Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
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!
- 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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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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.
7. Historical aspect
Parker started the use of broomstick cast in 1929.
Eyre-Brook introduced traction in bed for 18-24 months.
8. Blood supply to femoral head
Retinacular arteries
Metaphyseal arteries
Artery of the round
ligament
9. Blood supply to femoral head
Infants
1. Metaphyseal arteries .
2. Lat epiphyseal arteries
3. Lig teres – insignificant
4 mts – 4 years
1. Lat epiphyseal
2. Metaphyseal art. decrease in number
(due to appearance of growth plate).
10. Blood supply to femoral head
4 yrs to 7 years
1. Epiphyseal plate forms a barrier to metaphyseal vessels.
Pre-adolescent
1. After 7 yrs arteries of lig teres become more prominent
and anastomose with the lateral epiphyseal vessels.
11. Blood supply to femoral head
Adolescent
After skeletal maturity
metaphyseal vessels again come
into picture
12. Incidence
Male : Female = 4-5:1
2.5:1 in India
Age of onset earlier in females.
Age –
Range – 2-13 years.
Most common 4-8 years.
Average – 6 years.
Bilateral in 10-12 %
Incidence more in Caucasians as compared to
Negroid, mongoloid.
13. Etiology
Etiology not known.
Coagulation disorders.
Altered arterial status of femoral head.
Abnormal venous drainage.
Abnormal growth and development.
Trauma.
Hyperactivity or attention deficit disorder.
Genetic component.
Environmental influences.
As a sequelae to synovitis.
15. Altered arterial status
Angiographic studies have shown obstruction of
superior capsular arteries and decreased flow in
medial circumflex femoral arteries .
The intracapsular ring has been found to be
incomplete.
16. Abnormal venous drainage
Increased venous pressure in the
femoral neck
Congestion in the metaphysis
Venous outflow exits more distally in the diaphysis.
17. Abnormal growth and development
A delay in Bone age of 1.5 to 2 years
Low birth weight
Low levels of somatomedin C
18. Trauma.
In the developing femur (4 – 7 yrs),the major lateral
epiphyseal vessels must course through a narrow
passage ,which could make it susceptible to trauma.
22. Sequel to synovitis
Synovitis of the hip occurs early in Perthes disease.
Increased pressure in synovitis may cause a tamponade
effect on the vasculature
23. Pathogenesis
Waldenstrom staged the pathological
process of the disease as
1. Initial or ischaemic stage
2. Resorption or fragmentation stage
3. Reparative stage
4. Remodelling stage
24. Pathogenesis
Ischaemic stage
- Necrosis
- Crushing of trabaculae.
- degeneration of basal layer of
articular cartilage
- Thickening of peripheral
cartilagenous cap.
- Shape of head maintained.
26. Pathogenesis cont…
Resorption stage
- Invasion of vascular connective tissue.
- Resorption of dead bone by
Osteoclasts.
- loss of epiphyseal height due to
1) Collapse of bony trabaculae.
2) Resorption of dead bone
30. Remodelling stage
(replacement by biologically plastic bone)
If treated
Femoral head is
congrous
If untreated
Subluxation and deformity
31. Clinical Features
Painless limp leads to painful limp
Pain in the groin,anterior hip
or greater trochanter
Referred pain to the knee
Combination of antalgic & trendelenburg
gait.
32. Decreased range of motion especially abduction and internal rotation.
Atrophy of thigh muscles.
Shortening
33. Investigation
X-Ray –AP & Frog leg Lat view (Lowenstein view)
USG
Arthrography
Bone Scan
MRI
42. Arthrography
Shows configuration of the femoral head and its relation
with the acetabulum.
Containment
Congruity
Not routinely used .
43. Bone Scan
Diagnosis possible months before signs appear on X-Ray.
Avascular areas show cold spots.
44. Bone Scan
Convay et al
classification
Stage 1 is total lack
of uptake
45. Bone Scan( stage 2)
Revascularisation of a
lateral column
Failure to revascularise
at lat column is a grave
sign
Also called
“scintigraphic head at
risk sign”
Precedes radiographic
head at risk sign by 2-3
mths
51. Catterall classification
(based on x ray AP and Lat view).
