This child expresses gratitude for their family who bring them joy, their dogs who keep them company, their friends who care for them and listen, and their technology which makes their life easier.
This document expresses gratitude to the recipient for their friendship, noting that true friends can count on each other during difficult times and share in happy moments. It encourages the recipient to pass the message along to their own friends so that they know they are cared about.
This document contains letters and notes from students at Terrace Road School thanking volunteers for their help throughout the school year. The students express gratitude for volunteers assisting with field trips, activities at the YMCA, swimming lessons, and other opportunities. One note specifically thanks volunteers for the time and smiles they provided, and says the students would not have had all the fun experiences without the generosity of volunteers. Overall, the letters convey significant appreciation for the volunteers and recognition that their contributions helped make the school year enjoyable.
This document expresses gratitude for friendship, noting that friends can count on each other during difficult times and share both happy moments and hardships. It acknowledges that friendship is a precious gift and hopes the recipient has a great day surrounded by love from their closest friends and family.
This document expresses gratitude for friendship, acknowledging that friends can rely on each other during difficult times and share in happy moments. It reminds the reader that friends are always there to pray for each other, provide comfort, share sorrows, and celebrate successes. The sender hopes the recipient has a great day and passes this message on to other friends.
This document expresses gratitude for friendship, noting that friends can count on each other during difficult times and share both happy moments and hardships. It acknowledges that friendship is a precious gift and hopes the recipient has a great day surrounded by love from their closest friends and family.
This document expresses gratitude for friendship, noting that friends can count on each other during difficult times and share both happy moments and hardships. It acknowledges that friendship is a precious gift and hopes the recipient has a great day surrounded by love from their closest friends and family.
This document expresses gratitude for friendship, noting that friends can count on each other during difficult times and share both happy moments and hardships. It acknowledges that friendship is a precious gift and hopes the recipient has a great day surrounded by love from their closest friends and family.
This document expresses gratitude for friendship, noting that friends can count on each other during difficult times and share both happy moments and hardships. It acknowledges that friendship is a precious gift and hopes the recipient has a great day surrounded by love from their closest friends and family.
This document expresses gratitude to the recipient for their friendship, noting that true friends can count on each other during difficult times and share in happy moments. It encourages the recipient to pass the message along to their own friends so that they know they are cared about.
This document contains letters and notes from students at Terrace Road School thanking volunteers for their help throughout the school year. The students express gratitude for volunteers assisting with field trips, activities at the YMCA, swimming lessons, and other opportunities. One note specifically thanks volunteers for the time and smiles they provided, and says the students would not have had all the fun experiences without the generosity of volunteers. Overall, the letters convey significant appreciation for the volunteers and recognition that their contributions helped make the school year enjoyable.
This document expresses gratitude for friendship, noting that friends can count on each other during difficult times and share both happy moments and hardships. It acknowledges that friendship is a precious gift and hopes the recipient has a great day surrounded by love from their closest friends and family.
This document expresses gratitude for friendship, acknowledging that friends can rely on each other during difficult times and share in happy moments. It reminds the reader that friends are always there to pray for each other, provide comfort, share sorrows, and celebrate successes. The sender hopes the recipient has a great day and passes this message on to other friends.
This document expresses gratitude for friendship, noting that friends can count on each other during difficult times and share both happy moments and hardships. It acknowledges that friendship is a precious gift and hopes the recipient has a great day surrounded by love from their closest friends and family.
This document expresses gratitude for friendship, noting that friends can count on each other during difficult times and share both happy moments and hardships. It acknowledges that friendship is a precious gift and hopes the recipient has a great day surrounded by love from their closest friends and family.
This document expresses gratitude for friendship, noting that friends can count on each other during difficult times and share both happy moments and hardships. It acknowledges that friendship is a precious gift and hopes the recipient has a great day surrounded by love from their closest friends and family.
This document expresses gratitude for friendship, noting that friends can count on each other during difficult times and share both happy moments and hardships. It acknowledges that friendship is a precious gift and hopes the recipient has a great day surrounded by love from their closest friends and family.
