Prolactin is a unique hormone that has more than 300 functions across multiple body systems. It is produced primarily in the pituitary gland but also in other tissues. Prolactin levels have a circadian rhythm and are regulated by the hypothalamus. Abnormal prolactin levels can be caused by prolactinomas, drugs, or physiological states. Prolactinomas are benign pituitary tumors but macroadenomas larger than 1 cm require treatment. High or low prolactin impacts fertility in both males and females. Treatment involves lowering prolactin levels through dopamine agonists like bromocriptine or newer drugs.
Male gonadal function and dysfunction (male hypogonadism). Emphasis where made on the causes, types of male hypogonadism, diagnosis and treatment methods.
As reproductive clinicians, it is important that the pathological relevance of hyperprolactinemia is established before commencing treatment for this endocrinological disorder.
Most cases of true hyperprolactinemia are associated with amenorrhea or hormone deprivation in premenopausal women and can be managed by dopamine agonist or hormone replacement therapy respectively
Control mechanism of Female Reproductionsunitafeme
The menstrual cycle is the scientific term for the physiological changes that occur in fertile women for the purpose of sexual reproduction.The menstrual cycle is controlled by the endocrine system
Male gonadal function and dysfunction (male hypogonadism). Emphasis where made on the causes, types of male hypogonadism, diagnosis and treatment methods.
As reproductive clinicians, it is important that the pathological relevance of hyperprolactinemia is established before commencing treatment for this endocrinological disorder.
Most cases of true hyperprolactinemia are associated with amenorrhea or hormone deprivation in premenopausal women and can be managed by dopamine agonist or hormone replacement therapy respectively
Control mechanism of Female Reproductionsunitafeme
The menstrual cycle is the scientific term for the physiological changes that occur in fertile women for the purpose of sexual reproduction.The menstrual cycle is controlled by the endocrine system
The prolactin test is done to measure the levels of prolactin in the blood to check and monitor the associated disease condition. Prolactin is a hormone produced by the pituitary gland which is situated at the base of the brain.
Reference: https://www.1mg.com/labs/test/prolactin-test-1906
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It describes the Progesterone physiology. It describes the latest evidence as regards progesterone formulations, use of progesterone as Luteal phase support. It scrutinizes the value of serum progesterone in monitoring luteal phase
this presentation highlights the principles of uterine and ovarian transplantation. It explores the past and examines the current status for uterine and ovarian factor infertility.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
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3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- 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
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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.
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4. Agenda
• Introduction
• Why prolactin is a unique
hormone?
• The unique functions of prolactin
• The unique Assay.
• Abnormal levels: Unique
classification.
• Unique in neoplastic Behaviour.
• Prolactin and Infertility.
• Unique in treatment options.
7. • Prolactin is a 23 kDa single chain protein of 199 amino
acids synthesized and released principally by
lactotrophs in the anterior pituitary gland .
• A single PRL gene on chromosome 6.
• Synthesis and secretion is under the control of
hypothalamic factors, mainly the tonic inhibition of
Dopamine.
• It has more than 300 actions across reproduction,
metabolic, fluid and immune regulation systems and
mediated via endocrine, autocrine and paracrine
activities.
8. Geoffrey Harris
• The oldest hormone: 1928 in a cow´s
hypophysis These French scientists injected
a bovine pituitary extract into pseudo
pregnant rabbit.
• Its luteotrophic activity: 1945.
• In human: 1965 – 1971. Its isolation was
difficult due to its structure, which is
similar (in a 16%) to the growth hormone
(GH) structure.
9. Unique Hormone
Human PRL (hRPL), growth hormone
(hGH), and placental lactogen (hPL),
commonly referred to as lactogens,
are members of the cytokine
superfamily
Source
Control of secretion
Circadian rhythm
Forms
10. I. Source
Pituitary: anterior
lobe, lactotrophs, 3-
5% of the total cells
Extra-pituitary:
• Endometrium.
• Myometrium.
• Decidua.
• Immune cells.
• Brain.
• Breast.
• Prostate.
• Skin.
• Adipose tissue.
11. II. Control
of
secretion
neurotransmitter
Releasing Factor
The incomplete blood
brain barrier at the region
of arcuate nucleus
allowing for direct action
on dopamine neurons
Lactotrophs are the only pituitary cells that display spontaneous electrical
activity in the absence of hypothalamic stimulation
12. III. True
Circadian
Rhythm of
Prolactin
Secretion
• Circadian rhythm: Plasma concentrations of prolactin are the highest during sleep and the lowest during the
waking hours in humans.
