The document discusses oral mucositis, a common side effect of chemotherapy and radiation therapy for head and neck cancers. It describes the epidemiology, pathophysiology, and treatment options for oral mucositis. The pathophysiology is explained in four phases: initial inflammatory phase, epithelial phase, ulcerative/bacteriological phase, and healing phase. Treatment focuses on prophylaxis through oral hygiene and includes topical agents for fungal infections, ulcers, and pain. While treatment can be challenging, prophylaxis is emphasized to reduce the severity and complications of oral mucositis.
ORN is an inflammatory condition of bone that occurs after the bone has been exposed to therapeutic doses of radiation usually given for a malignancies.
As per AJCC 7th Ed, a pictorial review with prediction for change in future edition.
Presented at "Oral Oncology-An update" CME conducted by Shri Mata Vaishno Devi Narayana Superspecialty Hospital, Katra at Fortune Inn Riviera Hotel, Jammu on 21st Jan, 2017.
ORN is an inflammatory condition of bone that occurs after the bone has been exposed to therapeutic doses of radiation usually given for a malignancies.
As per AJCC 7th Ed, a pictorial review with prediction for change in future edition.
Presented at "Oral Oncology-An update" CME conducted by Shri Mata Vaishno Devi Narayana Superspecialty Hospital, Katra at Fortune Inn Riviera Hotel, Jammu on 21st Jan, 2017.
Side effects of radiation in head and neck cancerAnagha pachat
this presentation describes how radiation effects normal structures in head and neck region and about the late and acute toxicities which may occur if the radiation exceeds tolerance dose as per QUANTEC
A leader in the biopharmaceutical field, Brian Frenzel has worked extensively in drug product and business development. Brian Frenzel currently serves as president and CEO of Tosk, Inc., a company that works to develop products to alleviate the side effects of cancer treatments, such as mucositis.
Chemotherapy and prosthodontics implicationBHU VARANASI
The objective of this presentation to improve removable prosthodontic therapy during chemotherapy to improve the patient's quality of life, enhance nutrition by reducing oral irritation and ulceration, and control the oral microbial populations associated with chemotherapy and the wearing of a denture.
During chemotherapy what all thing, let a dentist know well
it helps to provide information regarding the what all to use or not use .
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This PowerPoint presentation offers a concise yet technical overview of antibiotic therapy. Dive into antibiotic mechanisms, classifications, indications, and prudent use. Master essential aspects of antibiotic therapy for informed clinical decision-making.
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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
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
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.
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
3. • Oral mucositis is a frequent adverse reaction of the
radiation therapy of the head and neck cancers, as well as
of chemotherapy.
• Mucositis may confine the patient's tolerance of
antineoplastic therapy, and the nutritional status is
endangered.
• Compromised patient’s quality of life.
-Oral Mucositis Complicating
Chemotherapy and/or Radiotherapy; CA Cancer J Clin 2001;51:290-315
Term oral mucositis emerged in the late 1980s to describe
the chemotherapy- and radiotherapy-induced inflammation
of the oral mucosa.
Effects are so debilitating resulting in consecutive
protraction or termination of antineoplastic therapy.
3
4. • Annually, the incidence is of approximately 400,000
cases of treatment-induced oral lesions.
• Oral complications subsequent to chemotherapy and/or
radiation therapy include mucositis, xerostomia, infection
(bacterial, fungal, or viral), particular neutropenia, dental
caries, taste alterations, and osteoradionecrosis.
• Oral mucositis represents a major nonhematologic
complication of cytoreductive chemotherapy and
radiotherapy
• Associated with morbidity, pain, odynodysphagia,
dysgeusia, followed by dehydration and malnutrition.
Complications of radiation therapy for head and neck cancers : the patients perspective.
Cancer Nursing 2002:25:461-7
It is the most common cause of pain during the treatment
of cancer and most distressing side effect of head and
neck radiation therapy, myelosuppressive chemotherapy
and stem cell transplantion.
4
5. • This mucosal changes can interfere with the cancer
therapy protocol
• It may require dose adjustments, Rx schedule
modifications
• The treatment is then usually discontinued in cases
of severe oral morbidity
• These interruptions in dosing regimens secondary to
oral complications can negatively affect the overall
patient prognosis.
-Oral Mucositis Complicating Chemotherapy and/or Radiotherapy;
CA Cancer J Clin 2001;51:290-315
Hyperfractionation, combined radiotherapy, use of
radiosensitizers cause increased severity of oral
mucositis.
Oral Mucositis: understanding the pathology and management:
HIPPOKRATIA 2012, 16, 3: 215-216
Chemotherapy induced stomatitis – less severe- lasts
upto 3-12 days
Radiotherapy induced stomatitis- upto 3-12 weeks
5
6. Epidemiology
• Incidence & severity varies individually.
