This document discusses abnormal labor presentations including malpositioning of the fetal head, breech presentation, and shoulder presentation. It notes increased risks to both mother and fetus compared to normal labor, especially with inexperienced personnel. Maternal risks include prolonged labor, infection, obstructed labor, trauma, and hemorrhage. Fetal risks include cord prolapse, hypoxia, infection, and trauma. Specific types of abnormal head position like occiput-posterior are described in detail including causes, diagnosis, mechanisms of labor, and treatment options. Face and brow presentations are also summarized briefly.
This presentation contains details on normal anatomy on female pelvis and fetal head, process of normal labour, abnormal labour, induction of labour and malpresentations.
Fetal malpositioning & malpresentation can pose a serious threat to maternal & fetal well being. The document discusses the risks, complication, and management of some of the common malpresentation & malpositioning.
Malpresentations are all presentations of
fetus other than vertex. Face presentation, brow presentation, shoulder presentation and breech presentation are common malpresentations.
BREECH PRESENTATION obstetrics and gynacology mbbs final yearsarath267362
BREECH PRESENTATION obstetrics and gynacology mbbs final year
presentation , pregnancy
final year mbbs
normal labor
breech labor complications
management
BREECH
tdmc kerala
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
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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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
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.
- 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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. types
•I :- Malposition and Mal-presentation of the
head ( occipito-posterior, face presentation
,brow presentation)
•II:- Breech presentation
•III:- Shoulder presentation(Transverse lie)
3. Risks of abnormallabour
•Abnormal labour carries increased risks to the
mother and the fetus more than normal labour
, specially if the labour is attended by an
inexperienced personel
4. Maternal risks of abnormal labour
1. prolonged labour
2. Infection
3. Obstructed labour
4. Anesthesia
5. Traumatic delivery
6. Hemorrhage
7. DVT
8. Pressure necrosis and fistula
9. death
6. Malposition & mal-presentation of the
fetal head
1) Occipito-posterior position
2) Face presentation
3) Brow presentation
7. Labour in occipito-posterior position
•The denominator is the occiput
•The occiput occupy the posterior part of the
female pelvis ie. occiput near the sacrum
10. Causes of O. P.
•Anthropoid pelvis favor direct o.p position
•Android pelvis favor oblique o.p. position
•Anteriorly situated placenta
• gross pendulous abdomen
•Congenital malformations
•Abnormal extensor tone
•Polyhydramnious
•Prematurity
•Multiple pregnancy
11. Diagnosis of occipito posterior
•By abdominal exam.
1. Flat lower abdomen below the umbilicus
2. easy to feel Fetal limbs anteriorly
3. difficult to feel the Fetal back
4. Head not engaged
5. Fetal heart at the flanks
12.
13. Diagnosis of occipito posterior
• By pelvic exam.
1. High presenting part
2. Bulging sausage shaped membranes
3. Or early rupture of membranes (cx.less than 3cm)
4. Easy to feelthe anterior fontanel behind the pubic
symphysis
5. Difficult to feelthe posterior fontanelnear the sacrum
6. ear directed posteriorly (in excessive caput & edema)
14. Mechanism of labour in O.P.
•Engagement in ROP (ROP 3times than LOP)
•Engaging diameter is suboccipito-frontal 10.5
cm if the head well flexed .
• Or occipito-frontal11.5 cm if the head deflexed
(both larger than normal OA suboccipito-
bregmatic 9.5 cm)
•This gives an oval shaped presenting part not
fit well on the cx. Of larger dimentions
15. Mechanism of labour in O.P.
•Internal rotation:- if the head well flexed the
occiput will touch the pelvic floor first and
rotated anteriorly 3/8th
of a circle 135 and
become occipito-anterior and the mechanism
then continue as in OA. But it takes longer time
to rotate
•This occurs in 70% of cases
16.
