This document discusses radiotherapy techniques for treating various cancers. It begins with statistics on global cancer incidence and mortality. It then describes different radiotherapy techniques including conventional radiotherapy, 3D conformal radiotherapy, intensity-modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), volumetric modulated arc therapy (VMAT), and PET-guided radiotherapy. Specific techniques for treating head and neck cancers, orbital cancers, and retinoblastoma are also summarized.
OCT is a great technology,Many ophthalmologist find very difficult to understand it ,SO I have tired to simplify it as much as possible .Hope everyone can understand now onwards the basic about OCT .
Every feedback s most welcomed sothat i can improve further in coming days
Please email your feedback to me in the following address
yourgyanu@gmail.com
Artificial lenses implanted in the anterior or posterior chamber of the eye in the presence of the natural crystalline lens to correct refractive errors. Phakic IOLs an evolving technique in the field of refractive surgery for the correction of moderate to high refractive errors. Patients with high myopia (above -10 diopters) constitute only about 2% of the myopic population but 13-15% of patients presenting for refractive surgery belong to this group. The increased knowledge on anterior segment anatomy and availability of better imaging technologies along with improved IOL designs and surgical techniques have led to higher success rates with these lenses.
Compared to corneal refractive surgery , phakic IOLs compete favorably for the correction of high ametropias, with excellent predictability, efficacy, safety and quality of vision.
OCT is a great technology,Many ophthalmologist find very difficult to understand it ,SO I have tired to simplify it as much as possible .Hope everyone can understand now onwards the basic about OCT .
Every feedback s most welcomed sothat i can improve further in coming days
Please email your feedback to me in the following address
yourgyanu@gmail.com
Artificial lenses implanted in the anterior or posterior chamber of the eye in the presence of the natural crystalline lens to correct refractive errors. Phakic IOLs an evolving technique in the field of refractive surgery for the correction of moderate to high refractive errors. Patients with high myopia (above -10 diopters) constitute only about 2% of the myopic population but 13-15% of patients presenting for refractive surgery belong to this group. The increased knowledge on anterior segment anatomy and availability of better imaging technologies along with improved IOL designs and surgical techniques have led to higher success rates with these lenses.
Compared to corneal refractive surgery , phakic IOLs compete favorably for the correction of high ametropias, with excellent predictability, efficacy, safety and quality of vision.
Practical Points in Emergency CT for Emergency PhysiciansRathachai Kaewlai
The handout describes some brief practical points on emergency CT, particularly for emergency physicians. They include imaging utilisation trends, radiation dose, contrast reaction, contrast-induced nephropathy, use of oral contrast medium and some caveats on emergency CT (esp. abdomen)
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
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
- 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
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
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!
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
13. Statistics
• >9.7 million cases are detected each
year
• 6.7 million people will die from
cancer
• Every day, around 1700 Americans
die of the disease
• 20.4 million people living with
cancer in the world today
• 1 in 3 people will be diagnosed with
cancer in the UK and 1 in 4 will die
from their disease
20. Role of radiotherapy in various cancers
• Needed for all most head and neck cancer
• Radical-
– Naso-pharynx, laryx, hypopharynx etc.
• post-op-adjuvant
– MOSTLY ALL ORAL CANCERS except T1 lesions
• Palliative
– compression, bleeding, obstruction, pain
6/1/2018 3:26:21 AM 20
21.
22.
23. Radiotherapy procedure
1. Tumor board decision
2. Positioning And immobilization
3. Imaging
4. Target delineation
5. Planning
6/1/2018
Mahatma Gandhi Cancer Hospital &
Research Institute,Visakhapatnanm
23
24. IMAGE GUIDED RADIATION THERAPY
EQUIPMENT REQUIRED
CT-SCAN MRI PET-CT
6/1/2018 24
Mahatma Gandhi Cancer Hospital &
Research Institute,Visakhapatnanm
34. Treating Head & Neck with Sliding Windows
6/1/2018 3:26:21 AM 34
35. IMRT
• Divides each treatment field into
multiple segments
• Modulates beam intensity,
giving discrete dose to each
segment
• Uses multiple, shaped beams
(~9) and thousands of segments
IMRT Initiated in 1995
Reached the clinic in 2000
60. Plaque placement
• Under GA / LA
• Conjunctiva peritomy
• Tumor location marked on sclera
• Dummy plaque used to confirm
location
• Plaque placed & sutured to
sclera
• Conjunctiva sutured
• Patient is kept in isolation
Courtesy : Dr Vijay Anand P Reddy
91. Orbital lymphoma
• Lymphoid tumors -common despite the orbit not containing lymph nodes
or a well defined lymphatic vasculature.
