on 09-Feb-2020 (Sun)

Après un interrogatoire et un examen clinique soigneux, un bilan hormonal couplé à une échographie pelvienne doit être réalisé devant un trouble du cycle.

• Ce bilan est à réaliser au moment des règles (J2–J5 du cycle) afin de pouvoir être interprété correctement.
  En cas de test à la dydrogestérone négatif, le bilan pourra être réalisé en aménorrhée.
  
  
• Le bilan hormonal comprendra :
  • Le dosage de l'hCG pour éliminer une éventuelle grossesse
  • Le dosage de la FSH plasmatique associé à l'œstradiolémie
  • Le dosage de la prolactine plasmatique
  • Éventuellement le dosage de la LH

En cas de dysovulation, un dosage de la prolactine et de la TSH est effectué

Diagnostic

Classiquement, les signes d'appel associent une aménorrhée vers l'âge de 50 ans à des signes climatériques :

• Bouffées vasomotrices (ou bouffées de chaleur)
• Crises de sueurs nocturnes
• Sécheresse vaginale

D'autres signes seront recherchés :

• Troubles du sommeil
• Céphalées
• Arthralgies
• Troubles de l'humeur et du caractère
• Troubles de libido

Il est théoriquement nécessaire d'attendre 12 mois d'aménorrhée pour parler de ménopause.
En fait, la prise en charge ne se justifie que si les signes climatériques altèrent la qualité de vie

Autres troubles climatériques

• D'autres troubles sont parfois ressentis par les femmes en période ménopausique.
• Ces troubles ne sont pas toujours liés à la carence œstrogénique.
• Il s'agit :
  • De troubles de l'humeur (irritabilité, état dépressif, anxiété, tristesse) chez 40 % des femmes
  • D'insomnie
  • De pertes de mémoire
  • De sécheresse vaginale pouvant être à l'origine de dyspareunie
  • De modifications de la libido
  • De modifications de la voix, etc

Contre-indications du THM.

• Contre-indications absolues
  • Cancer du sein (actuel et antécédent personnel de cancer du sein)
  • Antécédent personnel de :
    • Pathologie thrombotique artérielle (AVC ischémique, infarctus du myocarde)
    • Pathologie thromboembolique veineuse (antécédents de phlébite profonde inexpliquée, d'embolie pulmonaire, d'accidents emboligènes inexpliqués)
      
  • Maladies plus rares
    • Lupus
    • Tumeur hypophysaire
    • Porphyrie
    • Affections hépatiques graves et évolutives
    • Hyperlipidémies sévères
    • HTA grave

• Contre-indications relatives (nécessitent une discussion en fonction de leur sévérité et du contexte : désir de THM, possibilités de surveillance)
  • Pathologies pelviennes : myome, endométriose
  • Mastopathies bénignes à risque
  • Facteurs de risque vasculaires : HTA, diabète insulinodépendant, tabagisme, dyslipidémie, obésité, migraines, etc
  • Autres : cholestase

Le THM associe un œstrogène naturel (œstradiol ou valérate d'œstradiol, afin de compenser la carence responsable des symptômes) à un progestatif (afin de contrôler le risque de cancer de l'endomètre lié à une exposition prolongée aux œstrogènes seuls).

En cas d'hystérectomie, le traitement comporte uniquement un œstrogène

THM - Maladies thromboemboliques veineuses

• Le risque est multiplié par 2 à 4 lorsque le THM comporte l'administration des œstrogènes par voie orale.
• En revanche, ce risque est minime, voire inexistant lorsqu'il s'agit d'œstrogènes naturels par voie extra-orale (shunt de l'effet de 1 er passage hépatique des œstrogènes).

