This document discusses normal and abnormal puberty. It begins by defining key terms like adolescence and puberty. It then outlines the normal sequence of pubertal events including thelarche, adrenarche, and menarche. It also discusses factors that influence the onset of puberty. Abnormal puberty is categorized as either precocious or delayed. Precocious puberty can be true, pseudo, or incomplete. Causes and treatment approaches are provided. Delayed puberty can be caused by hypergonadotropic hypogonadism, hypogonadotropic hypogonadism, or eugonadism. The document concludes with discussing the approach to evaluating and treating delayed puberty.
Gynecologic diseases in childhood are common. This review is intended to enable careful and sound management of pediatric patients as the initial assessment is paramount to proper management.
Overview normal physiological development; skeletal growth, maturation of the reproductive tract, development secondary sexual characteristics, CNS maturation, personality and psychology of the female adolescent.
Gynecologic diseases in childhood are common. This review is intended to enable careful and sound management of pediatric patients as the initial assessment is paramount to proper management.
Overview normal physiological development; skeletal growth, maturation of the reproductive tract, development secondary sexual characteristics, CNS maturation, personality and psychology of the female adolescent.
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
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.
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.
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
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.
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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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.
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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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
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
3. DEFINITIONS
• ADOLESCENCE - the period of life during which a child becomes an
adult i.e. the physical , sexual and psychological development are
complete.
• PUBERTY - a physiological phase lasting 2 to 5 years, during which the
genital organs mature. It represents the first stage of adolescence
• THELARCHE – breast growth
• ADRENARCHE/PUBARCHE – increased activity of the suprarenal
cortex at puberty with increased production ofadrenal androgens
resulting in pubic hair (and axillary hair) growth
• MENARCHE– onset of menstruation
4. OESTROGEN FEEDBACK SYSTEM
Hypothalamus
• Gonadotropin releasing hormone (GnRH)
• Initially highly sensitive to negative feedback exerted from oestradiol
• At puberty – sensitivity decreases
Anterior
Pituitary
• Follicle stimulating hormone (FSH)
• Luteinising hormone (LH)
Ovaries
• Follicular development
• Oestrogen secretion
5. FACTORS ASSOCIATED WITH ONSET OF
PUBERTY
• Genetics
• Height and weight ratio (nutritional factors)
• Critical weight for menarche – 47.8kg
• Increased fat deposition from 17% to 23% for ovulation
• Therefore increased BMI = earlier menarche
• Maturation of the hypothalamus – sensitivity to oestrogen feedback
system
• Increased neurotransmitter output in CNS
• Onset of adrenal androgen activity
6. EFFECTS OF OESTROGEN
• Secondary sexual characteristics
• Thelarche
• Pubic/axillary hair growth to a small extent
• Skeletal growth growth spurt
• Menarche:
• Midpuberty oestrogen endometrial proliferation significant enough to result in the first
menstruation
• Genital organ changes:
• Vaginal length increases along with the size of the mons pubis, labia majora and minora
• Vaginal rugae become apparent, epithelium becomes thickened stratified squamous containing
glycogen
• Acidic environment
• Uterus and ovaries enlarge. Uterus:cervix ratio 2:1
• 2 million follicles present at birth are now closer to 300 000
7. SUMMARY OF PUBERTAL EVENTS
Thelarche
• 9.8 – 10.5 years
• Skeletal growth
occurs
simultaneously
Adrenarche
• 10.5 – 11 years
Menarche
• 12.8 years
• Mean interval
between
thelarche and
menarche is
approximately
2.5 years
8. ABNORMAL PUBERTY
• Precocious puberty: Appearance of secondary sexual characteristics
before age 8 OR menarche before age 9
• Delayed puberty: Sexual characteristics don’t develop by the age of
14 OR no menstruation until age 16
9. ABNORMAL PUBERTY
Precocious puberty:
• True precocious puberty: due to increased pituitary gonadotropins (LH and FSH)
• Pseudo-precocious puberty: due to increased sex steroids – peripheral origin
• Incomplete precocious puberty: only one pubertal change - such as thelarche or
adrenarche before the age of 8 years - without the presence of any other pubertal
changes and in absence of increased oestrogen production. The other pubertal
changes occur at the normal age.
