1) Several lesions can clinically simulate choroidal or ciliary body melanoma (posterior uveal melanoma). Over a 25 year period, 1,739 patients (14% of referrals) were found to have simulating lesions rather than melanoma.
2) The most common simulating lesion was choroidal nevus, accounting for 49% of pseudomelanomas. Other relatively common simulating lesions included peripheral exudative hemorrhagic chorioretinopathy (8%), congenital hypertrophy of the retinal pigment epithelium (6%), and hemorrhagic detachment of the retina or pigment epithelium (5%).
3) Compared to an earlier study period, the rate of chor
Objective: The association between telomerase reverse transcriptase (TERT) promoter mutation and outcome of melanoma is unclear and controversial. We aim to conduct a meta-analysis and investigate whether the TERT promoter mutation is a prognostic factor of melanoma.
Study Design: Appropriate studies were searched in 3 databases: PubMed, Web of Science, and Embase. Pooled hazard ratios (HRs) were counted through random effects model.
Results: Heterogeneity was moderate in overall survival (OS) (I2=43.7%, p=0.059) and low in disease-free survival (DFS) (I2=0.0%, p=0.587). Sensitivity analysis indicated that the removal of any of the study did not affect the final results. Evidence for publication bias was not found (Begg’s test, p=0.281; Egger’s test, p=0.078). The pooled OS HRs from combined effects analysis was determined (HR 1.07; 95% CI 0.83–1.39, p=0.585), together with the pooled HRs of DFS (HR 1.65; 95% CI 1.02–2.66, p=0.042). TERT promoter mutation predicted a good outcome in meta-static melanoma patients (HR 0.66; 95% CI 0.46–0.96, p=0.042). The pooled HRs of combined mutation in TERT promoter and BRAF (HR 6.27; 95% CI 2.7–14.58, p=0.000) predicted a bad outcome in melanoma patients.
Conclusion: TERT promoter mutation significantly predicted poor DFS outcome but, on the contrary, predicted a good outcome in metastatic melanoma patients. The combined TERT promoter and BRAF mutation was a significant independent factor of OS in melanoma patients.
Keywords: melanoma; meta-analysis; mutation; prognosis; promoter regions, genetic; skin neoplasms; telomerase; TERT promoter mutation; TERT protein, human
Histopathological patterns of cutaneous malignant melanoma in Sudaniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Objective: The association between telomerase reverse transcriptase (TERT) promoter mutation and outcome of melanoma is unclear and controversial. We aim to conduct a meta-analysis and investigate whether the TERT promoter mutation is a prognostic factor of melanoma.
Study Design: Appropriate studies were searched in 3 databases: PubMed, Web of Science, and Embase. Pooled hazard ratios (HRs) were counted through random effects model.
Results: Heterogeneity was moderate in overall survival (OS) (I2=43.7%, p=0.059) and low in disease-free survival (DFS) (I2=0.0%, p=0.587). Sensitivity analysis indicated that the removal of any of the study did not affect the final results. Evidence for publication bias was not found (Begg’s test, p=0.281; Egger’s test, p=0.078). The pooled OS HRs from combined effects analysis was determined (HR 1.07; 95% CI 0.83–1.39, p=0.585), together with the pooled HRs of DFS (HR 1.65; 95% CI 1.02–2.66, p=0.042). TERT promoter mutation predicted a good outcome in meta-static melanoma patients (HR 0.66; 95% CI 0.46–0.96, p=0.042). The pooled HRs of combined mutation in TERT promoter and BRAF (HR 6.27; 95% CI 2.7–14.58, p=0.000) predicted a bad outcome in melanoma patients.
Conclusion: TERT promoter mutation significantly predicted poor DFS outcome but, on the contrary, predicted a good outcome in metastatic melanoma patients. The combined TERT promoter and BRAF mutation was a significant independent factor of OS in melanoma patients.