• Incidence 13% of all orbital tumors.
• Primary or associated with systemic disease.
• Represents 8% of all extranodal NHL & 1 % of all NHL
• Approx 35% of patients with lymphoid tumors of orbital tumors will
eventually develop systemic lymphoma
• Presenting age- 15- 70 yrs
• Majority are low grade- 84%
92. • Biopsy
• Worked up for systemic disease
• Including a complete physical exam, a complete blood count,
bone marrow biopsy and CT scans of the thorax, abdomen and
pelvis.
• CSF examination
• CT scan -homogeneous mass with well defined borders that
does not destroy surrounding structures or bone.
• MRI – to assess extent ofdisease
• PET CT
97. Radiotherapy
• Stage I, II-RT main t/t
• - Whole orbit is to be
treated
• Energy- 1.25 Mv / 6Mv
• Supine
• Immobilise
• Ant & lat field using 45
wedges
• Looks into beam,
• dose- 25-30Gy@ 1.8- 2
Gy/#
• Bilateral disease- parallel
opposed fields
98. • If there is a forward displacement of eveball
• Involvement of post or anteromedial part of orbit
• Sup & inf oblique fields
99. Results: All patients had a complete response to RT. Intraorbital recurrence
developed in previously uninvolved areas not included in the initial target
volume in 4patients (33%) treated with partial orbit RT. All were salvaged by
repeat RT or surgery. No patient treated with whole orbit RT developed
intraorbital recurrence. The acute and long-term toxicity was similar in both
groups. All but 1 patient retained good vision.
Conclusion: Patients with orbital lymphoma should be treated to the entire
orbit.
100. Uveal melanoma
I. 3 Treatment Options:
Plaque vs Proton Beam vs Enucleation
III. 3 Clinical Questions, 3 Major Studies
102. • Work-up: fundus exam, ultrasound and
fluorescein angiography.
• Measurements: diameter by fundus exam,
thickness by ultrasound
• Biopsy: not done until after radiation for risk of
seeding.
Diagnosis
103. 3 Treatment Options
• Enucleation
Last resort
• Proton Beam
Useful when > 5 mm thickness
• Plaque Brachytherapy
Useful when < 5 mm thickness
104. • prior to 1970
• refractory
cases
Enucleation
109. Plaque
• Most common form of treatment
• Good for thin tumors, not thick tumors
• Commonly Iodine-
125 T1/2: 59.4 d
Av Energy: 35.5 keV
• Not possible over
optic nerve due to
anatomy
110. 3 Clinical Questions
I. Is radiation effective?
II. Does radiation cause vision loss?
III. Can prophylaxis prevent vision loss?
111. JAMAOphthalmology, Dec
2006
• Question: Is Radiotherapy as effective as
enucleation?
• Design: Randomized multi-center clinical trial of
iodine 125 brachytherapy vs enucleation.
• Conclusion: No difference in survival between
I-125 brachytherapy vs enucleation.
• Impact: Brachytherapy usually first line treatment.
115. Conclusions
I. Wills Eye protocol for work-up of non-metastatic
melanoma differs from other tumors:
- No biopsy, CT or MRI
- Diagnosis via fundus exam
- Thickness measured by ultrasound
II. Isodose patterns of Plaque vs Proton:
- Plaque ➞ Steep gradient ➞ Thin tumors
- Proton Beam ➞ Wide plateau ➞ Thick tumors.
III. Radiotherapy cures ocular tumors, yet causes
maculopathy
IV. Bevacizumab expected minimize maculopathy
- Too early for long term studies
120. • Leucocoria
– Most common initial sign
– Retinoblastoma remains intraocular and
curable for 3–6 months after the first
sign of leucocoria
• Other signs
– Proptosis
– Swelling
– Strabismus
– Hypopyon
– Poor visual tracking
Clinical
Presentation
heterochromia
strabismus
122. • 90% show calcification
• Dense homogenous
• Extension to choroid,vitreous
& sclera not reliable.
