This document discusses abnormal uterine bleeding (AUB). It defines AUB and normal menstruation. It describes various clinical types of AUB and potential causes. Evaluation involves history, examination, and investigations. Treatment options include medical approaches like hormonal therapies and surgical procedures like endometrial ablation. Dysfunctional uterine bleeding is discussed in depth as the most common cause of AUB.
what is endometriosis? Theories in endometriosis, sites of endometriosis. types and clinical presentation. signs and symptoms.
Investigations :TVS, CA125
laparoscopic findings
chocolate cyst and extrapelvic endometriosis.
Classification of endometiosis
Diffential diagnosis
Management :of asymptomatic and symptomatic cases
drugs and minimally invasive surgery
surgey and preventive measures in endometiosis.
Presentation on the description of normal and abnormal uterine bleeding, menstrual cycle, FIGO classification with PALM-COEIN, common differentials of AUB, assessment, diagnosis, and management.
what is endometriosis? Theories in endometriosis, sites of endometriosis. types and clinical presentation. signs and symptoms.
Investigations :TVS, CA125
laparoscopic findings
chocolate cyst and extrapelvic endometriosis.
Classification of endometiosis
Diffential diagnosis
Management :of asymptomatic and symptomatic cases
drugs and minimally invasive surgery
surgey and preventive measures in endometiosis.
Presentation on the description of normal and abnormal uterine bleeding, menstrual cycle, FIGO classification with PALM-COEIN, common differentials of AUB, assessment, diagnosis, and management.
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
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
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
2. DEFINE
Any deviation in normal frequency, duration or amount of
menstruation in women of reproductive age.
NORMAL MENSES
Frequency: 21-35 d
Duration: 3-7 d
Volume: 30-80 ml
ABOUBAKR ELNASHAR
3. CLINICAL TYPES
Polymenorrhoea: frequent (<21 d) menstruation, at
regular intervals
Menorrhagia: Excessive (>80 ml) & / or prolonged
menstruation, at regular intervals
Metrorrhagia: Excessive (>80 ml) & / or prolonged
menstruation at irregular intervals.
Menometrorrhagia: both.
Intermenstual bleeding: episodes of uterine
bleeding between regular menstruations
Hypomenorrhoea: scanty menstruation.
Oligomenorrhea: infrequent menstruation (>35 d)
ABOUBAKR ELNASHAR
7. Pathology
Endocrine abnormality Endometrium
Anovulatory
90% Insufficient follicles Inadequate proliferative or atrophic
Persistent follicles Proliferative or hyperplastic
Ovulatory
10% Short proliferative phase Normal
Long proliferative phase Normal
Insufficient C. luteum Irregular or deficient secretory
leading to short luteal phase
Persistent C luteum leading to Irregular shedding
long luteal phase
ABOUBAKR ELNASHAR
9. Risk of endometrial cancer
Chronic anovulation has 3 times increased risk
(Coulam,1989).
Chronic proliferation of the endometrium leading to
adenomatous hyperplasia, leading to atypical
adenomatous hyperplasia, leading to endometrial
carcinoma. Transition can take up to 10 yrs or more.
ABOUBAKR ELNASHAR
10. Diagnosis
Aim:
1. Nature & severity of bleeding
2. Exclusion of organic causes
3. Ovulatory or anovulatory
How:
ABOUBAKR ELNASHAR
11. I. History:
1. Personal: age, wishes of the patient
2. Menstrual
3. Obstetric
4. Past
5. Present: amount, duration, color, smell, relation to
sexual intercourse, associated symptoms
ABOUBAKR ELNASHAR
12. II. Examination:
1. General:
pallor, endocrinopathy, coagulopathy, pregnancy
2. Abdominal:
liver, spleen, pelvi abdominal mass
3. Pelvic:
origin of the bleeding, cause
ABOUBAKR ELNASHAR
13. III.Investigations
Systemic:
1. CBC (for all, Grade A)
2. BHCG
3. Prolactin & TSH
4. Prothrombin time, partial thrmoplastin time,
bleeding time, platelets, Von Willebrand factor
ABOUBAKR ELNASHAR
14. Local:
1. Pap smear
2. Endometrial biopsy
3. D & C
4. Hysteroscopy
5. U/S
ABOUBAKR ELNASHAR
16. Assessment of the amount of the bleeding:
50% of excessive menstruation have normal amount of
blood loss by objective methods
1.Subjective methods:
history of passage of clots, flooding, use of large
number of pads, do not reflect the actual blood loss
2.Semiobjective:
i.Iron deficiency anemia
ii.Menstrual calendar
(August,1996)
III. Pictorial blood loss chart
(Higham,1990)
:
ABOUBAKR ELNASHAR
17. Menstrual calender (August,1996)
Saturday 7 14 21 28
Sunday 1 8 15 22 29
Monday 2 9 16 23 30
Tuesday 3 10 17 24 31
Wednesday 4 11 18 25
Thursday 5 12 19 26
Friday 6 13 20 27
. Spotting
- Slight loss
O Moderate loss
Very heavy loss
ABOUBAKR ELNASHAR
18. Pictorial blood loss chart: (Higham,1990)
Days of the bleeding Score
1 2 3 4 5 6 7 8
Towel
1 ponit
5 ponits
10 points
Clots 1p clot 1 point
5p clot 5 points
Flooding 5 points
Score >100 = MenorrrhagiaABOUBAKR ELNASHAR
19. Endometrial biopsy:
Indications:
.Between 20 & 40
.If endometrial thickness on TVS is >12mm, endometrial
sample should be taken to exclude endometrial
hyperplasia (Grade A).
