Demographic Profile, anemia status and fetal outcome of the pregnant women at...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Demographic Profile, anemia status and fetal outcome of the pregnant women at...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Prevalence of Anamiea and Its Predictors in Pregnant Women Attending Antenata...iosrjce
Background: Anemia impairs cognitive development, reduces physical work capacity and in severe cases
increases risk of mortality particularly during prenatal period. In India, 16% of maternal deaths are attributed
to anemia. However, high prevalence of anemia among pregnant women persists in India despite the
availability of effective, low-cost interventions for prevention and treatment. Aknowledge of them
sociodemographic factors associated with anemia will help to formulate multipronged strategies to attack this
important public health problem in pregnancy.
Objective: To assess the prevalence of anaemia and its predicting factors among pregnant women attending
antenatal clinic at Tertiary care center.
Study Design: Descriptive cross-sectional study
Methods: A hospital based cross-sectional study design was conducted from January 2014 – September 2014
among 5788 pregnant womens who had been attending antenatal clinic. Red blood cell morphology and Hgb
level determination were assessed following the standard procedures. Socio-demographic data was collected by
using a structured questionnaire. The data entered and analyzed by using the SPSS version 16.0 statistical
software. P<0.05 was considered as statistically significant.
Result: Overall prevalence of anemia among the pregnant women was found to be 86.37%. Factors such as
diet, level of education of women and their husbands and socioeconomic status were found to be significantly
associated with the prevalence of anemia in pregnancy.
Conclusion: The present study showed high prevalence of anemia and the majority of them were of the
moderate type (hemoglobin: 10-10.9 g/dl). Low socioeconomic class, illiteracy, Multiparous were significantly
associated with high prevalence of anemia during pregnancy in Indian women.
15-minute power-point to present the research of a two-phase informative study that collected survey and qualitative data through a series of focus groups regarding the current description and future implications of PCOS multidisciplinary clinics while emphasizing the role, importance, and challenges for dietitians.
Prevalence and Correlates of Polycystic Ovarian Syndrome among Women Attendin...AJHSSR Journal
Polycystic ovarian syndrome (PCOS) is a complex endocrine disorder which affects 5% to10%
of women worldwide. The disease is caused by insulin resistant that results in hyperinsulinaemia, and further
stimulates the excessive production of androgen and luteinizing hormone. Hyperandrogenism which is referred
to the excessive production of androgen leads to the clinical conditions like acne, obesity, alopecia and irregular
menstruation. Previous studies have shown the risk factors of PCOS include age, ethnicity, obesity, smoking,
alcohol consumption and menstrual problem. A cross sectional study was conducted at infertility clinic in
Hospital Serdang. Simple random sampling was adopted to recruit 138 women who attended the infertile clinic.
Data including sociodemographic data, lifestyle factors, medical disorders, gynaecology disorders, family
medical history, menstrual problem, diagnostic criteria of PCOS, metabolic parameters, and causes of infertility,
were retrieved from medical record. Chi square test and SPSS version 21 was used for data analysis. Among
138 participants, 37.7% are diagnosed with PCOS and 62.3% are not diagnosed with PCOS. Among PCOS
patients, 92.3% are found to age less than 35 years old, 90.4% Malay, 75% with menstrual problem and 80.8%
obese. Age, menstrual problem, and obesity were significantly associated with PCOS diagnosis. Measures like
medical education and healthy lifestyle should be implemented to prevent the complications of PCOS.
