endometrial cancer
endometrial carcinoma
gynaecological oncology
uterine cancer
uterus
post menopausal bleeding
endometrial neoplasms
gynaecology
cancer
endometrial cancer
endometrial carcinoma
gynaecological oncology
uterine cancer
uterus
post menopausal bleeding
endometrial neoplasms
gynaecology
cancer
June 1, 2016◆Volume 93, Number 11www.aafp.org/afpAmerican Family Physician 937Ovarian cancer is the most lethal gynecologic cancer. Less than one-half of patients survive for more than five years after diagnosis. Ovarian cancer affects women of all ages but is most commonly diagnosed after menopause. More than 75% of affected women are diagnosed at an advanced stage because early-stage disease is usually asymptomatic and symptoms of late-stage disease are nonspecific. The strongest risk factors are advancing age and family history of ovarian and breast cancer.
PREDICTIVE AND DIAGNOSTIC BIOMARKERS FOR OVARIAN CANCERDr. Girija Wagh
OVARIAN CANCER HAS ELUDED SCREENING AND EARLY DETECTION . SEVERAL BIOMARKERS ARE PROPOSED AND HERE IS A AN UPDATED REVIEW OF WHAT EXISTS IN THE CURRENT CLIMATE FOR THE SAME Ovarian carcinomas relate to highest death rate in gynecologic malignancies as absence of symptoms shield the disease in the early stage. Current evidences have been devoted to discovering early effective screening mechanism prior to the onset of clinical symptoms.Serum biomarkers may aid in the diagnosis of Early ovarian cancer
Distinguish malignant from benign disease
Prevent unnecessary surgery
Improve rates of early detection. Prof Girija Wagh is the Head of the Department of OBG at Bharati University Medical College and Hospital and a well acknowledged teacher and a researcher.This overview will certainly help the learners to approach this condition with more promise
Tumor markers
Many cancers are associated with the abnormal production of some molecules which can be measured in plasma. These molecules are known as tumor markers.
A good tumor maker should have those properties:
1. A tumor marker should be present in or produced by tumor itself.
2. A tumor marker should not be present in healthy tissues.
3. Plasma level of a tumor marker should be at a minimum level in healthy subjects and in benign conditions.
4. A tumor marker should be specific for a tissue, it should have different immunological properties when it is synthesized in other tissues.
5. Plasma level of the tumor marker should be in proportion to the both size of the tumor and the activity of the tumor.
6. Half-life of a tumor should not be very long
7. A tumor marker should be present in plasma at a detectable level, even though tumor size is very small
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptx
ROMA (Risk of Ovarian Malignancy Algorithm)
1. Risk of Ovarian Malignancy
Algorithm (ROMA)
Dr. Bikash Chaudhury
HOD Biochemistry
2. Outline of the Presentation
• Overview of Ovarian Cancer
• Current clinical tools to assess Ovarian Cancer
• Ca 125 & HE4
• MAAAs
• ROMA
• Summary
3. Ovarian Cancer is a Major Women's Health Problem
1ACOG Practice Bulletin. Obstet Gynecol. 2007;110:201-213.
• High morbidity and mortality
• Appropriate treatment improves survival1
– Oncology specialists
– High volume centres
• Need better risk assessment tools
4. Epidemiology
• 5th leading cause of cancer deaths in women and affecting at
least 1 in 70 women
• 5-year survival rate is around 80-90%for patients with Stage I
disease and only 30%with Stage III and Stage IV
• In India, Ovary is the third leading site of cancer among women.
• The age adjusted incidence rates of ovarian cancer vary between
5.4 to 8.0 per 1,00,000 populations in different parts of the
country.
6. Survival Rates for Ovarian Cancer Need to be Improved
Ovarian Cancer 5-yr Survival Rate by Stage
Stage Distribution
at Diagnosis
Survival Rate
Heintz APM, et al. FIGO Annual Report on the Results of Treatment in Gynecologic Cancers. 2000; 24 :107-138.
Holschneider CH, Berek JS. Semin Surg Oncol. 2000;19:3-10.
Stage I 20-27% 73-93%
Stage II 5-10% 45-70%
Stage III 52-58% 21-37%
Stage IV 11-17% 11-25%
7. Current Clinical Tools to Assess Risk of Ovarian Cancer
• History
• Physical exam
• Imaging (US, CT and MRI)
• Tumor markers (CA 125)
8. “Top Ten” Biomarkers for
Detection of Ovarian Cancer
• CA 125
• HE4
• CA 15-3
• CA 72-4
• B7-H4 (Ov-110)
• Transthyretin
• IGFBP-2
• SMRP (Mesomark™)
• HK6
• Cytokeratin 19
(CYFRA 21-1)
9. Ultrasound Assessment of Pelvic Mass
• Limitations of Ultrasound
– Not all morphologic variables are commonly reported or
measured
– User variability (tertiary care vs community)
– Ultrasound reporting is not standardized
– Quality and complexity of machine (e.g. Doppler)
– Complex algorithms
Moore RG et al. J Clin Oncol. 2007;25:4159-4161.