17. Mechanism of labour in O.P.
• If the head is deflexed :- the sinciput touches the pelvic
floor first so rotates anteriorly and the occiput rotates
posteriorly through 1/8th
of a circle (45 ) short rptation
giving direct occipitoposterior
• The mechanism differs , descent continues and the head
delivers by a combination of flexion first, followed by
extention
• The emerging diameter is occipito-frontalof 11.5 cm
causing great distension at the vulva and perineum and
perinealtears may occur unless episiotomy performed
• Occurs in 10% of cases
18. Mechanism of labour in O.P.
•Arrest of rotation at lateral position (right
occipito-lateral or left occipito-lateral)
•No mechanism of labour
•Deep transverse arrest
•Need assisted delivery
•Occurs in 20% of cases
19. Features of labour in O.P.
1. Slow progress (slow cx. dilatation, descent,
rotation)
2. Backache is more
3. Incoordinate uterine contraction
4. Early rupture of membranes
5. Higher chance for cord prolaps
6. Higher chance for infection
7. Higher chance for perineallaceration
8. Excessive moulding of the head may cause
tentorrial tear
20. Treatment of O.P.
Before the onset of labour , no attempt for correction
During first stage of labour
1. Correction of malposition cannot be done
2. Observation of uterine contraction, cx dilatation, descent,and
use partogram
3. Continuous fetal heart monitoring
4. Due to increased risk for operative delivery and anesthesia ,
give nothing by mouth,only occasionalsips of water
5. Maintain maternal hydration by iv fluid
6. Oxytocin infusion is often indicated to correct incoordinate
uterine contractions
21. Treatment of O.P.
•Cesarean section is indicated in first stage in
the following conditions
1. Failure to progress in spite of good uterine
contractions for 3 hours
2. Fetal distress
3. Maternal distress
22. Treatment of O.P.
•Treatment in second stage
•Mistaken diagnosis of 2nd
stage is not
uncommon, the patient have urge to
pushdown before full dilatation (pressure
effect of the large occiput on the pelvic plexus
•p/v exam is essential to confirm the diagnosis
23. Rx of 2nd
stage continue
•p/v to assess degree of deflexion
•Determine excessive molding
•Determine caput succidanium
•If detect that , spontaneous labour is unlikeley
to occur
•Pain relieve is essential in O.P.
•Epidural analgesia , pethidine
26. Manual rotation
•Correction of malposition by manipulation with
the hand under epidural anesthesia
•Disadvantage need anesthesia, hand take
additional space , may cause trauma, pulling is
not feasible
27.
28. •Kielland forceps rotation
•Same disadvantages but ,can pull the head
Vacuum extraction ( Vantouse , Kiwi)
Advantages
Applied without anesthesia, not take extra space,
easy to use minimal skills
34. Face presentation
•The head is fully extended
•1/300 deliveries
•Causes : same as O.P.
•The denominator is the mentum (chin)
•Mento-posterior no mechanism of labour the
chest try to enter the pelvis at the same time
with the head (sternobregmatic 16-18cm)
35.
36. Mechanism of labour in mento anterior
•Engagement in mentolateralML or RMA
•Engaging diameter is the submento bregmatic 9.5
cm
•Descent occurs slowly
•Rotation occur late in 2nd
stage
•Engagement occur at +2 or +3 station
•Delay in 2nd
stage due to oblique line of thrust from
the back to the head
•The face deliver by flexion
•Emerging diameter is the submentovertical 11cm
37. Diagnosis of face presentation
•Abdominal findings:- Longitudinal lie, cephalic ,
a groove can be felt between the head and
back , the head is high
•p/v feel the chin, mouth, jaws, nose, orbital
ridge
38. management
•Exclude CPD, hypertension , placenta previa,
other risk factors , estimated fetal wt 3.5kg
•If any of the above cesarean section safer
•Manage as in case of O.P.
39. Brow presentation
•1/1000
•Incomplete extension
•It is usually a transient presentation , either change
to vertex or to face
•Causes as face
•Diagnosis
•On abdominal exam as in face but the groove is less
prominent
•p/v :- feelant. Fontanel, orbital ridge, roote of the
nose, eyes, but not the chin
40.
41. Mechanism of labour in brow
•No mechanism of labour . The engaging
diameter is the mentovertical 14 cm so
cesarean section is indicated in persistent brow