Propranolol for treatment of infantile hemangiomasmesfin mamuye
Propranolol repurposing for Infantile hemangioma (IH) is the most common vascular tumor of infancy, They are the most common soft-tissue tumors of childhood.
Aflibercept in combination with fluorouracil, leucovorin, and irinotecan in t...Mary Ondinee Manalo Igot
Folfiri aflibercept poster for apcc 2015
Aflibercept in combination with fluorouracil, leucovorin, and irinotecan in the treatment of Asian patients with metastatic colorectal cancer
Propranolol for treatment of infantile hemangiomasmesfin mamuye
Propranolol repurposing for Infantile hemangioma (IH) is the most common vascular tumor of infancy, They are the most common soft-tissue tumors of childhood.
Aflibercept in combination with fluorouracil, leucovorin, and irinotecan in t...Mary Ondinee Manalo Igot
Folfiri aflibercept poster for apcc 2015
Aflibercept in combination with fluorouracil, leucovorin, and irinotecan in the treatment of Asian patients with metastatic colorectal cancer
Obesity is now clearly established as a major risk factor for endometrial cancer.
In medium income country like ours , Obesity prevention and lifestyle initiatives should become the responsibility of public health services. Stepwise programmes with realistic time-related goals are required, starting with modification of lifestyle, progressing to pharmacotherapy and ultimately obesity surgery.
The real challenge now is to triage those women at a higher risk and offer them prophylactic measures as COCPs ,DMPA, oral progesterone or Mirena coil.
Standard treatment for endometrial cancer is surgery.
Obesity is associated with numerous disorders which put the patient at increase risk of peri-operative complications that require more detailed pre-operative assessment and more intensive post-operative care.
Thus treatment for endometrial cancer needs to be reassessed in the complex and increasingly common situation of the obese, older women with this disease.
Background: Cervical screening through conventional cervical cytology is most commonly used throughout the world. The Cervical cancer is the second most common cancer worldwide and in developing countries, the leading cause of death. It is one of the most preventable and curable of all cancers.
Objective: To Study the role of Pap smear in detecting neoplastic and non-neoplastic lesions of cervix and to determine the occurrence of various lesions in remote area of Bagalkot.
Methods: This is prospective study of 240 women with age group 20 to 60 years was carried out from May 2015 to June 2016 cytology section of pathology department, S. Nijalingappa Medical College & H.S.K Hospital & Research Centre, Bagalkot, India. Pap smears were prepared, fixed, stained and carefully examined.
Results: In this study, Reactive cellular changes associated with inflammation was the most common with 182 cases (75.8%) followed by Low-grade squamous intraepithelial lesions (SIL) with 11 cases (4.5%), then atypical squamous epithelial cells of undetermined significance 8 cases (3.3%), High-grade squamous intraepithelial lesions with 5 cases (2.1%), Atrophy with 3 cases (1.3%) and Atypical Glandular Cell in 3 cases (1.3%). The average age of women for all the epithelial abnormalities was 40 years.
Conclusion: This study will increase awareness of the Pap test and cervical cancer, thereby paving a way for the prevention of cervical cancer.
Key-words- Pap smear, Cervical cancer, The Bethesda System, Squamous intraepithelial lesions (SIL)
Correlation of Estrogen and Progesterone Receptor expression in Breast Canceriosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Insight AUB Presentations based on FOGSI AUB GUIDELINES DGFPublicAwareness
DISCLAIMER
Use of these slides is permitted only for the purpose of scientific and educational presentations.
While every reasonable effort has been made to ensure accuracy of content, it is the responsibility of the practitioner, relying on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. DGF shall not be responsible or in any way liable for the continued accuracy &/or veracity of the information or for any errors, omissions or inaccuracies or for any injury and/or damage to persons or property arising from relying on the information contained in the presentation or otherwise.
Evaluation the efficacy of IVIgG in treatment of Hemolytic Disease of Newborniosrphr_editor
Hemolytic disease of newborn (HDN) is an important cause of hyperbilirubinemia in the
neonatal period,and delayed diagnosis and treatment may lead to permanent brain damage. Traditional
neonatal treatment of HDN is intensive phototherapy and exchange transfusion.Intravenous
immunoglobulin(IVIgG) has been introduced as an alternative therapy to exchange transfusion. This study was
conducted to assess the effect of IVIG in HDN .