The effect of Metformin on endometrial tumor-regulatory genes and systemic metabolic parameters in polycystic ovarian syndrome – a proof-of-concept study
IOSR Journal of Pharmacy and Biological Sciences(IOSR-JPBS) is an open access international journal that provides rapid publication (within a month) of articles in all areas of Pharmacy and Biological Science. The journal welcomes publications of high quality papers on theoretical developments and practical applications in Pharmacy and Biological Science. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Polycystic ovary syndrome PCOS is a common endocrine and metabolic disorder in premenopausal women. Heterogeneous by its nature, PCOS is defined as combination of signs and symptoms of androgen excess and ovarian dysfunction in the absence of other specific diagnoses. The etiology of the syndrome remains unknown, but evidence suggests that PCOS might be a complex multigenic disorder with strong epigenetic and environmental influences, including diet and lifestyle factors. It affects 8 to 13 of reproductive aged women. Polycystic ovary syndrome PCOS is associated with hormonal, biochemical disturbance and adverse cosmetic, reproductive, metabolic, and psychological consequences, resulting in reduced health related quality of life HRQoL . The most recent international guidelines set lifestyle management as the cornerstone of the PCOS treatment. Hridyanshi | R. K. Patil | Lovish Kansal "Polycystic Ovary Syndrome: A Review" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-4 , June 2021, URL: https://www.ijtsrd.compapers/ijtsrd41134.pdf Paper URL: https://www.ijtsrd.commedicine/gynecology/41134/polycystic-ovary-syndrome-a-review/hridyanshi
Prevalence of Anamiea and Its Predictors in Pregnant Women Attending Antenata...iosrjce
Background: Anemia impairs cognitive development, reduces physical work capacity and in severe cases
increases risk of mortality particularly during prenatal period. In India, 16% of maternal deaths are attributed
to anemia. However, high prevalence of anemia among pregnant women persists in India despite the
availability of effective, low-cost interventions for prevention and treatment. Aknowledge of them
sociodemographic factors associated with anemia will help to formulate multipronged strategies to attack this
important public health problem in pregnancy.
Objective: To assess the prevalence of anaemia and its predicting factors among pregnant women attending
antenatal clinic at Tertiary care center.
Study Design: Descriptive cross-sectional study
Methods: A hospital based cross-sectional study design was conducted from January 2014 – September 2014
among 5788 pregnant womens who had been attending antenatal clinic. Red blood cell morphology and Hgb
level determination were assessed following the standard procedures. Socio-demographic data was collected by
using a structured questionnaire. The data entered and analyzed by using the SPSS version 16.0 statistical
software. P<0.05 was considered as statistically significant.
Result: Overall prevalence of anemia among the pregnant women was found to be 86.37%. Factors such as
diet, level of education of women and their husbands and socioeconomic status were found to be significantly
associated with the prevalence of anemia in pregnancy.
Conclusion: The present study showed high prevalence of anemia and the majority of them were of the
moderate type (hemoglobin: 10-10.9 g/dl). Low socioeconomic class, illiteracy, Multiparous were significantly
associated with high prevalence of anemia during pregnancy in Indian women.
15-minute power-point to present the research of a two-phase informative study that collected survey and qualitative data through a series of focus groups regarding the current description and future implications of PCOS multidisciplinary clinics while emphasizing the role, importance, and challenges for dietitians.
Prevalence and Correlates of Polycystic Ovarian Syndrome among Women Attendin...AJHSSR Journal
Polycystic ovarian syndrome (PCOS) is a complex endocrine disorder which affects 5% to10%
of women worldwide. The disease is caused by insulin resistant that results in hyperinsulinaemia, and further
stimulates the excessive production of androgen and luteinizing hormone. Hyperandrogenism which is referred
to the excessive production of androgen leads to the clinical conditions like acne, obesity, alopecia and irregular
menstruation. Previous studies have shown the risk factors of PCOS include age, ethnicity, obesity, smoking,
alcohol consumption and menstrual problem. A cross sectional study was conducted at infertility clinic in
Hospital Serdang. Simple random sampling was adopted to recruit 138 women who attended the infertile clinic.
Data including sociodemographic data, lifestyle factors, medical disorders, gynaecology disorders, family
medical history, menstrual problem, diagnostic criteria of PCOS, metabolic parameters, and causes of infertility,
were retrieved from medical record. Chi square test and SPSS version 21 was used for data analysis. Among
138 participants, 37.7% are diagnosed with PCOS and 62.3% are not diagnosed with PCOS. Among PCOS
patients, 92.3% are found to age less than 35 years old, 90.4% Malay, 75% with menstrual problem and 80.8%
obese. Age, menstrual problem, and obesity were significantly associated with PCOS diagnosis. Measures like
medical education and healthy lifestyle should be implemented to prevent the complications of PCOS.