This document expresses gratitude for friendship, acknowledging that friends can rely on each other during difficult times and share in happy moments. It reminds the reader that friends are always there to pray for each other, provide comfort, share sorrows, and celebrate successes. The sender hopes the recipient has a great day and passes this message on to other friends.
This document expresses gratitude for friendship, noting that friends can count on each other during difficult times and share both happy moments and hardships. It acknowledges that friendship is a precious gift and hopes the recipient has a great day surrounded by love from their closest friends and family.
This document expresses gratitude for friendship, noting that friends can count on each other during difficult times and share both happy moments and hardships. It acknowledges that friendship is a precious gift and hopes the recipient has a great day surrounded by love from their closest friends and family.
This document expresses gratitude for friendship, acknowledging that friends can rely on each other during difficult times and share in happy moments. It reminds the reader that friends are always there to pray for each other, provide comfort, share sorrows, and celebrate successes. The sender hopes the recipient has a great day and passes this message on to other friends.
This document expresses gratitude for friendship, noting that friends can count on each other during difficult times and share both happy moments and hardships. It acknowledges that friendship is a precious gift and hopes the recipient has a great day surrounded by love from their closest friends and family.
This child expresses gratitude for their family, teacher, and friend network. They are thankful for their family's support, their teacher's assistance with schoolwork, and how their dad's cousin and friends provide help when needed or if injured.
The document is a long message from a person to their friend "Bez". The writer expresses how much Bez means to them and how Bez has helped and supported them through difficult times in their life. They reminisce fondly on good memories and times they spent together in the past. The writer declares their love for Bez and says that Bez will always have a special place in their heart. They wish the best for Bez and their relationship.
The document expresses gratitude to a friend for their friendship and support through both difficult and happy times. It states that true friends can be counted on in hardship and will share in joy. The writer wishes the recipient love and happiness from their closest relationships each day. The message encourages passing it on to other friends to show them they are cared for as well.
The author thanks their friend for being part of their life and for being someone they can rely on during difficult times. They express appreciation for their friend's companionship and ability to share both happy moments and sorrows. The author wishes their friend love, happiness, and blessings from those closest to them each day.
The document expresses gratitude to the recipient for their friendship, noting that true friends can be counted on during difficult times and share in happy moments. It encourages the recipient to pass the message along to their own friends so that they know they are being thought of.
The document expresses gratitude to the recipient for their friendship, noting that true friends can be counted on during difficult times and share in happy moments. It encourages the recipient to pass the message along to their own friends so that they know they are being thought of.
The document expresses gratitude for family who provide care and companionship, school which facilitates learning, gymnastics where cool tricks can be learned, a dog that provides comfort through cuddling, and friends who attend parties.
This document is a birthday message from a sibling to their brother. In three sentences, it summarizes that the sibling wishes their brother, nicknamed Ajay Anna, a happy birthday and expresses how much they care for their brother who has always been by their side from childhood. It notes that their sibling love is strengthened by their silly arguments but shows how much they care for each other. The sibling misses being with their brother on his birthday and looks forward to more fun family times together in the future.
This document expresses gratitude for friendship and shares that a friendship is a precious gift based on mutual love and support. The author thanks their friend for filling their life with happiness and promises to always be there to listen, comfort, and celebrate their friend's successes. The message encourages sharing it with other friends to let them know they are in one's thoughts.
This document expresses gratitude for a precious friendship, one that provides mutual love and support during both difficult and happy times. The author thanks their friend for filling their life with happiness and promises to always be there to listen, comfort, and celebrate with their friend. They hope this message reminds the recipient of the sender's friendship and thoughts for them.
This document expresses gratitude for a precious friendship, one that provides mutual love and support during both difficult and happy times. The author thanks their friend for filling their life with happiness and promises to always be there to listen, comfort, and celebrate with their friend. They hope this message reminds the recipient of the sender's friendship and thoughts for them.
