retroperitoneal tumors esp. retroperitoneal sarcoma is most challenging condition to treat in retroperitoneal region inspite of using all treatment modalities.here is brief description of its management acc. to nccn , and other text book ref.
retroperitoneal tumors esp. retroperitoneal sarcoma is most challenging condition to treat in retroperitoneal region inspite of using all treatment modalities.here is brief description of its management acc. to nccn , and other text book ref.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
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
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.
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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Evaluation of antidepressant activity of clitoris ternatea in animals
ROSE CASE SPINAL SBRT BY DR KANHU CHARAN PATRO
1. RADIATION ONCOLOGY SIMULATION TO EXECUTION
ROSE CASE SPINAL SBRT
5/16/2024 1
Dr Kanhu Charan Patro
MD,DNB(Radiation Oncology),MBA,FICRO,FAROI(USA),PDCR,CEPC
Clinical Director, HOD (Radiation Oncology)
ISRo- Institute of Stereotactic Radiation oncology
Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam
drkcpatro@gmail.com /M- +91-9160470564/ www.drkanhupatro.com
2. Case scenario
• 45-year-old female, who has been treated for
Her2+ve carcinoma left breast around 2020.
• She presented to our OPD with c/o backache.
• The patient was diagnosed with a sclerotic lesion
over L1 vertebra.
3. Treatment objectives
GOAL OF TREATMENT CHOICE OF TREATMENT DEPENDS ON
Achieving maximum pain control
Structural and neurological
preservation and restoration
Prevention of pathological fracture/
skeletal related events
Local control of disease
Performance status
Biology and extent of disease
Life expectncy
Quality of life
5. Neurological Assessment
• Bilsky Grading system
No epidural disease
Epidural impingement,
No deformation of thecal
sac
Epidural impingement.,
Deformation of thecal
sac
Epidural spinal ord
compression ,
No visible CSF
Epidural spinal cord
compression,
Visible CSF present
Deformation of thecalsac,
Abutment of spinal cord
9. Systemic assessment
• All treatment decisions are predicted on the patient’s
ability to tolerate the treatment based on
Systemic co-morbidities
General tumor burden [Extraspinal (visceral and bone)
metastatic disease]
General Frailty
Physiological age/ Performance status
13. MODIFIED WEINSTEIN-BORIANI-BAIGINI SYSTEM
Sector 1: Vertebral body
Sector 2: Left pedicle
Sector 3: Left transverse
process and lamina
Sector 4: Spinous process
Sector 5: Right transverse
process and lamina
Sector 6: Right pedicle.
18. CTV Delineation
• Should contain GTV and invlude bony CTV expansion to
account for subclinical spread.
• Includes abnormal marrow signal suspicious for
microscopic invasion.
• Circumferential CTVs encircling the cord should be avoided
except,
If vertebral body,bilateral pedicle/ lamina and spinous
process are all involved
If extensive metastatic disease along the circumference of
epidural space present without spinal cord compression
19. GTV involvement ISRC GTVanatomic
classification
ISRC bony CTV
recommendation
CTV description
Any portion of the
vertebral body
1 1 Include the entire
vertebral body
20. GTV involvement ISRC GTVanatomic
classification
ISRC bony CTV
recommendation
CTV description
Lateralized within the
vertebral body
1 1,2 Include the entire
vertebral body and
the ipsilateral
pedicle/transverse
process
21. GTV involvement ISRC GTVanatomic
classification
ISRC bony CTV
recommendation
CTV description
Diffusely involves the
vertebral body
1 1,2,6 Include the entire
vertebral body and
the bilateral
pedicles/transverse
processes
22. GTV involvement ISRC GTVanatomic
classification
ISRC bony CTV
recommendation
CTV description
Vertebral body and
unilateral pedicle
1,2 1,2,3 Include entire
vertebral body,
pedicle, ipsilateral
transverse process,
and ipsilateral lamina
23. GTV involvement ISRC GTVanatomic
classification
ISRC bony CTV
recommendation
CTV description
Vertebral body and
bilateral
pedicles/transverse
processes
6,1,2,±3,±5 1,2,3,5,6 Include entire
vertebral body,
bilateral
pedicles/transverse
processes, and
bilateral laminae.
28. PTV
• Uniform expansion around the CTV (1.5-2.5 mm margin)
• Should contain entire GTV and CTV.
• PTV margin adjacent to crtical structures may be modified
to allow spacing at discretion of treating physician unless
GTV compromised.
• Never overlap with cord/ cord avoidance structure.
• To allow for unavoidable underdosing of PTV in close
proximity to spinal cord, while maintaining consistency in
the treatment prescription PTV-Cord PRV is done
35. Conformity Index 0.89
Homogeneity Index 1.2
Target Coverage
Isodose lines
Pink 100% Isodose Line
Green 80% Isodose Line
Brown 60% Isodose Line
Light blue 40% Isodose Line
36. Isodose lines Volume Radius
100% 26.9cc 1.86cm
80% 52.4cc 2.32cm
60% 88.1cc 2.76cm
40% 205.1cc 3.66cm
Gradient
Index
Equivalent Radius
D/b Isodose Line Desirable Achieved
80% and 60% <2mm 4mm
80% and 40% <8mm 13mm
42. PREMEDICATION
• Tab. Dexamethasone 4mg thrice daily starting day
before
• Tab. Pan 40 once daily starting day before
• Diabetes care if
• Taper the steroid over 3 weeks
• PPI
Peri medication
5/16/2024 42
43. Response assessment: SPINO (SPIne response
assessment in Neuro-Oncology)
• Focus on pain control and imaging based local tumor
control
• Pain response
• Brief Pain Inventory (BPI) preferred (assessment based on
worst pain score)
• International Consensus Pain Response Endpoints (ICPRE)
should be adopted as standard guidelines for pain response
• Time of assessment: 3 months after SBRT
• Imaging follow-up frequency - Spine MRI preferred every 2-
3 months for first 12-18 months
• Every 3-6 months thereafter
44.
45. • Imaging-based local tumour response
• MRI preferred
• RECIST criteria not optimum
Local control Local progression
Absence of progression within
the treated area on serial
imaging (2 or 3 consecutive MRI
scans 6-8 weeks apart)
Gross unequivocal increase in
tumor volume or linear
dimension
Any new or progressive tumour
within the epidural space
Neurological deterioration
attributable to pre-existing
epidural disease with equivocal
increased epidural disease
dimensions on MRI
46. • Pseudoprogression, necrosis: interval imaging,
occasionally biopsy needed.
• Difficulties in interpretation
MRI signal changes confined within bone segment (in
high-dose volume) without epidural or paraspinal
progression.
Coincident vertebral compression fracture
47.
48.
49. • The superior and inferior extent of CTV is determined by the vertebral
levels.
(Exception: If GTV involves any part of the S1 ala, CTV commences from the
superior aspect of the S1 ala).
• At the level of S1–S2 (but occasionally S3), lateral surfaces of the
sacrum (alae) can be identified as having an anterior and posterior
section due to the fusion of two separate ossification centers during
development.
• Inferiorly (S3–S5), the alae develop from one ossification center.
• If including the alae prophylactically in the CTV as the adjacent
marrow space to the compartment containing the GTV, the
ossification line (if visible) can be used to contain the overall size of
the CTV
• Ossification lines are not typical barriers to spread; therefore, if the
GTV involves any portion of the ala, it is not advisable to use these
lines to limit the CTV volume