The effect of Metformin on endometrial tumor-regulatory genes and systemic metabolic parameters in polycystic ovarian syndrome – a proof-of-concept study
IOSR Journal of Pharmacy and Biological Sciences(IOSR-JPBS) is an open access international journal that provides rapid publication (within a month) of articles in all areas of Pharmacy and Biological Science. The journal welcomes publications of high quality papers on theoretical developments and practical applications in Pharmacy and Biological Science. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Polycystic ovary syndrome PCOS is a common endocrine and metabolic disorder in premenopausal women. Heterogeneous by its nature, PCOS is defined as combination of signs and symptoms of androgen excess and ovarian dysfunction in the absence of other specific diagnoses. The etiology of the syndrome remains unknown, but evidence suggests that PCOS might be a complex multigenic disorder with strong epigenetic and environmental influences, including diet and lifestyle factors. It affects 8 to 13 of reproductive aged women. Polycystic ovary syndrome PCOS is associated with hormonal, biochemical disturbance and adverse cosmetic, reproductive, metabolic, and psychological consequences, resulting in reduced health related quality of life HRQoL . The most recent international guidelines set lifestyle management as the cornerstone of the PCOS treatment. Hridyanshi | R. K. Patil | Lovish Kansal "Polycystic Ovary Syndrome: A Review" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-4 , June 2021, URL: https://www.ijtsrd.compapers/ijtsrd41134.pdf Paper URL: https://www.ijtsrd.commedicine/gynecology/41134/polycystic-ovary-syndrome-a-review/hridyanshi
A Case Report on Intrahepatic Cholestasis of Pregnancyijtsrd
This case study is about a primigravida mother period of gestation 29 weeks and 5 days diagnosed with intrahepatic cholestasis of pregnancy IHCP . She had been married since 1 year and it is her first pregnancy. The patient is having gestational diabetes mellitus and hypothyroidism. The patients was admitted to antenatal ward of St. Stephen’s Hospital , New Delhi, with chief complaints of itching in palms, soles and over umbilical area since 2 weeks. During the physical examination the rashes were seen on abdomen, legs and breast. Per abdomen examination and ultrasound revealed that vertex presentation of the fetus and FHR as 136 min and fetal weight as 1923 gram and presence of low lying placenta. Routine blood examination revealed that patient was also a case of gestational diabetes mellitus and hypothyroidism. After all the required investigation she was diagnosed with IHCP with gestational diabetes mellitus and hypothyroidism. IHCP is a pregnancy related liver disorder characterized by pruritus, most often in the late second or early trimester of pregnancy and raised serum bile acids. The maternal outcome after treatment is fair but fetal outcomes becomes adverse in most of the conditions. Ms. Rana Kamar | Dr. Rajwant Randhawa | Dr. Priyanaka Choudhary "A Case Report on Intrahepatic Cholestasis of Pregnancy" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-1 , December 2021, URL: https://www.ijtsrd.com/papers/ijtsrd49087.pdf Paper URL: https://www.ijtsrd.com/medicine/nursing/49087/a-case-report-on-intrahepatic-cholestasis-of-pregnancy/ms-rana-kamar
A COMPARATIVE ANALYSIS OF HEMATOLOGICAL INDICES IN PREGNANT WOMEN AND NON PR...FidelityP
Red blood cell (RBC) indices are individual components of a routine blood test called the complete blood count (CBC). The CBC is used to measure the quantity and physical characteristics of different types of cells found in your blood. Blood consists of RBCs, white blood cells (WBCs), and platelets that are suspended in your plasma. Platelets are cells that enable clot formation. RBCs contain hemoglobin, which carries oxygen throughout your body to all of your tissues and organs. An RBC is pale red and gets its color from hemoglobin. It’s shaped like a doughnut, but it has a thinner area in the middle instead of a hole. Your RBCs are normally all the same color, size, and shape. However, certain conditions can cause variations that impair their ability to function properly. The RBC indices measure the size, shape, and physical characteristics of the RBCs. Your doctor can use RBC indices to help diagnose the cause of anemia. Anemia is a common blood disorder in which you have too few, misshapen, or poorly functional RBCs123
Do Women With Polycystic Morphology Without Any Other Features of PCOS Benefi...Alex Swanton
Women with ovaries of polycystic morphology (PCO), without any other features of polycystic ovary syndrome(PCOS), respond similarly to women with PCOS when stimulated with exogenous gonadotrophins, and both groups share various endocrinological disturbances underlying their pathology.
