The document discusses abortion and post-abortion care. It defines abortion as the termination of pregnancy before viability and notes definitions vary by country and gestational age cut-offs. It describes spontaneous versus induced abortion and classifications of incomplete versus complete abortion. Post-abortion care aims to reduce morbidity and mortality through treatment of complications, counseling, contraceptive services, and other health services while partnering with communities.
It is the expulsion or extraction from its mother of an embryo or fetus weighing 500 gm or less when it is not capable of independent survival (WHO).
The 500gm of fetal development is attained approximately at 22 weeks of gestation.
Expelled fetus- Abortus
It is the expulsion or extraction from its mother of an embryo or fetus weighing 500 gm or less when it is not capable of independent survival (WHO).
The 500gm of fetal development is attained approximately at 22 weeks of gestation.
Expelled fetus- Abortus
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
- 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
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
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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
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2 Case Reports of Gastric Ultrasound
2. The word abortion derives from the Latin aboriri—to
miscarry.
Abortion: spontaneous or induced termination of
pregnancy before fetal viability.
Definition differs from countries to countries based on
technology of neonatal care.
The WHO defines it as expulsion or extraction of an embryo
or fetus weighing 500 g or less from its mother. This typically
corresponds to a gestational age of 20 to 22 weeks or less.
Ethiopian definition is termination of pregnancy before 28
weeks of gestation or weight less than 1000g.
3. Can be spontaneous or induced.
Spontaneous abortion , also known as miscarriage.
Patients prefer the term "miscarriage" to "abortion."
Induced abortion is the medical or surgical termination of
pregnancy before the time of fetal viability.
Can be safe or unsafe.
Unsafe abortion persons lacking the necessary skills or in an
environment that does not conform to minimal medical standards,
or both.
Recurrent abortion ≥3 consecutive losses of clinically recognized
pregnancies prior to viability.
primary and
secondary recurrent abortion
4. Therapeutic abortion
Abortion done for the purpose of saving the life of the
mother or if the fetus has congenital/ chromosomal/
metabolic disorders that is incompatible with life often both.
Elective abortion
The interruption of pregnancy before viability at the request
of the woman, but not for medical reasons, is usually
termed elective or voluntary abortion.
According to the National Vital Statistics Reports,
approximately one pregnancy is electively terminated for
every four live births in the United States.
5. Spontaneous abortion is the most common complication of
early pregnancy.
15% of all clinically recognized pregnancies spontaneous
abortion.
More than 80% of these occurs in the 1st 12weeks of
pregnancy.
Another 15% of all pregnancies unsafe abortion.
World wide13% of maternal deaths– due to complication
of abortion.
For every maternal death due to unsafe abortion
—>10-15 women suffer from morbidity.
In some developing countries also contributes to 50%
maternal deaths.
6. Hemorrhage into the decidua basalis, followed by necrosis of
tissues adjacent to the bleeding=== ovum detaches==
uterine contractions == expulsion of the fetus
7. Fetal Factors:
1. Chromosomal abnormalities:
Cause at least 50% of early abortions.
2. Blighted ovum (anembryonic GS): where there is
no visible fetal tissue in the sac. 70% first-
trimester abortion
8. Maternal Factors
1. Maternal infections: uncommon
2. Trauma and maternal surgery :
External to the abdomen or during abdominal or pelvic
operations.
3. Endocrine causes:
Progesterone deficiency/LPD
DM
Thyroid Disease
Polycystic Ovarian Syndrome
11. Bleeding through a closed cervical os.
The bleeding is often painless, but may be
accompanied by minimal/mild suprapubic pain.
On examination the uterine size is appropriate for
gestational age.
Fetal cardiac activity is detectable by ultrasound if
the gestation is sufficiently advanced.
The exact etiology of bleeding often cannot be
determined and is frequently attributed to marginal
separation of the placenta.
12. About two thirds of pregnancies in women with
threatened abortion have a live embryo or fetus
present and
about 85% will survive.
13. Imminent abortion.
Significant bleeding.
Painful uterine cramps/contractions.
The cervix is dilated to variable extent.
The gestational tissue can often be felt or visualized through
the internal cervical os but no passage.
Amnionic fluid leakage.
14. After 12 weeks of gestation.
The membranes often rupture and the fetus is
passed.
Significant amounts of placental tissue may be
retained.
On examination the cervical os is open, gestational
tissue may be observed in the vagina/cervix.
The uterine size is smaller than expected for
gestational age, but not well contracted.
15. The amount of bleeding varies, but can be severe enough to
cause hypovolemic shock.
Painful cramps/contractions are often present.
16. Before 12 weeks of gestation.
The uterus is small and well contracted with a closed
cervix.
Scant vaginal bleeding, and only mild cramping.
17. In-utero death of the embryo or fetus prior to the periods of
viability with no expulsion of placental or fetal tissue.
Regression of symptoms associated with early pregnancy
(eg, nausea, breast tenderness) and they don't "feel
pregnant" anymore.