Keywords: melanoma; meta-analysis; mutation; prognosis; promoter regions, genetic; skin neoplasms; telomerase; TERT promoter mutation; TERT protein, human
Histopathological patterns of cutaneous malignant melanoma in Sudaniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Fine needle aspiration cytology (FNAC) is a simple and rapid diagnostic procedure to identify an etiology in an enlarged lymph node. The procedure is quite effective in diagnosing malignancies in superficial lymph nodes.
Aim: To evaluate the role of FNAC as a first line investigation to identify malignancies in superfi cial lymph nodes.
Gliomas are the commonest tumor of brain arising from the supportive cells of the brain with diverse form and presentation the treatment of which is surgical and demands adjuvant therapy for most of circumstances.
Objective: The prognostic indictors of age-related poor outcomes in patients with acute myeloid leukemia (AML) are still controversial. The aim of this work was to provide comprehensive insights into the effect of different hemocytes and to investigate the association between age and clinical features in adult patients with AML.
Study Design: A retrospective study was performed to determine the role of age in the therapeutic outcomes of AML. A total of 166 newly diagnosed adult patients’ data from January 2015 to November 2019 in Zhongshan Hospital of Xiamen University were collected and analyzed.
Results: Older patients presented a poorer prognosis (p=0.001) with shorter overall survival, which is served as age-related outcomes. Binary logistic regression demonstrated that cytogenetic risk (OR=4.508, 95% CI 2.733–7.435), leukocyte (OR=7.410, 95% CI 1.139–5.910), and bone marrow blast cells (OR=3.261, 95% CI 1.075–5.615) were independent indictors for age-related prognosis. In addition, Kaplan-Meier curve also revealed that the above factors were associated with overall survival (all p values <0.001).
Conclusion: Cytogenetic risk, leukocyte, and bone marrow blast cells are dominant factors which account for the age-related poor outcomes and shorter overall survival in AML.
Keywords: acute myeloid leukemia, adult, cytogenetic risk, hemocyte, leukemia, overall survival
Presentatie tijdens Groen Gras over de wijzigingen die de Wet werk en zekerheid met zich meebrengt. Op 1 januari 2015 gaat het eerste gedeelte van de nieuwe Wet werk en zekerheid in. Dat heeft grote gevolgen voor het personeelsbeleid. Bijvoorbeeld als u vaak uitzendkrachten inzet, maar ook voor de proeftijd bij tijdelijke contracten. Tijdens de bootcamp op Groen Gras praatten wij ondernemers bij.
Fine needle aspiration cytology (FNAC) is a simple and rapid diagnostic procedure to identify an etiology in an enlarged lymph node. The procedure is quite effective in diagnosing malignancies in superficial lymph nodes.
Aim: To evaluate the role of FNAC as a first line investigation to identify malignancies in superfi cial lymph nodes.
Gliomas are the commonest tumor of brain arising from the supportive cells of the brain with diverse form and presentation the treatment of which is surgical and demands adjuvant therapy for most of circumstances.
Objective: The prognostic indictors of age-related poor outcomes in patients with acute myeloid leukemia (AML) are still controversial. The aim of this work was to provide comprehensive insights into the effect of different hemocytes and to investigate the association between age and clinical features in adult patients with AML.
Study Design: A retrospective study was performed to determine the role of age in the therapeutic outcomes of AML. A total of 166 newly diagnosed adult patients’ data from January 2015 to November 2019 in Zhongshan Hospital of Xiamen University were collected and analyzed.
Results: Older patients presented a poorer prognosis (p=0.001) with shorter overall survival, which is served as age-related outcomes. Binary logistic regression demonstrated that cytogenetic risk (OR=4.508, 95% CI 2.733–7.435), leukocyte (OR=7.410, 95% CI 1.139–5.910), and bone marrow blast cells (OR=3.261, 95% CI 1.075–5.615) were independent indictors for age-related prognosis. In addition, Kaplan-Meier curve also revealed that the above factors were associated with overall survival (all p values <0.001).
Conclusion: Cytogenetic risk, leukocyte, and bone marrow blast cells are dominant factors which account for the age-related poor outcomes and shorter overall survival in AML.