This document expresses gratitude for a precious friendship, one that provides mutual love and support during both difficult and happy times. The author thanks their friend for filling their life with happiness and promises to always be there to listen, comfort, and celebrate with their friend. They hope this message reminds the recipient of the sender's friendship and thoughts for them.
This document expresses gratitude for a precious friendship, one that provides mutual love and support during both difficult and happy times. The author thanks their friend for filling their life with happiness and promises to always be there to listen, comfort, and celebrate with their friend. They hope this message reminds the recipient of the sender's friendship and thoughts for them.
This document expresses gratitude for friendship, acknowledging that friends can rely on each other for both difficult and happy times. It states that friendship is a precious gift and hopes the recipient knows they are cared for and thought of each day. The sender wishes the recipient a great day.
This document expresses gratitude for friendship and its importance in one's life. It states that friendship is a precious treasure that provides support during difficult times and allows one to share happy moments. It thanks the friend for filling their life with happiness and promises to always be there to listen, comfort, and celebrate successes with the friend. The document encourages sending the message to other friends to let them know they are thinking of them.
The document is a math activity book about penguins that involves counting penguins, writing number sentences by grouping penguins, ordering penguins from largest to smallest number, and completing a color-by-number activity. The reader is prompted to count 20 penguins, write the number sentences 7+3=10 and 5+5=10 by grouping penguins, order 10 penguins from largest to smallest number, and color a picture using a color-by-number key.
The document is about a math book involving penguins. It has the child count 20 penguins, then group and add some penguins to make the number sentence 7+3=10. It then has the child group the penguins in a different way and make the number sentence 4+6=10. Finally, it has the child order the penguins from largest to smallest number and includes instructions to color by number using different colors.
This document expresses gratitude for friendship, acknowledging that friends can rely on each other during difficult times and share in happy moments. It reminds the reader that friends are always there to pray for each other, provide comfort, share sorrows, and celebrate successes. The sender hopes the recipient has a great day and passes this message on to other friends.
This document expresses gratitude for friendship, noting that friends can count on each other during difficult times and share both happy moments and hardships. It acknowledges that friendship is a precious gift and hopes the recipient has a great day surrounded by love from their closest friends and family.
This document expresses gratitude for friendship, noting that friends can count on each other during difficult times and share both happy moments and hardships. It acknowledges that friendship is a precious gift and hopes the recipient has a great day surrounded by love from their closest friends and family.
This document expresses gratitude for friendship, acknowledging that friends can rely on each other during difficult times and share in happy moments. It reminds the reader that friends are always there to pray for each other, provide comfort, share sorrows, and celebrate successes. The sender hopes the recipient has a great day and passes this message on to other friends.
This document expresses gratitude for friendship, noting that friends can count on each other during difficult times and share both happy moments and hardships. It acknowledges that friendship is a precious gift and hopes the recipient has a great day surrounded by love from their closest friends and family.
This child expresses gratitude for their family, teacher, and friend network. They are thankful for their family's support, their teacher's assistance with schoolwork, and how their dad's cousin and friends provide help when needed or if injured.
The document is a long message from a person to their friend "Bez". The writer expresses how much Bez means to them and how Bez has helped and supported them through difficult times in their life. They reminisce fondly on good memories and times they spent together in the past. The writer declares their love for Bez and says that Bez will always have a special place in their heart. They wish the best for Bez and their relationship.
The document expresses gratitude to a friend for their friendship and support through both difficult and happy times. It states that true friends can be counted on in hardship and will share in joy. The writer wishes the recipient love and happiness from their closest relationships each day. The message encourages passing it on to other friends to show them they are cared for as well.
The author thanks their friend for being part of their life and for being someone they can rely on during difficult times. They express appreciation for their friend's companionship and ability to share both happy moments and sorrows. The author wishes their friend love, happiness, and blessings from those closest to them each day.
The document expresses gratitude to the recipient for their friendship, noting that true friends can be counted on during difficult times and share in happy moments. It encourages the recipient to pass the message along to their own friends so that they know they are being thought of.