Caris Centers of Excellence Virtual Molecular Tumor Board - October 15, 2015 ...Caris Life Sciences
Slide deck (no audio) from Caris Life Sciences' Virtual Molecular Tumor Board hosted by COE member MedStar Washington Cancer Institute (Dr. Avani S. Mohapatra)
Obesity is now clearly established as a major risk factor for endometrial cancer.
In medium income country like ours , Obesity prevention and lifestyle initiatives should become the responsibility of public health services. Stepwise programmes with realistic time-related goals are required, starting with modification of lifestyle, progressing to pharmacotherapy and ultimately obesity surgery.
The real challenge now is to triage those women at a higher risk and offer them prophylactic measures as COCPs ,DMPA, oral progesterone or Mirena coil.
Standard treatment for endometrial cancer is surgery.
Obesity is associated with numerous disorders which put the patient at increase risk of peri-operative complications that require more detailed pre-operative assessment and more intensive post-operative care.
Thus treatment for endometrial cancer needs to be reassessed in the complex and increasingly common situation of the obese, older women with this disease.
Background: Cervical screening through conventional cervical cytology is most commonly used throughout the world. The Cervical cancer is the second most common cancer worldwide and in developing countries, the leading cause of death. It is one of the most preventable and curable of all cancers.
Objective: To Study the role of Pap smear in detecting neoplastic and non-neoplastic lesions of cervix and to determine the occurrence of various lesions in remote area of Bagalkot.
Methods: This is prospective study of 240 women with age group 20 to 60 years was carried out from May 2015 to June 2016 cytology section of pathology department, S. Nijalingappa Medical College & H.S.K Hospital & Research Centre, Bagalkot, India. Pap smears were prepared, fixed, stained and carefully examined.
Results: In this study, Reactive cellular changes associated with inflammation was the most common with 182 cases (75.8%) followed by Low-grade squamous intraepithelial lesions (SIL) with 11 cases (4.5%), then atypical squamous epithelial cells of undetermined significance 8 cases (3.3%), High-grade squamous intraepithelial lesions with 5 cases (2.1%), Atrophy with 3 cases (1.3%) and Atypical Glandular Cell in 3 cases (1.3%). The average age of women for all the epithelial abnormalities was 40 years.
Conclusion: This study will increase awareness of the Pap test and cervical cancer, thereby paving a way for the prevention of cervical cancer.
Key-words- Pap smear, Cervical cancer, The Bethesda System, Squamous intraepithelial lesions (SIL)
Correlation of Estrogen and Progesterone Receptor expression in Breast Canceriosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Insight AUB Presentations based on FOGSI AUB GUIDELINES DGFPublicAwareness
DISCLAIMER
Use of these slides is permitted only for the purpose of scientific and educational presentations.
While every reasonable effort has been made to ensure accuracy of content, it is the responsibility of the practitioner, relying on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. DGF shall not be responsible or in any way liable for the continued accuracy &/or veracity of the information or for any errors, omissions or inaccuracies or for any injury and/or damage to persons or property arising from relying on the information contained in the presentation or otherwise.
Evaluation the efficacy of IVIgG in treatment of Hemolytic Disease of Newborniosrphr_editor
Hemolytic disease of newborn (HDN) is an important cause of hyperbilirubinemia in the
neonatal period,and delayed diagnosis and treatment may lead to permanent brain damage. Traditional
neonatal treatment of HDN is intensive phototherapy and exchange transfusion.Intravenous
immunoglobulin(IVIgG) has been introduced as an alternative therapy to exchange transfusion. This study was
conducted to assess the effect of IVIG in HDN .
Caris Centers of Excellence Virtual Molecular Tumor Board - October 15, 2015 ...Caris Life Sciences
Slide deck (no audio) from Caris Life Sciences' Virtual Molecular Tumor Board hosted by COE member MedStar Washington Cancer Institute (Dr. Avani S. Mohapatra)
New trends in treatment of Infantile hemangiomaEmad Qasem
A short presentation about papers published in 2014 ( about 1050 research ) showing new modalities of treatment of infantile hemangioma.
