Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
Antibiotic use in neonates. Protocols , Rationale, Antibiotic stewardship and newer agents, NICU microbiological profile. A grand presentation by Dr. Maskey in TUTH.
- 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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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
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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.
3. Introduction
• Over 30 years’ successful application of Bacillus Calmette
Guerin (BCG) to the clinical treatment of bladder cancer has
proved it one of the most promising immunotherapies for cancer
1
• Intravesical BCG results in a robust local immune response 2
• directly reacts to the tumor cells, causing apoptosis,
necrocytosis, oxidative stress, 1
1. Jiansong Han et al, 2020 ; Mechanisms of BCG in the treatment of bladder cancer-current understanding and the prospect
2. Shen et al., 2008
4. • Intravesical BCG is a live, attenuated mycobacteria and therefore has the
potential risk for transmission.
• Urine Routine and culture should be done before installation
• The preparation, handling and disposal should bring with it the same
precautions of other biohazardous materials.
• BCG powdered vaccine 80mg is reconstituted with 50 mL of saline
• Fluid, diuretic, and caffeine restriction before instillation limits dilution of the
agent by urine and facilitates adequate retention of the agent for 2 hours
1. Lamm et al. 2011
2. Herr, 2012
3. Lamm et al., 2000b
5. Administration procedure:
1. Assemble equipment on trolley as above.
2. Reconstitute BCG using closed system equipment as per manufacturers’
instructions. BCG should always be given within 2 hours of mixing.
3. Place both plastic and linen draw sheet underneath patient’s buttocks.
4. Insert urethral catheter as per policy and drain bladder
5. A plastic backed sheet should be placed under the catheter connection and
across the patient to prevent the spillage of BCG onto the patient or bedding if
there is a leak.
6. 6. Instil BCG into patient’s bladder in adherence to the manufacturer’s
instructions for using closed system products.
7. Remove catheter carefully and advise the patient they are to retain
liquid in bladder for up to two hours following instillation.
8. All efforts should be made to ensure the intravesical drugs do not
come into contact with the skin, clothing or other surfaces.
7. 9. Following insertion of intravesical therapeutic agents, the patient should lie prone,
supine left lateral and right lateral for 15 minutes each. The drug needs to remain
in the patient’s bladder for at least 1 hour (to a maximum of 2 hours).
10. equipment, in contact with cytotoxic material, should be disposed of into 2
cytotoxic waste bags, labelled and secured closed with cytotoxic tape and
disposed of in the clinical waste for incineration.
11. Following completion of the treatment, the patient should be advised to void into
the designated toilet.
12. The toilet should not be flushed. Two cups of bleach should be poured into the
toilet bowl and left for 20 minutes prior to flushing. Patients should be advised to
continue to use bleach in the toilet bowl with each void for 6 hours following
treatment.
8. 13. The patient should be encouraged to drink 2-3 litres of fluid for the
first 24 hours following treatment to encourage elimination of
absorbed drugs.
14. Urine samples should not routinely be sent to the laboratory within
72 hours of treatment.
15. The patient should be given instructions on after care, their next
appointment and contact details should they encounter any
problems prior to leaving the department.
9. Mechanism of action
• Initial step is direct binding to fibronectin within the bladder wall leading to direct
stimulation of cell-based immunologic response 1
• Numerous cytokines involved in the initiation or maintenance of inflammatory
processes including TNF-α, GM-CSF, IFN-γ, and IL-1, IL-2, IL-5, IL-6, IL-8, IL-10, IL-12,
and IL-18 have been detected in the urine of patients treated with intravesical BCG.1
• cytokine induction with preferential upregulation of IFN-γ, IL-2, and IL-12 reflects
induction of a T-helper type-1 (Th1) response 2
• This immunologic response activates cell-mediated cytotoxic mechanisms believed to
underlie the efficacy of BCG and other agents in the prevention of recurrence and
progression 2
1. Ludwig et al., 2004
2. Bohle and Brandau, 2003
10. Jiansong Han et al, 2020 ; Biomedicine & Pharmacotherapy Journal
Mechanisms of BCG in the treatment of bladder cancer-current understanding and the prospect
The model of mechanisms of BCG in bladder cancer.
When BCG is exposed to tumor microenviroment, it attaches to the cell surface and be internalized by tumor cells to
active different pathways such as NF-KB. Cytokines will be released by some immune cells like nuetrophils and
macrophages to attend immune cascade or kill the tumor cells directly
11. BCG Prophylaxis to Prevent Recurrence and
Progression
Conclusion:
• In NMIBC several intravesical therapies are associated with a decreased risk
of recurrence and Progression vs transurethral bladder tumor resection
alone
12. Conclusion
In 403 patients with CIS, BCG reduced the risk of progression by 35%
compared with intravesical chemotherapy.
15. Symptoms of cystitis and LUTS
• frequency, dysuria and occasional mild haematuria. These symptoms
usually subside within 24 to 48 hours
• Phenazopyridine, or non-steroidal anti-inflammatory drugs (NSAIDs).
• If symptoms improve within a few days: continue instillations.
• If symptoms persist or worsen:
• Postpone the instillation
• Perform a urine culture
• Start empirical antibiotic treatment
16. If symptoms persist even with antibiotic treatment:
• With positive culture: adjust antibiotic treatment according to
sensitivity
• With negative culture: quinolones and potentially analgesic anti-
inflammatory instillations once daily for 5 days (repeat cycle if
necessary) .
• If symptoms persist: anti-tuberculosis drugs + corticosteroids.
• If no response to treatment and/or contracted bladder: radical
cystectomy.
