1. Renal cell carcinoma (RCC) is the most common type of kidney cancer, accounting for 80-90% of primary malignant renal tumors in adults. RCC is typically diagnosed in patients between 50-70 years of age.
2. The main subtypes of RCC include clear cell RCC (70-80% of cases), papillary RCC (13-20% of cases), and chromophobe RCC (5% of cases). These subtypes have distinct histological features and imaging appearances.
3. Imaging plays an important role in the diagnosis and staging of RCC. On CT, clear cell RCC usually appears as a heterogeneous enhancing renal mass. Papillary R
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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.
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!
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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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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
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.
2. Renal cell carcinomas
Malignant tumours derived from the
renal epithelium.
It is the most common malignant renal
tumour,
with a variety of radiographic
appearances.
3.
4. Epidemiology
Patients are typically 50-70 years of age
at presentation ,
male female ratio 2:1 .
Renal cell carcinomas are thought to be
the 8th most common adult malignancy,
representing 2% of all cancers,
and account for 80-90% of primary
malignant adult renal neoplasms .
5. Epidemiology
• Majority of RCC occurs sporadically
• Tobacco smoking contributes to 24-30% of
RCC cases
- Tobacco results in a 2-fold increased
risk
• Occupational exposure to cadmium,
asbestos, petroleum
• Obesity
• Chronic phenacetin or aspirin use
• Acquired polycystic kidney disease due to
dialysis results in 30% increase risk
6. Epidemiology
2-4% of RCC associated with inherited
disorder
Von Hippel-Lindau disease
Xp11.2 translocation
familial clear cell cancer
tuberous sclerosis
7. Clinical Presentation
Presentation is classically described as the
triad of:
macroscopic haematuria: 60%
flank pain: 40%
palpable flank mass: 30-40%
Symptoms secondary to metastatic
disease: dysnea & cough, seizure &
headache, bone pain
9. Other Signs And Symptoms
Weight loss (33%)
Fever (20%)
Night sweats
Malaise
Varicocele,
usually left sided, due to obstruction of
the testicular vein (2% of males)
10. Metastasis
The tendency of metastasize widely
before giving rise to any local symptoms
and signs.
25% of RCC had metastasis
Most common location:
1. lung(more than 50%)
2. bone(33%)
3. Regional lymph nodes
4. Liver, adrenal, and brain
11. Classification of RCC
CLEAR CELL RENAL CARCINOMA (conventional): 70-80%
large uniform cells with clear
highly vascular
CLEAR CELL MULTILOCULAR RENAL CELL CARCINOMA
PAPILLARY RENAL CELL CARCINOMA: 13-20%
type I: sporadic, generally good prognosis
type II: inherited, bilateral and multi focal
CHROMOPHOBE RENAL CELL CARCINOMA: 5%
similar histologically to renal oncocytomas
best prognosis
COLLECTING DUCT RENAL CELL CARCINOMA (Bellini duct):
<1%
often younger patients
worst prognosis
RENAL MEDULLARY CARCINOMA: rare
seen primarily in patients with sickle cell disease or sickle cell trait
12. 1. Clear cell renal cell
carcinoma CCRCC is a renal cortical tumor typically
characterized by malignant epithelial cells with
clear cytoplasm
Clear cell RCC recapitulates(repeat during
growth) the epithelium of the proximal
convoluted tubules .
The intra-cyto-plasmic glycogen and lipids get
dissolved during histologic processing,
rendering the cells “clear”
A variable proportion of cells with granular
eosinophilic cytoplasm may be present
13. Imaging studies
Imaging studies of CCRCC have shown
that extensive cystic degeneration with
associated necrosis ,
Focal cystic necrosis is relatively
common.