Keywords: acute myeloid leukemia, adult, cytogenetic risk, hemocyte, leukemia, overall survival
Presentatie tijdens Groen Gras over de wijzigingen die de Wet werk en zekerheid met zich meebrengt. Op 1 januari 2015 gaat het eerste gedeelte van de nieuwe Wet werk en zekerheid in. Dat heeft grote gevolgen voor het personeelsbeleid. Bijvoorbeeld als u vaak uitzendkrachten inzet, maar ook voor de proeftijd bij tijdelijke contracten. Tijdens de bootcamp op Groen Gras praatten wij ondernemers bij.
"Small Trucking Firms and Disadvantaged Business Call on President to Freeze North Carolina Department of Transportation Stimulus Funds and Federal Dollars Until North Carolina's Disadvantaged Business Enterprise Program Addresses Noncompliance Issues
Epidemiologic Classification of Human Papillomavirus Types Associated with Ce...Alberto Cuadrado
background
Infection with human papilloma virus (HPV) is the main cause of cervical cancer, but
the risk associated with the various HPV types has not been adequately assessed.
methods
We pooled data from 11 case–control studies from nine countries involving 1918 women
with histologically confirmed squamous-cell cervical cancer and 1928 control women.
A common protocol and questionnaire were used. Information on risk factors was
obtained by personal interviews, and cervical cells were collected for detection of HPV
DNA and typing in a central laboratory by polymerase-chain-reaction–based assays
(with MY09/MY11 and GP5+/6+ primers).
results
HPV DNA was detected in 1739 of the 1918 patients with cervical cancer (90.7 percent)
and in 259 of the 1928 control women (13.4 percent). With the GP5+/6+ primer, HPV
DNA was detected in 96.6 percent of the patients and 15.6 percent of the controls. The
most common HPV types in patients, in descending order of frequency, were types 16,
18, 45, 31, 33, 52, 58, and 35. Among control women, types 16, 18, 45, 31, 6, 58, 35, and
33 were the most common. For studies using the GP5+/6+ primer, the pooled odds ratio
for cervical cancer associated with the presence of any HPV was 158.2 (95 percent
confidence interval, 113.4 to 220.6). The odds ratios were over 45 for the most common
and least common HPV types. Fifteen HPV types were classified as high-risk types
(16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82); 3 were classified as probable
high-risk types (26, 53, and 66); and 12 were classified as low-risk types (6, 11, 40,
42, 43, 44, 54, 61, 70, 72, 81, and CP6108). There was good agreement between our epidemiologic
classification and the classification based on phylogenetic grouping.
conclusions
In addition to HPV types 16 and 18, types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73,
and 82 should be considered carcinogenic, or high-risk, types, and types 26, 53, and 66
should be considered probably carcinogenic.
Solid pseudopapillary neoplasm of the pancreas is a distinctive pancreatic neoplasm with low metastatic potential. This study examines clinical differences and prognosis between male and female patients.
http://www.drmarcel.com.br
Adrenal Mass in Pregnancy: Diagnostic Approach and DilemmasApollo Hospitals
An adrenal incidentaloma is a mass lesion greater than 1 cm in diameter, incidentally found during radiologic examination for other reasons.
1. Such “adrenal incidentalomas” are increasingly recognised in clinical practice.
2. This is attributed to routine use of sophisticated and sensitive imaging techniques, with a reported prevalence of 4.4%.
3. Incidental findings of such masses pose dilemmas in evaluation and management, as current recommendations based on expert opinion.
4. Are open to debate in terms of cost and clinical
benefits. The uncertainties in management multiply with
such adrenal incidentalomas in the context of pregnancy.
We report a rare case of a large adrenal incidentaloma
complicating second trimester of pregnancy. This case
outlines the huge decisional dilemmas, both for the patient
and healthcare provider.
This is a presentation on most common applications of immunohistochemistry in breast lesions. Prepared by Dr Ashish Jawarkar, Assistant professor in pathology, Parul Institute of Medical sciences and research Vadodara
Objective: To determine the local incidence and clinical consequences of myoma following intraperitoneal dissemination via morcellation.
