Physiology Of Menstruation
By: Nur Afiqah Binti Jasmi (11-2013-031) & Luqman Hakim Bin Mohd Jais (11-2013-170)
Dokter Pembimbing: Dr. Harianto Wijaya Sp.OG
Physiology Of Menstruation
By: Nur Afiqah Binti Jasmi (11-2013-031) & Luqman Hakim Bin Mohd Jais (11-2013-170)
Dokter Pembimbing: Dr. Harianto Wijaya Sp.OG
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
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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.
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
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.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
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
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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2. Puberty
Physiological transition from childhood to
reproductive maturity
Associated with:
Growth spurt
Appearance of both primary and secondary sexual
characteristics in children
Occurs between 8 and 14yrs in girls
Occurs between 9 and 14yrs in boys
3. Influencing Factors
Genetics: 50-80% of variation in pubertal timing ( as race )
Environmental factors e.g. nutritional status ( obesse are
more likely to be earlier )
Excessive exercise
Psychological factors .
4. Normal Puberty: Endocrine control
Befor birth
Neoborn
Until 3 months of age > decline
Childhood
Suppression “CNS inhibition of hypothalamus “
“ feedback of low estradiol due to high sensetivity ”
Leptin → regulates appetite and metabolism through
hypothalmus. Permissive role in regulation of timing of
puberty
5. Normal Puberty: Endocrine control
Onset of puberty signalled by the secretion of pulses of Gonadotrophin
Releasing Hormone (GnRH)
Prior to puberty: hormonal feedback / central neural suppression of
GnRH release suppress onset of puberty
Hypothalamo-pituitary-gonadal axis starts working in foetus. After
birth, sex hormones and gonadotrophins (FSH, LH) found in adult
levels
Levels reduce in months after birth; pulsatile GnRH reduces in
childhood and increases in frequency and amplitude before puberty
For 2 yrs before puberty, rise in adrenal androgens early pubic hair
and spots
6.
7. Physiology of Puberty
Activation of the hypothalamic – pituitary –
gonadal axis
Induces and enhances progressive ovarian and
testicular sex hormone secretion
Responsible for the profound biological,
morphological and psychological changes which
adolescents experience
8. Late Prepubertal period
Btw age 8-11
Adrenal cortex secrete DHEA , DHWA-S and
Androstenedione .
These Androgens resulting in Adrenarche (
Pubarche )
9. ↑ GnrH > promote ovarian follicle maturation and
sex steroid production .
Resulting in development of Secondary sexual
features
10. Physical Changes
5 stages from childhood to full maturity
Marshall and Tanner (P1 – P5)
Reflect progression in changes of the external
genitalia and of sexual hair
Secondary sexual characteristics
Mean age 10.5yrs in girls
Mean age 11.5 – 12yrs in boys
11. Puberty: Girls
Thelarche (Breast budging ) usually first sign.
Often unilateral
Menarche usually 2-3 yrs after breast development
Growth spurt peaks before menarche
Pubic and axillary hair growth: sign of adrenal androgen
secretion
Starts at similar stage of apocrine gland sweat production
and associated with adult body odour
12. Pubertal Stages (Tanner)
Female
P1 Prepubertal
P2 Early development of subareolar breast bud
+/- small amounts of pubic and axillary hair
P3 Increase in size of palpable breast tissue and areolae, increased
dark curled pubic/axillary hair
P4 Breast tissue and areolae protrude above breast level. Adult
pubic hair but no spread to medial thighs.
P5 Mature adult breast. Pubic hair extends to upper thigh
13.
14. Menarche
Mean age in USA is 12.4 years .
During puberty oestradiol levels fluctuate widely
(reflecting successive waves of follicular development that
fail to reach ovulatory stage)
Endometrium affected by oestradiol. Undergoes cycles of
proliferation and regression until point where withdrawal
of oestrogen results in the first menstrual bleed (menarche)
15. Ovarian development
Rising levels of plasma gonadotrophins
Stimulate ovary to produce increasing amounts of
oestradiol
Oestradiol ► secondary sex characteristics
Breast growth and development
Reproductive organ growth and development
Fat redistribution (hips,breasts)
Bone Maturation
16. Ovulation
First ovulation occurs 6 – 9 mths after menarche
Plasma progesterone remains at low levels even if
secondary sexual characteristics have appeared
Rising progesterone after usually ► ovulation
Plasma testosterone rise during puberty (not as
much as in male)
17. Development of Uterus
Prepubertal uterus is tear-drop shaped
Neck and isthmus account for up to 66% of
uterine volume
Following production of oestrogens – uterus
becomes pear shaped
Uterine body increases in length (max 5 – 8cm)
and thickness (proportionately more than cervix)
18.
19. Assessment of abnormal puberty
Many causes
Aim of assessment: determine whether underlying
pathological abnormality vs constitutional and
benign pubertal changes
20. What is abnormal?
Delayed Puberty
Early or Precocious Puberty
More common in females( 5 times )
1 in 10,000 children
Uncommon in males (usually pathological)
< 8yrs in females
< 9yrs in males
May be associated with a growth spurt
21. Assessment 1
Full history of previous growth and development
Record timing and sequence of physical
milestones and behavioural changes of puberty
Full medical and surgical history
If underweight: take full nutritional history
Family hx of early or delayed puberty
Family hx of any genetic disease
22. Assessment 2
Plot height, weight, BMI and growth velocity
Compare with old measurements if available
Examine all systems: endocrine / neurology
Genitalia, body habitus, stage of puberty
25. Precocious Puberty
Onset of secondary sexual characteristics < 8yrs in
girls and < 9yrs in boys
5 times more common in girls
Usually benign central process – girls
Pathological in ~ 50% in boys
26. Premature thelarche / pubarche
Thelarche – beginning of breast development
Pubarche – first appearance of pubic hair
(more common in certain populations e.g asian / afro-caribbean )
More common than true precocious puberty
Benign variants
breast development in girls < 3yrs with spontaneous regression
Pubic hair in boys and girls < 7yrs due to adrenal androgen
secretion in middle childhood
28. Diagnostic Imaging
Pelvic USS (ovarian tumours / cysts)
Testicular USS (tumour)
Adrenal USS (MRI / CT better if tumour
considered)
Bone Age (if within 1yr of CA, puberty not started
or only just started; if > 2yrs, puberty already
started)
Brain MRI in all males and patients with
neurological signs or symptoms)
30. Issues
Treatment of the cause e.g. cranial neoplasm
Behavioural difficulties – psychology
Reduce rate of skeletal maturation (early growth
spurt may result in early epiphyseal closure and
reduced final adult height)
Halt or slow puberty (GnRH analogue)
Inhibit action of excess sex steroids