Focal calcification can be seen in 11-
26% of CCRCCs,
Ossification may also be present
14. CLEAR CELL RENAL
CARCINOMA
• Contrast-enhanced CT scan
of a clear cell RCC shows an
expansile , heterogeneously
enhancing right renal mass
(arrows) with associated
hypervascular retroperitoneal
lymphadenopathy
•Contrast-enhanced CT scan
obtained during the cortico-
medullary phase shows a
predominantly cystic clear cell
RCC (arrows) with peripheral
solid, enhancing components
15. Clear Cell RCC
•Axial gadolinium-
enhanced T1-
weighted MR
image obtained
during the
corticomedullary
phase shows a
small,
homogeneously
enhancing,
hypervascular
clear cell RCC
16. 2. Multilocular Cystic RCC
multiseptated cystic RCC whose septa contain
small clusters of clear cells.
Multilocular cystic RCC is found in adults aged
20–76 years with a mean age of 51 years.
Males predominate with a male-to-female ratio
of 3:1.
characterized by septated, variable-sized cysts
separated from the kidney by a fibrous capsule
. The cyst fluid may be serous or hemorrhagic
Asymmetric septal thickening may be seen.
Twenty percent of tumors show septal or wall
calcification
18. 3. Papillary RCC
second most common histologic subtype,
making up 10%–15% of RCCs.
Tumor epithelium is reminiscent of the
epithelium of the proximal convoluted
tubules
papillary RCCs often contain areas of
hemorrhage, necrosis, and cystic
degeneration
characterized by a predominantly papillary
growth pattern
19. imaging studies
appear hypovascular and homogeneous
on imaging studies
shows lesser degrees of contrast
enhancement than clear cell RCC at
contrast-enhanced CT
important feature of papillary RCC is
that bilateral and multifocal tumors
Larger tumors show heterogeneity due
to necrosis, hemorrhage, and
calcification
20. Papillary RCC
• Contrast-enhanced CT scan of a
papillary RCC shows a small
hypovascular mass (arrow) with
discrete foci of calcification
•Non-enhanced CT scan of a
papillary RCC shows a
complex cystic mass with
hemorrhage (arrow) and
associated retroperitoneal
lymph-adenopathy
21. MRI
Axial T2-
weighted MR
image of a
papillary RCC
shows a round,
uniformly
hypointense
tumor (arrows).
Note the
multiple
bilateral renal
cysts
(arrowheads).
22. 4. Chromophobe RCC
Chromophobe RCC is postulated to
differentiate toward type B intercalated
cells of the cortical collecting duct .
Chromophobe RCC shows a mean age
of incidence in the 6th decade.
Men and women are equally affected.
Macroscopically, chromophobe RCCs
are well circumscribed, solid, tan-brown
tumors with a mildly lobulated surface
23. Image Studies
Chromophobe RCC appears uniformly
hyperechoic at ultrasonography .
Despite their large size, chromophobe
RCCs demonstrate relatively
homogeneous enhancement at CT and MR
imaging
Chromophobe RCC may appear
hypointense on T2-weighted MR images.
At catheter angiography, chromophobe
RCC is commonly hypovascular
24. Chromophobe RCC
Axial gadolinium-
enhanced fat-saturated
three-dimensional
gradient-echo MR
image of a
chromophobe RCC
shows a relatively
hypovascular, expansile
right renal mass with
slightly heterogeneous
enhancement (arrows)
25. 5. Collecting Duct
Carcinoma
highly aggressive subtype of RCC that accounts for
<1% of all malignant renal neoplasms.
Origin from the medullary collecting duct is
suggested by immuno-cytochemistry findings that
are similar to principal cells of the collecting ducts of
Bellini .
Collecting duct carcinoma shows a male-to-female
ratio of approximately 2:1.
The age range is 13–83 years (mean age, 55 years).
typically appears as a gray-white infiltrative
neoplasm with its epicenter in the pelvicaliceal
system
characterized by an infiltrative growth pattern at
imaging
26. Image Studies
Collecting duct carcinoma may be
hyperechoic, isoechoic, or hypoechoic to
renal parenchyma at sonography.
At CT and MR imaging, collecting duct
carcinoma appears heterogeneous with
areas of necrosis, hemorrhage, and
calcification.
Collecting duct carcinoma commonly
shows low signal intensity on T2-weighted
MR images and hypovascularity at catheter
angiography
27. Collecting Duct Carcinoma
Power Doppler
sonogram of a
collecting duct
carcinoma shows a
solid, hypovascular
medullary neoplasm
(arrows).