Polycystic Ovarian Syndrome Diagnosis in a Patient Undergoing Treatment for B...Premier Publishers
BACKGROUND: The association between bipolar affective disorder (BAD) and polycystic ovarian syndrome (PCOS) is elucidated in medical literature. However, what is inconclusive is whether one causes the other and /or the neuroleptics such as sodium valproate could cause PCOS as a side effect. However, to the best of our knowledge, there is a dearth of such case reports in our setting. We therefore report a case of this nature in our setting with the aim of further reemphasizing the likely comorbidity and the need for collaborative multidisciplinary approach during management of such patients. CASE REPORT: We present a case of 34 years old, parity 0+1, human immune virus seronegative, a known patient of bipolar affective disorder (BAD) for 18 years. She was initially started on chlorpromazine and carbamazepine that she used for 13 years and later switched to sodium valproate and sertraline daily due to side effects of chlorpromazine in 2014. She presented with 6 years history of abnormal uterine bleeding and dysmennorrhoea for 2 months. A diagnosis of PCOS was made based on history and confirmed by laboratory and radiological investigations. CONCLUSIONS: Physicians need be aware of the likely comorbidity or sequel and the need for multidisciplinary engagement.
Medical Management of Chronic Pelvic Pain: The Evidence.Alex Swanton
Chronic pelvic pain (CPP) is a significant problem for both general practitioners in the primary care setting and gynaecologists alike. The incidence of CPP has often been overlooked due, partially, to an inappropriate referral pattern, but also due to the inherent difficulty in correctly diagnosing the condition.
Diabetes is a rapidly and serious health problem in Pakistan. This chronic condition is associated with serious long-term complications, including higher risk of heart disease and stroke. Aggressive treatment of hypertension and hyperlipideamia can result in a substantial reduction in cardiovascular events in patients with diabetes 1. Consequently pharmacist-led diabetes cardiovascular risk (DCVR) clinics have been established in both primary and secondary care sites in NHS Lothian during the past five years. An audit of the pharmaceutical care delivery at the clinics was conducted in order to evaluate practice and to standardize the pharmacists’ documentation of outcomes. Pharmaceutical care issues (PCI) and patient details were collected both prospectively and retrospectively from three DCVR clinics. The PCI`s were categorized according to a triangularised system consisting of multiple categories. These were ‘checks’, ‘changes’ (‘change in drug therapy process’ and ‘change in drug therapy’), ‘drug therapy problems’ and ‘quality assurance descriptors’ (‘timer perspective’ and ‘degree of change’). A verified medication assessment tool (MAT) for patients with chronic cardiovascular disease was applied to the patients from one of the clinics. The tool was used to quantify PCI`s and pharmacist actions that were centered on implementing or enforcing clinical guideline standards. A database was developed to be used as an assessment tool and to standardize the documentation of achievement of outcomes. Feedback on the audit of the pharmaceutical care delivery and the database was received from the DCVR clinic pharmacist at a focus group meeting.
“Intervention of a clinical pharmacist in order to reduce polypharmacy, avera...SriramNagarajan17
“Intervention of a clinical pharmacist in order to reduce polypharmacy, average cost of therapy and percentage of patients received injections (parenterals) in pediatrics dept; study carried out at multi-specialty teaching hospital”
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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
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.
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
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.
