidly, with a decrease in vasomotor symptoms as early as after 2 weeks of treatment.
• Among SSRIs and SNRIs: paroxetine, citalopram and escitalopram carry the best safety profiles.
• Escitalopram (Cipralex) is one of the first line options for hot flashes due to its favorable tolerability profile,
it is considered the antidepressant with the highest number of days of uninterrupted treatment, the best
adherence to treatment and the lowest proportion of switching to other drugs.
• Side effects:
Nausea, asthenia, dizziness, sleep disturbances, dry mouth, constipation and sexual dysfunction.
SNRIs can increase blood pressure; therefore, this variable should be monitored in all patients
• For women, who do not respond to one SSRI/SNRI, use another SSRI/SNRI before switching to another class
of drugs. In case, these are ineffective or not tolerated, consider administration of gabapentin
19. SSRIs and SNRIs in breast cancer patients
• For women with breast cancer, potential interference of antidepressants with tamoxifen since some
SSRIs and SNRIs can inhibit CYP2D6 enzyme with a consequent decrease in the formation of the active
metabolite from inactive tamoxifen.
• Among SSRIs, paroxetine and fluoxetine are the most potent inhibitors and they should be avoided
during tamoxifen use; on the contrary, citalopram and escitalopram only have a limited inhibitory effect
and can be used in tamoxifen users.
• Among SNRIs, venlafaxine and desvenlafaxine are the safest choices while using tamoxifen
• Contraindications to SSRIs and SNRIs use include: previous neuroleptic and serotonin syndrome, the
current use of monoamine oxidase inhibitors, bipolar disease, uncontrolled seizures, liver or kidney
insufficiency, and hypertension for SNRIs users.
20. Gabapentin and pregabalin
• Gabapentin: (Neurontin , available as 100mg, 300mg and 400mg capsules)
Dose (300-900 mg/day)
Compared to SSRIs/SNRIs, gabapentin is as effective but has more side effects
• Pregabalin: (Lyrica)
Dose ( 150-300 mg/day)
Pregabalin is effective in HFs relief but it is less studied than gabapentin
• Side effects:
drowsiness, unsteadiness and dizziness in up to 50% in postmenopausal healthy women
possible suicidal thoughts and behaviors with gabapentin and pregabalin
21. Gabapentin and pregabalin
• Gabapentin and pregabalin are anticonvulsant drugs able to decrease the frequency of HFs by binding to calcium
channels located in the hypothalamus and, consequently, better modulating thermoregulatory activity.
• Gabapentin may be a better choice for women with predominant nocturnal HFs for its added benefit on the
maintenance of sleep cycle. It is as effective as venlafaxine, but patients often prefer venlafaxine due to better
tolerance profile of later.
• The dosage of gabapentin needs to be individualized. Generally, start with 300mg daily as single dose at night
time because it can make the patient little dizzy and sleepy. The dose can be increased by 300mg every 2-3 days
until the recommended dose is reached, which is 300mg three times daily (900mg).
•While switching therapy from SSRI/SNRI to gabapentin, it is preferable to continue SSRI/SNRI for 1st 2 weeks while
gabapentin is being introduced and taking its full effect.
• The other drugs (clonidine and pregabalin) are used only infrequently for the management of HFs.
22. Clonidine
• Clonidine is an anti-hypertensive alpha-adrenergic agonist, which may inhibit flushing by
reducing peripheral vascular reactivity. However, the exact mechanism of action is still
unclear.
• Tradename : Catapres, available as 100 and 150 micrograms (mcg) tablets.
• Start the dose at 25 mcg ( a quarter of a tablet) twice daily. The dose can be increased as
tolerated to 50-75 mcg twice daily over two weeks if necessary.
• If after 2-4 weeks there is no noticeable benefit or significant side effects, treatment
should be stopped.
• However, significant side effects (dry moouth, dizziness, constipation, hypotension and
potential hypertension, if suddenly interrupted) have been often reported with clonidine
and, due to safety problems, its clinical use is poor.