1. The document provides maxims and advice from the works of Kautilya (also known as Chanakya and Vishngupta), an Indian philosopher who lived from 321 BC to 290 BC. He served as the chief minister of the Maurya Empire under Emperor Chandragupta Maurya.
2. The maxims cover a wide range of topics including ethics, economics, foreign policy, leadership, and citizens' duties. They emphasize the importance of righteousness, prosperity, having the right ruler, counsel from advisors, developing allies, avoiding laziness and vices, and following dharma.
3. The advice includes guidelines for rulers on acquiring wealth through activity and effort with God's
This document discusses the importance of water for the human body. It begins by explaining that after air, water is the most important necessity for living creatures and humans can only survive a few days without drinking water. It then discusses how the human body is made up of 68% water and that water is found both inside and outside of cells. It emphasizes that water is responsible for three-fourths of all activity in the body and explains the relationship between water intake and energy levels. The document advocates drinking 5-6 liters of water per day for optimal health and functioning of the body.
The document discusses establishing an amiable daily routine for health and avoiding illness. It outlines five principles or "dharma" that are important for health: the dharma of water, food, exercise, rest, and excretion/fasting. Following these principles, like drinking the proper amount of water, eating the right foods, exercising regularly, getting adequate rest, and allowing for proper excretion, is said to be key for maintaining good health and avoiding disease, more so than relying on modern medicine. Violating these principles can lead to illness.
Diabetes, also known as diabetes mellitus, is a disease where there are high levels of glucose in the blood. Normally, the pancreas produces insulin to regulate blood sugar levels, but in diabetes the pancreas either doesn't produce enough insulin or cells don't respond properly to insulin. This causes glucose to not be absorbed properly into cells for energy. The three main types of diabetes are type 1 where the pancreas produces little to no insulin, type 2 where cells don't respond to insulin properly, and gestational diabetes which occurs during pregnancy. Left untreated, diabetes can lead to serious health complications.
This document provides information about acute hepatitis, including its causes, clinical forms, and specific types. It discusses acute viral hepatitis and chronic viral hepatitis. The main causes of acute hepatitis are various viruses (A, B, C, E, EBV, CMV), alcohol, toxins, and drugs. Hepatitis A and E are enterically transmitted and cause acute disease without a chronic phase. Hepatitis B, C, and D are blood-borne viruses that can cause chronic infections. The document then provides more detailed information about the pathogenesis, transmission, clinical features, outcomes, prevention, and treatment of specific hepatitis viruses, including hepatitis A, E, B, and C.
This document discusses dysfunctional uterine bleeding (DUB), its classification, causes, and pathophysiology. It begins by defining DUB as abnormal uterine bleeding without identifiable organic disease. DUB is classified as primary or secondary to conditions like thyroid dysfunction. The document then covers characteristics of normal menstruation versus abnormal bleeding patterns like menorrhagia, hypomenorrhea, and others. It details the role of hormones in the normal menstrual cycle and how imbalances can lead to DUB, discussing mechanisms like estrogen withdrawal, breakthrough, and progesterone breakthrough bleeding. The document concludes by outlining several mechanisms through which DUB can occur, such as hyper-estrogenic states and impaired haemostatic and re-epithelialization
This document discusses the importance of combining both the art and science of clinical reasoning in diagnosis. It draws parallels between doctors and detectives, emphasizing the value of careful observation, deduction, and considering what information is both present and absent. While technology has advanced diagnosis, overreliance on protocols or algorithms can be flawed if not applied judiciously. The ideal clinician utilizes both up-to-date medical knowledge and detective-like analytical skills to fully understand the patient and identify any inconsistencies that may point to the underlying disease.
1. The document provides maxims and advice from the works of Kautilya (also known as Chanakya and Vishngupta), an Indian philosopher who lived from 321 BC to 290 BC. He served as the chief minister of the Maurya Empire under Emperor Chandragupta Maurya.
2. The maxims cover a wide range of topics including ethics, economics, foreign policy, leadership, and citizens' duties. They emphasize the importance of righteousness, prosperity, having the right ruler, counsel from advisors, developing allies, avoiding laziness and vices, and following dharma.
3. The advice includes guidelines for rulers on acquiring wealth through activity and effort with God's
This document discusses the importance of water for the human body. It begins by explaining that after air, water is the most important necessity for living creatures and humans can only survive a few days without drinking water. It then discusses how the human body is made up of 68% water and that water is found both inside and outside of cells. It emphasizes that water is responsible for three-fourths of all activity in the body and explains the relationship between water intake and energy levels. The document advocates drinking 5-6 liters of water per day for optimal health and functioning of the body.
