Panel Discussion on Post Menopausal Bleeding Lifecare Centre
Panel Discussion on Post Menopausal Bleeding
Moderator
Dr Jyoti Agarwal
Dr Meenakshi Sharma
Panelists
Dr Uma Rai
Dr Raj Bokaria
Dr Ila Gupta
Dr Vandana Gupta
Dr Renu Chawla
Dr Manju Barik
Dr Krishna Gopa
Dr Sharda Jain
Panel Discussion on Post Menopausal Bleeding Lifecare Centre
Panel Discussion on Post Menopausal Bleeding
Moderator
Dr Jyoti Agarwal
Dr Meenakshi Sharma
Panelists
Dr Uma Rai
Dr Raj Bokaria
Dr Ila Gupta
Dr Vandana Gupta
Dr Renu Chawla
Dr Manju Barik
Dr Krishna Gopa
Dr Sharda Jain
a nice presentation about the Ovarian Cancer its include an introduction with brief notes about the epidemiology and risk factors then shift to pathology and pathogenesis and diagnosis with signs , symptoms and lab tests with imaging modules , screening , management
Presentation at Chittaranjan Seva Sadan, Kolkata where Dr Dasgupta was invited as faculty in the CME organized by Medical Education and research Committee, Bengal Obstetrics and Gynaecological Society
Management of Early Stage Carcinoma CervixSubhash Thakur
This presentation covers the management of early stage carcinoma cervix (FIGO stage I to IIA). A brief introuduction to different surgical procedures and the radiation treatment techninques have been described.
a nice presentation about the Ovarian Cancer its include an introduction with brief notes about the epidemiology and risk factors then shift to pathology and pathogenesis and diagnosis with signs , symptoms and lab tests with imaging modules , screening , management
Presentation at Chittaranjan Seva Sadan, Kolkata where Dr Dasgupta was invited as faculty in the CME organized by Medical Education and research Committee, Bengal Obstetrics and Gynaecological Society
Management of Early Stage Carcinoma CervixSubhash Thakur
This presentation covers the management of early stage carcinoma cervix (FIGO stage I to IIA). A brief introuduction to different surgical procedures and the radiation treatment techninques have been described.
Management of ovarian masses e Clinical situations & recommendations Apollo Hospitals
Adenexal mass is a common clinical presentation. This clinical situation is a problem that affects women of all ages. The biggest challenge is that one should not miss out on a diagnosis of malignant ovarian tumor. An ovarian mass or cyst that raises the suspicion of malignancy is a common dilemma in a gynecological practice. In the United States, a woman has a 5-10% lifetime risk of undergoing surgery for a suspected ovarian neoplasm and an estimated 13e21% chance of this turning into a diagnosis of ovarian cancer. Most of the adnexal masses are benign but the first responsibility of the treating gynecologist is to exclude malignancy. Management decisions often are influenced by the age and family history and presentation of the patient.
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.
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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.
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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1. OVARIAN CANCERS: NO
LONGER SILENT KILLERS
DR. ASHUTOSH MUKHERJI,
ASSOCIATE PROFESSOR,
DEPARTMENT OF RADIOTHERAPY,
REGIONAL CANCER CENTRE, JIPMER
2.
Malignant epithelial ovarian tumors account for 90% of all malignancies of the
ovary and are the fourth most common cause of tumor-related death in women.
During the year 2002, it ranked third worldwide in frequency (4.1%) among all
cancers in women.
The overall lifetime risk of developing ovarian cancer for women in the US is 1.4%
to 1.8%. This risk varies from 0.6% for women with no family history, at least three
term pregnancies, and four or more years of oral contraceptive use, to 3.4% for
nulliparous women with no oral contraceptive use. For women with a family
history, the lifetime risk for ovarian cancer is estimated at 9.4%.
Worldwide highest rates observed in Northern and Western Europe, notably
Scandinavia, and in North America.
3.
1 in 12 women in urban India develop cancer in their lifetime (WHO study).
About 40% of new cases of cancer in India afflict women.
In the past decade, breast cancer has overtaken cervical cancer as the most
common cancer among women in Indian cities such as Mumbai and Delhi.