• Pulsatile rhythm:
• Starts raising 90 minutes after sleep beginning, with maximum peaks at 4-5 hours and it can stay high two hours
after waking up.
• Its discharges are 20-30 minutes intervals and the mean life is 20-30 minutes.
• This rhythm of prolactin secretion is maintained in a constant environment independent of the rhythm of
sleep.
13. IV. Forms
Extensive microheterogeneity
• Diverse modification:
polymerization;
proteolytic cleavage;
glycosylation and
phosphorylation
• Diverse impact: on
stability, half-life, receptor
binding, bioactivity.
15. • Endocrine: of the pituitary source.
The only anterior pituitary hormone
that does not have an endocrine
target tissue, and therefore lacks a
classical hormonal feedback system.
• Paracrine: of the extra pituitary
sources
• Autocrine: of the extra- pituitary
sources
At the molecular level, Prolactin behaves more like a cytokine and
growth factor than like a hormone (no second messenger model)
17. Neurogenesis
and
neuroprotection
Chronic stress exposure and depressive
states are known to affect neurogenesis.
Neurogenesis is the process that
produces new neurons throughout life.
Prolactin alters neural circuits to help the
individual to cope with stress
18. Metabolic
functions
Prolactin receptors are expressed on multiple tissues
involved in metabolic regulation, including adipose tissue,
liver, pancreas and the brain.
It appears to play a broad role in both pancreatic and
adipose development. In adipose tissue, prolactin is
essential in adipogenesis and adipocyte differentiation, as
well as modulating lipid metabolism.
It also regulates the secretion is several adipokines,
including stimulation of leptin and inhibition of
adiponectin production
Degradation generates smaller prolactin variants of 14 kDa,
16 kDa and 22 kDa prolactin with antiangiogenic properties
19. Male and prolactin
The most consistent stimulus for prolactin secretion in males is stress.
While there is no male equivalent of lactation, many of the other functions of
prolactin in females can also be observed in males.
Parental behaviour Parental care of offspring. Rearing of the offspring
Up to 40% of the male pituitary gland is dedicated to lactotrophs
20. PRL and Pregnancy
Serum PRL rises in a progressive way during gestation
(mean value 200 ng/mL)
Amniotic fluid PRL
• 15th -20th week: 1000 ng/ml. Highest concentration than any other
organic fluid
• At term: 450 ng/mL
• Production: fetal and the mother´s hypophysis
• Function:
• Osmoregulation to survive in the intrauterine liquid environment.
• Pulmonary maturing raising the content of phospholipids and
changes in the lecithin/sphingomyelin.
21. Peripartum cardiomyopathy
• The 16 kDa isoform of prolactin could also be a major factor
• The initiation and progression of peripartum cardiomyopathy
• The onset of preeclampsia.
• Lab evidence.
• Increased generation of the 16 kDa isoform
• Treatment with DA ameliorates it
• Augmentation of deterioration of the cardiac capillary network and its function.
22. PRL and breast feeding
• The nipple suction during breastfeeding favors a
bigger amount of hormone synthesis.
• Nipple and areola´s terminal nerves are
stimulated when suction occurs.
• This stimulus travels via afferent nerve pathways
to the hypothalamus, proving the prolactin
release, by inhibition of the release of dopamine.
25. Measurement of prolactin
• A simple blood test drawn
• First thing in the morning: be awake 2 hours before the test.
• Early in the menstrual cycle – before ovulation. This is because prolactin levels are
naturally higher after ovulation.
• Be 8-10 hours of fasting prior to extraction.
• Be relaxed and rested for at least 30 min before extraction.
• Avoids:
• High-protein or fat diet: 24 hours
• Intercourse: 24 hours
• Stimulation of the breast and nipples: 24 hours
• Stress: physical examination: 24 hours.
26. Values
• 5-20 ng/mL is considered normal in both sexes.
• 20 ng/mL males
• 25 ng/mL females.
• During pregnancy and lactation: upto 200-400 ng/mL
• > 20 ng/mL in two successive measurements is defined as
hyperprolactinemia
• > 250 ng/mL usually indication for prolactinoma.
• > 500 ng/mL it is considered as diagnosis for macroprolactinoma
Conversion factor: mU/l × 0,0472 =ng/ml; ng/ml × 21,2 = mU/l.)