The document discusses establishing an amiable daily routine for health and avoiding illness. It outlines five principles or "dharma" that are important for health: the dharma of water, food, exercise, rest, and excretion/fasting. Following these principles, like drinking the proper amount of water, eating the right foods, exercising regularly, getting adequate rest, and allowing for proper excretion, is said to be key for maintaining good health and avoiding disease, more so than relying on modern medicine. Violating these principles can lead to illness.
Diabetes, also known as diabetes mellitus, is a disease where there are high levels of glucose in the blood. Normally, the pancreas produces insulin to regulate blood sugar levels, but in diabetes the pancreas either doesn't produce enough insulin or cells don't respond properly to insulin. This causes glucose to not be absorbed properly into cells for energy. The three main types of diabetes are type 1 where the pancreas produces little to no insulin, type 2 where cells don't respond to insulin properly, and gestational diabetes which occurs during pregnancy. Left untreated, diabetes can lead to serious health complications.
This document provides information about acute hepatitis, including its causes, clinical forms, and specific types. It discusses acute viral hepatitis and chronic viral hepatitis. The main causes of acute hepatitis are various viruses (A, B, C, E, EBV, CMV), alcohol, toxins, and drugs. Hepatitis A and E are enterically transmitted and cause acute disease without a chronic phase. Hepatitis B, C, and D are blood-borne viruses that can cause chronic infections. The document then provides more detailed information about the pathogenesis, transmission, clinical features, outcomes, prevention, and treatment of specific hepatitis viruses, including hepatitis A, E, B, and C.
This document discusses dysfunctional uterine bleeding (DUB), its classification, causes, and pathophysiology. It begins by defining DUB as abnormal uterine bleeding without identifiable organic disease. DUB is classified as primary or secondary to conditions like thyroid dysfunction. The document then covers characteristics of normal menstruation versus abnormal bleeding patterns like menorrhagia, hypomenorrhea, and others. It details the role of hormones in the normal menstrual cycle and how imbalances can lead to DUB, discussing mechanisms like estrogen withdrawal, breakthrough, and progesterone breakthrough bleeding. The document concludes by outlining several mechanisms through which DUB can occur, such as hyper-estrogenic states and impaired haemostatic and re-epithelialization
This document discusses the importance of combining both the art and science of clinical reasoning in diagnosis. It draws parallels between doctors and detectives, emphasizing the value of careful observation, deduction, and considering what information is both present and absent. While technology has advanced diagnosis, overreliance on protocols or algorithms can be flawed if not applied judiciously. The ideal clinician utilizes both up-to-date medical knowledge and detective-like analytical skills to fully understand the patient and identify any inconsistencies that may point to the underlying disease.
Collection of blood for investigation met microteaching pptJitendra Ingole
Blood can be collected from veins, capillaries, or arteries for hematological, biochemical, serological, and cultural examinations. Common sites for blood collection are veins, capillaries, and less frequently arteries. The procedure involves using apparatus like spirit, cotton, lancets, syringes, and containers while following aseptic precautions. Complications can include immediate local issues like failed blood draw or continued bleeding, immediate general issues like fainting, and late issues like infection, thrombosis, or disease transmission.
This document discusses diabetes, high cholesterol, and ways to manage these conditions. It notes that lifestyle factors like diet, exercise, sleep, and stress management are important for prevention and treatment. Genetics also play a role. The document provides tips for patients like following a proper medication regimen, monitoring blood sugar and weight, reducing salt intake, supplementing with vitamins, and exercising regularly. The goal is to keep blood pressure, blood sugar, and resting heart rate below certain thresholds through lifestyle modifications.
Dr Ingole_hypertension treatment concepts ,.,Jitendra Ingole
This document discusses treatment for hypertension and provides recommendations. It begins by noting the prevalence of hypertension is about 12% among undergraduate students studied. It emphasizes the need to identify and treat hypertension. It discusses various drug treatments for hypertension including dual-benefit drugs that also treat conditions like migraine or diabetes. It notes guidelines around drugs like beta-blockers and provides cautions. It discusses lifestyle factors like salt, sleep, stress, exercise and weight that impact hypertension. It recommends regular home blood pressure monitoring, periodic drug compliance checks, and adjusting treatment based on monitoring under a doctor's guidance. The document stresses a multifactorial treatment approach.
The document discusses epilepsy and pregnancy, outlining several key points:
1. The aims of treatment for epileptic women who are pregnant are to control seizures, prevent obstetric complications, and ensure adequate neonatal outcomes.
2. Babies born to epileptic mothers face higher risks of seizures, developmental issues, and birth defects ranging from 4-8% compared to 2-3% in the general population.