• Depends upon therapeutic agent.
• Berger and Kilroy estimated that about 40% of
patients which undergo chemotherapy develop
mucositis
• This risk grows with the number of
therapy cycles and previous
episodes of mucositis.
6
7. • Drugs interfering DNA synthesis (S-phase–specific
agents like fluorouracil, methotrexate, and
cytarabine) develop more significant cytototoxic
effects.
• Studies by Peterson and Wilkes estimated that with
bolus and continuous infusions there is an increased
risk of mucositis, compared to prolonged or
repetitive regimens of lower doses of cytoreductive
agents
Incidence:
76% - bone marrow transplantation
30-60% - radiation therapy
90% chemotherapy
7
8. • The severity and duration of mucositis depends on
type of radiation source, total dose, dose intensity,
amount of the irrradiated mucosa, smoking, alcohol
ingestion, and level of oral hygiene.
• In patients treated with standard 2 Gy of daily
fractionated radiotherapy programs, mucosal
erythema occurs in the first seven days.
8
9. • Mucositis (patchy or confluent) peaks after 4-5
weeks of treatment with the same dose of radiation.
• In less than 2 Gy, the severity of mucositis might be
low.
• In spite of this, in accelerated radiotherapy
programs, mucositis increase in gravity at 21 days.
• Interstitial radioactive implants - in 7-10 days and
peaks after 14 days.
9
Risk Factors:
Patient Related:
• Age
• Gender- Women
• Smoking, excessive alcohol – as they alter epithelial
mucosal environment (Raber-Durlacher, 1999)
Treatment Related:
• Radiotherapy- Head & Neck and total body irradiation
during bone marrow transplantation
• Chemotherapeutic agents:
Anti-metabolites like etoposide, 5 FU, and methotrexate.
Bleomycin, cisplatin, cyclophosphamide, cytarabine,
dactinomycin, daunorubicin, docetaxel, doxorubicin,
mitomycin, paclitaxel, vinblastine, vincristine, and
vinorelbine (Wilkes & Ades, 2004).
10. Pathophysiology
• Exact pathophysiology – not elucidated
• Two proposed mechanisms
– Direct mucositis
– Indirect mucositis
• Direct mucositis is related with chemotherapy and
radiation therapy interference with the maturity and
cellular growth of epithelial cells, who present a
rapid turnover, every 7-14 days.
10
11. • These cells are susceptible to the effects of cytotoxic
therapy and finally appear changes to normal
turnover and cell death.
• Indirect invasion of Gram-negative bacteria and
fungal species can cause the indirect mucositis.
•
• The neutropenic patients have an increased risk
The onset of indirect mucositis varies, and is
related with the timing of the polymorphonuclear
granular leukocytes nadir, associated with the
cytoreductive agent administered develops from
10-21 days after the onset of the chemotherapy
regimen.
11
12. • Mechanism is explained in four stages.
• Phase 1: Initial inflammatory/vascular phase
Radiation exposed cells death cytokines
TNF-alpha
• Inflammatory mediators increasing vascular
permeability enhancing cytotoxic drug uptake
into the oral mucosa damage to tissue
12
TNF-alpha has the ability to cause necrosi
with blood flow, cytotoxic inflammation, a
regulation of immune responses .
(Rieger, 2001).
13. Phase 2: Epithelial phase
• Antineoplastic therapy inhibits cell division in
the oral mucosal epithelium reduced epithelial
turnover and renewal epithelial breakdown.
• The erythema appears from increased vascularity
and epithelial atrophy 4-5 days after the beginning of
chemotherapy.
• At this stage, any microtrauma leads to ulceration of
the oral mucosa.
13
14. Phase III: ulcerative / bacteriological phase
• Breakdown of the oral epithelium an
ulcerative stage epithelial loss and furious
exudation formation of pseudomembranes
and ulcers microbial colonization
• Exacerbated by concomitant neutropenia.
14
15. • Infectious complications
arising in neutropenic bone
marrow transplantation
recipients are due to
aggressive myelo-suppressive
antineoplastic drug therapy.
• The ulcerative mucositis is an
important etiologic factor in
the development of systemic
streptococcal infections in the
neutropenic cancer patients
15
16. Phase IV: Healing phase.
• Duration- 12-16 days
• Depends on epithelial proliferation rate,
hematopoietic recovery, reestablishment of the local
microbial flora, and absence of factors interfering
with the wound healing
16
Current trends in managing oral mucositis:
Clinical journal of oncology nursing, volume 9, number 5 •
Current trends in managing oral mucositis: Clinical journal of oncology nursing, volume 9,
number 5 •
17. Treatment options available:
Prophylactic measures:
• Good oral hygiene & prevention, identification and
early treatment of oral lesions
• Avoidance of wearing removable dentures,
orthodontic Rx and applying chlorine releasing
products like chlorhexidine gluconate (0.12% and
0.2%), carbonated water, hydrogen peroxide etc.,
• Soft foods, low carbohydrate diet, high fluid intake-
recommended.