10. CA125 HAS BEEN THE MOST
COMMONLY
USED MARKER IN THE PREDICTION OF
OVARIAN CANCER FOR YEARS
TOGETHER……..BUT THE PARADIGM IS
NOW CHANGING, DUE TO THE
SHORTCOMINGS OF CA125 !!
11. Limitations of CA125 as a marker for ovarian cancer
Non specificity to ovarian cancer:
• Besides ovarian cancer, CA 125 levels are raised in
several other non-cancerous conditions like endometriosis,
pelvic inflammatory disease and benign ovarian cysts
• Elevated CA125 levels have also been commonly noted in
physiological states like menstruation and pregnancy.
12. Limitations of CA125 as a marker for ovarian cancer
Therefore, the rate of false positive results is
high, when CA 125 is used as a biomarker of
ovarian cancer.
Infact, this tendency towards false positivity is
further augmented when CA 125 is used for
detecting ovarian cancer in pre-menopausal
women.
13. Cannot be employed as a biomarker for early detection of
ovarian cancer:
• Less sensitive in detecting patients with early ovarian cancer.
Elevated levels of CA 125 are reported only in 50% of Stage 1
ovarian cancer cases
• This limits its use to only biomarker for monitoring therapeutic
efficacy in ovarian cancer.
Limitations of CA125 as a marker for ovarian cancer
14. HE4 (Human Epididymal Protein 4)
• Initially discovered to be over-expressed in
epididymal tissue and later in ovarian cancer tissue.
• Tumour expression is histologic dependent.
Most Serous and Endometrioid tutors
50% of Clear Cell Tumours
0 % of Mucinous tumours.
15. Why HE4 ???
HE4 overcomes some of the drawbacks of
CA125 as a biomarker for ovarian cancer
16. HE4 as a biomarker for ovarian cancer
• Detects ovarian cancer with a 67% sensitivity at a specificity
level of 96%. Therefore, false positivity is significantly lower as
compared to CA125 testing
• Differentiates between ovarian cancer and benign ovarian
Conditions
• Elevated HE4 levels are expressed in early stage ovarian
cancer and hence HE4 testing can detect Stage I disease
17. HE4 as a biomarker for ovarian cancer
• Can be effectively employed for therapeutic monitoring and
recurrence estimations. Recent clinical evidence testifies that
levels elevate at least 5-8 months prior to relapse of ovarian
cancer
• The positive predictive value of HE4 as a biomarker is higher
as HE4 predictions have shown a significantly greater positive
correlation with PET/CT results
18. Should HE4 completely replace CA 125?
Is it time to totally abandon CA 125 as a
marker for ovarian cancer?
“NO”……………….
Lets explore what recent clinical
evidence recommends !!
19. HE4+CA125: In conjunction with each other
• Clinical evidence recommends that HE4 testing
should be combined with CA 125 measurements.
• The diagnostic accuracy and sensitivity of the
combination of HE4 and CA125 is significantly
higher than either of the biomarkers used alone.
25. Multianalyte Assays with Algorithmic Analyses
(MAAAs)
• Multianalyte Assays with Algorithmic Analyses (MAAAs) are
procedures that utilize multiple results derived various assays
• The individual component procedures are not reported
separately.
• MAAAs are then used in algorithmic analyses to derive a single
result, reported typically as a numeric score or probability.
• MAAAs are typically unique to a single vendor.
27. What is ROMA?
• Current clinical evidence recommends combining HE4 with
CA125 for screening, monitoring and prognostication of ovarian
cancer.
• Risk of ovarian malignancy algorithm (ROMA) as the name
suggests, is a US-FDA approved risk stratification tool for
ovarian cancer.
28. How does ROMA work?
Under the ROMA stratification, 3 patient variables are used:
1. HE4 levels
2. CA125 levels
3. Patient’s menopausal status
Based on these variables, a numerical score is derived for each
individual patient by using an established formula
The score determines the risk of malignancy in an individual
patient, classified as either high or low.
30. Interpretation (in the current set-up):
• Pre-menopausal : 11.4 %
– < 11.4 % : Low risk of finding epithelial ovarian cancer
– ≥ 11.4 % : High risk of finding epithelial ovarian cancer
• Post-menopausal : 29.9 %
– < 29.9 % : Low risk of finding epithelial ovarian cancer
– ≥ 29.9 % : High risk of finding epithelial ovarian cancer
31. ROMA score is intended for use in women who
meet the following criteria :
• Are over 18 years of Age
• Have an ovarian mass
• Surgery is planned
• Not yet referred to an oncologist
32. Caution for use of ROMA Score :
• The test is not intended as screening or stand alone diagnostic
assay for ovarian cancer.
• ROMA has not been validated for following groups :
– Women previously treated for malignancy
– Women Currently being treated with chemotherapy
– Pregnant women
– Women < 18 years of age.
• ROMA should not be used without an independent clinical /
radiological evaluation and is not intended to be a screening test or
to determine whether a patient should proceed to surgery.
36. ROMA Demonstrates Superior Performance
• Correctly identifies 94% of Epithelial Ovarian
Carcinomas
• Performs better than other markers individually
• Simple and easy to use
• Quantitative test
• No subjective data
• Assigns a risk for malignancy