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
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
The clinical management of patients with polycystic ovarian syndrome PCOS in Pakistan: A case control study
1. www.pharmacreations.com
~ 17~
Pharmacreations | Vol. 1 | Issue 1 | Mar-2014
Journal Home page: www.pharmacreations.com
Research article Open Access
The clinical management of patients with polycystic ovarian
syndrome PCOS in Pakistan: A case control study
Mehwish Rizvi1
, *Atta Abbas1, 2
Sidra Tanwir1
, Arif Sabah1
1
Faculty of Pharmacy, Ziauddin University, Karachi, Pakistan.
2
Department of Pharmacy, Health and Well Being, University of Sunderland, England,
United Kingdom.
* Corresponding author: Atta Abbas
E-mail id: bg33bd@student.sunderland.ac.uk
ABSTRACT
Polycystic ovarian syndrome PCOS is common in women all over the globe. In addition to irregular menstrual
cycles and infertility, the rates of co morbidities are notably higher in women with PCOS. It has also been
associated with obesity as well. The scenario of Pakistan is different from the developed countries as the reporting
of the disease and disclosure by the patient is a daunting task due to the sensitivity of the issue keeping in view the
society’s frame of mind and overall social environment of the country. The lack of disease awareness has lead to
poor reporting and managing of the disease at patients and physicians ends respectively. A pharmacist can play an
important role as a physician and patient counselor and this educational intervention of a pharmacist has a pivotal
role in the said regard. The present case study is based on 31 patients and their physicians and discusses the
criticalities of PCOS with regards to health care system of Pakistan.
Keywords: Patient; Clinical Management; Polycystic Ovarian Syndrome; PCOS; Pakistan; Case study.
INTRODUCTION
Polycystic ovarian syndrome PCOS is a very
common disorder of endocrinal origin in women all
over the globe. In addition to infertility (Darion et.al,
2011), the rates of co morbidities are also
significantly higher in women with PCOS. The
terminology polycystic syndrome refers to the
presence of small, benign and painless cysts in the
ovaries, which are clinically manifested by a faction
of symptoms and changes in hormonal levels. The
hormonal imbalance is the major underlying reason
for this ailment. (Ricardo Aziz 2004). It has been
associated with obesity and other metabolic
abnormalities as well (Al-Azemi, 2004).
The scenario of Pakistan is different from the
developed countries as the reporting of the disease
and disclosure by the patient is a daunting task due to
the sensitivity of the issue keeping in view the
society’s frame of mind and overall social
environment of the country. To date, PCOS has never
been reported in clinical practice of Pakistan and this
case study is based on clinical aspects of PCOS
patients being treated in different health care settings
of the country who were suffering from the
syndrome. It reports the pharmaco-epidemiological
information of patients of PCOS as well as their
pharmaco-therapeutics and discusses the critical
Journal of Pharmacreations
2. Atta Abbas et al / Journal of Pharmacreations Vol-1(1) 2014 [17-21]
www.pharmacreations.com
~ 18~
findings in the actual clinical practice. Prior to the
recording of the information, the patients and
physicians were informed and a written consent was
obtained from them and as well as the health care
facility in which the study was carried out. A number
of patients of PCOS along with their physicians were
included in the study to study the clinical
management of the disease in context of health care
environment of Pakistan.
CASE PRESENTATION
A total of 31 patients and their physicians consented
and were available for their clinical data to be
recorded. The majority of patients lied in the age
range of 11-20 years (70.9%) and all presented with
complain of irregular menstrual cycle (100%) and
infertility for most part (54%), hirsutism was also
observed in half of the patients (46%) in combination
with the primary complain.
Graph 1.1 Age of patients
Graph 1.2 Patient Complain
The physicians pointed out hyperandrogenism (P
value <0.01) and chronic anovulation (P value
<0.05) as major findings along with others and also
hinted at risk factors such as obesity (P value <0.05)
and family history (P value >0.05). The physicians
further reported that the family history of patients
also revealed obesity and emotional disturbance and
to some extent inadequate dietary intake. The
complications which were usually seen were
abnormal uterine bleeding (P value <0.01) and
endometrial cancer (P value >0.05). According to the
physicians, co morbidities include diabetes mellitus
DM (P value >0.05) and to some extent hypertension
HTN (P value >0.05). The physicians usually
preferred a combination of medication therapy along
with lifestyle modifications.
