This document discusses several types of thyroid cancer including anaplastic carcinoma, medullary carcinoma, and malignant lymphoma. Anaplastic carcinoma is very aggressive with a median survival of 6 months. Medullary carcinoma can be sporadic, familial, or associated with MEN 2A/2B syndromes. Malignant lymphoma of the thyroid usually arises in pre-existing Hashimoto's thyroiditis. Diagnosis of these cancers involves physical exam, imaging, biopsy, and tumor markers. Treatment options depend on the cancer type and stage but may include surgery, radiation, chemotherapy, and monitoring of tumor markers.
Three grades of tumours are recognized:
(1) pineocytoma, the most common of all pineal parenchymal tumors
(2) pineal parenchymal tumor of intermediate differentiation
(3) pineoblastoma, the rarest but most malignant parenchymal cell tumor
The most common thyroid problems involve abnormal production of thyroid hormones. Too much thyroid hormone results in a condition known as hyperthyroidism. Insufficient hormone production leads to hypothyroidism. Fewer than 1% of all thyroid nodules are malignant (cancerous). Females are more likely to have thyroid cancer at a ratio of 3:1. The cause of thyroid cancer is unknown, but certain risk factors have been identified and include a family history of goiter, exposure to high levels of radiation, and certain hereditary syndromes
Three grades of tumours are recognized:
(1) pineocytoma, the most common of all pineal parenchymal tumors
(2) pineal parenchymal tumor of intermediate differentiation
(3) pineoblastoma, the rarest but most malignant parenchymal cell tumor
The most common thyroid problems involve abnormal production of thyroid hormones. Too much thyroid hormone results in a condition known as hyperthyroidism. Insufficient hormone production leads to hypothyroidism. Fewer than 1% of all thyroid nodules are malignant (cancerous). Females are more likely to have thyroid cancer at a ratio of 3:1. The cause of thyroid cancer is unknown, but certain risk factors have been identified and include a family history of goiter, exposure to high levels of radiation, and certain hereditary syndromes
Last update of thyroid cancer management from diagnosis till follow up
You can request other lectures by emailing me at salahmab76@yahoo.com or calling me 0020 100 408 1234
Dr Salah Mabrouk Khallaf
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
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Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
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Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Acetabularia Information For Class 9 .docxvaibhavrinwa19
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The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
2. Anaplastic carcinoma
• This is one of the most aggressive malignancies in humans.
• Median survival 6 months.
• % of thyroid cancer 1–2%.
• The disease is characterized by rapid growth, visceral invasion
and distant metastases.
• The peak incidence occurs in the 6th to7th decade of life.
Women comprise 55% to 77% of patients.
• Risk factors for thyroid cancer (Female gender, exposure to
ionizing radiation, and family history of thyroid cancer).
3. clinical features
• Rapidly growing mass. A dull aching pain in the neck is quite common
• Local invasion may involve, RLN and causes hoarseness of the voice , the
trachea causing dyspnea and stridor , and involvement of esophagus
causing dysphagia .
• Invasion of the cervical sympathetic nerves may cause Horner's syndrome
(contraction of the pupil ,enophthalmos , narrowing of the palpebral fissure
and loss of sweating of face and neck .)
• Direct tissue invasion and systemic metastasis to lung, bone and brain
(Pulmonary metastases are common )
Note : Anaplastic CA can presents commonly with cervical invasion and
pulmonary metastases at the same time , unlike the papillary in which
pulmonary metastases is less common .
4. •Physical
examination
1. General examination
• Patients often breathe with difficulty and
have stridor .
• There is often wasting and anemia.
• There may be evidence of skeletal
metastases even pathological
fractures.
• In advanced cases the liver may be
enlarged.
5. 2. Thyroid
examination
• Diffuse thyroid enlargement and
the mass is hard and solid.
• The mass in the neck has no
definable shape.
• The overlying skin often has a
red-blue tinge because the
underlying infiltration interferes
with its venous drainage.
• 50% may have enlarged cervical
6. Diagnosis
• The diagnosis is usually suspected on clinical
examination and confirmed by FNAB or core
biopsy.
• FNAB has been shown to be accurate in
90% of cases.
• CT and MRI are useful in defining the local
extent of disease and identifying distant
metastases
7. High risk findings in US for
malignancy
1. Micro-calcification
2. Hypo-echoic nodule / Solid
3. Irregular margin
4. Intra-nodular vascularity
5. More tall then wide
8. Staging
TNM CLASSIFICATION:
• All anaplastic carcinoma is stage IV
• Stage IV contains 3 stages:
IV A ; Tumor is limited to the thyroid and surgically
resectable.
IV B : Tumor extending beyond thyroid and
considered surgically irresectable.
IV C: Tumor presented with distant metastasis.
10. • Initial surgical resection or debulking may be
considered if preoperative imaging suggests
feasibility.