THM - Cancers hormonodépendants

• Une œstrogénothérapie pouvant aggraver l'évolution du cancer du sein lorsqu'il existe déjà, il importe d'examiner soigneusement les seins et de disposer d'une mammographie de moins d'un an avant d'instaurer le THM

• Sur le versant expressif, le babillage notamment canonique (redoublement des syllabes qui apparaît entre 6 et 7 mois) a valeur de langage et précède l'apparition des premiers mots entre 10 et 12 mois.

L'augmentation du nombre de mots est variable d'un enfant à l'autre.

• En moyenne, l'enfant à 15 mois possède dix mots
• Entre 18 à 24 mois, l'enfant arrive à une masse critique de cinquante mots, il est alors capable d'apprendre entre quatre et dix mots nouveaux par jour.

Communalist Approach The historians of this school, relying completely on the colonial historiography of medieval India and colonial era textbooks, viewed Hindus and Muslims as permanent hostile groups whose interests were mutually different and antagonistic to each other.

Dupleix was, in fact, the originator of the practice of subsidiary alliance in India. He placed a French army at Hyderabad at the expense of the subahdar.

Dupleix was recalled in 1754 due to the initial defeat of the French army in the Second Carnatic War and the heavy cost incurred by the company due to Dupleix’s political decisions

In China, Japan and the Indonesian archipelago, Indian cotton was popular for its lightweight, yet strong qualities. When the Dutch, English and French acquired materials from India, it was not only for their home countries, but for transport to Malacca or Java, for example, where they were traded for spices.

When the French East India Company started trading in India, they entered an already well established, complex economic system, an intricate network of production, negotiation, delivery, and distribution. Large commercial fleets as well as prosperous shore-based businesses were run by Indian merchants. Weavers and merchants worked with overland freight operators and brokers, who worked with exporters and ship owners. These agents had also to negotiate with local state officials for commercial privileges. The European traders had to learn well established rules and practices and successfully collaborate with indigenous envoys.

The Danes are better known for their missionary activities than for commerce.

The Danes The Danish East India Company was established in 1616 and, in 1620

The world’s first central bank—the Bank of England—was established to sell government debt to the money markets on the promise of a decent return on Britain’s defeating rival countries like France and Spain.

the Indian brand of socialism is a ‘democratic socialism’ and not a ‘communistic socialism’ (also known as ‘state socialism’) which involves the nationalisation of all means of production and distribution and the abolition of private property.

polity, as stipulated in the Preamble, is based on the doctrine of popular sovereignty, that is, possession of supreme power by the people.

A republic also means two more things: one, vesting of political sovereignty in the people and not in a single individual like a king; second, the absence of any privileged class and hence all public offices being opened to every citizen without any discrimination.

The Preamble declares that fraternity has to assure two things—the dignity of the individual and the unity and integrity of the nation

The Preamble is neither a source of power to legislature nor a prohibition upon the powers of legislature. 2. It is non-justiciable, that is, its provisions are not enforceable in courts of law.

The Preamble has been amended only once so far, in 1976, by the 42nd Constitutional Amendment Act, which has added three new words— Socialist, Secular and Integrity—to the Preamble

Legally, sale, storage, transportation and usage of unapproved GM seeds is a punishable offence under the Rules of Environmental Protection Act 1989. Also, sale of unapproved seeds can attract action under the Seed Act of 1966 and the Cotton Act of 1957.

anada and the US allowed GM crops to be grown commercially in 1996

GM cotton permitted to be grown in India are hybrids/varieties that contain ‘cry1Ac’ and ‘cry2Ab’ genes, isolated from the soil bacterium Bacillus thuringiensis (Bt) and coding for proteins toxic to bollworm insect pests.