3. Folic acid supplementation and monotherapy with antiepileptic drugs can help reduce risks, but all drugs studied still show major malformation rates of at least 6%. Close monitoring is important for both mother and baby.
A 55-year-old female patient presented with breathlessness and was found to have signs of acromegaly such as enlarged hands and feet from a previous pituitary tumor surgery. Her ECG showed signs of left ventricular hypertrophy but was otherwise normal. The next day, she experienced chest pain and went into cardiogenic shock. Resuscitation efforts were unsuccessful and she suffered cardiac arrest. Her ECG then revealed subtle signs of myocardial ischemia that were discussed, including tall, broad T waves and ST depression in lead aVL.
The document discusses the need for a refresher course on obstructive airways diseases (OAD) in India. It notes that OADs such as asthma and COPD represent a major health burden in India, with prevalence increasing. However, a large number of OAD cases remain undiagnosed due to underuse of spirometry testing and poor management of patients in clinical practice. Inhaler therapy is also not widely used properly. A refresher course could help address these issues to improve diagnosis and management of OADs in India.
This document discusses the differential diagnosis, examination, and management of diplopia presenting in the emergency department. It begins with an example case of a 65-year-old man with diabetes and hypertension presenting with acute onset binocular diplopia and left eye ptosis. Physical examination reveals a left third nerve palsy with pupillary sparing, consistent with a "diabetic third" palsy. For isolated third nerve palsies with pupillary sparing, imaging may not be necessary and outpatient follow up is appropriate. The document reviews cranial nerve anatomy, causes of diplopia, techniques for cranial nerve examination, and indications for emergent neuroimaging.
Non-tumor dysfunction of the ovaries affects 5-10% of women of reproductive age. Key characteristics of polycystic ovary syndrome (PCOS) include hyperandrogenism, untimely LH secretion, oligomenorrhea, anovulatory infertility, hirsutism, and insulin resistance. Signs and symptoms include infertility, irregular periods, hirsutism, acne, and obesity. Ultrasound often shows polycystic ovaries with enlarged volume and stroma thickness. The pathogenesis involves hypothalamus/pituitary dysfunction, defective follicle maturation, and hyperinsulinemia causing increased ovarian androgen production. Treatment options aim to reduce androgen levels through hormonal suppression, anti
This document discusses intrauterine growth restriction (IUGR), also known as fetal growth restriction. It defines IUGR as a fetus being at or below the 10th percentile for weight based on gestational age. The document covers causes of IUGR including maternal, fetal, placental and unknown factors. It discusses methods for diagnosing and monitoring IUGR pregnancies, including ultrasound, biophysical profile and Doppler of the umbilical artery. Treatment options presented include bed rest, aspirin therapy, nutritional supplementation and deciding on optimal delivery timing balancing prematurity risks versus risks of remaining in the hostile uterine environment.
This document discusses uterine anomalies, their prevalence in the general and infertile populations, and their clinical presentations. Uterine anomalies are classified into three groups based on embryonic development defects: 1) agenesis of the uterus and vagina, 2) defects in vertical fusion that can be obstructive or non-obstructive, and 3) lateral fusion defects that can also be obstructive or non-obstructive. Specific types of uterine anomalies include unicornuate, bicornuate, septate, subseptate, arcuate, and didelphys uteri.
Caesarean section is a surgical procedure to deliver a baby through incisions in the abdomen and uterus. It is indicated when vaginal delivery would put the mother or baby's health at risk or is not possible due to issues like failed labor, fetal distress, or breech presentation. The procedure involves making incisions in the mother's abdomen and lower uterine segment. The baby and placenta are then delivered and the uterine incision is closed with stitches. Post-operative care focuses on monitoring for bleeding, infection, and other complications to support the mother's recovery.
This document discusses the evaluation and diagnosis of bleeding in early pregnancy. It lists potential causes of bleeding such as abortion, ectopic pregnancy, and tumors. It describes assessing the amount and rate of bleeding. The diagnosis involves taking a careful history of the menstrual cycle and symptoms, performing a pelvic exam to check the cervix, uterus, and adnexa, and conducting pregnancy tests and ultrasound exams. Ectopic pregnancy is considered, and expectant versus medical management options are mentioned.