Failure to obtain sufficient sample for H/P does not
require further investigation unless the endometrial
thickness is >12 mm (Grade B)
Aim:
diagnosis of the type of the bleeding
ABOUBAKR ELNASHAR
20. Methods:
As an outpatient procedure, without general anesthesia.
1.Pipelle curette
2.Sharman curette, Gravlee jet washer, Isac cell
sampler
3.Accrette
4.vabra aspirator
Advantages:
An adequate & acceptable screening procedure in
females under 40 yrs
ABOUBAKR ELNASHAR
22. D & C:
Indications:
1. Mandatory after 4o yrs
2. Persistent or recurrent bleeding between 20 & 40 yrs
ABOUBAKR ELNASHAR
23. Aim:
1.Diagnosis of organic disease e.g. endometritis, polyp,
carcinoma, TB, fibroid
2.Diagnosis of the type of the endometrium:
hyperplastic, proliferative, secretory, irregular ripening,
shedding, atrophic. This provides a guide to etiology &
treatment
3.Arrest of the bleeding, if the bleeding is severe or
persistent, particularly hyperplastic endometrium.
Curettage is essentially a diagnostic & not a therapeutic
procedure.
ABOUBAKR ELNASHAR
26. Hysteroscopy:
Indications:
Mandatory after 40 yrs
1. Erratic menstrual bleeding
2. Failed medical treatment
3. TVS suggestive of intrauterine pathology e.g. polyp,
fibroid (Grade B)
ABOUBAKR ELNASHAR
27. Aim:
1.Excellent view of the uterine cavity & diagnosis of
polyps, submucous fibroid, hyperplasia.
2.Biopsy of the suspected areas
3.Treatment
ABOUBAKR ELNASHAR
28. Advantages over D &C
1.The whole uterine cavity can be visualized
2.Very small lesions such as polyps can be
identified & biopsed or removed
3.Bleeding from ruptured venules & echymoses can
be readily identified
4.The sensitivity in detecting intrauterine pathology
is 98%
(Loffer,1989)
5.Outpatient procedure
ABOUBAKR ELNASHAR
30. Ultrasonography:
1. TAS:
can exclude pelvic masses, pregnancy complications
2. TVS:
More informative than TAS. Measurement of the
endometrial thickness is not a replacement for
biopsy. All endometrial carcinoma in postmenopausal
with endometrial thickness>4 mm
(Osmers,1990)
3. Saline sonography:
an alternative to office hysteroscopy in selected
cases. It is better tolerated than office hysteroscopy
or HSG
ABOUBAKR ELNASHAR
31. TVS is recommended in:
1. Weight >90 Kg
2. Age > 40 yrs
3. Other risk factors for endometrial hyperplasia or
carcinoma e.g.
infertility,
Nulliparity
family history of colon or endometrial cancer,
exposure to unopposed estrogen (Grade B)
ABOUBAKR ELNASHAR
35. Strategy of treatment
<20 yrs 20-40 yrs > 40 yrs
Medical Always First resort after endometrial biopsy Temporizing & if
surgery is refused or
imminent menopause
Surgical Never Seldom, only if medical treatment fail First resort if bleeding
is recurrent
ABOUBAKR ELNASHAR
36. Medical treatment:
Antifibrinolytics
Mechanism of action:
The endometrium possess an active fibrinolytic
system, & the fibrinolytic activity is higher in
menorrhagia.
Effect:
Greater reduction of menstrual bleeding than other
therapies (PSI, oral luteal phase progestagen &
etamsylate)
(Cochrane library,2002).
Tranexamic acid is effective in treating menorrhagia
associated with IUCD.
ABOUBAKR ELNASHAR
37. Side effects: is dose related.
Nausea , vomiting, diarrhea, dizziness. Rarely:
transient color vision disturbance, intracranial
thrombosis. But, no evidence that tranxemic acid
increases the risk in absence of past or family
history of thrombophilia. This treatment is not
associated with an increase in side effects
compared to placebo or other therapies
(Cochrane library,2002).