The document expresses gratitude to the recipient for their friendship, noting that true friends can be counted on during difficult times and share in happy moments. It encourages the recipient to pass the message along to their own friends so that they know they are being thought of.
The document expresses gratitude for family who provide care and companionship, school which facilitates learning, gymnastics where cool tricks can be learned, a dog that provides comfort through cuddling, and friends who attend parties.
This document is a birthday message from a sibling to their brother. In three sentences, it summarizes that the sibling wishes their brother, nicknamed Ajay Anna, a happy birthday and expresses how much they care for their brother who has always been by their side from childhood. It notes that their sibling love is strengthened by their silly arguments but shows how much they care for each other. The sibling misses being with their brother on his birthday and looks forward to more fun family times together in the future.
This document expresses gratitude for friendship and shares that a friendship is a precious gift based on mutual love and support. The author thanks their friend for filling their life with happiness and promises to always be there to listen, comfort, and celebrate their friend's successes. The message encourages sharing it with other friends to let them know they are in one's thoughts.
This document expresses gratitude for a precious friendship, one that provides mutual love and support during both difficult and happy times. The author thanks their friend for filling their life with happiness and promises to always be there to listen, comfort, and celebrate with their friend. They hope this message reminds the recipient of the sender's friendship and thoughts for them.
This document expresses gratitude for a precious friendship, one that provides mutual love and support during both difficult and happy times. The author thanks their friend for filling their life with happiness and promises to always be there to listen, comfort, and celebrate with their friend. They hope this message reminds the recipient of the sender's friendship and thoughts for them.
This document expresses gratitude for a precious friendship, one that provides mutual love and support during both difficult and happy times. The author thanks their friend for filling their life with happiness and promises to always be there to listen, comfort, and celebrate with their friend. They hope this message reminds the recipient of the sender's friendship and thoughts for them.
This document expresses gratitude for a precious friendship, one that provides mutual love and support during both difficult and happy times. The author thanks their friend for filling their life with happiness and promises to always be there to listen, comfort, and celebrate with their friend. They hope this message reminds the recipient of the sender's friendship and thoughts for them.
This document expresses gratitude for friendship, acknowledging that friends can rely on each other for both difficult and happy times. It states that friendship is a precious gift and hopes the recipient knows they are cared for and thought of each day. The sender wishes the recipient a great day.
This document expresses gratitude for friendship and its importance in one's life. It states that friendship is a precious treasure that provides support during difficult times and allows one to share happy moments. It thanks the friend for filling their life with happiness and promises to always be there to listen, comfort, and celebrate successes with the friend. The document encourages sending the message to other friends to let them know they are thinking of them.
The document is a math activity book about penguins that involves counting penguins, writing number sentences by grouping penguins, ordering penguins from largest to smallest number, and completing a color-by-number activity. The reader is prompted to count 20 penguins, write the number sentences 7+3=10 and 5+5=10 by grouping penguins, order 10 penguins from largest to smallest number, and color a picture using a color-by-number key.
The document is about a math book involving penguins. It has the child count 20 penguins, then group and add some penguins to make the number sentence 7+3=10. It then has the child group the penguins in a different way and make the number sentence 4+6=10. Finally, it has the child order the penguins from largest to smallest number and includes instructions to color by number using different colors.
The document is an interactive math book about penguins that prompts the reader to count penguins, write number sentences by grouping penguins, and order and color penguins by number. The reader is asked to count 20 penguins, write the number sentences 7+3=10 and 5+5=10 by grouping penguins, order 10 penguins from largest to smallest number, and color items by number using different colors.
The document is an interactive math book about penguins that prompts the reader to count penguins, write number sentences by grouping penguins, and order and color penguins by number. The reader is asked to count 20 penguins, write the number sentences 7+3=10 and 5+5=10 by grouping penguins, order 10 penguins from largest to smallest number, and color items by number by clicking on borders and a fill bucket.