This document discusses different types of amenorrhea, or absent menstrual periods. It describes primary amenorrhea, which is the absence of menstruation by age 16 with no development of secondary sex characteristics. This can be caused by hypogonadotropic or hypergonadotropic hypogonadism. Hypergonadotropic amenorrhea is often due to genetic conditions like Turner's syndrome or enzyme deficiencies. Hypogonadotropic amenorrhea has causes like Kallmann's syndrome, infections, or pituitary tumors. Treatment depends on the underlying cause and may include hormone replacement, surgery, or removal of obstructions. Anorexia nervosa can also cause amenorrhea due to severe weight loss and altered
This document defines abortion and discusses its classification, incidence, etiology, clinical features, investigations, treatment, and complications. It defines abortion as the expulsion of an embryo or fetus weighing less than 500g before 24 weeks of gestation. Abortions can be spontaneous (threatened, inevitable, complete, incomplete, missed, or septic) or induced (legal or illegal). Common causes include genetic factors, endocrine issues, infections, anatomical abnormalities, and immunological or blood disorders. Investigations may include ultrasounds and lab tests. Treatment depends on the type and includes rest, medication, dilation and curettage, or laparotomy in complicated cases. Recurrent abortion is defined as 3 or more consecutive losses and
Abnormal cytology & histology of cervix _ Histopathology Jitendra Ingole
This document discusses the morphological abnormalities seen in cervical cytology and histology specimens. It describes the cellular abnormalities seen in mild, moderate, and severe dyskaryosis, which correlate with cervical intraepithelial neoplasia (CIN) grades 1, 2, and 3, respectively. Examples of abnormal nuclear features, cell shapes, and architectural patterns are provided for each grade of dyskaryosis/CIN. Koilocytosis, carcinoma in situ, and invasive carcinoma are also described. A comparison of past and current cervical cancer classification systems is given.
This document discusses the importance of a detective-like clinical approach to diagnosis. It emphasizes that history taking and physical examination are paramount, and provide the foundation for further testing or treatment. A careful, thoughtful diagnostic process considering all available clues is more valuable than reliance on technology alone. An ideal clinician observes details, deduces likely explanations, and has a broad base of knowledge - similar to the skills of fictional detectives. Following diagnostic algorithms too rigidly can miss important insights from each individual patient's full story.
Sel list 10 july 13 neet pg seat selection 2013 Jitendra Ingole
This document is a selection list for admissions to postgraduate medical courses in Maharashtra for the 2013-2014 academic year, round 1.0. It provides instructions for selected candidates regarding document submission and fee payment deadlines. The list includes 69 candidates selected for courses like MD Radiology, MD Medicine, and MS Orthopedics at various colleges in Maharashtra. It notes that candidates who obtained their MBBS from a Maharashtra government institution must submit a bond release certificate.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
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.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Collection of blood for investigation met microteaching pptJitendra Ingole
Blood can be collected from veins, capillaries, or arteries for hematological, biochemical, serological, and cultural examinations. Common sites for blood collection are veins, capillaries, and less frequently arteries. The procedure involves using apparatus like spirit, cotton, lancets, syringes, and containers while following aseptic precautions. Complications can include immediate local issues like failed blood draw or continued bleeding, immediate general issues like fainting, and late issues like infection, thrombosis, or disease transmission.
This document discusses diabetes, high cholesterol, and ways to manage these conditions. It notes that lifestyle factors like diet, exercise, sleep, and stress management are important for prevention and treatment. Genetics also play a role. The document provides tips for patients like following a proper medication regimen, monitoring blood sugar and weight, reducing salt intake, supplementing with vitamins, and exercising regularly. The goal is to keep blood pressure, blood sugar, and resting heart rate below certain thresholds through lifestyle modifications.
Dr Ingole_hypertension treatment concepts ,.,Jitendra Ingole
This document discusses treatment for hypertension and provides recommendations. It begins by noting the prevalence of hypertension is about 12% among undergraduate students studied. It emphasizes the need to identify and treat hypertension. It discusses various drug treatments for hypertension including dual-benefit drugs that also treat conditions like migraine or diabetes. It notes guidelines around drugs like beta-blockers and provides cautions. It discusses lifestyle factors like salt, sleep, stress, exercise and weight that impact hypertension. It recommends regular home blood pressure monitoring, periodic drug compliance checks, and adjusting treatment based on monitoring under a doctor's guidance. The document stresses a multifactorial treatment approach.
The document discusses epilepsy and pregnancy, outlining several key points:
1. The aims of treatment for epileptic women who are pregnant are to control seizures, prevent obstetric complications, and ensure adequate neonatal outcomes.
2. Babies born to epileptic mothers face higher risks of seizures, developmental issues, and birth defects ranging from 4-8% compared to 2-3% in the general population.
3. Folic acid supplementation and monotherapy with antiepileptic drugs can help reduce risks, but all drugs studied still show major malformation rates of at least 6%. Close monitoring is important for both mother and baby.
