Gestational trophoblastic disease (GTD) is a group of rare diseases in which abnormal trophoblast cells grow inside the uterus after conception. It encompasses a spectrum of proliferative abnormalities of trophoblast associated with pregnancy. In GTD, a tumor develops inside the uterus from tissue that forms after conception. This tissue is made of trophoblast cells and normally surrounds the fertilized egg in the uterus. Trophoblast cells help connect fertilized egg to the wall of the uterus and form part of the placenta. Sometimes there is problem with the fertilized egg and trophoblast cells. Instead of a healthy fetus developing, a tumor forms. Until there are signs or symptoms of the tumor, the pregnancy will seem like a normal pregnancy.
Most GTD is benign and does not spread, but some types become malignant and spread to nearby tissues or distant parts of the body. It is a general term and includes different types of disease:
• Hyaditiform Moles (HM)
o Complete HM
o Partial HM
• Gestational Trophoblastic Neoplasia (GTN)
o Invasive moles
o Choriocarcinomas
o Placental site trophoblastic tumors (very rare)
o Epithelioid trophoblastic tumor (even more rare)
Hyatid is the greek term which means “watery”. Hyaditiform mole is a rare mass or growth that forms inside the womb (uterus) at the beginning of the pregnancy. It is type of gestational trophoblastic disease (GTD).
Vesicular mole is defined as the abnormal condition of the placenta where partly degenerative and partly proliferative changes occur in the young chorionic villi.
• These changes results in the formation of clusters of small cysts of varying sizes. It is best regarded as a benign Neoplasia of the chorion with malignant potential.
Approximately 1 in every 1000 pregnancies is diagnosed as a molar pregnancy. In India the incidence is 1 in 400.The highest incidence is in Philippines being 1 in 80 pregnancies.
It is the expulsion or extraction from its mother of an embryo or fetus weighing 500 gm or less when it is not capable of independent survival (WHO).
The 500gm of fetal development is attained approximately at 22 weeks of gestation.
Expelled fetus- Abortus
Molar pregnancy is one of the sub types of gestational trophoblastic diseases characterized by abnormal trophoblastic proliferation . These are significant due to the risk of development of gestational trophoblastic neoplasia
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.
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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
- 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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
2. Trophoblast cells help connect fertilized egg
to the wall of the uterus and form part of the
placenta. Sometimes there is problem with
the fertilized egg and trophoblast cells.
Instead of a healthy fetus developing, a
tumor forms. Until there are signs or
symptoms of the tumor, the pregnancy will
seem like a normal pregnancy.
3. It is a general term and includes different types of
disease:
•Hyaditiform mole/Vesicular mole
COMPLETE
HYADTIFORM
MOLE
PARTIAL
HYADTIFORM
MOLE
5. Hyatid is the greek term which means “watery”.
Hyaditiform mole is a rare mass or growth that forms
inside the womb (uterus) at the beginning of the
pregnancy. It is type of gestational trophoblastic
disease (GTD).
6. DEFINITION-
Vesicular mole is defined as
the abnormal condition of the
placenta where partly
degenerative and partly
proliferative changes occur in
the young chorionic villi.
INCIDENCE-
Approximately 1 in every
1000 pregnancies is diagnosed
as a molar pregnancy. In India
the incidence is 1 in 400
NORMAL PLACENTA
VESICULAR MOLE
8. COMPLETE MOLE PARTIAL MOLE
•Whole conceptus formed
into mass of vesicles
•Only a part of trophoblast
shows molar changes
•No fetus is present (Sac is
empty)
•There is fetus or at least
an amniotic sac
•It is the result of the
fertilization of annucleated
ovum with a sperm which
will duplicate giving rise to
chromosomes of paternal
origin only.
•It is the result of the
fertilisation of an ovum by
2 sperms so the
chromosomal number is 69
chromosomes
10. TYPES-
Complete Mole-
◦ The whole conceptus is
transformed into a mass of
vesicles.
