1. Puberty is defined as the transitional stage from childhood to adulthood that is characterized by physiological changes and development of secondary sex characteristics.
2. It typically occurs between ages 10-16 and is influenced by genetic and environmental factors such as nutrition, geography, and light exposure.
3. The stages of puberty include thelarche, adrenarche, growth spurt, menarche, and development of secondary sex characteristics over approximately 4.5 years.
in this slide physiological, psychological and social aspects of menopause, Hormonal replacement therapy, surgical menopause , guidance and counselling / role of midwifery nurse practitioner in menopause.
Puberty & adolescence by Pandian M, Tutor, Dept of Physiology, DYPMCKOP,MHPandian M
Introduction
Components of puberty
Sudden spurt of physical growth
Appearance of secondary sex characters
Stages of development of secondary sex characters.
Types of secondary sex characters.
Hormonal changes during puberty
Control of onset of puberty
Applied aspects
What is puberty?
Puberty is the time in life when a person becomes sexually mature. It is a physical change that usually happens between ages 10 and 14 for girls and ages 12 and 16 for boys. Some African American girls start puberty earlier than white girls, making their age range for puberty 9 to 14.
Puberty starts when a part of the brain called the hypothalmus begins releasing a hormone called gonadotropin releasing hormone (GnRH).
GnRH then signals the pituitary gland to release two more hormones - luteinizing hormone (LH) and follicle-stimulating hormone (FSH) – to start sexual development.
A study funded in part by NICHD has identified a gene that appears to be the crucial signal for the beginning of puberty. Without a functioning copy of the gene, known as GPR54, humans appear unable to enter puberty normally.
in this slide physiological, psychological and social aspects of menopause, Hormonal replacement therapy, surgical menopause , guidance and counselling / role of midwifery nurse practitioner in menopause.
Puberty & adolescence by Pandian M, Tutor, Dept of Physiology, DYPMCKOP,MHPandian M
Introduction
Components of puberty
Sudden spurt of physical growth
Appearance of secondary sex characters
Stages of development of secondary sex characters.
Types of secondary sex characters.
Hormonal changes during puberty
Control of onset of puberty
Applied aspects
What is puberty?
Puberty is the time in life when a person becomes sexually mature. It is a physical change that usually happens between ages 10 and 14 for girls and ages 12 and 16 for boys. Some African American girls start puberty earlier than white girls, making their age range for puberty 9 to 14.
Puberty starts when a part of the brain called the hypothalmus begins releasing a hormone called gonadotropin releasing hormone (GnRH).
GnRH then signals the pituitary gland to release two more hormones - luteinizing hormone (LH) and follicle-stimulating hormone (FSH) – to start sexual development.
A study funded in part by NICHD has identified a gene that appears to be the crucial signal for the beginning of puberty. Without a functioning copy of the gene, known as GPR54, humans appear unable to enter puberty normally.
precocious puberty is one of the grey areas for pediatricians and gyenecologists. this is an attempt to answer some of the questions the content is references taken from authorative textbooks
Dickson Cv Akankwatsa is an ambitious 3rd year student at Bishop Stuart University, Uganda , pursuing a bachelor of Nursing science. More so, a HOSTEL councilor contestant 2016/17 in the same institution.
Pediatrics notes about "Normal & Abnormal Puberty". These notes were published in 2018.
You can download them also from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
L6-8.Disorders of the reproductive system.pptxDr Bilal Natiq
In the male, the testis serves two principal functions: synthesis of testosterone by the interstitial Leydig cells under the control of luteinising hormone (LH), and spermatogenesis by Sertoli cells under the control of follicle-stimulating hormone (FSH) (but also requiring adequate testosterone).
A case presentation and discussion of ALL presented in a Tertiary Care Hospital ER. Includes presenting complaints, work-up, diagnosis and relevant case discussion.
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
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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.
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.
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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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
- 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
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. Define
Transitional stage from childhood to adulthood manifested by physiological changes & development of SSC .
Aboubakr Elnashar
3. Timing Usually occurs between the ages of 10 & 16 years .
Major determination is genetic. Other factor .
1.Geographic location
2. Exposure to light.
3.General health & nutrition:
Aboubakr Elnashar
4. A.Critical body weight of 47.8 Kg (Frisch hypothesis).
B.A greater percentage of body fat (16% to 23.5%) may serve as initiating signal. Moderately obese girls have earlier menarche. Anorectics have delayed menarche. Puberty is delayed in morbid obesity, other factors are involved.