Materials and Method: An electronic search for laparoscopic myomectomies from the computer data base of a tertiary hospital and a separate search for sarcoma or myomata with atypical features on National Cancer Registry were carried out for the 10-year study period. The identified cases have their medical records traced, their data extracted and studied in details
- 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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
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!
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
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.
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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
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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
Pharma Pcd Franchise in Jharkhand - Yodley Lifesciences
PSEUDOMELANOMAS OF THE
1. PSEUDOMELANOMAS OF THE
POSTERIOR UVEAL TRACT
The 2006 Taylor R. Smith Lecture
JERRY A. SHIELDS, MD, ARMAN MASHAYEKHI, MD, SEONG RA, BS,
CAROL L. SHIELDS, MD
Purpose: To determine the types and frequency of lesions that clinically simulate
choroidal or ciliary body melanoma (posterior uveal melanoma; PUM).
Patients and Methods: A review was conducted on cases of patients referred to the
ocular oncology service from October 1978 through September 2003 with the diagnosis of
possible PUM but who were subsequently diagnosed by the authors to have a simulating
lesion rather than PUM. The type and percent of pseudomelanomas were tabulated and
compared with findings of a similar study from our service on data collected before 1978.
Results: There were 12,000 patients referred because of a lesion believed to be a
PUM during the 25 years included in the data collection. Of these patients, 1,739 (14%)
were found to have a simulating condition. There were 54 different conditions that simu-
lated melanoma. The most frequent condition was choroidal nevus, accounting for 851
cases (49%) of the pseudomelanomas. This was followed by peripheral exudative hem-
orrhagic chorioretinopathy (139 cases; 8%), congenital hypertrophy of the retinal pigment
epithelium (108 cases; 6%), hemorrhagic detachment of the retina or pigment epithelium
(86 cases; 5%), circumscribed choroidal hemangioma (79 cases; 5%) and age-related
macular degeneration (76 cases; 4%). Compared with the 1980 report, the rate of
pseudomelanomas diagnosed as choroidal nevus increased from 26% to 49%.
Conclusion: A variety of lesions can simulate PUM. Suspicious choroidal nevus is still the
lesion most difficult to differentiate from PUM. Most other pseudomelanomas account for a
lower percent compared with findings from the prior study, suggesting that clinicians are now
more familiar with the other pseudomelanomas and less likely to refer them to rule out PUM.
RETINA 25:767–771, 2005
S everal lesions can clinically simulate ciliary body
or choroidal melanoma (posterior uveal melano-
ma; PUM).1– 4 Historically, many eyes with simulating
lesions were enucleated because PUM was highly
suspected.5–7 With increased awareness of the clin-
ical features of these pseudomelanomas combined
with selective ancillary studies and more conserva-
From the Oncology Service, Wills Eye Hospital, Thomas Jef- tive treatments, the problem of erroneous enucle-
ferson University, Philadelphia, Pennsylvania. ation has been alleviated.8 However, there are still
Supported by the Eye Tumor Research Foundation, Philadel-
phia, PA (Drs. C. Shields and J. Shields), the Award of Merit in many patients referred to an ocular oncology center
Retina Research, Houston, TX (Dr. J. Shields), the Macula Foun- with the diagnosis of PUM who are subsequently
dation, New York, NY (Dr. C. Shields), and the Rosenthal Award
of the Macula Society (Dr. C. Shields).
diagnosed to have a simulating condition. We report
To be presented as the 2006 Taylor R. Smith Lecture, Aspen our experience with these simulating lesions over
Retinal Detachment Society, Aspen, Colorado, March 8, 2006. the last 25 years and compare the results with those
Reprint requests: Jerry A. Shields, MD, Ocular Oncology Ser-
vice, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA of an earlier study of pseudomelanomas from the
19107; e-mail: jerry.shields@shieldsoncology.com same facility.