While cancer of the cervix is still a major killer of Indian women (accounting
for about 73000 deaths per year); it has shown significant decline in some
urban cancer registries and a modest decline in the rural registries.
On the other hand ovarian cancers have shown a steady increase in numbers
in data compiled from 1968 to 2005
6.
In India, cancer of the ovary is one of the most common cancers in
females and occupied third / fourth rank among cancers occurring in
women during the year 2004-05 in various Indian registries.
Epithelial ovarian cancers have been called “Silent Killers” as they rarely
give rise to symptoms in the early stages and by the time a patient
presents with large abdominal growth or other signs, the disease has
grown considerably or even spread to other organs.
Only 25% of cancers are detected as stage I disease. When diagnosed in
Stage I, however, the cure rate can approach 90% with modern
cytoreductive surgery and combination chemotherapy
7.
Once stage III and IV ovarian cancer, (peritoneal and extra peritoneal
metastatic spread), is diagnosed, the survival decreases to approximately
20-25% five-year survival despite appropriate treatment.
According to NCCN guidelines, patients who are suspected of having
ovarian malignancy; presenting with symptoms like:
Abdominal fullness or bloating not responding to medication
Lump or tenderness in the abdomen
Increased frequency of urination with feeling of lump in abdomen
Increasing feeling of lack of appetite
1.
2.
3.
4.
should be investigated further (imaging, clinical examination, biomarkers).
8.
9. NICE guidelines recommend:
To investigate if a woman (especially if 50 or over) reports having any of the
following symptoms on a persistent or frequent basis – particularly more than 12
times per month:
– persistent abdominal distension
– feeling full (early satiety) and/or loss of appetite
– pelvic or abdominal pain
- increased urinary urgency and/or frequency.
Carry out appropriate tests for ovarian cancer in any woman of 50 or over who
has experienced symptoms within the last 12 months that suggest irritable bowel
syndrome (IBS), because IBS rarely presents for the first time in women of this
age.
Measure serum CA125 in primary care in women with symptoms that suggest
ovarian cancer.
1.
If serum CA125 is 35 IU/ml or greater, ultrasound scan of the abdomen and
pelvis to be done.
2.
Any woman with normal serum CA125 (less than 35 IU/ml), or CA125 ≥ 35
IU/ml but a normal ultrasound to be assessed carefully for other clinical causes
of symptoms.
10. Tumour markers: which to use?
Measure serum CA125 in all women with suspected ovarian cancer.
In women under 40 with suspected ovarian cancer, measure levels of
alpha fetoprotein (AFP) and beta human chorionic gonadotrophin (betahCG) as well as serum CA125, to identify women who may not have
epithelial ovarian cancer.
11.
Based on screening patterns, 2 distinct populations are at increased risk
for ovarian cancer:
1.
Women with hereditary risk factors for disease, comprise 10% of all
cases.
2.
Much larger group includes postmenopausal women who are over 50
years of age, in whom 90% of ovarian cancer occurs sporadically.
12. Role of Trans vaginal USG:
From 1987 to 1999, 14,469 women were enrolled onto the University of
Kentucky Ovarian Cancer Screening Program and underwent TVS
screening on an annual basis.
Abnormality criteria were simplistic and included an ovarian volume of
more than 10 cm3 in a postmenopausal woman, an ovarian volume of
more than 20 cm3 in a premenopausal woman, and any cystic ovarian
lesion with an internal or papillary projection.
180 women with persistent ovarian masses underwent surgery to remove
the lesion. 17 were found to have ovarian cancers. The effectiveness of
TVS as a screening tool was:
13.
14.
15.
Trans-vaginal or pelvic ultrasonography is used to visualize the adnexae.
Benign and malignant tumours are distinguished from one another on the
basis of morphology.
Complex ovarian cysts with wall abnormalities or solid areas are associated
with significant risk for malignant disease whereas unilocular ovarian cysts are
associated with a less than 1% risk for ovarian cancer in asymptomatic
premenopausal women.
Second-line studies, such as morphologic tumor indexing or Doppler
sonography, may prove beneficial in differentiating benign from malignant
masses and increasing the positive predictive value of a screening algorithm
while maintaining a high sensitivity.
