The document discusses the treatment of idiopathic short stature (ISS) in children. It defines ISS as height more than 2 standard deviations below the mean without an identifiable medical cause. Growth hormone treatment can increase growth velocity and adult height but results are modest. Treatment requires consideration of psychosocial factors and risks. The optimal dosing of growth hormone for ISS is 25-50 mcg/kg/day. Other potential treatments mentioned include IGF-1, GnRH analogs, testosterone, and aromatase inhibitors but long-term safety and efficacy are not well established.
Slides from an Apple Keynote presentation given by Jackson David Reynolds on December 1, 2015 at the University of North Georgia, Gainesville campus for Dr. Jeanelle Morgan, PhD’s Genetics course.
Slides from an Apple Keynote presentation given by Jackson David Reynolds on December 1, 2015 at the University of North Georgia, Gainesville campus for Dr. Jeanelle Morgan, PhD’s Genetics course.
precocious puberty is one of the grey areas for pediatricians and gyenecologists. this is an attempt to answer some of the questions the content is references taken from authorative textbooks
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
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
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
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. • Their Prophet said to them: 'Allah has raised Saul to
be your king. ' But they replied: 'Should he be given
the kingship over us, when we are more deserving of
it than he and he has not been given abundant
wealth? ' He said: 'Allah has chosen him over you
and increased him with amplitude in knowledge and
body. Allah gives His kingship to whom He will. Allah
is the Embracer, the Knower.
3. Case senario
• 12 year old boy healthy
• his height is far below 3ed centile
• aslo far from mid parentral height.
• No FH of constitutional delay.
• GV 4 cm/year , on exam : non dysmorphic
• bone age 1yaer delay .
• GH stimulation test normal. IGF-1, IGFBP3
normal.
4. • It is common condition.
• The term has been in use since at
least 1975.
• It is a clinical description rather than a
disease.
Idiopathic short stature
5. introduction
• Definition: stature that is 2 standard
deviations (SD) or more below the
mean for age (approximately the 2nd
percentile) and for whom no
endocrine, metabolic, or other
diagnosis can be made .
6. • Children with ISS fall into two main
groups:
• Familial short stature (in which bone age
is not delayed and the child is growing
within the parental target range)
• Constitutional delay of growth (in which
bone age is delayed)
• Also combination of these two condition.
introduction
7. presentation
• usually Children with ISS have
normal growth velocity
• no biochemical or other evidence for
a specific growth-retarding condition.
• normal growth hormone (GH)
responses to pharmacologic agents
• some children with ISS may have low
serum concentrations of IGF-I
8. treatment
• Several studies have demonstrated
that growth hormone therapy
generally increases height velocity
acutely and may increase adult
height in children with ISS.
GROWTH HORMONE
9. • was approved by the United States Food
and Drug Administration (FDA) in 2003.
• The indication is for children with current
height below -2.25 SD of the mean, in
whom the epiphyses are not closed, and
whose expected adult height is less than
63 inches (160 cm) for boys and 59
inches (150 cm) for girls
GROWTH HORMONE
10. • the use of growth hormone for ISS
remains controversial.
• A majority of children with short stature
will experience some catch-up growth
during puberty without GH treatment
• There is little evidence that short stature
has a detrimental effect on an
individual's psychosocial or physical
functioning.
GROWTH HORMONE
11. • The available evidence suggests only
modest efficacy for GH treatment in
children and adolescents with ISS.
• treated individuals remain relatively
short compared with their peers
GROWTH HORMONE
12. • The decision to treat children and adolescents
with ISS using growth hormone requires
complex psychosocial considerations
• GH treatment should be considered only if the
short stature represents a disability to the child
and is not amenable to counseling and
reassurance
• GH treatment could have adverse psychosocial
consequences due to the extreme focus on a
child's stature conferred by GH treatment.
• Most patients with ISS have normal
psychosocial functioning.
GROWTH HORMONE
Psychosocial considerations
13. • Growth hormone treatment at standard
doses appears to have minimal
physiological adverse effects.
• High-dose GH treatment
(71 mcg/kg/day) was reported to
accelerate the onset of puberty and
epiphyseal closure in children with ISS
but lower doses (34 or
53mcg/kg/day) did not
GROWTH HORMONE
Safety
14. • For children with ISS the optimal
dosing range is well established.
• In prepubertal children with ISS, GH
routinely is used in the range of 25 to
50 mcg/kg/day.
• Higher doses lead to modest
increases in short-term growth
velocity and adult height .
GROWTH HORMONE
Dosing
15. For how long
• continue treatment only if the height
velocity increases by 50 percent or at
least 2.5 cm/year above the baseline
height velocity.
• If the initial growth response is
significant . treatment is continued until
linear growth decreases to less than 2.0
to 2.5 cm (about 1 inch)/year.
• If bone age >14 for girls, >16 for boys.
GROWTH HORMONE
16. Dose adjustment
• evidence supports the idea of
adjusting GH dose based on IGF-I
levels when treating children with
ISS.
• GH dosing be adjusted to maintain
IGF-I within a normal range.
GROWTH HORMONE
17. • IGF-I levels approximately four weeks
after beginning therapy or changing
the GH dose, and approximately
every 6 to 12 months
thereafter, similar to the approach we
use for patients with GH deficiency
GROWTH HORMONE
Dose adjustment
19. Recombinant human IGF-I
• Recombinant IGF-I (rhIGF-I) has
been effectively used for treatment of
children with "severe primary IGF-I
deficiency.
• A preparation of rhIGF-I is approved
by the FDA for this use.
20. • Patients with ISS may have degrees of
growth hormone insensitivity, with
normal or elevated circulating serum
GH levels but low levels of insulin-like
growth factor-I (IGF-I) and IGF binding
protein 3 (IGFBP-3).
• For these children, direct replacement
of IGF-I may be more effective than GH
treatment.
Recombinant human IGF-I
21. GnRH analogs
• An alternative approach to attempt to
delay pubertal development and
epiphyseal fusion.
• The range of the effect is limited to
approximately 0 to 4 cm.
22. Testosterone
• Boys with mild to moderate short
stature whose puberty and bone age
are delayed
• treatment with testosterone during
adolescence may be helpful to
promote puberty and accelerate
linear growth.
23. Aromatase inhibitors
• in adolescent males it will facilitate
growth by delaying epiphyseal closure.
• Preliminary studies suggest that
treatment with aromatase inhibitors, with
or without concomitant growth hormone,
increases predicted adult height.
• long-term safety and efficacy results are
not available
• In girls, aromatase inhibitors would be
expected to slow growth because they
inhibit estrogen production.
24. conclusion
• Treatment of children with idiopathic short
stature (ISS) with growth hormone is
controversial .
• the decision to treat children with ISS
using growth hormone depends on
individual considerations.
• Growth hormone treatment is likely to yield
only modest gains in height compared with
no treatment