GEAC established under Ministry of Environment, Forest and Climate Change (MoEFCC) is the apex body for approval of activities involving large scale use of hazardous microorganisms and recombinants in research and industrial production from the environmental angle. • The GEAC is also responsible for approval of proposals relating to release of genetically engineered organisms and products into the environment including experimental field trials. Ht-bt cotton

Article 2 relates to the admission or establishment of new states that are not part of the Union of India. Article 3, on the other hand, relates to the formation of or changes in the existing states of the Union of India. In other words, Article 3 deals with the internal re-adjustment inter se of the territories of the constituent states of the Union of India. PARLIAMENT’S POWER TO REORGANISE THE STATES Article 3 authorises the Parliament to: (a) form a new state by separation of territory from any state or by uniting two or more states or parts of states or by uniting any territory to a part of any state, (b) increase the area of any state, (c) diminish the area of any state, (d) alter the boundaries of any state, and (e) alter the name of any state. However, Article 3 lays down two conditions in this regard: one, a bill contemplating the above changes can be introduced in the Parliament only with the prior recommendation of the President; and two, before recommending the bill, the President has to refer the same to the state legistature concerned for expressing its views within a specified period. Further, the power of Parliament to form new states includes the power to form a new state or union territory by uniting a part of any state or union territory to any other state or union territory 3 . The President (or Parliament) is not bound by the views of the state legislature and may either accept or reject them, even if the views are received in time.

Indian territory can be ceded to a foreign state only by amending the Constitution under Article 368

Consequently, the 9th Constitutional Amendment Act (1960) was enacted to transfer the said territory to Pakistan. On the other hand, the Supreme Court in 1969 ruled that, settlement of a boundary dispute between India and another country does not require a constitutional amendment. It can be done by executive action as it does not involve cession of Indian territory to a foreign country.

Fazl Ali Commission The creation of Andhra state intensified the demand from other regions for creation of states on linguistic basis. This forced the Government of India to appoint (in December 1953) a three-member States Reorganisation Commission under the chairmanship of Fazl Ali to re-examine the whole question. Its other two members were K M Panikkar and H N Kunzru. It submitted its report in September 1955 and broadly accepted language as the basis of reorganisation of states. But, it rejected the theory of ‘one language– one state’. Its view was that the unity of India should be regarded as the primary consideration in any redrawing of the country’s political units. It identified four major factors that can be taken into account in any scheme of reorganisation of states: (a) Preservation and strengthening of the unity and security of the country. (b) Linguistic and cultural homogeneity. (c) Financial, economic and administrative considerations. (d) Planning and promotion of the welfare of the people in each state as well as of the nation as a whole. The commission suggested the abolition of the four-fold classification of states under the original Constitution and creation of 16 states and 3 centrally administered territories.

The Constitution confers the following rights and privileges on the citizens of India (and denies the same to aliens): 1. Right against discrimination on grounds of religion, race, caste, sex or place of birth (Article 15). 2. Right to equality of opportunity in the matter of public employment (Article 16). 3. Right to freedom of speech and expression, assembly, association, movement, residence and profession (Article 19). 4. Cultural and educational rights (Articles 29 and 30). 5. Right to vote in elections to the Lok Sabha and state legislative assembly. 6. Right to contest for the membership of the Parliament and the state

Accordingly, the Parliament has enacted the Citizenship Act, 1955, which has been amended in 1957, 1960, 1985, 1986, 1992, 2003, 2005 and 2015.

T Fundamental Rights he Fundamental Rights are enshrined in Part III of the Constitution from Articles 12 to 35.

justiciable’ Fundamental Rights.

Most of them are available against the arbitrary action of the State, with a few exceptions like those against the State’s action and against the action of private individuals. When the rights that are available against the State’s action only are violated by the private individuals, there are no constitutional remedies but only ordinary legal remedies

They are not sacrosanct or permanent. The Parliament can curtail or repeal them but only by a constitutional amendment act and not by an ordinary act. Moreover, this can be done without affecting the ‘basic structure’ of the Constitution. (The amendability of fundamental rights is explained in detail in Chapter 11)

the six rights guaranteed by Article 19 can be suspended only when emergency is declared on the grounds of war or external aggression (i.e., external emergency) and not on the ground of armed rebellion

Most of them are directly enforceable (self-executory) while a few of them can be enforced on the basis of a law made for giving effect to them. Such a law can be made only by the Parliament and not by state legislatures so that uniformity throughout the country is maintained (Article 35).