767
2. 768 RETINA, THE JOURNAL OF RETINAL AND VITREOUS DISEASES ● 2005 ● VOLUME 25 ● NUMBER 6
Patients and Methods Table 1. Demographic Features of Pseudomelanoma in
1,739 Consecutive Patients
Since 1974, we have recorded the referral diagnosis
of all new patients seen at the oncology service. If the Feature Value
patient had a referral diagnosis of ciliary body or Age
choroidal melanoma but proved by examination to Mean 61 y
have a different diagnosis, the case was also coded as Median 64 y
Range 8 wk to 97 y
a pseudomelanoma. We included only those patients
Race, no. (%)*
who were referred because of legitimate concern over White 1,643 (94)
PUM. In this study, we reviewed our files from Oc- African American 52 (3)
tober 1978 through September 2003 to determine the Hispanic 15 (1)
type and frequency of pseudomelanomas. Data were Asian 29 (2)
Sex, no. (%)
collected regarding patient age, race, and sex. The
Male 717 (40)
exact tissue affected and the final diagnoses were Female 1,022 (60)
recorded. We compared the incidence of the specific Follow-up (mo)
pseudomelanomas with those from a prior study from Mean 21
our service in which data collection included the 5 Median 5
Range 6–299
years before October 1978.4
Because we did not have histopathologic confirma- * Information on race was not available for 56 patients.
tion that a small melanocytic choroidal lesion was a
nevus, rather than melanoma, we relied on certain
criteria that we used for years to make a presumptive senting 14% of all patients referred with the diagnosis
diagnosis. We generally coded a melanocytic lesion as of possible PUM. Thus, 86% of patients referred with
a nevus if it were 6 mm in diameter and 2.5 mm a diagnosis of PUM had a correct diagnosis. The most
in thickness and as a melanoma if it were 6 mm in frequent pseudomelanoma was choroidal nevus,
diameter and 2.5 mm in thickness. However, there which accounted for 851 cases or 49% of the total
was some variability in coding such lesions. For ex- number of simulating lesions. Other conditions that
ample, if a lesion were in the nevus size range but had were referred to rule out PUM are shown in Table 2.
surface orange pigment, subretinal fluid, and docu-
mented growth, we upgraded it to a melanoma for Discussion
purposes of diagnostic coding, and it was not included
The conditions that can simulate PUM and the
with the pseudomelanoma tabulations. Likewise, if a
features that help distinguish them from PUM are well
lesion were barely in the melanoma size range but had
described in the literature.1– 4 In our series, choroidal
surface drusen, had no subretinal fluid, and had not
nevus was the most frequent pseudomelanoma, ac-
been documented to, it was coded as a nevus and was
counting for 49% of cases. This represents a sharp
included in the study as a pseudomelanoma. All pa-
increase since the 1980 report,4 in which choroidal
tients were observed by us or by referring physicians,
nevus represented 27% of cases. We realize that by
and in the rare instance where a presumed nevus
using the criteria for differentiating nevus from mel-
showed subsequent growth, it was reclassified as a
anoma as described under Patients and Methods we
melanoma and was not included in the pseudomela-
could have made a few errors in the diagnosis of
noma statistics.
borderline lesions. However, based on our clinical
experience and on publications in the literature, such
Results
categorization should separate nevus from melanoma
During the 25 years included in the data collection, in most cases. A lesion with two or more risk factors
there were 12,000 patients referred to the oncology for metastasis was generally classified as melanoma,
service because of a lesion suspected to be a possible depending on all of the clinical circumstances.9 –11
PUM. General ophthalmologists or retinal specialists There are possible explanations why choroidal ne-
referred most patients. Demographic information is vus accounted for a higher percent of pseudomela-
included in Table 1. Most patients were adult whites. noma in this series as compared with prior studies.