Regression of role of corticosteroids, Progression of Propranolol role and Restriction of role of surgery are the most prominent points
A Case report of Hypothyroidism associated with cutaneous hemangioma is also explained inside
The spectrum of childhood neoplasms – Evaluation of 161 cases in surgical pat...Apollo Hospitals
Although major cause of childhood morbidity and mortality in the developing world is still malnutrition and infections, pediatric neoplasms are also rising in number. Although pediatric neoplasms occur infrequently, they present a challenging diagnostic and therapeutic problem. Unfamiliarity with these conditions may lead to the erroneous diagnosis and unnecessary aggressive therapy. This was a retrospective analysis of 161 cases of pediatric tumors, both benign and malignant, in surgical pathology department excluding neurosurgery, cardiothoracic, and hemato-lymphoid malignancies (age group 0–12 years) encountered over a period of 5 years: January 2004–December 2008. The clinical, radiological, and therapeutic data were obtained from patients’ case paper records. Pattern of childhood tumors was studied with a focus on tumor incidence, age and sex distribution, demographic pattern, and histological type.
Leukemia- Past, Present, and the Future Hatel R. Moonat, DO, FAAP Lindsey Za...CristinaGeorgianaZah
Leukemia- Past, Present, and the Future
Hatel R. Moonat, DO, FAAP
Lindsey Zaremba BSN, RN, CPN, CPHON
TCH Cancer and Hematology Centers, The Woodlands
September 19, 2019
Crimson Publishers-Immunological System Cellular: CD8 Lymphocytes in Children...CrimsonpublishersMedical
Immunological System Cellular: CD8 Lymphocytes in Children and Adolescents with Cancer in Cochabamba, Bolivia by Maria del Rosario Davalos Gamboa* in Research in Medical & Engineering Sciences
Detailed Powerpoint Presentation on Wilms Tumour …. It includes definition with images, causes, sign and symptoms all treatment modalities with nursing responsibilities and recent research related to this...
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.
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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 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
2. Briefly explain how these functions are carried out
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
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
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
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
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Propranolol repurposing for infantile hemangiomas
1. Drug information center ( DIC )
Propranolol repurposing for infantile
hemangiomas
Presented by Mesfin Mamuye
2. Presentation outline ;.
• Introduction to infantile hemangiomas
• Introduction to propranolol
• New mechanism of action
• Result of clinical study
• Recommendation
• References
3. Infantile hemangioma (IH)
• Infantile hemangioma (IH) is the most common
vascular tumor of infancy, They are the most
common soft-tissue tumors of childhood.
• The lesions are usually not detectable at birth
but appear during the first 4 to 6 weeks of life.
• For reasons unknown, IH affects more females
than males, and is also more prevalent in
premature and Caucasian babies.
[Chiller, K.G., D. Passaro, and I.J. Frieden 2014].
4. Continue…
• Frequency of infantile hemangiomas
at particular sites is as follows: around
Head and neck - 60% , Trunk - 25% ,
Extremities - 15%.
• The area involving such as: face or site at
high risk for ulceration causing airway
obstraction, dysfunction, hemorrhage or
disfigurement and infection.
[ Xiao Q, Zhang B, Yu W 2015]
5.
6.
7. There are three general types of infantile
hemangiomas:
• Superficial hemangiomas, which occur on the
outer layers of the skin, are typically bright red to
purple in color.
• Deep hemangiomas, which grow under the skin
in the fat, may be blue, purple or even skin color
(if they are deep enough under the skin surface).
• Mixed hemangiomas are the most common
type of hemangioma. These hemangiomas have
both superficial and deep components.
[ Stark E et al ; 2016]
8. PATHOPHYSIOLOGY
• IHs are vascular tumors that involve the
proliferation of benign endothelial like cells
that possess histochemical markers. these
markers are also present on placental blood
vessels.
• The immunohistochemical profile
differentiates IH from other vascular
birthmarks or tumors.
[Waner M,et.al,2010]
9. Continue…
• The pathophysiology associated with the
unique natural history of these lesions, with
initial rapid proliferation followed by gradual
involution and regression, has not been
completely elucidated.
• Recent data suggest an endothelial progenitor
cell as the source of origin of the tumors.
[Kleinman ME, et al,2013]
10. Diagnosis
• Hemangioma tumors are generally diagnosed visually.
Additional tests may be performed to assess size and
morphology.
• Ultrasound. This test uses sound waves to construct an
image of the tumor, allowing clinicians to inspect the
degree of vascularization.
• Imaging tests. Magnetic resonance imaging (MRI)
and computed tomography (CT) are used to determine
tumor size and proximity to other tissues.
• Biopsy. A tissue biopsy is performed if cancer or a
legion other than a hemangioma is suspected.
