Eric C. Chu, MD
- Medical Instructor in the Department of Medicine
https://medicine.duke.edu/faculty/eric-c-chu-md
Istihaza is caused by the weakness of retentive power of uterus (secondary to either hiddat or riqaat khoon or sue mizaj rehm or injury /trauma to the uterus) as a result expulsive power of uterus becomes strong; which in turn leads to dilatation of uterine vessels resulting in excessive menstrual blood loss [5 medicine cabinets with mirrors buy coversyl 4 mg with mastercard, 6] symptoms emphysema generic 4 mg coversyl. Therefore treatment 1860 neurological cheap coversyl 4 mg, there is a need for alternate therapy which is to be safe treatment rosacea order 4mg coversyl overnight delivery, effective, easily available and free from side effects. In classical Unani literature, various effective formulations are available for the treatment of Istihaza; hence safoof habis and majoon muqawwi rehm sada has been selected as research drugs for the study, possessing the properties like habis, qabiz and muqawwi rehm; consequently it arrest the excessive menstrual blood loss and strengthen the uterus to prevent further episodes of bleeding [11]. In addition, majoon muqawwi rehm sada which contains withania somnifera (asgand) to strengthens the uterus and regularize the menstruation as it is known to contain phytohormones [14]. Materials and methods Study Design: A standard controlled randomized single blind study was carried out in the Dept. The patients (n=40) who fulfilled the inclusion criteria were randomly divided in to two groups by computer generated simple randomization table with the help of Random Allocation Software [15]. Selection Criteria: Patients in reproductive age group with dysfunctional uterine bleeding (infrequent cycles followed by heavy prolonged bleeding with history of above complaints at least for 2-3 cycles) were included in the study and patient with organic pelvic pathology, thyroid dysfunction, coagulation disorders, systemic illness, malignancy, and on hormonal contraceptives were excluded. Study Procedure: In each patient on entry into the study, detailed menstrual history (including duration of cycle, duration & amount of flow and history of passing clots) were recorded in case record form designed for the study; complete physical examination was performed to look for anaemia and pelvic examination was done to exclude the pelvic pathology. All patients were instructed to maintain a menstrual calendar and not to use any medication during the trial. Assessment of mizaj of every patient was done as per the parameters mentioned in classical Unani literature [17]. Test group: Unani formulations; Safoof habis -6 gm in two divided doses during an active bleeding phase and majoon muqawwi rehm sada -6gm twice daily was administered orally during an interval. Control group: Norethisterone acetate-5mg three times daily during an active bleeding phase followed by 5 mg once daily was administered orally for 21 days. Baseline Characteristics Age in years 13-20 21-30 31-40 Marital status Unmarried Married Socio economic status Upper Lower Duration of protocol therapy: 3 Cycles. Blinding and Compliance: Blinding of patients in either group was maintained as medicine was dispensed in similar pack to one patient at a time. For maintaining patient compliance, drugs were given to patients for 1 month only, informed them to revisit and receive the remainder of the treatment in subsequent follow ups. Assessment cum Follow up: Patients were followed for three consecutive cycles during treatment and one cycle after treatment. Repeat biochemical test, hormonal assay and ultrasound pelvis were carried out after completion of treatment. Outcome Measures: Primary outcome measures were restoration of normal menstruation and changes in Pictorial blood assessment chart score; secondary outcome measures (changes in endometrial thickness and hormonal profile) were assessed for effectiveness of either therapy. But due to practical feasibility and availability of the patients in the hospital, the sample size of 40 was kept which were distributed equally in two groups [18]. Statistical Analysis: Student t test (two tailed, independent) has been used to find the significance of study parameters on continuous scale between two groups (inter group analysis) on metric parameters. Chi-square/ Fisher Exact test has been used to find the significance of study parameters on categorical scale between two or more groups. Results From 40 patients enrolled into the study, 36 accomplished the study and the same was subjected to statistical analysis. Table 1: Comparative evaluation of baseline characteristics in two groups Test Group (n=20) 8(40. Outcome Measures 59 Discussion Both groups were homogenous in baseline characteristics (P>0. Subjective parameters Abnormal bleeding per vaginum was assessed by duration of cycle, duration of flow and amount of flow. The improvement in duration of cycle in test group is attributed to medicinal properties of test drugs particularly asgand as it was administered during the interval period like hormonal pills. Asgand is widely used for curing menstrual disorders in females and is also known as an adaptogenic [21, 22]. No significant change in endometrial thickness was observed on inter group comparison. This effect is attributed to medicinal properties of asgand which consists of steroidal lactones and alkaloids that serve as an important hormone precursor and even it acts as gonodotropic due to its phytoestrogens [25]. Change in serum estradiol was not significant within the groups and moderately significant on inter group comparison with P=0.
