This document discusses multiple pregnancies, including twins and higher order multiples. It covers the types of twins (dizygotic and monozygotic), risk factors, complications specific to monozygotic twins, maternal physiological adaptations, diagnosis, antenatal care including fetal surveillance and method of delivery. Outcomes are outlined such as the perinatal mortality rate being 5 times higher for twins compared to singletons, and congenital anomalies accounting for 15% of twin pregnancy mortality. Intrauterine death of one twin increases other risks, and higher order multiples have very high mortality risks due to extreme prematurity.
Labour induction
Induction of labour
Guidelines on induction of labour
Guidelines on labour induction
induction of labour is not risk free
prostaglandins for induction of labour
Bishop score
Cervical ripening techniques
mechanical and pharmacological induction of labour
Post dates induction
options for cervical ripening
oral vs. vaginal misoprostol
advantages diadvantages and techniques for induction of labour
gynecology & obstetrics
Labour induction methods
review of guidelines for labour induction
Preterm labor is the labor that starts before the 37th completed week. In this presentation, we will discover causes, pathogenesis, diagnosis, clinical features, and management principles for preterm labor along with the most recent evidence.
Labour induction
Induction of labour
Guidelines on induction of labour
Guidelines on labour induction
induction of labour is not risk free
prostaglandins for induction of labour
Bishop score
Cervical ripening techniques
mechanical and pharmacological induction of labour
Post dates induction
options for cervical ripening
oral vs. vaginal misoprostol
advantages diadvantages and techniques for induction of labour
gynecology & obstetrics
Labour induction methods
review of guidelines for labour induction
Preterm labor is the labor that starts before the 37th completed week. In this presentation, we will discover causes, pathogenesis, diagnosis, clinical features, and management principles for preterm labor along with the most recent evidence.
With the use of fertility enhancing medications, advance maternal age pregnancies and just the natural order od twinning, this pregnancy presentation has become more common among providers. Here we explore the etiology, presentation and management of twin pregnancies.
Multiple pregnancies consists of two or more fetuses ,there are exceptions to this such as twins gestations made of a singleton viable fetus & a complete mole.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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.
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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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
- 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
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
09. MULTIPLE PREGNANCY 2.ppt
1. Ghadeer Al-Shaikh, MD, FRCSC
Assistant Professor & Consultant
Obstetrics & Gynecology
Urogynecology & Pelvic Reconstructive Surgery
Department of Obstetrics & Gynecology
College of Medicine
King Saud University
2. MULTIPLE PREGNANCY
Twin pregnancy represents 2 to 3% of all pregnancies.
The PNMR is 5 times that of singleton
3.
4. DIZYGOTIC TWINS
Most common represents 2/3 of cases.
Fertilization of more than one egg by more than one
sperm.
Non identical ,may be of different sex.
Two chorion and two amnion.
Placenta may be separate or fused.
5. Factors affecting it’s incidence
Induction of ovulation, 10% with clomide and 30%
with gonadotrophins.
Increase maternal age ? Due to increase
gonadotrophins production.
Increases with parity.
Heredity usually on maternal side.
Race; Nigeria 1:22 North America 1:90.
6. MONOZYGOTIC TWINS
Constant incidence of 1:250 births.
Not affected by heredity.
Not related to induction of ovulation.
Constitutes 1/3 of twins.
7. Results from division of
fertilized egg:
0-72 H. Diamniotic dichorionic.
4-8 days Diamniotic monochor.
9-12 days Monoamnio.monochor.
>12 days Conjoined twins.
9. Determination of zygosity
Very important as most of the complications occur in
monochorionic monozygotic twins.
10. During pregnancy by USS
Very accurate in the first trimester, two sacs, presence
of thick chorion between amniotic memb.
Less accurate in the second trimester the chorion
become thin and fuse with the amniotic memb.
11.
12.
13. Different sex indicates dizygotic twins.
Separate placentas indicates dizygotic twins
14. Determination of zygozity After Birth
By examination of the MEMBRANE, PLACENTA,SEX ,
BLOOD group .