• Detects intracranial disease
• 3D multiplanar capability.
• Hyperintense to vitreous on T1 &
markedly hypointense on T2
• Delineation of ON, IO & EO
spread
• Differentitates between tumor,
RD & subretinal fluid.
CT/MRI
125. Cryotherapy
Good local therapy. Leaves
Big scars
Photocoagulation Good local
therapy. Causes big scaring,
loses vascularization
Thermotherapy : Good
local therapy. Minimal
scaring
126. EYES PRESERVED
RE I to III RE IV to V
EBRT
ALONE
53% 45%
EBRT+SALV
AGE
96% 66%
CT ALONE 29% 11%
CT
+SALVAGE
94% 66%
CTRT - 75%
Eye Preservation
127. Vijay Anand P Reddy et al.
External Beam
Radiotherapy
134. • Retinoblastoma has been historically
treated with lateral beams to encompass
the affected retina(s), and spare the lens
anteriorly, if possible
• .
Radiation Therapy Techniques
141. Proton therapy
• The dosimetric advantage
of the Bragg-Peak, which
eliminates exit dose,
results in less low dose to
normal, uninvolved
tissue. The reduction in
peripheral dose as
compared with the IMRT
plan is highly desirable in
patients of this young
age, many of whom carry
a germline mutation,
predisposing them to the
development ofLee et al; Int J Radiat Oncol Biol Phys 63:362–372
142. • Reduces tumor volume
• Allows more focused, less damaging
therapeutic measures
Chemoreduction
161. CAUTION
C - Change in bowel or bladder habits
A - A sore that does not heal
U - Unusual bleeding or discharge
T - Thickening or lump in the breast or any part of the body
I - Indigestion or difficulty swallowing
O - Obvious change in a wart or mole
N - Nagging cough or hoarseness
205. TEAM OF EXPERTS IN SURGICAL ONCOLOGY
1. Dr.Murali Krishna Voonna M.S.,M.Ch.,
(Adyar Cancer Institute ,Chennai)
2. Dr.Karthik Chandra Vallam M.S., M.Ch,DNB.,
(TATA Memorial ,Mumbai)
3. Dr.M.P.S.Chandra Kalyan M.S,, M.Ch.,
(TATA Memorial ,Mumbai)
206. TEAM OF EXPERTS IN RADIATION ONCOLOGY
Dr. Kanhu Charan Patro M.D(RT).DNB(RT)
(ex. TATA Memorial ,Mumbai)
Dr. Partha Sarathi Bhattacharyya M.D (RT)
(ex. AIIMS,NEW DELHI)
Dr. Chittaranjan Kundhu M.D(RT)
(S.C.B.M.C ,Cuttack)
Dr. Venkata Krishna Reddy M.D (RT)
(ex.Christian Medical College ,Vellore)
207. TEAM OF EXPERTS IN MEDICAL ONCOLOGY
1. Dr. B.Rakesh Reddy M.D(Paed).,DM
(Medical Oncology) (AIIMS ,New Delhi)
208. TEAM OF EXPERTS IN CRITICAL CARE AND PAIN
1. Dr. K.V.D. Praveen M.D(Anesthesiology)
(PGIMER, Chandigarh)
2. Dr. A.Shirisha M.D (Anesthesiology)
(AMC ,Visakhapatnam)
3. Dr. Surendra Nadh D.A, DNB(Anesthesiology)
(ISPAT General Hospital, Odisha)
209. TEAM OF EXPERTS-- Radiology
1. Dr. P.Madhuri D.M.R.D
( AMC ,Visakhapatnam)
2. Dr. B.Revathi D.M.R.D
( RMC ,Kakinada)
213. EXPERTS FROM VARIOUS PRESTIGIOUS
INSTITUTIONS
1. ADYAR CANCER INSTITUTE, CHENNAI-1
2. TATA MEMORIAL HOSPITAL, MUMBAI-3
3. AIIMS,NEWDELHI-2
4. CMC-VELLORE-1
5. PGI-CHANDIGARH-2