A 55-year-old female patient presented with breathlessness and was found to have signs of acromegaly such as enlarged hands and feet from a previous pituitary tumor surgery. Her ECG showed signs of left ventricular hypertrophy but was otherwise normal. The next day, she experienced chest pain and went into cardiogenic shock. Resuscitation efforts were unsuccessful and she suffered cardiac arrest. Her ECG then revealed subtle signs of myocardial ischemia that were discussed, including tall, broad T waves and ST depression in lead aVL.
The document discusses the need for a refresher course on obstructive airways diseases (OAD) in India. It notes that OADs such as asthma and COPD represent a major health burden in India, with prevalence increasing. However, a large number of OAD cases remain undiagnosed due to underuse of spirometry testing and poor management of patients in clinical practice. Inhaler therapy is also not widely used properly. A refresher course could help address these issues to improve diagnosis and management of OADs in India.
This document discusses the differential diagnosis, examination, and management of diplopia presenting in the emergency department. It begins with an example case of a 65-year-old man with diabetes and hypertension presenting with acute onset binocular diplopia and left eye ptosis. Physical examination reveals a left third nerve palsy with pupillary sparing, consistent with a "diabetic third" palsy. For isolated third nerve palsies with pupillary sparing, imaging may not be necessary and outpatient follow up is appropriate. The document reviews cranial nerve anatomy, causes of diplopia, techniques for cranial nerve examination, and indications for emergent neuroimaging.
Non-tumor dysfunction of the ovaries affects 5-10% of women of reproductive age. Key characteristics of polycystic ovary syndrome (PCOS) include hyperandrogenism, untimely LH secretion, oligomenorrhea, anovulatory infertility, hirsutism, and insulin resistance. Signs and symptoms include infertility, irregular periods, hirsutism, acne, and obesity. Ultrasound often shows polycystic ovaries with enlarged volume and stroma thickness. The pathogenesis involves hypothalamus/pituitary dysfunction, defective follicle maturation, and hyperinsulinemia causing increased ovarian androgen production. Treatment options aim to reduce androgen levels through hormonal suppression, anti
This document discusses intrauterine growth restriction (IUGR), also known as fetal growth restriction. It defines IUGR as a fetus being at or below the 10th percentile for weight based on gestational age. The document covers causes of IUGR including maternal, fetal, placental and unknown factors. It discusses methods for diagnosing and monitoring IUGR pregnancies, including ultrasound, biophysical profile and Doppler of the umbilical artery. Treatment options presented include bed rest, aspirin therapy, nutritional supplementation and deciding on optimal delivery timing balancing prematurity risks versus risks of remaining in the hostile uterine environment.
This document discusses uterine anomalies, their prevalence in the general and infertile populations, and their clinical presentations. Uterine anomalies are classified into three groups based on embryonic development defects: 1) agenesis of the uterus and vagina, 2) defects in vertical fusion that can be obstructive or non-obstructive, and 3) lateral fusion defects that can also be obstructive or non-obstructive. Specific types of uterine anomalies include unicornuate, bicornuate, septate, subseptate, arcuate, and didelphys uteri.
Caesarean section is a surgical procedure to deliver a baby through incisions in the abdomen and uterus. It is indicated when vaginal delivery would put the mother or baby's health at risk or is not possible due to issues like failed labor, fetal distress, or breech presentation. The procedure involves making incisions in the mother's abdomen and lower uterine segment. The baby and placenta are then delivered and the uterine incision is closed with stitches. Post-operative care focuses on monitoring for bleeding, infection, and other complications to support the mother's recovery.
This document discusses the evaluation and diagnosis of bleeding in early pregnancy. It lists potential causes of bleeding such as abortion, ectopic pregnancy, and tumors. It describes assessing the amount and rate of bleeding. The diagnosis involves taking a careful history of the menstrual cycle and symptoms, performing a pelvic exam to check the cervix, uterus, and adnexa, and conducting pregnancy tests and ultrasound exams. Ectopic pregnancy is considered, and expectant versus medical management options are mentioned.
