This document discusses ovarian cancer epidemiology, pathology, staging, spread, management, and risk factors. It notes that ovarian cancer is the second most common gynecologic cancer, accounting for 10-15% of cases. Risk factors include low parity, infertility, delayed childbearing, family history, and genetic mutations. Late stage diagnosis and metastasis lead to poor prognosis. The majority are epithelial in origin. Surgical staging and debulking along with chemotherapy are standard treatment approaches.
a nice presentation about the Ovarian Cancer its include an introduction with brief notes about the epidemiology and risk factors then shift to pathology and pathogenesis and diagnosis with signs , symptoms and lab tests with imaging modules , screening , management
a nice presentation about the Ovarian Cancer its include an introduction with brief notes about the epidemiology and risk factors then shift to pathology and pathogenesis and diagnosis with signs , symptoms and lab tests with imaging modules , screening , management
It contains details about breast carcinoma-pathology,investigations and diagnosis,NACT,surgery and adjuvant therapy. Hope you will find it helpful.....
A lecture on endometrial hyperplasia and carcinoma, exploring the etiology, clinical features, types, investigations, management and treatment options and prognosis.
This was presented to undergraduate medical students at Livingstone Central Teaching Hospital, Livingstone, Zambia, department of Obstetrics and Gynecology by Nghitukuhamba T.E Kalipi (final year student) Cavendish University Zambia, School of Medicine.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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.
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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.
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
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
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.
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
1. Prof. M.C.Bansal
Ovarian Malignancy
MBBS,MS,MICOG,FICOG
Professor OBGY
Ex-Principal & Controller
Jhalawar Medical College & Hospital
Mahatma Gandhi Medical College, Jaipur.
2. Epidemology
2nd most common of all genital cancers , accounts for 10-15 %
incidence.
In last 2 decades its incidence as well as survival rate has increased.
The risk of woman developing ovarian cancer in her life time is 1:70
to 1: 100.
Women with low parity, infertility and delayed child bearing
predisposes higher chances.
5-10% ovarian tumors are genaticaly affected ---BRACE_1&@
mutations on chromosome 17 & 13 respectively . if one family
member is affected, the life long risk is 2.7% but it goer up to 13%
with2 or more sibblings. They develop at earlier age < 40 years.
. Inheritance pattern is autosomal dominant. The risk increases with
advancing age up to 70 years.
Induction of ovulation, industrial pollution, talc use at perineum, High
dietary fat , western world have increased incidences
streak ovaries, mums infection at puberty leading to premature
ovarian failure.
3. Epidemology----
Protective factors Multiparity , ocs ,Breast feeding
,anovulation ,Prophylactic oopherectomy.
Late diagnosis and early metastasis are responsible for
poor prognosis.
80% malignancies are of epithelial origion,.almost 80%
report in late stage iii or iv .
80% are primary carcinoma.
20% are secondary form.
Before menarche 10% are malignant.
During reproductive period15% are malignant., but rises
to > 50% after menopause.
4. Pathology
• Epitehelial ovarian carcinoma---80-90%
Papillary cystadenocarcinoma
Mucinous cystadenocarcnoma
• Nonepethelial carcinoma---10-20% these
include malignancy of (A) Germcells (2)Sex
cord stromal(3)Metastatic (4) Rare malignancy
like Sarcoma, lipoid cell carcinoma.
5. Coincidence of uterine and ovarian
cancer
• In some cases primary lies in uterus and direct spread to
ovaries
• Primary in ovary and secondaries in uterus.
• Estrogen / and progesteron producing tumor of ovary and
primary cancer endometrium.
• Cancer present in uterus and cancer in ovary are histologicaly
different.
• Theerfore extended hysterectomy along with bilateral
oopherectomy should always be done in either case’
6. Spread
• Lymphatic--- Para -aortic Lymph Nodes and
superior gastric , mediastinal---pleural effusion
, supra-clavicular.