The importance of surgical staging in the treatment of malignant pleural mesothelioma symptoms 4dpo generic coversyl 4 mg with amex. Important prognostic factors in patients with malignant pleural mesothelioma treatment 7th feb cardiff purchase 8mg coversyl otc, managed surgically medicine of the wolf purchase coversyl 4mg visa. Resection margins medicine express buy discount coversyl 8 mg on-line, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results of 183 patients. Staging of bone sarcomas is the process whereby patients are evaluated with regard to histology, as well as the local and distant extent of disease. Bone sarcomas are staged based on grade, size, and the presence and location of metastases. Site groups for bone sarcoma: Extremity Pelvis Spine the radiograph remains the mainstay in determining whether a lesion of bone requires staging and usually is the modality that permits reliable prediction of the probable histology of a lesion of bone. To improve conspicuity in locations such as the pelvis or vertebrae, these sequences could be augmented by fat-suppressed pulse sequences. Reports indicate usefulness in detecting extrapulmonary metastases, evaluating response to chemotherapy, and determining local recurrence adjacent to prosthetic implants. Extra pulmonary metastases occur infrequently, and may include secondary bone metastases, for example. Biopsy of the tumor completes the staging process, and the location of the biopsy must be carefully planned to allow for eventual en bloc resection of the entire biopsy tract together with a malignant neoplasm. Imaging the tumor after biopsy may compromise the accuracy of the staging process. The pathologic diagnosis is based on the microscopic examination of tissue, correlated with imaging studies. Because regional lymph node involvement from bone tumors is rare, the pathologic stage grouping includes any of the following combinations: pT pG pN pM, or pT pG cN cM, or cT cN pM. Based upon published outcomes data, the current staging system accommodates a two-tiered system (low vs. Clinical staging includes all relevant data prior to primary definitive therapy, including physical examination, imaging, and biopsy. This divided into lesions of maximum dimension 8 cm or less (T1), and lesions greater than 8 cm (T2). T3 has been redefined to include only high-grade tumors, discontinuous, within the same bone. Job Name: - /381449t primary lesions or lesions that were previously treated and have subsequently recurred. Those patients with a "good" response, >90% tumor necrosis, have a better prognosis than those with less necrosis. As with soft tissue sarcomas, investigation has been undertaken to identify molecular markers that are useful both as prognostic tools as well as in directing treatment. In contrast, a study concluded that no prognostic value was attributed to different fusion genes when evaluated for event-free and overall survival by univariate analysis. Nuclear survivin expression/localization has been associated with prolonged survival. Finally, telomerase expression in osteosarcoma is associated with decreased progression free survival and overall survival. Investigation to identify molecular markers in chondrosarcoma has progressed at a slower pace. Intramedullary high grade Osteoblastic Chondroblastic Fibroblastic Mixed Small cell Other (telangiectatic, epithelioid, chondromyxoid fibroma-like, chondroblastoma-like, osteoblastomalike, giant cell rich) b. Intramedullary Conventional (hyaline/myxoid) Clear cell Dedifferentiated Mesenchymal b. Prognostic relevance of cell biologic and biochemical features in conventional chondrosarcomas. Peripheral chondrosarcoma progression is accompanied by decreased Indian hedgehog signaling. Primary metastatic osteosarcoma: presentation and outcome of patients treated on neoadjuvant cooperative osteosarcoma study group protocols.