70.90%
20.10%
8%
1%
Age of Patients
11-20 years 21-30 years 31-40 years Above 40 years
100%
54%
46%
0%
20%
40%
60%
80%
100%
120%
Complains of patients
%ofPatients
Irregular mentrual
cycles
Infertility
Hirsutism
4. Atta Abbas et al / Journal of Pharmacreations Vol-1(1) 2014 [17-21]
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the physicians rely heavily on their personal practices
and years dealing with the issue. The economic status
of patients is also a major decisive factor; Pakistan is
a county where a patient has to pay direct medical
expenses (Liaquat A Khowaja et.al, 2007). This is a
major issue when it comes to expensive diagnostic
testing.
It is evident that PCOS cannot be cured. However,
the condition can be treated with lifestyle changes
and medication therapy. (Mehwish Rizvi et al, 2014)
The 1st
line treatment option is lifestyle changes
which include weight management, exercise and
dietary modifications followed by medication therapy
as 2nd
line treatment option. (Richard SL et.al, 2013).
The medication therapy is formulated in accordance
to the sign and symptoms associated with PCOS i.e.
for treating irregular menstrual periods, the oral
contraceptive find their place in the first spot while
Clomiphene and Metformin come first in treating
fertility problems associated with the disease (NHS,
2013).
The focus of the investigators in the case study was
limited to the two aforementioned conditions as they
were the ones being mostly observed in patients
during the study period. The study reported that the
1st
line treatment option was usually opted in
combination with 2nd
line i.e. lifestyle changes
coupled with medication therapy. Coming on to the
2nd
line option of medication therapy oral
contraceptives are the drugs of choice followed by
Clomiphene and metformin. However, the most
commonly prescribed medications in patients with
PCOs were Metformin 500mg BD and OD followed
by Progesterone + Estrogen for hormonal therapy.
Clomiphene found its place as a 3rd
line medication
option with dose and duration of therapy of 50mg for
5days respectively. Progesterone for irregular
menstrual cycles were comparatively less common
among all but was prescribed anyhow. Surgical
intervention targeting restoration of ovulation is
usually placed at the last option. (Richard SL et.al,
2013). No clinical indication was provided and the
physicians banked on their personal practice using
the aforementioned medication therapy regimen. A
pharmacist was not consulted in the treatment plan.
However it is reported on various occasions that
inclusion of a pharmacist and the educational
interventions he or she performs has promoted
benefit to the patient (Alicia Pol et.al, 2012). The
non-pharmacological treatment mainly encompassed
patient education and it was done by a physician or
sometimes by a female nurse depending upon the
patient. Contrary to this, in developed countries a
pharmacist usually performs this role. (Azhar et.al,
2009). One of the reasons is the hesitation of the
patient, as mentioned earlier the disclosure of the
disease and discussion with a physician of opposite
gender is considered as a red line which should not be
crossed. However, patients feel comfortable with
same gender. In some cases, the physician’s
information is not updated as it should be as was the
case in this study, the physician did not know the 1st
line therapies. Such adversary highlights the need of
an educational intervention by a pharmacist to update
the physician’s knowledge and counsel the patient.
CONCLUSION
The absence of disease awareness has lead to poor
reporting and managing of the disease at patient’s and
physician’s end respectively. A pharmacist similar to
the developed countries can assume the role of
disease educator and/or patient counselor. Since
obesity is a major risk factor, health promotion
activities and campaigns regarding obesity awareness
must be a part of health care system. An education
intervention by a pharmacist has a pivotal role in the
said regard.
STATEMENT OF CONSENT
An informed written consent was obtained from the
patients and the physicians prior to recording the
information.
CONFLICT OF INTEREST
The authors declare no conflict of interests exists.
ACKNOWLEDGEMENT
The authors express their foremost gratitude to the
patients and physicians for their participation.
AUTHOR’S CONTRIBUTION
All authors contributed equally in all aspects of the
study.
SOURCE OF FUNDING
None
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