This document discusses different types of amenorrhea, or absent menstrual periods. It describes primary amenorrhea, which is the absence of menstruation by age 16 with no development of secondary sex characteristics. This can be caused by hypogonadotropic or hypergonadotropic hypogonadism. Hypergonadotropic amenorrhea is often due to genetic conditions like Turner's syndrome or enzyme deficiencies. Hypogonadotropic amenorrhea has causes like Kallmann's syndrome, infections, or pituitary tumors. Treatment depends on the underlying cause and may include hormone replacement, surgery, or removal of obstructions. Anorexia nervosa can also cause amenorrhea due to severe weight loss and altered
This document defines abortion and discusses its classification, incidence, etiology, clinical features, investigations, treatment, and complications. It defines abortion as the expulsion of an embryo or fetus weighing less than 500g before 24 weeks of gestation. Abortions can be spontaneous (threatened, inevitable, complete, incomplete, missed, or septic) or induced (legal or illegal). Common causes include genetic factors, endocrine issues, infections, anatomical abnormalities, and immunological or blood disorders. Investigations may include ultrasounds and lab tests. Treatment depends on the type and includes rest, medication, dilation and curettage, or laparotomy in complicated cases. Recurrent abortion is defined as 3 or more consecutive losses and
Abnormal cytology & histology of cervix _ Histopathology Jitendra Ingole
This document discusses the morphological abnormalities seen in cervical cytology and histology specimens. It describes the cellular abnormalities seen in mild, moderate, and severe dyskaryosis, which correlate with cervical intraepithelial neoplasia (CIN) grades 1, 2, and 3, respectively. Examples of abnormal nuclear features, cell shapes, and architectural patterns are provided for each grade of dyskaryosis/CIN. Koilocytosis, carcinoma in situ, and invasive carcinoma are also described. A comparison of past and current cervical cancer classification systems is given.
This document discusses the importance of a detective-like clinical approach to diagnosis. It emphasizes that history taking and physical examination are paramount, and provide the foundation for further testing or treatment. A careful, thoughtful diagnostic process considering all available clues is more valuable than reliance on technology alone. An ideal clinician observes details, deduces likely explanations, and has a broad base of knowledge - similar to the skills of fictional detectives. Following diagnostic algorithms too rigidly can miss important insights from each individual patient's full story.
Sel list 10 july 13 neet pg seat selection 2013 Jitendra Ingole
This document is a selection list for admissions to postgraduate medical courses in Maharashtra for the 2013-2014 academic year, round 1.0. It provides instructions for selected candidates regarding document submission and fee payment deadlines. The list includes 69 candidates selected for courses like MD Radiology, MD Medicine, and MS Orthopedics at various colleges in Maharashtra. It notes that candidates who obtained their MBBS from a Maharashtra government institution must submit a bond release certificate.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
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.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)
Original pdf article demise of physical examination jitendra ingole and ap jain medicine update 2007
1. 888
Medicine Update
154
Demise of Physical Examination
AP JAIN, JITENDRA INGOLE
CONSIDER THIS...
A patient with chest pain
admitted in ICU. Resident asks
intern to take BP. But later resident
becomes so much busy, that he
forgets to ask for BP recording.
Later in night, patient deteriorates,
his BP is taken by another resident.
He suspects something unusual.
The second resident quickly gets CT Thorax done based
on BP recording.
And lo, behold, the patient indeed has dissecting
aortic aneurysm. So, what’s the message ? The message
is very clear: Well conducted history and physical
examination are a must. And that even a single point in
the history or physical examination may hold all
important clue.
CURRENT SCENARIO
In the present era of modern medicine, the deterioration of skills in physical examination has become much
more evident. And many a times it is too painful to know
that some of the eventualities could have been averted
by meticulous clinical examination rather than blindly
relying on investigation reports.
And what is happening now-a-days:
• Routine use of sophisticated diagnostic tools is killing the art of
clinical reasoning.
• Blind faith in technology: Treating
the reports rather than the patient.
• Pre-determined diagnostic algorithms: One is ought
to know that these algorithms are meant to assist the
clinician and they are not absolute. Thus, a judicious
use is required rather than blind adherence.
Almost all the eminent clinicians repeatedly stress
upon importance of meticulous history and clinical
examination. In fact, a good history can itself suggest
many differential diagnoses and the possibilities are
narrowed down by proper clinical examination.
Investigations serve as to confirm and supporting our
working diagnosis rather than a tool of discovery in
itself. In other words, investigations should always be
guided by history and clinical examination.
So, what happens when one is not accustomed with
clinical examination? One may think ,”I am not able to
make out anything. Let’s order this battery of investigations and see if we can get something.”
This is wrong attitude and should be avoided at all
costs—for it creates more confusion than solutions. To
illustrate this fact: Not all the persons who are positive
for rheumatoid factor, have the disease. In fact, 5% of
normal individuals can have RA factor (Harrison’s
Principles of Internal Medicine, 16th Edn).
Early physicians also believed that clinical examination has mystical power and be given priority always.
Consider the following: “By far the most frequently
used drug in the general practice is the doctor himself.
No pharmacology of this important drug exists……”
(Michael Balint).