According to the Supreme Court, even a private body or an agency working as an instrument of the State falls within the meaning of the ‘State’ under Article 12. LAWS INCONSISTENT WITH FUNDAMENTAL RIGHTS Article 13 declares that all laws that are inconsistent with or in derogation of any of the fundamental rights shall be void.

Right to freedom of religion (Article 25– 28) (a) Freedom of conscience and free profession, practice and propagation of religion (Article 25). (b) Freedom to manage religious affairs (Article 26). (c) Freedom from payment of taxes for promotion of any religion (Article 27). (d) Freedom from attending religious instruction or worship in certain educational institutions (Article 28). 5. Cultural and educational rights (Articles 29–30) (a) Protection of language, script and culture of minorities (Article 29). (b) Right of minorities to establish and administer educational institutions (Article 30). 6. Right to constitutional remedies (Article 32) Right to move the Supreme Court for the enforcement of fundamental rights including the writs of (i) habeas corpus, (ii) mandamus, (iii)prohibition, (iv) certiorari, and (v) quo war-rento (Article 32).

Right to elementary education (Article 21A). 5. Right of minorities to establish and administer educational institutions (Article 30).

The concept of ‘equality before law’ is of British origin while the concept of ‘equal protection of laws’ has been taken from the American Constitution.

In the Indian System, the constitution is the source of the individual rights. The Supreme Court held that the ‘Rule of Law’ as embodied in Article 14 is a ‘basic feature’ of the constitution. Hence, it cannot be destroyed even by an amendment.

The President of India and the Governor of States enjoy the following immunities (Article 361): (i) The President or the Governor is not answerable to any court for the exercise and performance of the powers and duties of his office. (ii) No criminal proceedings shall be instituted or continued against the President or the Governor in any court during his term of office. (iii) No process for the arrest or imprisonment of the President or the Governor shall be issued from any court during his term of office. (iv) No civil proceedings against the President or the Governor shall be instituted during his term of office in any court in respect of any act done by him in his personal capacity, whether before or after he entered upon his office, until the expiration of two months next after notice has been delivered to him. 2. No person shall be liable to any civil or criminal proceedings in any court in respect of the publication in a newspaper (or by radio or television) of a substantially true report of any proceedings of either House of Parliament or either House of the Legislature of a State (Article 361-A). 3. No member of Parliament shall be liable to any proceedings in any court in respect of anything said or any vote given by him in Parliament or any committee thereof (Article 105).

Parliament can prescribe residence as a condition for certain employment or appointment in a state or union territory or local authority or other authority. As the Public Employment (Requirement as to Residence) Act of 1957 expired in 1974, there is no such provision for any state except Andhra Pradesh 5 and Telangana 5a .

Mandal Commission and Aftermath In 1979, the Morarji Desai Government appointed the Second 6 Backward Classes Commission under the chairmanship of B P Mandal, a Member of Parliament, in terms of Article 340 of the Constitution to investigate the conditions of the socially and educationally backward classes and suggest measures for their advancement. The commission submitted its report in 1980 and identified as many as 3743 castes as socially and educationally backward classes. They constitute nearly 52% component of the population, excluding the scheduled castes (SCs) and the scheduled tribes (STs). The commission recommended for reservation of 27% government jobs for the Other Backward Classes (OBCs) so that the total reservation for all ((SCs, STs and OBCs) amounts to 50%

Ram Nandan Committee was appointed to identify the creamy layer among the OBCs. It submitted its report in 1993, which was accepted. (b) National Commission for Backward Classes was established in 1993 by an act of Parliament.