I – only anterior portion of epiphysis
affected.
II – anterior segment involved central
sequestrum present
III – most of epiphysis sequestered with
unaffected portions located medial
and lateral to central segment
IV – all of epiphysis sequestered.
54. Herring Lat Pillar
Group-A no involvement of the lateral
pillar, with no density changes and no
loss of height of the lateral pillar
Group-B hips have lucency in the
lateral pillar and may have some loss
of height , but not exceeding 50% of
the original height.
Group-C hips are those with more
lucency in the lateral pillar and >50%
loss of height
74. CE angle of Weiberg
Indicator of acetabular depth
It is the angle formed by a
perpendicular line through the
midpoint of the femoral head
and a line from the femoral
head center to the upper outer
acetabular margin.
Normal = 20 to 40 degrees
Angle >25 = good, 20-25= fair, <
20 = poor
77. Epiphyseal index & quotient
Epiphyseal index = greatest height of the epiphysis
divided by its width.
Epiphyseal quotient = Epiphyseal index of involved hip
divided by the index for uninvolved hip.
>0.6 = good
0.4-0.6 = fair
<0.4 = poor
80. Stulberg classificaton
Class I – Shape of the femoral head was
basically normal.
Class II – Loss of head height but within 2 mm
to a concentric circle on AP and frog
leg X-Ray
Class III – Deviates more than 2 mm and
acetabulum contour matches
the head contour
Class IV – Head Flattened, Flattened area
<1cm. Acetabulum contour matches
the head contour
Class V – Collapse of femoral head, Acetabular
contour does not change
81. Stulberg classificaton
Class I & II – Spherically congruent.
Class III & IV – Congruous Incongruity
OR
Aspherical congruity.
Class V – Incongruous incongruity
OR
Aspherically incongruent.
87. Differential diagnosis
Tuberculosis of the hip
AVN due to leukemia, lymphoma, gauchers disease,
hemoglobinopathies etc
Meyers dysplasia
AVN following dislocation.
Transient synovitis
88. Treatment
Objectives
- To produce a normal femoral
head and neck
- To produce a normal acetabulum
- A congruous hip which is fully
mobile
- To prevent degenerative arthritis
of the hip later in life
89. Treatment
Treatment efforts are directed towards
- Restoration and maintenance of
full mobility of the hip
- Containment of the femoral
head.
- Resumption of weight bearing
and full activity as soon as
possible
90. Treatment
Caterall group 1 and
group 2 ( < 7 years)
No
Herring group 1 & Treatment
group 2 (< 6 years)
91. Treatment
Treatment is divided into 3 phases
Initial Phase – restore & maintain mobility
Active Phase – Containment and maintainance of full mobility.
Reconstructive phase – correct residual deformities.
92. Treatment ( Initial Phase )
Physiotherapy – active and passive
range of motion
exercises to restore
motion
Traction – B/L skin traction and
gradually abducting over 1-2
weeks till full abduction is
regained.
93. Treatment ( Active Phase )
Consists of containment of the femoral head within the
acetabulum. This can be achieved by
orthosis
or by
surgery
94. Treatment (Orthosis)
Non Ambulatory weight releiving
1. Abduction broomstick plaster cast
2. Hip pica cast
Ambulatory Both limbs included
1. Petrie Abduction cast
2. Toronto orthosis
3. Newington orthosis
4. Birmingham brace
5. Atlanta Scotish Rite Brace
102. Treatment (Orthosis)
Orthotic treatment is discontinued when the
disease enters the reparative phase and healing
is established.
103. The radiographic evidence of healing are
1. Appearance of irregular ossification in the femoral
head.
2 . Increased density of femoral head should
disappear.
3 . Medial segment of femoral head should increase in
size and height.
4 . Metaphyseal rarefaction involving the lateral cortex
of the metaphysis should ossify.
5 . There should be intact lateral column.