• Avoid toothpaste above grade 1 mucositis
17
18. Therapeutic attitude – WHO staging- 1979
• 0 = normality
• I = generalized erythema (painless pink mucosa
with abundant saliva and normal voice function)
• II = erythema involving small ulcerations and
preserved solid swallowing capacity
• III = extensive ulcers with edematous gingival
tissue and thick saliva, preserved liquid
swallowing capacity, pain and speech difficulties
• IV = very extensive ulcers with bleeding gums,
infections, the absence of saliva, incapacity to
swallow, and intense pain. 18
19. Rx indications:
• Grades 0 and I: Hygiene measures:
(a) correct tooth brushing (b) chlorhexidine
digluconate mouth rinsing (c) fluid intake to
maintain salivation (d) preservation of lip integrity
• Grade II: grade 0 & 1 measures every 4 hours +
carbonated water and nystatin solution (5 ml every 6
hours) as rinses. Dentures to be worn only during
mealtimes
19
20. Grade III & IV:
• Grade II measures + topical and systemic treatments
based on etiology of the lesions
• For Fungal infections - nystatin solution (5 ml/ 4 hrs)
and fluconazole in solution (200 mg/day via the oral
route)
• For local herpetic infections -aciclovir cream (5
applications a day).
• For oral ulcerations - 0.1% fluocinolone acetonide in
orabase, 0.1% triamcinolone acetonide in orabase,
1% hydrocortisone in orabase.
20
21. Patient education:
• Sit upright, eat soft food, in small proportions
and chew completely.
• Avoid acid foods, hot and crunchy foods.
• Measures to keep mouth moist
21
22. Conclusion
• Oral mucositis is a serious and challenging
complication of cytoreductive therapy in cancer
patients.
• As treatment is limited- prophylaxis is stressed
• Patient’s psychological condition has to be assesed
• Although mucositis is rarely life-threatening, it will
interfere, to a great extent, with the outcome of the
cancer treatment.
22
23. Review of Cross References
Magic Mouthwash: Mixture of lidocaine, diphenhydramine
and magnesium or aluminium hydroxide.
Amifostine
• A radioprotective compound & antioxidant.
• Indicated in prevention of radiotherapy induced
xerostomia
• No effect on incidence of mucositis but reduced severity.
• Dose: 200 mg/m2. Limitation - Nausea
23Prophylactic use of amifostine to prevent :Int J Radiat Oncol Biol Phys. 2002; 52
24. Biologic Response Modulators:
• Recombinant Human Keratinocyte Growth Factor 1
(Palifermin) – reduced severity and duration of
mucositis
• Palifermin or placebo was administered for 3 days
before and 3 days after transplant.
• The results showed that the incidence of grades 3
and 4 oral mucositis, were 63% with palifermin
versus 98% with placebo. 24
Spielberger et al., 2004.
25. A randomized clinical trial of two different durations of oral cryotherapy for
prevention of 5-fluorouracil- related stomatitis. Cancer 1993;72:2234- 2238.
Cryotherapy:
• Application of ice chips prior to administration of
bolus vasoconstriction decreased
uptake of drug by mucous membrane.
• Proven useful in 5-FU, which has short plasma half-
life
• Also useful in melphalan and edatrexate-based
chemotherapy regimens.
25
26. (Cancer J Clin 2001;51:290-315)
Capsaicin:
• Capsaicin, a potent inhibitor of neuropathic pain
demonstrated a marked reduction of oral pain in patients
experiencing oral mucositis.
Vitamin E:
• Tocopherol’s antioxidant and membrane stabilizing
potency interferes with inflammatory damage caused by
reactive oxygen species and free radicals.
Vitamin A:
• Inhibitory effects upon inflammation and epithelial
proliferation 26
27. Non-Pharmacological Methods:
• Radiation Shields:
Fabrication of protective radiation stents and midline
mucosa-sparing blocks
• Laser:
Low energy He-Ne lasers (soft lasers) hastens oral re-
epithelialization by producing photochemical
reactions in cells.
Studies showed that they decreased duration and
pain
27
Current trends in managing oral mucositis: clinical journal
of oncology nursing: Vol 9: 2005
28. Merits:
• Grading of mucositis
• Grading of treatment
indications given
• Good focus on
prophylactic
measures
28
Demerits:
• Treatment options
are not enumerated