Mysore High Court held that the subject matter of Article 17 is not untouchability in its literal or grammatical sense but the ‘practice as it had developed historically in the country’. It refers to the social disabilities imposed on certain classes of persons by reason of their birth in certain castes. Hence, it does not cover social boycott of a few individuals or their exclusion from religious services, etc.

hereditary titles of nobility like Maharaja, Raj Bahadur, Rai Bahadur, Rai Saheb, Dewan Bahadur, etc, which were conferred by colonial States are banned by Article 18 as these are against the principle of equal status of all.

he Supreme Court upheld the constitutional validity of the National Awards—Bharat Ratna, Padma Vibhushan, Padma Bhushan and Padma Sri. It ruled that these awards do not amount to ‘titles’ within the

Freedom of Assembly

This freedom can be exercised only on public land and the assembly must be peaceful and unarmed.

The State can impose reasonable restrictions on the exercise of right of assembly on two grounds, namely, sovereignty and integrity of India and public order including the maintenance of traffic in the area concerned. Under Section 144 of Criminal Procedure Code (1973), a magistrate can restrain an assembly, meeting or procession if there is a risk of obstruction, annoyance or danger to human life, health or safety or a disturbance of the public tranquillity or a riot or any affray. Under Section 141 of the Indian Penal Code, as assembly of five or more persons becomes unlawful if the object is (a) to resist the execution of any law or legal process; (b) to forcibly occupy the property of some person; (c) to commit any mischief or criminal trespass; (d) to force some person to do

Reasonable restrictions can be imposed on the exercise of this right by the State on the grounds of sovereignty and integrity of India, public order and morality. Subject to these restrictions, the citizens have complete liberty to form associations or unions for pursuing lawful objectives and purposes. However, the right to obtain recognition of the association is not a fundamental right.

Freedom of Residence Every citizen has the right to reside and settle in any part of the territory of the country. This right has two parts: (a) the right to reside in any part of the country, which means to stay at any place temporarily, and (b) the right to settle in any part of the country, which means to set up a home or domicile at any place permanently.

no objection can be made when the State carries on a trade, business, industry or service either as a monopoly (complete or partial) to the exclusion of citizens (all or some only) or in competition with any citizen. The State is not required to justify its monopoly. This right does not include the right to carry on a profession or business or trade or occupation that is immoral (trafficking in women or children) or dangerous

• Dans la manœuvre de Bethoux, on refoule le col utérin à l’aide d’une pince et les fuites urinaires disparaissent.

• Dans la manœuvre de Bonney, on remonte le col vésical dans l’enceinte abdominale en mettant deux doigts de part et d’autre du col vésical et ainsi, les fuites urinaires à l’effort disparaissent.
  Elle correspond à un bon pronostic chirurgical en cas d’IUE.

• Le TVT test ou manœuvre d’Ulmsten consiste à réaliser un soutènement de l’urètre sans pression à l’aide d’une valve ou d’une pince longuette afin d’empêcher sa descente au cours d’un effort de poussée.
  Si les fuites urinaires n’apparaissent plus, une intervention type TVT devrait être efficace.

According to the scientists, including those from NASA’s Jet Propulsion Laboratory in the US, a seawater current called the Beaufort Gyre keeps the polar environment in balance by storing fresh water near the surface of the Arctic ocean.

The researchers said this fresh water is important in the Arctic since it floats above the warmer, salty water, and helps protect the sea ice from melting - in turn regulating the Earth’s climate.

Due to this decades-long decline of the Arctic’s summertime ice cover, the Beaufort Gyre is more exposed to the wind, which has spun the gyre faster, trapping the fresh water in its current, the scientists noted.

The westerly winds have also persistently dragged the current in one direction for over 20 years, increasing its speed and size, as well as preventing the fresh water from leaving the Arctic Ocean, they said.

Water from the Arctic loses heat and moisture to the atmosphere, and sinks to the bottom of the ocean, where it drives water from the north Atlantic Ocean down to the tropics in a conveyor-belt-like current called the Atlantic Meridional Overturning Circulation, the scientists explained.

extinct ancient elephant called Deinotherium indicum.