Soft-tissue sarcoma and pesticides exposure in men: Results of a Canadian case-control study symptoms 8 days past ovulation cheap 8 mg coversyl fast delivery. Fish oil rich in eicosapentaenoic acid protects against oxidative stress-related renal dysfunction induced by tcdd in Wistar rats symptoms 5 weeks pregnant cramps purchase 4 mg coversyl with visa. Interactions of herbicides 2 symptoms 7 days before period quality 8mg coversyl,4-D and dinoseb with liver mitochondrial bioenergetics medicine 6mp medication order 8 mg coversyl overnight delivery. Rheumatoid arthritis in Agricultural Health Study spouses: Associations with pesticides and other farm exposures. Tobacco smoking and risk of haematological malignancies in adults: A case control study. Relationship between serum dioxin-like polychlorinated biphenyls and post-testicular maturation in human sperm. Dioxin-like compounds and bone quality in Cree women of Eastern James Bay (Canada): A cross-sectional study. The development and prognosis of chronic intoxication by tetrachlorodibenzo-p-dioxin in men. Increased oxidative/nitrosative stress markers measured non-invasively in patients with high 2,3,7,8-tetrachloro-dibenzo-p-dioxin plasma level. Persistent organic pollutants are related to the change in circulating lipid levels during a 5 year follow-up. Paternal and joint parental occupational pesticide exposure and spina bifida in the National Birth Defects Prevention Study, 1997 to 2002. Potential involvement of chemicals in liver cancer progression: An alternative toxicological approach combining biomarkers and innovative technologies. Suppression of human B cell activation by 2,3,7,8-tetrachlorodibenzo-p-dioxin involves altered regulation of B cell lymphoma-6. Perinatal dioxin exposure and the neurodevelopment of Vietnamese toddlers at 1 year of age. Molecular interactions of the aryl hydrocarbon receptor and its biological and toxicological relevance for reproduction. A health survey of workers in a 2,4-D and 2,4,5-T plant with special attention to chloracne, porphyria cutanea tarda, and psychologic parameters. A comprehensive contribution of genes for aryl hydrocarbon receptor signaling pathway to hypertension susceptibility. Dual roles of the 90-kDa heat shock protein hsp90 in modulating functional activities of the dioxin receptor. Aryl hydrocarbon receptor-induced adrenomedullin mediates cigarette smoke carcinogenicity in humans and mice. A path analysis of multiple neurotoxic chemicals and cognitive functioning in older U. Proceeding of the 15th International Symposium on Chlorinated Dioxins and Related Compounds 25:381386. The aryl hydrocarbon receptor cross-talks with multiple signal transduction pathways. Chronic cardiovascular disease-associated gene network analysis in human umbilical vein endothelial cells exposed to 2,3,7,8-tetrachlorodibenzop-dioxin. Aryl hydrocarbon receptor exogenous ligand 3-methylchoranthrene inhibited endometrial cancer cells proliferation. Risk factors for reduced glomerular filtration rate in a Nicaraguan community affected by Mesoamerican nephropathy. Marking time: the dynamic role of chromatin and covalent modification in transcription. Prenatal and early life exposure to polychlorinated dibenzo-p-dioxins, dibenzofurans and biphenyls may influence dehydroepiandrosterone sulfate levels at prepubertal age: Results from the Duisburg Birth Cohort Study. Mortality and cancer morbidity among chlorinated phenoxyacid applicators in Finland. Maternal exposure to polychlorinated biphenyls and the secondary sex ratio: An occupational cohort study. Maternal occupational pesticide exposure and risk of congenital heart defects in the National Birth Defects Prevention Study. Mutations in Cu/Zn superoxide dismutase gene are associated with familial amyotrophic lateral sclerosis. Aryl hydrocarbon receptor expression is associated with a family history of upper gastrointestinal tract cancer in a high-risk population exposed to aromatic hydrocarbons.