17. Haematuria
• Perform urine culture to exclude haemorrhagic cystitis, if other
symptoms present.
• If haematuria persists, perform cystoscopy to evaluate presence of
bladder tumour
18. Symptomatic granulomatous prostatitis
• Symptoms rarely present: perform urine culture.
• Quinolones is treatment of choice
• If quinolones are not effective: isoniazid (300 mg/day) and rifampicin
(600 mg/day) for three months.
• Cessation of intravesical therapy.
19. Epididymo-orchitis
• Perform urine culture and administer quinolones.
• Cessation of intravesical therapy.
• Orchidectomy if abscess or no response to treatment.
20. Arthritis
• Rare complication and considered autoimmune reaction.
• Arthralgia and arthritis : treatment with NSAIDs.
• If no/partial response, proceed to corticosteroids, high-dose
quinolones or antituberculosis drugs.
21. Persistent high-grade fever
• (> 38.5°C for > 48 h)
• Permanent discontinuation of BCG instillations.
• Immediate evaluation: urine culture, blood tests, chest X-ray.
• Prompt treatment with more than two antimicrobial agents while
diagnostic evaluation is conducted.
• Consultation with an infectious diseases specialist.
22. BCG sepsis
• Evaluation: total count, urine culture, chest X-ray, ESR, CRP
• Cessation of BCG.
• For severe infection:
• High-dose quinolones or isoniazid, rifampicin and ethambutol
• Start ATT for 6 months
• Early, high-dose corticosteroids as long as symptoms persist.
• Consider an empirical non-specific antibiotic to cover Gram-negative
bacteria and/or Enterococcus.
23. Allergic reactions
• Antihistamines and anti-inflammatory agents.
• Consider high-dose quinolones or isoniazid and rifampicin for
persistent symptoms.
• Delay therapy until reactions resolve
24. Bacille Calmette-Guérin: Treatment Schedule
• Several studies and AUA guidelines suggest that a 6-week induction course 1
• Durations of maintenance therapy based on risk stratification of the tumor 2
• Southwest Oncology Group (SWOG) reported the most significant impact of
maintenance therapy. Patients received a 6-week induction course followed by 3
weekly instillations at 3 and 6 months and every 6 months thereafter for 3 years.1
• intermediate-risk disease, a 1-year course of maintenance BCG was administered at
months 3, 6, and 12. 2
1. Chang et al., 2016
2. Oddens et al. 2013
25.
26.
27. BCG-refractory tumour
• If T1G3/HG tumour is present at 3 months . Further conservative
treatment with BCG is associated with an increased risk of
progression
• If TaG3/HG tumour is present after 3 months and/or at 6 months,
after either re-induction or first course of maintenance.
• If CIS (without concomitant papillary tumour) is present at 3 months
and persists at 6 months after either re-induction or first course of
maintenance. If patients with CIS present at 3 months, an additional
BCG course can achieve a complete response in > 50% of cases
• If HG tumour appears during BCG maintenance therapy
28. BCG-relapsing tumour
• Recurrence of G3/HG tumour after completion of BCG maintenance,
despite an initial response
• Radical cystectomy or repeat BCG course according to individual
situation.
• Bladder-preserving strategies
29. BCG unresponsive tumour
• BCG refractory or T1Ta/HG BCG recurrence within 6 months of
completion of adequate BCG exposure
• or
• Development of CIS within 12 months of completion of adequate BCG
exposure
• Radical cystectomy or bladder preservation strategy
non–muscle-invasive bladder cancer (NMIBC) is the term commonly applied to malignant urothelial tumors that have not invaded the detrusor muscle of the bladder .
The terminology of NMIBC encompasses the relatively benign course of low-grade papillary tumors, the more aggressive clinical course of high-grade tumors including urothelial carcinoma in situ (CIS), and high-grade Ta and T1 tumors
BCG not only works on bladder cancer by activating the immune system, but also
Commercially available strains include Pasteur, Connaught, and Tice
Should the BCG come into contact with the patient’s skin at the time of administration, an absorbent cloth should be placed over the spillage, which is then disposed of into the cytotoxic waste bag. The area should then be washed thoroughly with copious amounts of soap and water.
and should then be allowed to move freely to ensure the drug has the opportunity to bathe all parts of the bladder mucosa.
Release of tumor necrosis factor–related apoptosis inducing ligand (TRAIL) also appears to be a key event in propagation of the BCG response and is associated with response to BCG
FAP on BCG surface binds to fibronectin on the cell surface for adsorption after intravesical instillation of BCG; then, the repaired bladder epithelial cells and tumor cells internalize BCG. Through a variety of cell surface receptors and intracellular signal transduction pathways, on the one hand, cell apoptosis, cell necrosis, oxidative stress, and others directly induce tumor cell death; On the other hand, the induced cytokines cause an immune cascade that facilitates the host’s immune system to kill tumor cells. BCG can directly act on many cells in the entire tumor immune microenvironment, such as tumor cells, macrophages, neutrophils, T cells, dendritic cells, and other cells. These cells interact with each other, relying on released cytokines of IL-6 and IL-8 at an early stage to generate cascade reactions and heighten the effect.
Prevention: initiate BCG at least 2 weeks post-transurethral resection of the bladder (if no signs and symptoms of haematuria).
several studies and AUA guidelines suggest that a 6-week induction course alone is insufficient to obtain an optimal response in many patients and that maintenance therapy is requisite
Adequate BCG is defined as the completion of at least 5 of 6 doses of an initial induction course plus at least 2 out of 6 doses of a second induction course or 2 out of 3 doses of maintenance therapy.