◦ No embryo is present.
◦ It is the result of the fertilization
of annucleated ovum (which has
no chromosomes) with a sperm
which will duplicate giving rise
to chromosomes of paternal
origin only.
11. Partial Mole-
◦ A part of the trophoblastic
tissue only shows molar
changes
◦ There is a fetus or at least an
amniotic sac.
◦ It is the result of the
fertilisation of an ovum by 2
sperms so the chromosomal
number is 69 chromosomes.
12. CLINICAL
MANIFESTATION-
Symptoms-
Vaginal Bleeding (“White
currant in red currant juice”)
Lower abdominal pain
Hyper emesis
Breathlessness
Thyrotoxic features- tremors,
tachycardia
Symptoms of hyperthyroidism
Expulsion of grape like vesicles
per vaginum.
History of quickening absent GRAPE LIKE
VESICLES
13. Per abdomen-
Size of the uterus is more than expected for the
period of amenorrhea.
Feel of the uterus is firm elastic due to absence of
amniotic sac.
Fetal parts are not felt, nor any fetal movements.
Absence of fetal heart sound which cannot be
detected even by Doppler.
14. Per Vaginal-
Internal ballottement cannot
be elicited.
Presence of vesicles in the
vaginal discharge.
If the cervical os is open,
instead of the membranes,
blood clot or the vesicles
may be felt.
15. DIAGNOSTIC EVALUATION-
History taking
Pelvic examination
Tests done may include-
Complete blood count, ABO and Rh grouping.
Hepatic, Renal and thyroid function tests.
hCG (quantitative levels) blood test
X-ray – abdomen and chest
18. SUPPORTIVE THERAPY-
IV infusion with ringers solution is started.
Blood transfusion is given with the patient is
anaemic
Parenteral antibiotic is given if there is associated
infection.
.
20. The patients can be grouped into-
Group A- the mole is in the process of expulsion
(less common)
Group B- the uterus remains inert (early diagnosis)
21. Group A- cervix is favourable-
Suction evacuation under diazepam sedation or
general anaesthesia.
Conventional dilatation of the cervix followed by
evacuation.
◦ Continuous monitoring of the patient.
◦ 500 ml Ringers solution IV infusion is set up
◦ Use of oxytocin for the expulsion of the moles.
22. Digital exploration and removal of the moles by
ovum forceps under general anaesthesia may also be
an alternative.
Once the evacuation procedure is complete,
methergin 0.2 mg is given IM.
OVUM FORCEP
REMOVAL OF MOLES BY
OVUM FORCEP
23. Group B- cervix is tubular and closed
Prior slow dilatation of the cervix is done by
introducing laminaria tent followed by suction and
evacuation.
Alternatively, vaginal misoprostol (PGE1) 400 ug, 3
hours before surgery may be used.
LAMINARIA TENT
FOR CERVICAL
DILATATION
24. Following evacuation, Anti- D immunoglobulin
should be given to the Rh- negative non immunized
patient.
The other options are- hysterectomy and hysterotomy
25. FOLLOW UP-
Routine follow ups is mandatory for all cases for at
least 1 year.
The hCG levels following evacuation should regress
to normal within 4-8 weeks time.
Initially the check up should be done at an interval of
one week till the serum hCG level becomes negative.
26. Once negative, the patient is followed every 1 month
for 6 months
Women who undergo chemotherapy should be
followed for 1 year after hCG has been normal.
The patient should not get pregnant during the period
of follow- up.
27. CONTRACEPTIVE ADVICE-
The patient is traditionally advised not to be pregnant
for at least one year.
But, if the patient so desires, she can get pregnant
after 6 months following the negative hCG titre.
IUD is contraindicated.
Combined oral pills can be used after the hCG value
has become normal.
Injection DMPA can be used safely.
Barrier method and surgical method of contraception.
