Current controversies in cervical cancer management (2014)Jyotirup Goswami
Overview of the current controversies in the management of cervical cancer, including screening, prevention, staging, chemoradiation,teletherapy techniques, brachytherapy techniques
Current controversies in cervical cancer management (2014)Jyotirup Goswami
Overview of the current controversies in the management of cervical cancer, including screening, prevention, staging, chemoradiation,teletherapy techniques, brachytherapy techniques
The Event Industry’s Evangelist of Open SourceMichelle Bruno
Visual summary of the EventTechBrief.com article, "The Event Industry’s Evangelist of Open Source." Read the full article or subscribe to the e-newsletter at EventTechBrief.com.
"The Wired City: Reimagining Journalism and Civic Life," by Dan Kennedy, will be published in May 2013 by University of Massachusetts Press. For more information, please visit http://thewiredcity.org.
Tried to summarise all landmark trials in carcinoma breast in radiation oncology,medical oncology as well in surgical oncology.
References taken from Devita Book,Breast Disease book from Springer,journals like NEJM,JAMA,LANCET,ANNL ONCOLOGY etc,internet,Perez book,Practical Clinical Oncology by Hanna etc textbooks.
Thanks.
While the role of radiation therapy in carcinoma cervix management is undauntable for all stages. Recurrent carcinoma cervix need a lot of personalisation
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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
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.
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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San Antonio Breast Cancer Symposium 2007 Highlights – Radiotherapy
1. San Antonio Breast Cancer Symposium 2007 Highlights – Radiotherapy Kathleen C. Horst, M.D. Assistant Professor Department of Radiation Oncology Stanford University
3. The Cambridge Breast Intensity Modulated Radiotherapy (IMRT) Trial: Dosimetry Results Abstract # 4086 Coles, et al. 1089 patients with breast cancer treated with BCT Standard treatment plan < 2 cm 3 of breast tissue > 107% > 2 cm 3 of breast tissue > 107% Non-randomized Randomized Standard RT IMRT
4. 317/1089 (29%) had acceptable homogeneity with standard 2D radiotherapy. IMRT significantly reduced both “hot spots” and “cold spots”. The Cambridge Breast Intensity Modulated Radiotherapy (IMRT) Trial: Dosimetry Results Abstract # 4086 Coles, et al.
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8. Prospective trial of individual optimal positioning (prone vs supine) for whole breast radiotherapy: results of 224 patients Abstract # 4082 Formenti, et al.
9. Prospective trial of individual optimal positioning (prone vs supine) for whole breast radiotherapy: results of 224 patients Abstract # 4082 Formenti, et al. CONCLUSIONS: Prone enables best sparing of heart and lung in most patients (204/224) Most patients best treated supine (17/20) had left-sided lesions When prone, heart is displaced anteriorly 5-19 mm (Duke) May limit utility of prone technique
10. Node-Negative Post BCS 1234 patients Accelerated Hypofractionated Whole Breast Irradiation (AHWBI) 42.5 Gy/16 fractions 622 patients Standard Whole Breast Irradiation (SWBI) 50 Gy/25 fractions 612 patients Stratification: Age Size Systemic tx Center Recruitment April ’93- Sept ’96 Radiotherapy Fractionation Schedules Abstract #21 Whelan, et al. Long-term results of a randomized trial of accelerated hypofractionated whole breast irradiation following breast conserving surgery in women with node negative breast cancer R
11. SWBI AHWBI n=612 n=622 n (%) n (%) Age < 50 yrs 148 (24) 157 (25) Tumor size ≥ 2 cm 203 (33) 190 (31) ER negative 157 (26) 165 (26) Tumor grade high 116 (21) 117 (20) Tamoxifen 266 (41) 265 (41) Chemotherapy 72 (11) 75 (11) BASELINE CHARACTERISTICS
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13. SWBI AHWBI Age (y) < 50 10.7 7.5 ≥ 50 5.4 5.8 Tumor < 2 cm 6.1 5.4 Size (cm) ≥ 2 cm 7.8 8.0 Systemic yes 5.9 6.5 Therapy no 7.4 5.8 Local Recurrence Rates at 10 years
14. Baseline 3 yr 5 yr 10 yr SWBI 83% (604) 77% (496) 79% (423) 71% (216) AHWBI 84% (616) 77% (518) 78% (448) 70% (235) Cosmetic Outcome by Time and Treatment % excellent or good (# evaluable)
15. 3 yr 5 yr 10 yr Skin SWBI 2% 3% 8% AHWBI 2% 3% 9% Subcutaneous tissue SWBI 5% 6% 11% AHWBI 4% 5% 12% % Grades 2-3 RTOG/EORTC Late Radiation Morbidity by Time and Treatment
16. SWBI AHWBI (n=612) (n=622) Cancer related 13.2% (81) 13.7% (85) Non-cancer related 7.4% (45) 5.9% (37) Total 20.6% (126) 19.6% (122) Cause of Death
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18. JCO. 25:18S (June 20 Supplement), 2007: LBA518 T1-3, N0-1 Post BCS Recruitment 1999-2002 Radiotherapy Fractionation Schedules ASCO 2007 Dewar, et al. Hypofractionation for early breast cancer: First results of the UK standardisation of breast radiotherapy (START) trials START A 2236 patients 50 Gy/25 fractions/5 weeks 41.6 Gy/13 fractions/5 weeks 39 Gy/13 fractions/5 weeks START B 2215 patients 40 Gy/15 fractions/3 weeks 50 Gy/25 fractions/5 weeks
19. Radiotherapy Fractionation Schedules RATIONALE Tumor response (i.e., local control) thought to be as sensitive to fraction size as late adverse effects Radiation fraction sizes > 2.0 Gy may have advantages in breast cancer treatment 1 Goals: test the benefit of fraction sizes > 2.0 Gy in terms of locoregional control late normal tissue responses 1 Owen R et al. Lancet Oncol 7:467-71, 2006.