• Blood spread---uncommon---lungs
• Direct spread through peritoneum----Rupture
capsule—exfoliation of malignant cells,
peritoneal irritation---ascites, omental cake.,
intestine, parietal, visceral peritoneum---- liver
spleen, dome of diaphragm, uterus, tubes.
16. Management
• Laparotomy and maximal removal of cancer tissue----intra
operative staging, cytology of ascitic fluid, pan hysterectomy,
partial or complete omantectomy, enucleation of cancer
growth on parietal and visceral peritoneum with out
perforating the viscera.
• If non operable---intra peritoneal instillation of radioisotopes
(p34)or chemotherapeutic agent.
• Chemotherapy---followed by second look laparotomy to
remove uterus ,ovaries ,omantum and any residual cancer
tissue.
• Radiotherapy for nodal metastasis.
• Stem cell Therapy.
• Immunotherapy.
• Palliative therapy –to relieve pain(opiates/NSAIDs, nutritional
supplimentaton(callories, proteins to keep Hb > 10 gm% and
wt loss < 10 %), psychological support , symptomatic
17.
18.
19.
20.
21. Role of Laparoscopy in the Clinical Management of Ovarian
Cancer
At present, the role of laparoscopy in the management of
ovarian cancer is evolving. There are several clinical settings
in which the potential for this surgical modality has been
investigated
(a) primary surgery for early-stage ovarian cancer
(b) restaging of unstaged ovarian cancer
(c) primary cytoreductive surgery for advanced-stage ovarian
cancer
(d) assessment of resectability
(e) intra-peritoneal catheter placement
(f) second-look surgery
(g) secondary cytoreductive surgery.
22. STRATEGIES TO REDUCE THE INCIDENCE OF GENITAL TRACT
MALIGNANCIES
• First injection at elected time.
• Second injection 2 months later.
• Third injection 6 months after the first injection.
• The cost of each injection is $200, and immunity is expected to last 5 years.
The only benefit as seen today is a longer interval of screening in HPV-
negative women. page 429 page 430 There have been advances in strategies
evolved to reduce the incidence of genital cancers. The following are
notable amongst these: 1. The role and value of periodic 'Pap smear' tests is
well-established in reducing the incidence of invasive carcinoma of the
cervix.
• 2. Evaluation of abnormal Pap tests with colposcopy-directed biopsies has
enabled the diagnosis of intraepithelial cancers and diagnosis of early
invasive cancer of the cervix.
23. • 3. The practice of preferring total over subtotal
hysterectomy for benign diseases (fibroids, adenomyosis,
dysfunctional uterine bleeding-DUB) protects against risk
of future cervical stump carcinoma estimated to occur in
2% of cases.
• 4. Early diagnosis of sexually transmitted diseases (STDs)
and their eradication. Herpes and HPV infections render
an individual prone to cancer of vulva and the cervix.
Barrier contraceptives protect against STD as well as
cervical cancer.
• 5. HPV vaccine is now available which may eradicate
lower genital tract malignancies in young women. The
available vaccine is type specific and therefore protective
in only 60-70%.
• 6. The treatment of cervical dysplasia by CO2
laser/conization for CIN lesions.
24. • 7. Addition of progestogens to oestrogens in
hormone replacement therapy (HRT) reduces the
risks of uterine endometrial cancer.
• 8. Thorough investigation of a woman with
postmenopausal bleeding often brings to light
early unsuspected endometrial/ovarian/tubal
cancers.
• 9. The practice of routine removal of both ovaries
when performing hysterectomy for benign
conditions after the age of 50 years is a
prophylaxis against risk of future ovarian cancer.
Prophylactic oophorectomy in a genetically
predisposed woman is recommended, though
premature menopause remains a risk. This also
reduces breast cancer by 50%.
25. • 10. Early diagnosis of ovarian cancer is the
primary objective for long-term survival, though
this is not obtained as of today. Seventy-five per
cent tumours are advanced when diagnosed.