It is clearly evident that not many physicians now
have the same attitude. Many of the physicians today
are lost in the world of investigations. Thus, the fear
becomes imperative that clinical examination skills
would gradually atrophy and become redundant if not
stressed upon.
2. Demise of Physical Examination
Incidentally, the same is also true with
stethoscope. The golden era of stethoscope
was from invention to death of Sir William
Osler in 1919. Gradually the art of listening
by stethoscope is eroding. Many a times,
stethoscope is put as a habit!
According to a study of residents, conducted in 1992
at Duke University—each resident was asked to identify
murmur programmed in mannequin and then of real
patients, at random. And the results were dismaying.
On an average, a resident could identify only 20% of
the heart sounds correctly.
What next …..? The fear is very rightly placed – That
even stethoscope may become extinct in coming few
decades if not years. As we make advances, the distance
from patient is growing. A doctor may not even need to
sit in front of patient. The question is where will it lead
us to?
So, Is the Vital Art of Examining
the Patients Extinguishing?
One may ask the question: Is this demise in clinical
skills a crisis or an evolution due to technology? As
newer tools of diagnosis evolve, clinical skills are
gradually decreasing. Does this mean that one should
not use technology at all? Or, does it mean that no further
research should be carried in Medical field to evolve new
technologies and instruments?
The answer would be: Judicious use of technology is
required. What do we mean by judicious? It means that
an investigation should be performed only if it is going
to alter the management of patient. Doing a test just
because it is available does not make any point. And
thus, when one is surrounded by a myriad of investigations, today’s clinician has even greater responsibility
than ever to choose a proper investigation guided by
history and examination.
THE OTHER ASPECT OF THE ISSUE
It is also a well known fact that clinical examination
alone cannot predict whether a given patient with stroke
has infarct or hemorrhage. Imaging studies are essential
to confirm this. Thus, many ask this question, “Is
physical examination attractive from outside and
worthless at its core?”
Example 1: The frequently
asked question: Is physical exam
or CXR better to diagnose Pneumonia? In 1997, review of studies
suggested that CXR alone can
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not establish diagnosis of pneumonia. CXR complements
physical examination; does NOT replace it!
Example 2: A patient admitted to superspeciality
hospital with chest discomfort without any previous
history or risk factors. She was straightway put through
angiography.
Patient was told that she would require angioplasty.
Patient was taken by surprise by these events and she
asked for a day’s time. During routine round in the
evening same day, a doctor pointed that she did not have
any chest pain nor any exertional dyspnea, anytime. So,
the angiography film was again reviewed by another
doctor and found that an artifact was interpreted as
obstruction.
Example 3: Wenckebach discovered the arrhythmia
even before ECG was invented based on arterial and
jugular venous pulsations timings! Now, the answers
are:
“We will straightway get an ECG.” ; “Who has time
to stare at patient’s neck?”; “ECG is most accurate. Why
waste our time then in physical examination?”
Why the Demise ?
There are many reasons that can be attributed to the
demise of clinical examination. As the workload increases, doctor has to see more patients in a limited period
of time. Thus, less time is available for each patient.
Secondly, doctor (and even patients) are uncomfortable with uncertainties of diagnosis. They always want
a foolproof diagnosis and treatment, all the time.
Consider this example: Herniated Disk has 90%
Clinical Probability (on physical examination); but has
100% certainty with MRI. Thus, patient and doctor go
for MRI even if the diagnosis is certain on examination.
The other reasons that have appeared recently are:
• Fear of law suits (especially due to Consumer
Protection Act)
• Fear of subjective observation.
Hence, what is happening today is (i) to burn money
to make diagnostic work-up superficial; (ii) losing
intellectual pleasure that comes from careful diagnostic
reasoning. Thus, an investigation, however sophisticated
and expensive, if performed in the inappropriate clinical
settings, will be useless.
WHAT CAN BE DONE?
Demise of clinical examination—
reasons are many and effects are saddening. But million dollar question
is: What can be done? Let us try to
answer it:
3. 890
Medicine Update
1. Common sense: Harvey Cushing (1869–1939) ‘Three
fifths of practice of medicine depends on common
sense, a knowledge of people and of human reactions’. And as a well known fact, common sense is
less common !
2. Sherlock Holmes aphorisms: The ideal qualities that
all doctors should try to adhere to are: Observation,
Deduction, Knowledge. These qualities are common
with doctors and detectives (Doctor as detective: BMJ
2005). Here are some of the famous quotes of Sherlock
Holmes to stress importance of observation in clinical
examination:
a. You see but you do not observe.
b. My method is founded upon observation of
trifles.
c. Never trust general impressions, but concentrate
on details.
d. It is capital mistake to theorise before one has the
data.
e. There is nothing like first hand evidence.
f. There is nothing more deceptive than an obvious
fact.
g. The world is full of obvious things which nobody
by any chance observes.
h. When you have eliminated all impossible,
whatever remains, however improbable, must be
the truth.
i. Do not try to twist the facts to suit theories. Rather,
theories should suit the facts.