Examination of the newborn DNA and HLA may be
needed in few cases.
16. Specific Complications in
Monochorionic Twins
TWIN-TWIN transfusion.
Results from vascular anastomoses between twins
vessels at the placenta.
Usually arterio (donor) venous (recipient).
Occurs in 10% of monochorionic twins.
17. TWIN-TWIN transfusion
Chronic shunt occurs ,the donor bleeds into the
recipient so one is pale with oligohydramnios while the
other is polycythemic with hydramnios.
If not treated death occurs in 80-100% of cases.
18. Possible methods of treatment:
Repeated amniocentesis from recipient.
Indomethacin.
Fetoscopy and laser ablation of communicating
vessels.
19.
20. Other Complications in Monochorionic Twins:
Congenital malformation. Twice that of singleton.
Umbilical cord anomalies. In 3 – 4 %.
Conjoined twins. Rare 1:70000 deli varies. The
majority are thoracopagus.
PNMR of monochorionic is 5 times that of
dichorionic twins(120 VS 24/ 1000 births)
21. Maternal Physiological Adaptation
Increase blood volume and cardiac output.
Increase demand for iron and folic acid.
Maternal respiratory difficulty.
Excess fluid retention and edema.
Increase attacks of supine hypotension.
22. DIAGNOSIS OF MULTIPLE PREGNANCY
+ve family history mainly on maternal side.
+ve history of ovulation induction.
Exaggerated symptoms of pregnancy.
Marked edema of lower limb.
Discrepancy between date and uterine size.
Palpation of many fetal parts.
23. Auscultation of two fetal heart beats at two different
sites with a difference of 10 beats
USS
Two sacs by 5 weeks by TV USS.
Two embryos by 7 weeks by TV USS.
24. Antenatal Care
AIM
Prolongation of gestation age, increase fetal weight.
Improve PNM and morbidity.
Decrease incidence of maternal complications.
25. Antenatal Care
Follow Up
Every two weeks.
Iron and folic acid to avoid anemia.
Assess cervical length and competency.
26. Antenatal Care
Fetal Surveillance
Monthly USS from 24 weeks to assess fetal growth and
weight.
A discordinate weight difference of >25% is abnormal
(IUGR).
Weekly CTG from 36 weeks.
27. Method Of Delivery
Vertex- Vertex (50%)
Vaginal delivery.
Vertex- Breech (20%)
Vaginal delivery by senior obstetrician
28.
29.
30. Method Of Delivery
Breech- Vertex( 20%)
Safer to deliver by CS to avoid the rare interlocking
twins( 1:1000 twins ).
Breech-Breech( 10%)
Usually by CS.
32. Perinatal Outcome
PNMR is 5 times that of singleton (30-50/1000 births).
RDS accounts for 50% 0f PNMR.2nd twin is more
affected.
Birth trauma . 2ND twin is 4 times affected than 1st .
Incidence of SB is twice that of singleton.
33. Perinatal Outcome
Congenital anomalies is responsible for 15% of PNMR.
Cerebral hemorrhage and birth asphyxia are
responsible for 10% of PNMR.
Cerebral palsy is 4 times that of singleton .
50% of twins babies are borne with low birth(<2500
gms.) from prematurity & IUGR.
34. INTRAUTERINE DEATH OF ONE TWIN
Early in pregnancy usually no risk.
In 2nd or 3rd trimester:
Increase risk of DIC .
Increase risk of thrombosis in the a live one
The risk is much higher in monochorionic than in
dichorionic twins
35. The alive baby should be delivered by 32-34 weeks in
monochorionic twins.
36. HIGH RANK MULTIPLE GESTATION
Spontaneous triplets 1:8000 births.
Spontaneous quadruplets 1:700,000 births.
The main risk is sever prematurity .
CS is the usual and safe mode of delivary.
High PNMR of 50-100 / 1000 births