Pseudomelanomas occurred in middle-aged or older First, ophthalmologists have become more familiar
patients, similar to the age distribution for PUM. The with the clinical features of the various lesions that
number and percent of the various pseudomelanomas simulate melanoma, like disciform macular degener-
are shown in Table 2. There were 1,739 patients ation, congenital hypertrophy of the retinal pigment
whose cases were coded as pseudomelanomas, repre- epithelium (RPE), choroidal hemangioma, and choroi-
3. PSEUDOMELANOMAS OF POSTERIOR UVEA • SHIELDS ET AL 769
Table 2. Diagnoses of Pseudomelanoma in 1,739 peripheral exudative hemorrhagic chorioretinopathy
Consecutive Patients (peripheral diskiform degeneration), which accounted
No. (%) of for 139 cases (8%). It accounted for 11% of cases in
Diagnosis Patients our prior series and still represents a lesion that often
prompts referral for a possible PUM.2,4 However, the
Choroidal nevus 851 (49)
Peripheral exudative hemorrhagic 139 (8) classic appearance of subretinal blood in various
chorioretinopathy stages of resolution is different from a comparable-
Congenital hypertrophy of RPE 108 (6) sized peripheral choroidal melanoma that would be
Hemorrhagic detachment retina or 86 (5)
pigment epithelium unlikely to cause appreciable subretinal hemorrhage.
Circumscribed choroidal hemangioma 79 (5) We acknowledge that there could be some overlap
Age-related macular degeneration 76 (4) among the lesions that we called peripheral exudative
Hyperplasia of RPE 42 (2)
Optic disk melanocytoma 37 (2) hemorrhagic chorioretinopathy, hemorrhagic detach-
Choroidal metastasis 34 (2) ment of the retina or RPE, and age-related macular
Hemorrhagic choroidal detachment 29 (2) degeneration. However, we coded a lesion as periph-
Vasoproliferative tumor 20 (1)
Rhegmatogenous retinal detachment 18 (1) eral exudative hemorrhagic chorioretinopathy if it oc-
Choroidal detachment 17 (1) curred as a hemorrhagic and/or exudative lesion in the
Uveal effusion syndrome 17 (1) equatorial region in an older person in the setting of
Choroidal or disk granuloma 14 (1)
Adenoma of RPE or CPE 13 ( 1) peripheral drusen. We coded any other cause of hem-
Sclerochoroidal calcification 12 (1) orrhage besides peripheral exudative hemorrhagic chori-
Staphyloma 12 (1)
Cataract 10 (1) oretinopathy and age-related macular degeneration as
Retinal capillary hemangioma (capillary 10 (1) hemorrhagic detachment of the retina or RPE. Causes of
or cavernous) such bleeding included hemorrhage from retinal macroa-
Adenoma of nonpigmented CPE 10 ( 1)
Leiomyoma, ciliary body 10 ( 1) neurysm, polypoidal choroidopathy, trauma, anticoagu-
Degenerative retinoschisis 8( 1) lant use, and several other conditions.
Retinal cavernous hemangioma 7( 1) The third most frequent pseudomelanoma was sol-
Chorioretinal scar 7( 1)
Vortex vein varix 7( 1) itary congenital hypertrophy of the RPE, accounting
Vitreous hemorrhage 7( 1) for 108 cases (6%).12–14 Larger congenital hypertro-
Choroidal osteoma 5( 1) phy of the RPE lesions that are located in the periph-
Preretinal macular gliosis 5( 1)
Scleritis 5( 1) eral fundus can frequently give the illusion of greater
Combined hamartoma of retina and RPE 4( 1) elevation. However, the sharp border, distinct black or
Ocular melanocytosis (choroidal) 4( 1) gray color, depigmented or pigmented halo, and de-
Subluxated lens 4( 1)
Compression by orbital tumor 3( 1) pigmented lacunae in the lesion should differentiate it
Central retinal vein obstruction 3( 1) from melanoma. Although congenital hypertrophy of
Retinal foreign body 3( 1)
Lens fragments/remnants 3( 1) the RPE was traditionally believed to be a stationary
Neurilemoma 3( 1) lesion, it is now known to gradually enlarge in most
Limited choroidal hemorrhage 3( 1) cases.12,14 In addition, congenital hypertrophy of the
Coloboma 2( 1)
Pars plana cyst 2( 1) RPE can rarely spawn an elevated component that we
Hazy media with suspicious ultrasound 2( 1) believe represents an adenoma of the RPE.15 In one
findings such case in which histopathologic examination was
White without pressure 2( 1)
Familial exudative vitreoretinopathy 1( 1) performed, the lesion proved to be an adenocarcinoma
Lattice degeneration of retina 1( 1) of the RPE.16
Choroidal lymphoma 1( 1) Other lesions that can resemble PUM are listed in
Myelinated nerve fibers 1( 1)
Neurofibroma 1( 1) Table 2. Hemorrhagic detachment of the retina or RPE
Optic disk/retina astrocytic hamartoma 1( 1) accounted for 86 pseudomelanomas (5%). This was
RPE, retinal pigment epithelium; CPE, ciliary body epithelium.