28. CECT
Contrast-enhanced
CT scan of a
collecting duct
carcinoma shows a
heterogeneously
enhancing left renal
mass (arrows) with
prominent
calcifications
(arrowheads).
29. 6. Renal Medullary
Carcinoma
referred to as the seventh sickle cell nephropathy, is an
extremely rare malignant neoplasm occurring almost
exclusively in patients with sickle cell trait
Renal medullary carcinoma is almost always found in
young patients; the typical age range is between 10 and
40 years (mean age, 22 years). The male-to-female ratio
is 2:1.
appears as an infiltrative, heterogeneous mass with a
medullary epicenter
Manifests as an infiltrative, heterogeneous medullary
neoplasm
Hemorrhage and necrosis contribute to tumor
heterogeneity.
Renal medullary carcinoma is typically associated with
caliectasis.
30. Image studies
Renal medullary carcinoma appears
hypointense on T2-weighted MR images
likely due to the presence of by-products
of hemorrhage and necrosis.
Tumors are typically hypovascular at
catheter angiography
31. Medullary Carcinoma
Contrast-enhanced
CT scan of a renal
medullary
carcinoma shows a
heterogeneously
enhancing right
renal mass (black
arrow) with
associated cystic
retroperitoneal
lymphadenopathy
(white arrows).
32. Imaging of RCC
Ultrasonography
Intravenous Urography (IVU):
CT scanning: more sensitive, mass+renal
hilum, perinephric space and vena cava,
adrenals, regional LN and adjacent organs
Renal Angiography
MRI: to evaluate collecting system and IVC
involvement
34. USG
Hyper echoic mostly in small tumors <3
cm
Isoechoic / hypoechoic mostly in larger
tumors
Cystic lesion with increase in acoustic
transmission due to extensive necrosis
Inhomogeneity due to hemorrhage ,
necrosis , cystic degeneration
36. IVU
Diminished function (parenchymal
replacement, hydronephrosis)
Absence of contrast excretion (renal vein
occlusion)
Necrotic part of tumour filled with
contrast media
37. NCCT
Unenhanced
CT scan shows
a 2.5-cm-
diameter soft-
tissue mass
deforming the
contour of the
right kidney
(arrow)
38. corticomedullary phase
Contrast-enhanced CT
scan obtained during
the corticomedullary
phase shows that the
mass is
hypoattenuating
compared with the
renal cortex and has
peripheral
enhancement (arrow).
The cortex is brightly
enhanced, whereas
the medulla is
relatively unenhanced.
39. nephrographic phase
Contrast-
enhanced CT scan
obtained during the
nephrographic
phase shows the
hypervascular
mass is well
demarcated from
the homogeneously
enhancing renal
parenchyma
(arrow)
40. CT Scan of Left RCC
Heterogenous mass due to hemorrhagic /necrosis
41. CT
On non-contrast CT the lesions appear of soft tissue attenuation.
Larger lesions frequently have areas of necrosis.
Approximately 30% demonstrate some calcification .
During the corticomedullary phase of enhancement, 25-70 seconds
after administration of contrast, renal cell carcinomas demonstrate
variable enhancement, usually less than the normal cortex.
Small lesions may enhance a similar amount and be difficult to
detect.
In general small lesions enhance homogeneously, whereas larger
lesions have irregular enhancement due to areas of necrosis.
The clear cell sub type may show much stronger enhancement
46. Magnetic resonance scan
A, Magnetic resonance scan
of kidneys without
administration of gadolinium
suggests anterior right renal
mass.
B, After intravenous
administration of gadolinium-
labeled diethylene-triamine-
penta-acetic acid, MRI shows
enhancement of this mass
indicative of malignancy
47. MRI
T1: often heterogeneous due to
necrosis, haemorrhage and solid
components
T2: appearances depend on histology
clear cell RCC: hyperintense
papillary RCC: hypointense
T1 C+ (Gd): often shows prompt arterial
enhancement