11. • Constitutional – premature maturation of the hypothalamic-pituitary-
ovarian axis GnRH is secreted earlier which stimulates sex steroid
production puberty occurs in the normal order but earlier
12. Intracranial lesions
• Ventricular hamartoma
• Pineal tumour
• Craniopharyngioma
• Astrocytoma
• Glioma
• Neurofibroma
• Ependymoma
• Suprasellar teratoma
• Hydrocephalus
• Cerebral palsy
• Infections
Within the hypothalamus
Near the hypothalamus
CNS causes
13. Extracranial lesions – tumours that secrete gonadotropins
• Ectopic gonadotropin-secreting tumours of the ovary
• Dysgerminoma – malignant germ cell tumour occurring in the ovary
• Choriocarcinoma – secretes HCG which stimulate ovarian secretion of oestrogen
• Hepatoblastoma
Hypothyroidism – severe hypothyroidism causes increased levels
of TSH and FSH
• Cross reactivity of TSH on FSH receptor OR
• Direct ovarian stimulation from FSH
• Short stature, delayed bone age, thelarche, genital development, pubarche,
menstruation
15. GnRH independent causes – unprovoked by hypothalamus
Feminising tumours
• Ovarian - granulosa cell tumour
• Adrenal - adrenoblastoma
• Often palpable in the abdomen
Exogenous oestrogen
• Injection of oestrogen preparations
• Oestrogen contamination of food
16. McCune-Albright syndrome
• Due to a sporadic somatic mutation (occurring after conception)
• Diagnosis is based on a triad of signs of which 2 must be present:
• Precocious puberty – usually early menarche
• Café-au-lait spots – large, irregularly shaped, usually on upper body and face;
present from birth
• Polyostotic fibrous dysplasia – develop fibrous tissue in bones resulting in
pathological fractures
• Other associated features:
• Ovarian cysts
• GH/prolactin-secreting adenomas
• Hyperthyroidism
• Adrenal hypercortisolism – cushing’s syndrome
• Osteomalacia
• Treatment: inhibit ovarian steroidogenesis - testolactone
17. INCOMPLETE PRECOCIOUS PUBERTY
Premature
thelarche
Unilateral/bilateral
Waxes and wanes
Normal puberty and
reproduction follows
Premature
menarche
Rare
Consider infections, foreign
body, abuse or trauma,
local neoplasms
Premature
adrenarche
Due to early rise in adrenal
androgens
May be associated with
anovulation, hirsutism and
hyperinsulinaemia.
18. APPROACH TO PRECOCIOUS PUBERTY
History
•Exclude iatrogenic source of oestrogen/androgen
•Exclude life-threatening causes eg tumour of CNS, ovary, adrenal
•Trauma, foreign body, abuse
Examination
•Weight/height = BMI; Tanner stage
•Genitalia exam
•Abdomen/pelvis – tumours, local causes
•Neurological/Opthalmologic – CNS tumours/infections
•Features of McCune-Albright syndrome or hypothyroidism
Investigations
•Biochemistry – FSH/LH/Prolactin/Oestrogen/Testosterone/TSH/HCG/provocative tests - GnRH
•X-ray – wrist for bone age
•U/S abdomen/pelvis – exclude tumours of ovaries, adrenals, liver
•CT brain - tumours
20. PSYCHOSOCIAL ASPECTS
• Counselling parents and child in order to avoid abuse
• Reduce emotional problems
• Provide contraception if necessary
21. no signs of secondary sexual development by
the age of 14 OR no menstruation by age 16
Delayed
puberty
• Delayed onset: Breast bud does not appear till 13 years or menarche does not
occur till 16 years
• Delayed progression: Menarche does not occur within 5 years after breast bud
23. HYPERGONADOTROPIC HYPOGONADISM
Low oestrogen level is due to ovarian failure rather than loss of
gonadotropin stimulation
CONGENITAL ACQUIRED
Turner’s syndrome Surgical/traumatic castration
Swyer syndrome Autoimmune ovarian failure
Mixed gonadal dysgenesis Chemotherapy/radiotherapy
Pure gonadal dysgenesis Infections
Gonadal
dysgenesis
24. HYPOGONADOTROPIC HYPOGONADISM
Low oestrogen resulting from low gonadotropins. Causes may be
generalised or focal, reversible or irreversible
REVERSIBLE CAUSES IRREVERSIBLE CAUSES
Physiologic delay GnRH deficiency
Hypopituitarism
Nutritional disorders
Excessive weight loss/energy
expenditure
Malnutrition
Anorexia nervosa
Congenital CNS defects
Kallmann’s syndrome – delayed
puberty and anosmia
Acquired – post surgery/radiotherapy
damage
Prolactinoma CNS tumours – craniopharyngioma
Endocrinopathies
Hypercortisolism (Cushings)
Hypothyroidism
Prader-willi syndrome – short stature,
obsessive eating, hypotonia
CHARGE syndrome
25. EUGONADISM
Normal levels of gonadotropins and sex steroids – defect is at end-
organ
• Mullerian duct agenesis – congenital absence of uterus and vagina
• Uterovaginal plate – complete vaginal septum with imperforate
hymen
• Intersex disorders – androgen insensitivity
26. APPROACH TO DELAYED PUBERTY
History
•Exclude obvious genetic disorders
•Sense of smell? Diet/exercise habits? Cognitive defecits?
•Exclude previous trauma/medical therapy resulting in damage
•Exclude life-threatening causes eg tumour of CNS, ovary, adrenal
Examination
•Weight/height = BMI; Tanner stage
•Genitalia exam – ambigious genitalia
•Abdomen/pelvis – tumours, local causes
•Neurological/Opthalmologic – CNS tumours/infections
Investigations
•Biochemistry – FSH/LH/Prolactin/Oestrogen/Testosterone/TSH/HCG/provocative tests - GnRH
•X-ray – wrist for bone age
•U/S abdomen/pelvis – exclude tumours of ovaries/assess anatomy
•CT brain – tumours
•Genetic - karyotype
27. TREATMENT PRINCIPLES
Treat underlying
cause
Tumours/infections
XY patients –
gonadectomy and
sex hormone
treatment
Develop secondary
sexual
characteristics/growth
spurt
Appropriately
timed hormone
treatment
Gradually
increasing
increments of
oestrogen therapy
Counselling/reassurance/
monitoring
Especially if
constitutional
delay is suspected
Editor's Notes
At birth oestradiol suppresses hypothalamus from secreting GnRH
At puberty, there is decreased sensitivity to negative oestrogen feedback GnRH secretion to upregulate oestrogen and progesterone secretion