different from typical age-related macular degenera-
tion or peripheral exudative hemorrhagic chorioreti-
nopathy by virtue of its parafoveal or postequatorial
dal metastasis, and are less likely to refer them as location and could have been due to a number of
suspected melanoma. Second, our group in recent unclear causes, as mentioned above. Choroidal metas-
years has propagated treatment of selected borderline tasis can resemble amelanotic choroidal melanoma.
lesions that possess reported risk factors for growth The ophthalmoscopic features that differentiate cho-
and metastasis, thus stimulating more referrals for roidal melanoma from choroidal metastasis have been
borderline lesions. reported.1– 4,5,17 In addition, ancillary studies like flu-
The second most frequent pseudomelanoma was orescein angiography and ultrasonography can be
4. 770 RETINA, THE JOURNAL OF RETINAL AND VITREOUS DISEASES ● 2005 ● VOLUME 25 ● NUMBER 6
helpful in the differentiation.1–5 In some cases, fine- yellow lesion, usually found along the retinal vascular
needle aspiration biopsy of the intraocular mass may arcades, can resemble a amelanotic melanoma. Varix
be necessary to establish the diagnosis.18 Circum- of a vortex vein ampulla can dilate in certain fields of
scribed choroidal hemangioma is another condition gaze and appear as an elevated choroidal mass.42,43
that can mimic choroidal melanoma,2,3,19,20 account- However, it flattens or collapses in other fields of gaze
ing for 5% of pseudomelanomas in our series. It has a or when slight pressure is applied to the globe. Other
typical red orange color, shows early hyperfluores- unusual examples of pseudomelanoma included staph-
cence with angiography, and has high internal reflec- yloma (12 cases), dense cortical cataract that was
tivity with ultrasonography.2,3,20 believed to be a pigmented ciliary body melanoma
Lesions like combined hamartoma of the retina and (10), totally dislocated lens in the posterior fundus (4),
RPE,21,22 reactive hyperplasia of the RPE, optic disk fundus foreign body for which the patient recalled no
melanocytoma,23–26 retinal vasoproliferative tumor,27 ocular trauma (3), and others.
and choroidal osteoma28,29 usually have rather distinc- In summary, we reviewed the diagnoses and fre-
tive features that should serve to differentiate them quency of lesions that prompted referral to our oncol-
from melanoma.21–29 Some intraocular tumors, like ogy service because of suspected PUM and compared
ciliary body leiomyoma,2,3,30 neoplasms of the pig- their frequency with findings from an older study.
ment epithelium,2,3,31,32 and nonpigmented ciliary ep- Choroidal nevus still accounts for most pseudomela-
ithelium,33 were once believed to be indistinguishable nomas, and its differentiation from small PUM re-
from PUM and may still be difficult in certain cases. mains a clinical dilemma. Other lesions that were
However, recent studies have addressed their differ- more difficult to differentiate from melanoma a few
ences from melanoma.30 –33 years ago, like congenital hypertrophy of the RPE,
There are other tumors that may be impossible choroidal hemangioma, and age-related macular de-
clinically to differentiate from melanoma. These in- generation, are now being diagnosed more accurately
clude benign peripheral nerve sheath tumors such as and account for a lower percent of pseudomelanomas.
choroidal neurofibroma and neurilemoma (schwanno- The salient features that differentiate some of these
ma).2,3,34 These rare spindle cell uveal tumors can be lesions from PUM have been elucidated.
identical to amelanotic melanoma with regard to oph-
thalmoscopic features and ancillary studies. We have References
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