Dose:
3-6 gm /d for the first 3 days of the cycle
ABOUBAKR ELNASHAR
38. PSI:
Mechanism;
the endometrium is a rich source of PGE2 & PGF2œ
& its concentrations are greater in menorrhagia. PSI
decreases endometrial PG concentrations.
Effect:
PSI decreased menstrual blood by 24% &
norethisterone by 20%.
The beneficial effect of mefenamic acid on
MBL & other symptoms e.g. dysmenorrhea, headache,
nausea, diarrhea & depression persists for several
months.
ABOUBAKR ELNASHAR
39. Dose:
Mefenamic acid 500 mg tds during menses.
Side effects:
nausea, vomiting, gastric discomfort, diarrhea,
dizziness. Rarely: haemolytic anemia,
thrombocytopenia. The degree of reduction of MBL
is not as great as it is with tranxamic acid but PSI
have a lower side effect profile.
ABOUBAKR ELNASHAR
40. Etamsylate:
Mechanism of action:
maintain capillary integrity, anti-hyalurunidase activity
& inhibitory effect on PG
Dose:
500 mg qid, starting 5 days before anticipated onset
of the cycle & continued for 10 days
ABOUBAKR ELNASHAR
41. Effect:
20% reduction in MBL.
There is no conclusive evidence of the effectivness of
etamsylate in reducing menorrhgea (Grade A)
Side effects:
headache, rash, nausea
ABOUBAKR ELNASHAR
42. Systemic progestagens:
Norethisterone & medroxyprogesterone acetate
Effect:
Ovulatory DUB:
not effective if given at low dose for short duration
(5-10 days) in the luteal phase. Effective if NEA is
given at higher dose for 3 w out of 4 w (5 mg tds
from D5 to 26)
Anovulatory DUB:
useful
Side effects:
weight gain, nausea, bloating, edema, headache,
acne, depression, exacerbation of epilepsy &
migraine, loss of libido
ABOUBAKR ELNASHAR
43. Intrauterine progestagens
Levonorgestrel intrauterine system
levonova,Mirena:
Delivers 20ug LNG /d. for 5 yr
Metraplant:
T shaped IUCD & levonorgestrel on the
shoulder & stem
Azzam IUCD:
Cu T & levonorgestrel on the stem
ABOUBAKR ELNASHAR
44. Effect;
1.Comparable to endometrial resection for
management of DUB.
2.Superior to PSI & antifibrinolytics
3.May be an alternative to hysterectomy in some
patients
ABOUBAKR ELNASHAR
46. Side effects;
1.BTB in the first cycles
2.20% develop amenorrhea within 1 yr
3.Functional ovarian cysts
Special indications:
1. Intractable bleeding associated with chronic illness
2. Ovulatory heavy bleeding
ABOUBAKR ELNASHAR
47. The combined contraceptive pill:
Effect:
Reduce MBL by 50%
Mechanism of action:
endometrial suppression
Side effects;
headache, migraine, weight gain,
breast tenderness, nausea, cholestatic jaundice,
hypertension, thrombotic episodes,
ABOUBAKR ELNASHAR
48. Danazol:
synthetic androgen with antioestrogenic &
antiprogestagenic activity
Mechanism;
inhibits the release of pituitary Gnt & has direct
suppressive effect on the endometrium
Effect:
reduction in MBL (more effective than PSI) &
amenorhea at doses >400 mg/d
ABOUBAKR ELNASHAR
49. Side effects:
headache, weight gain, acne, rashes, hirsuitism,
mood & voice changes, flushes, muscle spasm,
reduced HDL, diminished breast size.
Rarely: cholestatic jaundice.
It is effective in reducing blood loss but side effects
limit it to a second choice therapy or short term use
only (Grade A)
Dose:
200 mg/d
ABOUBAKR ELNASHAR
50. GnRH analog
Side effects;
hot flushes, sweats, headache, irritability,
loss of libido, vaginal dryness,
lethargy, reduced bone density.
ABOUBAKR ELNASHAR
55. Indications:
1. Failure of medical treatment
2. Family is completed
3. Uterine cavity <10 cm
4. Submucos fibroid <5 cm
5. Endometrium is normal or low risk hyperplasia.
ABOUBAKR ELNASHAR
56. Complications of hysteroscopic methods
1. Uterine perforation
2. Bleeding
3. Infection.
4. Fluid overload
5. Gas embolism
ABOUBAKR ELNASHAR
58. Advantages:
1. Complete cure
2. Avoidance of long term medical treatment
3. Removal of any missed pathology
Disadvantages:
1.Major operation
2.Hospital admission
3.Mortality & morbidity
ABOUBAKR ELNASHAR