• 11. Oral combined pills reduce the incidence of
uterine and ovarian cancer by 40-50%. Barrier
contraceptives prevent cervical cancer.
• 12. Gene study can select women at high risk
for cancer.
26. • 13. Evaluation of adnexal masses with scans,
Doppler velocimetric studies, and CA-125 tumour
marker to diagnose ovarian cancer.
• 14. Hysteroscopy/laparoscopy/selective biopsies of
suspicious lesions.
• 15. Routine mammography for all women over the
age of 40 years, earlier whenever clinical
examination reveals a doubtful lump, or in women
with strong family history of breast cancer.
• For many women the obstetrician-gynaecologist is
likely to be the only physician to provide them
healthcare. Hence the importance of developing
skills for evaluation and counselling for genital
cancers and adopting clinical practices which
reduce the future risks of genital cancers lies with
the gynaecologists.
27. KEY POINTS
• Vulval intraepithelial neoplasia (VIN) is a well-recognized
entity which can be effectively treated by conservative
surgery.
• Vulval cancer, mostly squamous cell carcinoma, is
encountered in 2-4% of all genital tract malignancies. An
elderly woman of low parity and associated with previous STD
is the high-risk case.
• The treatment of vulval cancer is based on the age of the
woman, type and extent of the lesion and involvement of the
regional lymph nodes. Local wide excision, skinning
vulvectomy with split skin graft, laser therapy and simple or
radical vulvectomy have improved the survival rate without
increasing the surgical morbidity.
28. • Endometrial cancer is the disease of the perimenopausal and
postmenopausal women with low parity.
• Endometrial cancer is fast becoming the more common
cancer in women. Early menarche, late menopause, small
family size, obesity, carbohydrate intolerance, PCOD-related
infertility and unsupervised HRT in menopausal women
contribute to its occurrence.
• Oestrogen therapy, tamoxifen cause hyperplasia and
endometrial cancer over a period of time. Oral combined pills
have a protective effect and reduce the incidence by 40-50%.
29. • CT and MRI help in preoperative staging and determine the
extent of spread of malignancy. Hysteroscopic evaluation and
biopsy improve the diagnostic accuracy.
• Abdominal hysterectomy with bilateral salpingo-
oophorectomy, peritoneal washing and omental biopsy form
the primary surgical therapy in early stages.
• Radiotherapy and chemotherapy are recommended in the
advanced stage of the disease and are also adjuvants to
surgery.
30. • Progestogens are beneficial in advanced stages of endometrial
cancer and pulmonary metastasis.
• Carcinoma of the cervix is the most common genital tract
cancer in women and ranks second to the breast cancer. It
occurs in younger women.
• Late marriage, contraception, small family size, improved
personal hygiene, avoidance of extramarital relationships and
regular gynaecological check-ups inclusive of a Pap test and
colposcopy have contributed to the lowering of its incidence.
• Endometrial cancer developing in a woman following
unopposed oestrogen uptake is well-differentiated and less
invasive with better prognosis. It also responds well to
progestogens.
31. • Endocervical cancer has different aetiology and requires
chemotherapy with radiotherapy, followed by radical
surgery.
• Fallopian tube cancer is rare, and is often mistaken for
ovarian cancer. It is treated the same way as ovarian cancer.
• Ovarian cancer is the second most common genital cancer.
It remains asymptomatic for a long time. Many cases are
already far advanced at the time of diagnosis. Germ cell
tumours and mesenchymomas are known to occur in
younger women. Epithelial tumours occur in older women.
Surgical removal is adequate treatment for cases of
borderline malignancy. Surgery followed by chemotherapy
is indicated in advanced cases.
• The gold standard is abdominal hysterectomy and bilateral
salpingo-oophorectomy with omentectomy in the early and
operative cases of ovarian cancer. Debulking, radiotherapy
and chemotherapy prolong life and duration of remission.