Aboubakr Elnashar
5. What
When
How
1. Thelarche
Development of breast, 5Taner stages
±10 yrs, first sign of puberty
E2
2. Adrenarche
Development of pubic hair, 5 Taner stages & axillary hair, 3Taner stages
PH: 1yr after Thelarche
AH is the final SCC
Adrenal androgen
3. Spurt of growth
Accelerated growth, 6-11cm/yr
With adrenarche
GH & E2
4. Menarche
The first menstruation
±12yr
(9-17.7)
Midpubertal E2
Stages (Physiological changes)
The pubertal sequence requires 4.5 yrs. (range, 1.5-6 yrs)
Aboubakr Elnashar
10. Uterus: enlarge, U/C:2/1 Ovaries: .increase in size, almond shape .300 thousands primary follicle at menarche (2 million at birth)
Aboubakr Elnashar
11. Summary of pubertal events 1.FSH & LH rise moderately before the age of 10 yrs, followed by a rise in E2. LH pulse frequency increases are first seen in sleep but then are extended throughout the day. The final adult pattern is 1.5 to 2 hrs intervals between pulse. 2.Increased levels of E2 (gonadarche) results in Maturation of SSC. Increased skeletal growth at low levels of E2. Increased GH & IGF-1
Aboubakr Elnashar
13. 3. Adrenal androgen cause adrenarche (pelvic & axillary hair). No major role in growth. It is an independent event.
4. Midpuberty levels of E2 are sufficient to induce menstruation.
5. Postmenarchal periods are irregular for 12-18 mo {LH surge is late pubertal event}
Aboubakr Elnashar
15. Leptin & puberty
Leptin is a peptide secreted by adipose tissues; it acts on CNS neurons, regulating eating behavior & energy balance.
Higher levels of leptin correspond to earlier menarche. Girls with idiopathic precocious puberty have higher leptin levels. Leptin levels decrease with increasing Tanner stage. They have increased sensitivity to leptin. The decrease may allow greater food intake.
Aboubakr Elnashar
16. Growth hormone:
At puberty its secretion is critically dependent on sex steroid.
It stimulates IGF-1 in cartilage & IGF-1 production in liver.
Aboubakr Elnashar
18. Etiology, Classification
A. True, GnRH dependent, complete, central, isosexual: Activation of the HPO axis, development of the gonads, SSC & ovulation
1.Constitutional, idiopathic: (85%)diagnosed by exclusion.
2.CNS: Meningitis, encephalitis, hydrocephalus
Aboubakr Elnashar
19. B. Pseudo, GnRH independent, incomplete, peripheral, iso or hetrosexual :
No activation of the HPO axis, but extrapituitary HCG or sex steroid exposure.
No developments of the gonads, No ovulation but development of SSC.
Aboubakr Elnashar
20. 1. Isosexual:
Feminizing T (Granulosa-Theca cell, malignant teratoma).
Estrogen intake.
Albright S (precocious puberty, café-au-lait skin patches, cystic bony changes).
Hypothyroidism (Short stature & retarded bone age).
Aboubakr Elnashar
21. The small cyst like space is similar to the Call-Exner bodies normally seen in granulosa cells
Aboubakr Elnashar
23. 2. Hetrosexual: Virilizing T: virilization but no uterine bleeding. Androgen intake. CAH
Aboubakr Elnashar
24. C. Partial: premature thelarche or adrenarche. It is due to end-organ increased sensitivity to normal circulating low E or A. Follow-up
Aboubakr Elnashar
25. Diagnosis
History
Examination
i. Growth: Tanner stage, height & weight percentile
ii. External genitalia changes
iii. Abdominal, pelvic & neurological examination.
IV. Signs of androgenization
v. Other findings: signs of Albright S, hypothyroidism
Aboubakr Elnashar
26. d. X ray of the lower ends of radius & ulna:bone age
a. Retarded: hypothyroidism b. Normal: Partial
c. Advanced:
FSH: Low (<2 IU/ml) ---- pseudo-----follow up
Normal (> 2 mIU/ml) ----- true:
CT or MRI --------Normal (idiopathic)
Abnormal (CNS lesion)
Aboubakr Elnashar
27. Treatment Objectives:
•Arrest maturation until normal pubertal age.
•Attenuate & diminish established precocious characteristics.
•Maximize adult height.
•Avoid abuse, reduce emotional & social problems
Aboubakr Elnashar
28. Treatment of the cause:
•Albright S ( MPA or Testolactone, aromatase inhibitor).
•Ovarian or CNS tumor (excision).
•Hypothyriodism, CAH
Aboubakr Elnashar
29. Constitutional: GnRh analogue Drug of choice because it achieves all objectives. It acts by binding to the anterior pituitary receptors causing down-regulation & desensitization of the pituitary.
Aboubakr Elnashar
30. Regression of symptoms occurs in the first year {Regression of pubertal characteristics, amenorrhea & decreased growth velocity}. Delayed epiphyseal fusion; treatment more effective if begun before bone age >12 yrs.
Aboubakr Elnashar
31. Maintain E2 at <10 pg/mL.
Children require higher doses than adults for suppression.
Adrenarche will continue.
Treatment is continued until the epiphyses are fused or the appropriate pubertal & chronological ages are matched.
Aboubakr Elnashar
32. SSC do not develop by the age of 14 y or no menstruation till age of 16y
Aboubakr Elnashar
33. It is either :
* Delayed onset: Breast bud does not appear till 13 years or menarche does not occur till 16 years . or
* Delayed progreession : Menarche does not occur within 5 years after breast bud .
Aboubakr Elnashar
34. Causes Early cycles are anovulatory E unopposed by P endometrial hyperplasia Treatment for 3 cycles: Norethistrone acetate 5mg twice daily for 21 d or OCP
Aboubakr Elnashar