Novel selenium-graphene catalyst for fuel cells

India has developed a selenium-graphene–based catalyst which is more efficient, costs less and also remains stable for longer than the usual platinum based catalysts. The institutes involved in the work are: Tata Institute of Fundamental Research, Hyderabad (TIFR-H), University of Hyderabad and Indian Institute of Science Education and Research (IISER) Thiruvananthapuram.

Normally, fuel cells use expensive platinum-like elements. “These expensive metal-based technologies perform excellently for initial few cycles, but then get degraded in performance due to many reasons

The oxygen reduction reaction is a key step in the functioning of the fuel cell.

Platinum is often used to catalyse this reaction. As a substitute, the group developed the catalyst with selenium and graphene.

Such direct water converting oxygen reduction reaction catalyst has enormous applications in other fields too, such as metal-air battery

Johann Dobereiner of Germany in 1817 found that, if he took a triad of elements with similar properties, the atomic weight of the middle element is roughly midway between those of the other two [e.g., sodium with atomic weight 23 is midway between lithium (3) and potassium (39)

John Newlands stated his “law of octaves”: if elements are arranged in increasing atomic weight order, those with similar properties occur after each interval of seven elements (for example, lithium and sodium, or carbon and silicon)

silicon and have an atomic weight of 72. Sure enough it was found in 1886, and was named germanium.

The new framework is aimed at facilitating further concrete action on marine waste, though on a voluntary basis, after the G20 Hamburg Summit in Germany adopted the “G20 action plan on marine litter” in 2017.

India has been an associate member of the IPTA since the last four years. But this is the first time that we will be hosting the annual meeting,” Dr. J.K.Solanki, head of administration, NCRA, said.

The IPTA is a collaboration of radio astronomers from a dozen countries across the globe. It uses more than 12 radio telescopes all over the world with an aim to detect ultra-low frequency gravitational waves.

he current status of the quest for ultra-low frequency Gravitational Waves and the roadmap for future technical and scientific challenges is to be the main focus of the meeting.

“These waves are wrinkles in space-time produced by two massive black holes, each revolving around the other. Such black holes, which weigh billion times more than our Sun, are found in the centres of colliding galaxies. These waves affect radio pulses from 10km size stars called radio pulsars by changing ever so slightly the period of radio pulsation of these stars

Bitcoin use causing huge CO2 emissions: Study

A team of scientists in Assam has developed a chemical process that turns ‘dirty’ coal into a biomedical ‘dot’ to help detect cancer cells.

chemical method of producing carbon quantum dots (CQDs) from cheap, abundant, low-quality and high-sulphur coals.

Carbon-based nanomaterials are used as diagnostic tools for bio-imaging, especially in detecting cancer cells, for chemical sensing and in opto-electronics.

The CQDs that the CSIR-NEIST team developed emit a bluish colour with “high-stability, good-conductivity, low-toxicity, environmental friendliness, and good optical properties

Our observed annual mass losses suggest that of the total ice mass present in 1975, about 87% remained in 2000 and 72% remained in 2016,” the study’s authors wrote.

Significantly, the document contains a modified version of the relativity theory and shows that Einstein was facing fierce resistance within the scientific community.

Once an indispensable part of daily life in Japan, ultra-thin washi paper was used for everything from writing and painting to lampshades, umbrellas, and sliding doors, but demand has plunged as lifestyles have become more westernised.

The traditional hand-made paper is manufactured from plants called kozo, or mulberry, which has fibres that are much longer than materials used for paper in the west such as wood and cotton.

The wild yak is an endangered species restricted to the higher Himalayas of Asia, the Tibetan plateau and parts of North Russia. It can tolerate temperatures as low as -40 degrees Celsius and is associated with the Himalayan tahr and White-bellied musk deer.