20. Radiotherapy Fractionation Schedules ASCO 2007 Dewar, et al. Hypofractionation for early breast cancer: First results of the UK standardisation of breast radiotherapy (START) trials Median follow up = 5.1 yrs Median follow up = 6.0 yrs
21. Radiotherapy Fractionation Schedules ASCO 2007 Dewar, et al. Hypofractionation for early breast cancer: First results of the UK standardisation of breast radiotherapy (START) trials
22. Are patients with T1-2 breast cancer with 1-3 +LN suitable candidates for partial breast radiotherapy trial enrollment? Abstract # 4089 Truong, et al.
23. Are patients with T1-2 breast cancer with 1-3 +LN suitable candidates for partial breast radiotherapy trial enrollment? Abstract # 4089 Truong, et al. 5688 women pT1-2, 0-3 N+ breast ca Treated with BCT (1989-1999) N0 (n=4433) vs 1-3 N+ (n=1255) Median follow up = 8.6 yrs
24. Are patients with T1-2 breast cancer with 1-3 +LN suitable candidates for partial breast radiotherapy trial enrollment? Abstract # 4089 Truong, et al.
25. Are patients with T1-2 breast cancer with 1-3 +LN suitable candidates for partial breast radiotherapy trial enrollment? Abstract # 4089 Truong, et al. CONCLUSIONS: Patients with 1-3 N+ have high risks of regional nodal relapse ~10-15% despite standard whole breast XRT and systemic therapy, particularly young age grade III histology ER- disease >20% positive nodes Such patients should receive standard whole breast XRT and are not ideal candidates for PBI trial enrollment
26. Update of the Phase II MammoSite Brachytherapy Trial for DCIS Abstract # 4079 Streeter, et al.
27. NSABP B39/RTOG 0413 Interstitial/intracavitary brachytherapy, 3DCRT European Institute of Oncology Intraoperative electrons TARGIT Intrabeam – photoelectron 50 kV photons RAPID Canadian External Beam Ongoing Trials in Partial Breast Irradiation Other Intraoperative techniques Stanford University of North Carolina MSKCC (Intraoperative HAM applicator) Protons MGH Permanent radioactive seed University of Toronto, Canada Other Intracavitary applicators Cianna Medical SenoRx North American Scientific Xoft
28. Identification of Patients for Post-Mastectomy Radiotherapy using the Cambridge Index Abstract # 4093 Wilson, et al. Index designed to help identify intermediate and low risk patients who might be at higher risk of local recurrence after mastectomy. Applied since 1999. Retrospective review of patients from 2000-2003
29. Low level of LR in both the Low and Intermediate risk groups confirms that appropriate patients in the Intermediate risk group are receiving PMRT Identification of Patients for Post-Mastectomy Radiotherapy using the Cambridge Index Abstract # 4093 Wilson, et al. Intermediate risk Score < 3 (n=21) Low risk Score < 3 (n=131) Chest Wall XRT n=198 (55%) No XRT n=159 (45%) High risk (n=125) Intermediate risk Score > 3 (n=63) Low risk Score > 3 (n=17)
30. Increased use of regional radiotherapy is associated with improved outcome in a population based cohort of women with breast cancer and 1-3 positive nodes Abstract # 4076 Wai, et al.
31. EORTC 10925 LN+ or any medial/central lesion Breast Only vs Breast + Upper IM/Medial SCV NCIC MA.20 LN+ and high risk LN- Breast Only vs Breast + Upper IM, high axilla, SCV Ongoing Trials in Regional Nodal RT in Breast Conservation Therapy
32.
Editor's Notes
Likely that patients can be safely and effectively treated to a lower total dose with fewer fractions Further trials are needed to test the limits of hypofractionation