PELVIC ORGAN PROLAPSE, uterine prolapse , cystocele, rectocele, urethrocele, supports of uterus, sling surgeries, pessaries, grades of prolapse, uterine preserving surgery for pop, pelvic floor repair, vaginal hysterectomy, ward mayos surgery, pop q grading, grading of prolapse, laproscopic surgeries for prolapse, peregee, apogee , mesh repair, tot, tvt, colpo suspension, colpoclysis, SUI management, epidemiology of prolapse, decubitus ulcer, best ppt for pelvic organ prolapse, better understanding of pelvic organ prolapse and pelvic floor.
PELVIC ORGAN PROLAPSE, uterine prolapse , cystocele, rectocele, urethrocele, supports of uterus, sling surgeries, pessaries, grades of prolapse, uterine preserving surgery for pop, pelvic floor repair, vaginal hysterectomy, ward mayos surgery, pop q grading, grading of prolapse, laproscopic surgeries for prolapse, peregee, apogee , mesh repair, tot, tvt, colpo suspension, colpoclysis, SUI management, epidemiology of prolapse, decubitus ulcer, best ppt for pelvic organ prolapse, better understanding of pelvic organ prolapse and pelvic floor.
Asccp management guidelines august 2014 ppt. Dr. Sharda Jain /Dr Jyoti Agarw...Lifecare Centre
Updated Consensus
American society of Colpscopy & cervical pathology
Guidelines 2014for Managing forAbnormal Cervical Cancer Screening Test and Cancer Precursors
Dr. Sharda Jain /Dr Jyoti Agarwal / dr. Jyoti Bhasker
Nulife module 6 screening for malignancies editedManinder Ahuja
These six modules from 2-7 are on mid life health care of women and were made with intention of training general gynecologist and other speciality into care of mid life women and have Mid Life OPD cards as mainstay of care.
A brief discussion over CA Cervix. All newest updates in management protocol and revised by reknowned gynecologistts. Very much helpful for both under and post graduate students/Doctors.
PAP SMEAR PATHOLOGY Various slide ABOUTE many candition can see in popanicula smear test short disscution about epidemiology and screening hpv bethesda reporting and how to pop smearing when to pop smear and organism metaplasia and other condition lsil hsil cin1 cin2 cin3 ascus asch
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
5. Zone between the original
squmocolumnar junction which is
squamosquamous due to metaplasia & is
outside to the newly developed SCJ
which is inside .
Metaplastic process is very active at the
time of menarche ,during or after first
pregnancy.
This metaplastic cells have potential to
undergo atypical transformation by
trauma or infection.
9. Metaplasia –reserve cells beneath columnar
epithelium sometimes transforms in to
mature squamous cells
They are normal cells without nuclear
atypia & do not become malignant.
Abnormal nuclear changes is atypical
metaplasia is precursor of dysplasia
10. Dysplasia - cell resembling cancer cells
Cell morphology is altered
Disorderly arrangement of cells
cell vary in size shape & polarity
alteraration in nuclear cytoplasmic ratio.
large irregular hyperchromatic nuclei
mitotic figure .
lesion progress with time end up as frank
cancer
11. CIN
Richart introduced the concept .
Part or the full thickness of the stratified
squamous epithelium is replaced by cells
showing varying degrees of dysplasia .
Lesions progress with time.
30 % of lesion by 10 yr may end up as
frank invasive cancer .
13. CIN I -
Represents atypical cells with
increased nuclear to cytoplasmic ratio
and hyperchromatic nuclei present in
the lower 1/3 of the epithelial layer
from the basement membrane .
May revert to normal, persist or
progress
15. CIN II
Shows further progression of
nuclear abnormalities with greater
involvement of the epithelial
thickness. In CIN II, immature
basaloid cells occupy the lower 2/3
of the epithelium
17. CIN III
Represents almost total
involvement of the epithelium with
only one or two layers of mature
cells remaining at the surface.
When the entire epithelium is
involved, the term carcinoma in situ
(CIS) is applied.
21. What is Bethesda system of cytological
abnormality ?
22. Table 17.2 Bethesda System 2001
Specimen Type: Indicate conventional smear (Pap smear) vs.
liquid based vs. other
Specimen Adequacy
Satisfactory for evaluation (describe presence or absence of
endocervical/transformation zone component and any other
quality indicators, eg, partially obscuring blood, inflammation,
etc.)
Unsatisfactory for evaluation (specify reason)
Specimen rejected/not processed (specify reason)
Specimen processed and examined, but unsatisfactory for
evaluation of epithelial abnormality because of (specify reason)
23. General Categorization (optional)
Negative for intraepithelial lesion or malignancy
Epithelial cell abnormality: See Interpretation/Result
(specify “squamous―or “glandular―as
appropriate)
Other: See Interpretation/Result (eg, endometrial cells
in a woman 40 years of age)
24. Automated Review
If case examined by automated device, specify device
and result
Ancillary Testing
Provide a brief description of the test methods and
report the result so that it is easily understood by the
clinician
25. Interpretation/Result
Negative for Intraepithelial Lesion or Malignancy
(when there is no cellular evidence of neoplasia, state this in
the General Categorization above and/or in the
Interpretation/Result section of the report, whether or not
there are organisms or other nonneoplastic findings)
Organisms
Trichomonas vaginalis
Fungal organisms morphologically consistent with Candida
spp.