[Price et al.2011 ]
11. Management of IH
Medical care of clinically significant hemangiomas
has been limited to a few medications:
corticosteroids, interferon alfa, vincristine, &
imiquimod. surgery, and radiotherapy. pulsed dye
laser
- Beta-blockers, most specifically Propranolol,
have recently been serendipitously been shown to
induce involution of infantile hemangiomas.
[Frieden IJ, et al 2014]
12. propranolol
Introduction
• It is non selective beta blocker , the action of
epinephrine and norepinephrine on beta -1 and
beta -2 adrenergic receptors blocker.
• Propranolol is being used for cardiovascular
indication such as : hypertension, angina
pectoris , tachyarrhythmia , myocardial
infraction, and other non- cardiogenic
indications including essential tremor ,
migraine, cluster headaches and
thyrotoxicosis.
[Stroch CH, Hoeger PH 2016]
13. Pharmacokinetics
• Propranolol is a highly lipophilic drug achieving
high concentrations in the brain.
• Propranolol is rapidly and completely absorbed, with
peak plasma levels achieved about 1–3 hours after
ingestion. Approximately 90% of circulating propranolol
is bound to plasma proteins (albumin and alpha1 acid
glycoprotein).
• Co administration with food appears to
enhance bioavailability.
• The main metabolite 4-hydroxypropranolol, with a
longer half life from 3 to 6 hours. excreted in the
urine. [Stapleton MP ,2010 ]
14. New Mechanisms of Action
β2-adrenergic receptors are present on
endothelial cells of infantile hemangiomas.
The proposed mechanism of action of
propranolol in hemangiomas included
vasoconstriction, apoptosis of capillary
endothelial cells, and decreased the
production of vascular endothelial growth
factor and fibroblastic growth factor.
[Kum JJ, Khan ZA. 2015]
15. Result of clinical study
• performed a randomized controlled trial of
oral propranolol in 460 infants aged 1 to 5
months with infantile hemangiomas (IH).
Patients administered a dose of 3.4 mg/kg
per day exhibited a 60% rate of successful
treatment (complete or nearly complete
resolution of the target hemangioma),
compared with a 4% rate among those
treated with placebo.
[ Léauté-Labrèze et al. 2015 ]
16. Continue…
• conducted a randomized controlled trial in 40 children
between the ages of 9 weeks and 5 years with facial IHs.
Children younger than 6 months were admitted to the
hospital for monitoring after their first dose at weeks 1
and 2. No significant hypoglycemia, hypotension, or
bradycardia occurred. Significant decrease in IH redness
and elevation occurred in the propranolol group at weeks
12 and 24 .The authors concluded that propranolol
hydrochloride administered orally at 2 mg/kg per day
reduced the volume, color, and elevation of focal and
segmental IH in infants younger than 6 months and
children up to 5 years of age.
• [ Hogeling et al. (2011) ]
17. Adverse effects
• Most frequent adverse effects after taken
propranolol for IH reported were sleep
disturbances (3.7%) and asymptomatic or
unspecified hypotension (2.8% ), followed by
somnolence (2.2%), cool or mottled extremities
(1.7%), pulmonary symptoms including
wheezing (1.4%), asymptomatic or unspecified
bradycardia (0.9%), hypoglycemia (0.9%),
gastroesophageal reflux or GI upset (0.7%),
symptomatic hypotension (0.3%), and
symptomatic bradycardia (0.1%).
[ Drolet BA, Frommelt PC, et al 2013 ]
18. Figure 1: Infantile hemangioma- red-purplish lobulated like macules at the lateral
postural aspect of back at first contact with patient (Picture courtesy of Wu Jianbo,
Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan
University).
19. • Figure 2: Infantile hemangioma-after one month of treatment on topical propranolol.
(Picture courtesy of Wu Jianbo, Department of Dermatology and Venereology at
Zhongnan Hospital of Wuhan University).
20. Figure 3: Infantile hemangioma-after three months of treatment on topical propranolol.
(Picture courtesy of Wu Jianbo, Department of Dermatology and Venereology at
Zhongnan Hospital of Wuhan University).
21. Dose
• Oral propranolol in infant is started with an
initial dose of 0.5 mg/kg/day, and gradually
is increased up to 2-3 mg/kg/day divided
into 2-3 daily dose after clearance of
cardiopulmonary contraindications. The
treatment is usually stopped at 12-24
months of age, but occasionally longer
treatment may be required because of
recurrences .