Application of morphologic scoring systems to sonographic screening
protocols could allow the maintenance of a high sensitivity, approaching 80%
to 90%, and improve the positive predictive value to greater than 20%.
18. CA-125 SCREENING: WHAT DOES IT MEAN?
Bast and colleagues in 1981 first described CA-125, a 200 kd glycoprotein
recognized by the murine monoclonal antibody OC 125 as a marker for
epithelial malignancies. They demonstrated that a raised level of antigen
was detectable in the serum of 82% of women with epithelial ovarian
cancer but in only 1% of healthy blood donors.
Serum tumour markers for ovarian cancer like CA-125 is expressed by
about 80% of epithelial cancers (the most common type of malignant
tumour) but has limited specificity when used alone.
However it may also be increased in the presence of other cancers
(pancreatic, breast, bladder, liver, lung) as well as benign disease
(diverticulitis, leiomyoma, endometriosis). Specificity of CA-125 screening
is improved by the addition of pelvic ultrasonography as a second-line test
to assess ovarian lesions.
19.
Stratified by disease stage, elevated levels were found in more than 90%
of patients with advanced stage ovarian cancer but in only 50% of
patients with stage I disease.
In addition, elevated levels of CA125 are more strongly associated with
serous, rather than mucinous tumors
Numerous studies have confirmed the usefulness of CA125 levels in
monitoring the progress of patients with epithelial ovarian cancer. Most
reports indicate that a rise in CA125 levels precedes clinical detection by
about 3 months
20.
Commonly accepted definitions of disease recurrence based on serum
CA125 levels alone specify a doubling of this tumor marker level, either
from the upper limit of normal (35 U/mL) in patients with normalization
of this marker after primary treatment or from the nadir levels in patients
with an elevated serum marker value that never normalizes after primary
treatment.
Marksman (2006) suggested that reduction in serum CA-125
concentration over the initial 2 cycles of chemotherapy was an
independent predictor of survival.
Ron (1991) suggested early response (CA125 normalcy by the end of the
second chemotherapeutic course) was a highly significant predictor of
disease-free survival at 12 months.
21.
The postoperative serum CA125 level is an independent prognostic factor
in patients with invasive ovarian cancer and CA125 tumor marker half-life
(t1/2) and tumor marker doubling time (DT) often used as kinetic
parameters for the evaluation of clinical response and follow-up of
patients with ovarian cancer
Serum CA125 half-life during early chemotherapy is an independent
prognostic factor for both the achievement of a pathologically complete
response.
22.
Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, to
evaluate the efficacy of transvaginal ultrasound and serum cancer antigen
125 (CA-125) as screening tools to reduce ovarian cancer mortality
evaluated nearly 40,000 women.
These women underwent screening with a CA-125 blood test and
transvaginal ultrasound at baseline, an annual transvaginal ultrasound for
an additional 3 years, and an annual CA-125 for an additional 5 years.
There was no statistically significant reduction in mortality from ovarian
cancer in a cohort of women derived from the general population who
were screened for ovarian cancer with 6 annual CA-125 tests and 4
annual transvaginal ultrasound examinations even though more cases
were detected. However compliance with screening was high in the
intervention group.
25.
Ovarian cancer screening recommended for women over age of 50.
Those willing to pursue further work up and investigation if screening is
positive.
Estimated to have a 7 – 9 year benefit from screening.
Patients with BRCA 1 or BRCA 2 mutations.
Those with strong family history of ovarian cancers.
Ovarian cancer screening is not recommended for women with no risk
factors (RR≤3).
26.
For women with increase risk (RR=3-6 times), after evaluating risks and
benefits, ovarian cancer screening with CA-125 and/or transvaginal
ultrasonography can be done.
In women at inherited risk (RR>6 times), usually with mutations in ovarian
cancer susceptibility genes, should receive screening by a combination of
transvaginal ultrasonography and CA-125.
For patients with mutations in BRCA1 or the mismatch repair genes,
MLH1, MSH2, and MSH6, screening should begin around 30-35 years of
age.