Shift in flora suggestive of bacterial vaginosis
Bacteria morphologically consistent with Actinomyces spp.
Cellular changes consistent with herpes simplex virus
26. Other Nonneoplastic Findings (optional to report;
list not inclusive):
Reactive cellular changes associated with:
inflammation (includes typical repair)
radiation
intrauterine contraceptive device (IUD)
Glandular cells status posthysterectomy
Atrophy
27. Other
Endometrial cells (in a woman 40 years of age)
(specify if negative for squamous intraepithelial lesion•)
Epithelial Cell Abnormalities
Squamous Cell
Atypical squamous cells
of undetermined significance (ASC-US)
cannot exclude HSIL (ASC-H)
Low-grade squamous intraepithelial lesion (LSIL) encompassing:
HPV/mild dysplasia/CIN 1
High-grade squamous intraepithelial lesion (HSIL) encompassing:
moderate and severe dysplasia, CIS/CIN 2 and CIN 3
with features suspicious for invasion (if invasion is suspected)
Squamous cell carcinoma
28. Glandular Cell
Atypical
endocervical cells (not otherwise specified [NOS] or specify in
comments)
endometrial cells (NOS or specify in comments)
glandular cells (NOS or specify in comments)
Atypical
endocervical cells, favor neoplastic
glandular cells, favor neoplastic
Endocervical adenocarcinoma in situ
Adenocarcinoma
endocervical
endometrial
extrauterine
NOS
29. Other Malignant Neoplasms (specify)
Educational Notes and Suggestions (optional)
31. Pap Test
The Pap test was introduced as a
cervical screening test in 1943 by
George Papanicolaou . It is a way to
examine cells collected from the cervix
and vagina. This test can show the
presence of infection, inflammation,
abnormal cells, or cancer.
32. George Papanicolaou
The first observation of cancer
cells in the smear of the uterine
cervix was one of the most
thrilling experiences of my
scientific career
36. A Pap test is simple, quick, painless.
While a woman lies on an examination table, the
clinician inserts a speculum into her vagina to
open it. To do the test, a sample of cells is taken
from in and around the cervix with a wooden
scraper and placed on a glass slide and rinsed in
liquid fixative and sent to a laboratory for
examination.
37. Ayers Spatula
Concave end to fit the
cervix
Convex end for
vaginal wall and
vaginal pool scrapings
38. Sample Cervix
Use concave end
Rotate 360 degrees
Don’t use too much
force (bleeding, pain)
Don’t use too little force
(inadequate sample)
39. Cytobrush
Insert ~ 2 cm (until
brush is fully inside
canal)
Rotate only 180
degrees (otherwise
will cause bleeding)
42. Pap test
A woman should have this test when she is not
menstruating;
the best time is between 10 & 20 days after the first
day of the menstrual period.
For about 2 days before a Pap test, she should
avoid intercourse douching, or using vaginal
medicines or spermicidal foams, creams or jellies.
43. Methods to Improve Accuracy of
Pap smear
1. Perform a Pap smear when the patient is in the
proliferative phase.
2. The patient should avoid intercourse or
intravaginal products/douches for 24-48 hours
before examination
3. Use no lubricant prior to the test
4. Have cytobrush, spatula, slide and other supplies
on hand before exam.
44. Methods to Improve Accuracy of
Pap smear(cont.)
1. Rotate the Ayers spatula through a 360-
degree arc over the SCJ and avoid excessive
pressure
2. Collect the endocervical specimen using
cytobrush or saline-moistened cotton swab
and apply it to the same slide .
3. Rapidly apply fixative to the slide, if spray
is used hold it 10 inches from the slide
45. Liquid - based cytology
Specimen is placed in a liquid fixative
Removes blood ,mucus
Suspended cells are placed over slide to
form thin monolayer
Can be employed to test HPV infection .
50. Role of vaccination
• Claimed to induce higher antibodies in blood & site of
infection
• Antibodies neutralize the virus & prevent entry into cells
51. Routine HPV Vaccination
Recommendations
The vaccination series can be started as young as 9
years of age
“Catch-up” vaccination recommended for females 13
through 26 years of age
61. Treatment options in preinvasive
lesion
Local destructive by cauterisation, cryosurgery,
laser
Local excision by conisation with knife , LLETZ
Radical excision by trachelectomy
,hysterectomy .
63. MANAGEMENT OF MILD DYSPLASIA ,LSIL
Treat the infection ,
Follow –up cytology every 6-12 months .
If persistent over 1 year follow up with
colposcopy & treat by ablation by coagulation
,cryosurgery ,laser.
Life long follow up .
64. Criteria for conservative methods in
preinvsive lesions
65. Criteria for conservative methods in preinvasive
lesions
Young woman desirous of childbearing .
Entire lesion is within squamocolumnar junction
No micro or macroinvasion proved by biopsy .
No endocervical involvment .
69. IS BOTH DIAGNOSTIC & THERAPEUTIC
WHEN ABNORMAL AREA IS LARGE
DONE WHEN SQUAMOCOLUMNAR JUNCTION
HAS RECEDED IN THE ENDOCERVICAL CANAL
DESCREPANCY BETWEEN CYTOLOGY &
COLPOSCOPY
DONE UNDER G.A
BY LASER BLEEDING IS LESS
71. It is indicated when patient is not
compliance with follow-up and has
completed her family.
Associated fibroids ,DUB , prolapse
Microinvasion exists .
Recurrent high -grade CIN