3. Some Clinical pearls: Some of the common clinical
pearls that we come across often are listed below:
a. Uncommon manifestations of common diseases
are more common than common manifestations
of uncommon diseases.
b. If we make rare diagnosis, it will rarely be correct.
c. Important facts or findings that are not uncovered
during the initial clinical assessment of the patient
have an uncanny way of eluding later detection
as the work up progresses.
d. You see only what you look for and you recognize
only what you know.
e. The least indicated procedures lead to most
complications.
f. There is something more important than all
medicine—the human touch.
4. Build trust in patient-physician relationship: Trust
develops through a series of small encounters
wherein one party demonstrates “trustworthiness”
to the other. Keeping small promises such as “I will
get back to you with the test results”, or “I will call
specialist for your this problem and try to provide
best possible solution for you.”
5. Advisory role: This role is also dependant on trust.
The advisory role places immense responsibilities on
physician wherein patient trusts him for all important decisions such as surgery, starting of complex
regimen treatment, etc. in belief that the doctor will
take best decisions for him. A word here is for
patients also that patient must believe that their
physician is reliable, understanding and honest if
they are to have confidence in their physician’s
advice.
6. Therapeutic role of physician: It resides in
addressing to the patient’s concerns, conveying
empathy, building trust, giving advice and being
supportive. This nonetheless means that physician
should done the mantle of psychotherapist
completely. But the beauty of Physician’s role lies in
the fact that his role switches back and forth between
being physician and providing empathy and
emotional support.
7. Importance of ideals: Ideals are crucial. They
continually set standards that we all strive for and
at times, achieve.
HOW SIMPLE OBSERVATIONS
CAN LEAD US TO DIAGNOSIS?
The examples have been given to
illustrate the importance of meticulous
observation. It is co-incidence that the job
of detective and doctor, both require this
quality.
Here is a lady detective—Mma Ramotswe, an
intelligent detective, who was waiting to see her doctor
for about an hour outside his consulting room. She
makes accurate and intelligent observations when she
was sitting in waiting room, which she narrates to doctor
afterwards.
She tells that first patient was butcher? How? Because
he had lost a finger on his left hand and was
continuously scratching his body.
The second female patient unable to sleep at night.
Because, she had slept off while waiting and had to be
awakened on her turn. Besides there were milk stains
on her clothes… must have been awake due to baby.
Third female patient was unhappy but not
depressed. Because she was continuously knitting and
was busy which a depressed person cannot do.
4. Demise of Physical Examination
And then, it was the turn of the detective to get
surprised, as the doctor tells her not to eat too much
doughnuts. How he could have drawn this inference?
Because her weight was not decreasing since last few
years . Secondly, sugar was spilled in front of her dress
from doughnuts.
TAKE HOME MESSAGE
Detailed history and clinical examination must be
given priority. History should be used to formulate
differential diagnosis and clinical examination should
help to narrow down the possibilities. Finally, judicious
and only essential investigations should be used to
confirm the diagnosis.
One ought never to forget the different roles of
physician—viz. advisory role, therapeutic role to utilize
the patient-physician relationship in a more productive
way and to the patient’s beneficence. Also, a good
physician must be flexible—able to adopt consumerism,
paternalism, mutuality and priority for well-being of
patient.
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Clinical examination is less expensive. It can be
performed anywhere and also increases doctor-patient
bond. On other hand, technology is not foolproof; it has
its own limitations that needs to be kept in mind always
while interpreting the results.
And yes, we must perform clinical examination well
each and every time. Simply because, one never knows
when it will hold vital clue for diagnosis.
SUGGESTED READING
1. Doctor as Detective. BMJ 2005;331:24-31.
2. Howard M. The Stethoscope and Art of Listening. NEJM
2006;6:354.
3. Michael Balint. The doctor, his patient and the illness. New
York, NY: International Universities Press Inc; 1972.
4. Peter E Lipsky. Rheumatoid Arthritis: Braunwald, et al.
Harrison’s Principles of Internal Medicine, 16th edn., Mc Graw
Hill 2005;1968-77.
5. Sandeep J. Demise of Clinical Examination. NEJM 2006;6:354.
6. William Branch, Jr. Is the therapeutic nature of the PatientPhysician relationship being undermined? A Primary Care
Physician’s Perspective. Arch of Int Medicine 2000;160:28.