The chapter summary outlines the major revisions while more details about the staging system revision rationale and interpretation are forthcoming in separate manuscripts (in preparation) treatment efficacy generic coversyl 4 mg without prescription. Continued local extension may result in growth into deep structures medicine januvia cheap 4 mg coversyl free shipping, including adipose tissue medicine man purchase coversyl 8 mg with visa, cartilage symptoms queasy stomach and headache order 4 mg coversyl with visa, muscle, and bone. Once deeper extension occurs, growth may become discontinuous, resulting in deeper local extension, in transit metastasis, and nodal metastasis. Nodal metastasis usually occurs in an orderly manner, initially in a single node, which expands in size. Surgical resection of lymph node tissue is necessary when involvement is suspected. Low-grade tumors show considerable cell differentiation, uniform cell size, infrequent cellular mitoses and nuclear irregularity, and intact intercellular bridges. Multiple studies corroborate a correlation between tumor size and more biologically aggressive disease, including local recurrence and metastasis in univariate analysis. Several published studies point toward 2 cm as a threshold beyond which tumors are more likely to metastasize to lymph nodes. A limited number of studies suggest 4 cm as significant thresholds,20 while others show other factors to be important. Poor prognosis for recurrence and metastasis has been correlated with multiple factors such as anatomic site, tumor diameter, poor differentiation, perineural invasion, as well extension >2 mm depth. In an initial study, no metastases were associated with primary tumors less than 2 mm in depth (tumor thickness), but a metastatic rate of 15% was noted with tumors greater than 6 mm in depth. Specific anatomic locations on the hair-bearing lip and ear appear to have an increased local recurrence and metastatic potential and thus have been categorized as high risk in the seventh edition system (Table 29. The multivariate analysis showed that advanced P staging (P2 and P3) were independent risk factors for a decrease in local control rate, and the pathologic involvement of neck nodes did not worsen survival of patients with parotid disease. Overall, this analysis concluded that single-modality therapy, P3 stage, and presence of immunosuppression independently predicted a decrease in survival. Both univariate and multivariate analysis confirmed that survival was significantly worse for patients with advanced P stage, suggesting a revised classification of nodal status. While preliminary data exists to suggest that cervical disease may portend a worse prognosis than similar disease in the parotid, there is insufficient data to support this separation at this time. Separating out facial nerve involvement or involvement of the skull base (now T4) from extensive parotid disease will further clarify the prognosis of these patients. Organ transplant recipients develop squamous cell carcinoma 65 times more disease. Several different lymph node states are classified as N2: N2a represents a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension; N2b is defined by multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension; N2c includes bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension. Tumors 2 cm or less in diameter are classified as T2 if the tumor has two or more high-risk features. Environmental risk factors predisposing to the development of basal cell carcinoma. Factors associated with nonmelanoma skin cancer following renal transplantation in Queensland, Australia. Desmoplastic squamous cell carcinoma of skin and vermilion surface: a highly malignant subtype of skin cancer. Cutaneous metastatic squamous cell carcinoma to the parotid gland: analysis and outcome. Parotid and cervical nodal status predict prognosis for patients with head and neck metastatic cutaneous squamous cell carcinoma. Skin cancer in kidney and heart transplant recipients and different long-term immunosuppressive therapy regimens. Skin cancer in organ transplant recipients: epidemiology, pathogenesis, and management. A populationbased study of skin cancer incidence and prevalence in renal transplant recipients.
Generic coversyl 8mg. The Symptoms of Nicotine Withdrawal.
References
- Slifkin M, Tempesti P, Poutsiaka DD, et al. Late and atypical cytomegalovirus disease in solid-organ transplant recipients. Clin Infect Dis. 2001;33:E62-EAhsan N, Rao KV. Hepatobiliary diseases after kidney transplantation unrelated to classic hepatitis virus. Semin Dial. 2002;15:358-365.
- Scott M, Vesely I. Aortic valve cusp microstructure: the role of elastin. Ann Thorac Surg. 1995;60:S391-4.
- Boru UT, Erdogan H, Alp R, et al. Treatment of chronic inflammatory demyelinating polyneuropathy with high dose intravenous methylprednisolone monthly for five years: 10-year follow up. Clin Neurol Neurosurg. 2014;118:89-93.
- Kassan SS, Moutsopoulos HM. Clinical manifestations and early diagnosis of Sjogren syndrome. Arch Intern Med 2004;164(12):1275-84.