29. Stress
• Examples:
• Physical stress.
• Drawing blood sample.
• Pyschological reasons.
• Anxiety and irritability may be due to hyperprolactinemia.
30. Drugs
• First generation Anti-psychotic
medications.
• Serotonin reuptake inhibitors
• fluvoxamine; fluoxetine;
paroxetine, duloxetine
• Some types of sedatives
• Catecholamine depletory
• Dopamine synthesis inhibitor
• Neuropeptides
• Anticonvulsants
• Opiates and opiate antagonists
• Estrogen Oral contraceptives
(birth control pills)
• Anti HT: methyldopa, verapamil.
• GIT drugs: metoclopramide and
cimetidine.
31. Hypoprolactinemia
• A medical condition characterized by a deficiency in the serum levels of the
hypothalamic-pituitary hormone prolactin.
• Prolactin levels below 3 μg/L in women, 5 μg/L in men.
• Causes:
• Autoimmune disease.
• Hypopituitarism.
• Growth hormone deficiency.
• Hypothyroidism.
• Excessive dopamine action (drug-induced)
• Menstrual disorders, delayed puberty, infertility, and subfertility
33. • Pituitary adenomas are the most common tumour type in the
pituitary gland.
• 1/3 About one-third of all pituitary tumours are not associated with
hypersecretory syndromes but, rather, present with symptoms of an
intracranial mass.
• Classification based on size:
• Microadenoma: < 1 cm
• Macroadenoma: > 1 cm
34. Microadenoma
• Less than one centimetre in diameter.
• Can be present in healthy people who do
not have high prolactin levels.
• Microadenomas can be treated with
medication.
• They do not grow large
• Do not need to be treated if hormone
levels are normal.
• Microprolactinomas usually follow a
benign course and rarely progress to
macroprolactinomas.
• Rare transformarion to other tumours
Macroadenoma
• Adenomas larger than 1 centimeter.
• If untreated, macroadenomas can
grow further and start to compress
the nearby tissues and structures.
• It is important to treat
macroadenomas whether or not a
woman is interested in getting
pregnant.
• Medication can be used to treat them
but if that fails, surgery may be
necessary.
40. Dopamine agonists
• To lower PRL levels
• To decrease tumor size.
• To restore gonadal function for patients.
Bromocriptine QuinagolideLisuride Pergolide Cabergoline
41. Bromocriptine
• It is an effective and inexpensive medication for high prolactin levels.
• The prolactin levels can be rechecked in 3 weeks. If the levels are still
elevated the dose can be increased or a different medication can be
tried.
• Due to the side effects, some women can not tolerate it:
• Vaginal bioadhesive suppositories
• Vaginal use of the pill
42. Cabergoline
• It is a longer acting medication.
• It is usually given once/ twice a week instead of every day.
Systematic reviews: Cabergoline is more
effective than bromocriptine in achieving
normoprolactinemia and resolving
amenorrhea/ oligomenorrhea and
galactorrhea.
46. Cabergoline and heart
• Cabergoline binds to the serotonin receptor subtype 2B (5-HT2B) located on heart valves. Activation of these receptors induces valvular interstitial cell mitogenesis and
proliferation, which in turn modifies the quantity and quality of the valvular extracellular matrix through actions on proteoglycans, collagen types I, III and IV, and matrix
metalloproteinases. As a result, valve leaflets and chords become thickened, retracted and stiff, leading most commonly to valvular regurgitation
Recommendations
All patients should undergo echocardiography before
commencing DA therapy.
Patients taking a dose of cabergoline of ≤2 mg/week
should undergo surveillance echocardiography at 5 years.
Patients taking a dose of cabergoline of >2 mg/week
should undergo annual echocardiography.
Patients taking a dose of ≤2 mg/week who develop a
change in valve function should undergo annual
echocardiography if treatment is to continue.
Decisions regarding discontinuation of medication should
only be made after review of serial imaging by an
echocardiographer experienced in analysing drug-induced
valvulopathy or carcinoid heart disease.
47. Cabergoline and
lung
Cabergoline binds to the serotonin receptor subtype on
fibrous tissues. Activation of these receptors induces
valvular interstitial cell mitogenesis and proliferation,
which in turn modifies the quantity and quality of the
valvular extracellular matrix through actions on
proteoglycans, collagen types I, III and IV, and matrix
metalloproteinases.