The document is an interactive math book about penguins that prompts the reader to count penguins, write number sentences by grouping penguins, and order and color penguins by number. The reader is asked to count 20 penguins, write the number sentences 7+3=10 and 5+5=10 by grouping penguins, order 10 penguins from largest to smallest number, and color items by number by clicking on borders and a fill bucket.
The document is an interactive math book about penguins that prompts the reader to:
1) Count 20 penguins shown and type the number.
2) Group some penguins and write a number sentence, such as 7 + 3 = 10 penguins.
3) Regroup the penguins and write another number sentence, such as 4 + 6 = 10 penguins.
4) Order the penguins from largest to smallest number and fill in a color by number page.
The document is a math book about penguins that prompts the reader to count penguins, write number sentences by grouping penguins, and order and color penguins by number. It asks the reader to count 20 penguins, write the number sentences 7+3=10 and 5+5=10 by grouping penguins, order penguins from largest to smallest number, and color items by number by clicking on borders and a fill bucket.
The document is a math book about penguins that prompts the reader to count penguins, write number sentences by grouping penguins, and put penguins in order from largest to smallest number. It also includes a color by number activity.
The document is about a penguin math activity book. It has the child count 20 penguins in an image and write the number. Then it has the child group some penguins and write number sentences, such as 7 + 3 = 10 penguins. It also has the child arrange the penguins from largest to smallest number and color items by number.
The document is a math activity book about penguins. It prompts the reader to count penguins, group them to make addition sentences, order them from largest to smallest number, and complete a color-by-number activity by coloring penguins different colors.
The document is an interactive math book about penguins that prompts the reader to count penguins, write number sentences by grouping penguins, and order and color penguins by number. The reader is asked to count 20 penguins, write the number sentences 7+3=10 and 5+5=10 by grouping penguins, order 10 penguins from largest to smallest number, and color items by number by clicking on borders and a fill bucket.
The document is a math book about penguins that prompts the reader to count penguins, write number sentences by grouping penguins, and order and color penguins by number. The reader is asked to count 20 penguins, write the number sentences 7+3=10 and 5+5=10 by grouping penguins, order 10 penguins from largest to smallest number, and color items by number by clicking on borders and a fill bucket.
The document is about a penguin math book activity where a child counts 20 penguins, groups them into addition problems like 7+3=10 and 4+6=10, orders the penguins from largest to smallest number, and completes a color-by-number activity by coloring penguins different colors.
The document describes a math book about penguins where the child groups penguins in different ways to write number sentences, types number sentences based on penguin pictures, and completes a pattern by counting and moving penguin images. The child learns early math concepts like addition, subtraction, and patterns by interacting with pictures of penguins.
The document describes penguin-themed math activities where students group penguins to make addition and subtraction number sentences, put penguins in order counting by twos to complete a pattern, and move images to their correct place in the pattern. Students practice addition, subtraction, ordering numbers, and patterns using penguin images.
The document is about a math book involving penguins. It has the student group penguins in different ways to make number sentences like 4+6=10 and 3+5+2=10. It then has students type number sentences for penguin pictures, put penguins in order counting by twos in a pattern, and move images to complete the pattern.
The document describes a math book about penguins where the reader groups penguins in different ways to write number sentences, types number sentences based on penguin pictures, and completes a pattern by counting penguins in order by twos and moving images to their correct place in the pattern.
This math book teaches grouping and addition of penguins by having the reader group similar penguins in different ways and write number sentences to describe each grouping, then provides pictures of penguins numbered consecutively with multiples of two and asks the reader to type the correct number sentence in a blue box.
The document describes penguin-themed math activities involving grouping, addition, subtraction, and patterns. Students are asked to group penguin images in different ways to write number sentences, solve subtraction problems, and complete counting and pattern activities by moving penguin images.
The document is about a math book involving penguins. It has the student group penguins in different ways to make number sentences adding up to 10. It then has the student solve a subtraction problem and complete a counting pattern moving penguin images into the correct order.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
- 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
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.