• If not, chemotherapy and external beam radiation
may be performed as first-line therapy, possibly
followed by surgery in responsive cases.
• Treatment is generally palliative (given its
aggressive nature) and may include early
tracheostomy for airway protection.
11.
12. Medullary carcinoma
• These are tumors of the para-follicular (C cells) derived from the
neural crest.
• 25% Inherited (Germline mutation RET oncogene).
• High levels of serum calcitonin and carcinoembryonic antigen are
produced by many medullary tumors, which should be tested for in
suspected cases.
• Calcitonin levels fall after resection and rise again with recurrence,
making it a valuable tumor marker in the follow-up of patients with
this disease.
• Some tumors are familial and account for 10–20% of all cases.
• The majority of patients are between the ages of 50 and 70 years
when the tumor is sporadic in nature
13. • When the condition occurs in young adults (20–30 years),
often with a family history, it may be a manifestation of the
multiple endocrine neoplasia syndrome (MEN) types 2a or
2b. In these cases, the medullary thyroid carcinoma may
be accompanied by associated conditions such as:
14. Medullary Thyroid Cancer Occurs in
Four Clinical Settings
1- Sporadic
• 80% of all cases of medullary thyroid cancer.
• Typically unilateral
• No associated endocrinopathies
• Peak onset 40 - 60.
• Females predominance: 3:2 ratio.
• One third will present with intractable diarrhea.
15. 2-MEN 2-A (Multiple Endocrine Neoplasia 2 A).
1. bilateral medullary carcinoma
2. pheochromocytoma
3. hyperparathyroidism.
• This syndrome is inherited as autosomal dominant. Because
of this, males and females are equally affected.
• Peak incidence of medullary carcinoma in these patients is in
the 30's.
16. 3-MEN 2 B This syndrome has
medullary carcinoma
• Inheritance is autosomal dominant as in MEN IIA (m=f)
• Pheochromocytomas must be detected prior to any operation.
• The idea here is to remove the pheochromocytoma first to remove the
risk of severe hypertensive episodes while the thyroid or parathyroid
is being operated on.
17. 4-Inherited medullary carcinoma without associated
endocrinopathies.
• This form of medullary carcinoma is the least aggressive.
• Like other types of thyroid cancers, the peak incidence is
between the ages of 40 and 50.
18. Presentation
• The common presentation is a firm, smooth and distinct
lump in the neck(most commonly in single lobe ).
• It is indistinguishable from any other form of thyroid
solitary nodule.
• The symptoms which should make you think of medullary
tumor, apart from a lump in the neck and the presence of
the above lesions in the patient or their family, are diarrhea
and flushing. Diarrhea occurs in one-third of the patients.
The fluidity of the stool and the frequency of defecation
are both increased.
19. • Diarrhea is a feature in 30% of cases and this
may be due to 5-hydroxytryptamine or
prostaglandins produced by the tumor cells.
• Involvement of lymph nodes occurs in 50–60% of
cases of medullary carcinoma and blood-borne
metastases are common.
20. Diagnosis
1. Family history.
2. ↑Serum Calcitonin
3. ↑CEA
4. FNAB.
• tumors are not TSH dependent and do not
take up radioactive iodine.
21. •Family members at risk should firstly
be screened for(RET mutation) in
their blood. when recognized as a
carrier of the mutation, should be
screened by neck ultrasound and
calcitonin.
22. Treatment
• Standard treatment is total thyroidectomy and
clearance of involved anterior cervical and superior
mediastinal lymph nodes. Without metastases,
operation is often curative but when nodes are
involved, 10-year survival falls to about 50%.
• External Beam Radiation for unresectable residual or
recurrent tumor.
• No effective Chemotherapy.
23. FAMILIAL MTC (RET mutation +ve)
Prophylactic Thyroidectomy:
Before age of 6 yrs for MEN2A
Before age of 1 yr for MEN2B
• Pheochromocytoma when associated should be operated
first
• During follow-up, calcitonin levels are monitored and raised
levels indicate tumor recurrence. Surgical re-exploration of
the neck may be undertaken to remove involved nodes.
24. Malignant lymphoma
• Thyroid lymphomas are rare and usually arise in pre-
existing autoimmune (Hashimoto’s) thyroiditis. Most are
non- Hodgkin lymphomas. Diagnosis can only be made
histologically, by core needle biopsy or open biopsy, as
FNA is inadequate.
• The prognosis is good, particularly if there is no
involvement of cervical lymph nodes.
• Presentation – rapid growing goiter + diffuse pain
• Median age is 7th decade.
25. •Treatment is with radiotherapy, and survival
depends on whether spread has extended beyond the
thyroid capsule. For lesions within the capsule, 5-year
survival is 85%, falling to 40% when local spread has
occurred.
• Response to irradiation is dramatic and radical
surgery is unnecessary once the diagnosis is
established by biopsy.
• advanced disease is managed by a chemotherapy