[ McGee P, Miller S, et al.2013]
22. Clinical trial
• Breast cancer patients who received
propranolol for hypertension displayed
reduced metastasis and cancer
recurrence.
• Propranolol Hydrochloride in Treating
Patients with Prostate Cancer Undergoing
Surgery
23. • Other beta- blockers such as atenolol and
nadolol may provide similar efficacy to
propranolol in IH treatment, have cohort-
blinded study comparing atenolol to
propranolol for treatment of IH. Among all
23 pt thirteen was with atenolol and ten
with propranolol. The results showed that
atenolol had 53.8% of complete response
and propranolol had 60% .
[ abarzua –araya et al.2014 ]
24. Recommendation
• examined if propranolol therapy is safe
and effective and superior to oral
corticosteroids for treating infantile
hemangiomas (IHs). [Price et al (2011) ]
• Propranolol has been approved by the Food
and Drug Administration (FDA), specifically
for the treatment of hemangiomas.
[Society for Pediatric Dermatol,2013].
25. Reference
• Chiller, K.G., D. Passaro, and I.J. Frieden, Hemangiomas of infancy: clinical
characteristics, morphologic subtypes, and their relationship to race,
ethnicity, and sex. Arch Dermatology, 2002. 138(12): p. 1567-76.
• Xiao Q, Zhang B, Yu W 2015. propranolol therapy of infantile
hemangiomas , pediatric surg. Int 29(6) : 575-581.
• Stark E et al : types of infantile hemangiomas: a review. Archives of
Disease in Childhood 2016 ; 96: 890-893.
• Waner M,et.al(2010). GLUT1: a newly discovered immune histochemical marker
for juvenile hemangiomas. Hum Pathol. ;31(1):11–22
• Kleinman ME, et al(2013). Hypoxia-induced mediators of stem/progenitor cell
trafficking are increased in children with hemangioma. Arterioscler Thromb Vasc
Biol.;27(12):2664–2670
• Price, C.J., et al., laboratory diagnosis for Infantile Hemangiomas A
Multicenter Retrospective Analysis. Archives of Dermatology, 2011. 147(12):
p. 1371-1376.
26. .
• Frieden IJ, Eichenfield LF, Esterly NB, Geronemus R, Mallory SB
Guidelines of care for hemangiomas of infancy. American Academy of
Dermatology Guidelines/Outcomes Committee. J Am Acad Dermatol
1997;37:631-7
• Stroch CH, Hoeger PH (2016) propranololfor infantile hemangiomas : insights into the
molecular mechanism of action. Br J Dermatol 163(2) : 269- 274 .
• Stapleton MP (2010). "Sir James Black and propranolol. The role of the
basic sciences in the history of cardiovascular pharmacology" Texas Heart
Institute Journal. 24 (4): 336–42. PMC 325477 . PMID 9456487.
• Kum JJ, Khan ZA. Mechanisms of propranolol action in infantile
hemangioma. Dermatoendocrinol 2015;6:e979699.
• Leaute-Labreze, C., et al., Propranolol for severe hemangiomas of
infancy. N Engl J Med, 2015. 358(24): p. 2649-51.
• Lawley, L, et al. Propranolol Treatment for Hemangioma of Infancy: Risks
and Recommendations. Pediatric Dermatology 2009, Vol.26 No.5 610-614.
27. • Hogeling M, Adams S, Wargon O. A randomized controlled trial of
propranolol for infantile hemangiomas. Pediatrics. 2011;128(2):e259-e266.
• McGee P, Miller S, Black C, Hoey S. propranolol for infantile hemangioma: A
review of current dosing regime in a regional pediatric hospital, Ulster Med
J. 2013; 82: 16-20.
• Abarzua-Araya A, et al, atenolol vs propranolol for the infantile
hemangiomas; A treatment randomized controlled study. J am Acad.
Dermatol. 2014; 168:222-224 .
• Drolet BA, Frommelt PC, chamlin SL, Haggstrom A, Bauman NM, Chiu YE,
et al. Infantile and use of propranolol for infantile hemangioma; report of a
consensus conference. Pediatrics. 2013; 131: 128- 140.
• Society for Pediatr Dermatol(2013). Propranolol treatment of infantile
hemangiomas: anticipatory guidance for parents and caretakers;30(1):155-
159.