Vaginal bleeding or brown discharge may occur.
The cervix is usually closed.
18. • May complicate both spontaneous and induced abortion.
• Fever, chills, malaise, abdominal pain, vaginal bleeding, and
foul smelling vaginal discharge.
• Physical examination may reveal
tachycardia,
tachypnea,
lower abdominal tenderness, and
a boggy, tender uterus with dilated cervix.
The infection may spread, leading to salpingitis, generalized
peritonitis, and septicemia.
Infeetions are usually polymicrobial.
19. Physiologic (ie, believed to be related to
implantation) bleeding
Ectopic pregnancy
GTD
Other Cervical, vaginal, or uterine pathology
20. Initial assessment
• Consider abortion– If at least two of the following are
experienced in a reproductive age: -Vaginal bleeding
-Lower abd. Pain &/or cramp
-Hx of amenorrhea
• Complete clinical assessment is necessary in such patient:
History: ask about:-
LMP
Bleeding(duration, amount)
Cramping(duration, severity)
Abdominal or shoulder pain
Symptoms of infection
21. Physical exam:
V/S
General appearance
General system exam
Abdominal exam( check)
bowel sounds
distension
tenderness-direct
-rebound
Remove any visible products from cervix or vagina!
22. Note(speculum exam)
Amount of bleeding
Cx- dilatation or laceration
Foul smelling discharge
Bimanual exam:
-Size and consistency of uterus
-Pelvic mass
-Pelvic tenderness
-Cx- closed or dilated
-Cx- motion tenderness
23. Laboratory
Hg/Hct, B/G & Rh
Based on clinical assessment when indicated:-
CBC
ESR
U/A
RFT, LFT
Plain film of the abdomen (erect)
Pelvic U/S
hCG
Cx- culture
24. 1)Threatened Abortion
Bed rest, pelvic rest
Avoid intercourse & douching
Monitor progress-V/S,U/S evaluation, Vx bleeding
If sign of infection—Evacuate Ux after antibiotics
coverage
2)Complete abortion
Confirm completeness—U/S
3) Incomplete, Inveitable, Missed abortion
Evacuation of the Ux
4) septic abortion
Broad spectrum antibiotics & Evacuation of the Ux
25. Method of evacuation
a) Surgical method
Electric Vacuum Aspiration(EVA)
Manual Vacuum Aspiration(MVA)
Dilation and evacuation (D & E)
Hysterotomy or hysterectomy
b) Medical method
Prostaglandins(Mifepristone, Misoprostol)
Oxytocin(High dose)
26. Mifepristone/Misoprostol
Mifepristone, 200 mg orally followed 24-48 hours by:
Misoprostol, 400 µg vaginally, buccally, or sublingually
Misoprostol Alone
800 µg vaginally or sublingually, repeated for up to
three doses
Methotrexate/Mlsoprostol
Methotrexate, 50 mg/m2 intramuscularly or orally
followed by:
Misoprostol, 800 µg vaginally in 3-7 days. Repeat if
needed 1 week after methotrexate initially given
27. Higher complications with unsafe abortion.
Short term
Hypovolumic shock(h’ggic shock)
Sepsis
Septic shock
Uterine perforation
Intra-abdominal injury
Heamatometra
Cervical injury
Anesthesia complications
Death
28. Long term
Infertility—secondary to infection, hysterectomy & asherman
syndrome
Tubo-ovarian abscess, hydrosalpinx
Chronic pelvic pain
Dyspareunia
Dysmenorrhea
29. 1) shock
s/s
Anxious, restless, confused or unconscious
Tachycardia, or weak pulse
Tachypnea
Low blood pressure or unrecordable
Pallor skin, conj., palms, mouth
Cold skin, clammy skin
Oliguria
Causes
Severe blood loss
Infection(sepsis)
30. Mx:
Universal measures
• Ensure airway is open
• Turn head & body to the side in case she vomites
• Keep her warm
• Elevate legs
• O2 supplementation
• Fluids: Crystalloids
• Blood transfusion
Hgb< 5mg/100ml/Hct< 15%
• Medicines
If signs of infection- Broad
spectrum antibiotics
31. 2) Uterine perforation
S/S
An instrument( sound, cannula, curette) extends beyond
expected limit
Fat or bowel is found in the tissue removed from the Ux
Severe pain
Unstable V/s
Hypotension in the absence of external bleeding
Mx:
Stabilize the pt
Monitor V/S —If unstable(hypotension)
Immediate Laparatomy
Broad spectrum antibiotics
32. 3) Sepsis
Etiology—Polymicrobial
Symptoms
-Chills, fever, sweating
-Hx of interference
Signs
-Foul smelling vaginal discharge
-Distended abd.
-Tenderness
-Low B/P
Mx:
If in shock—mx as above
Broad spectrum antibiotics
34. Consists of series of medical and related
interventions designed to manage the
complications of spontaneous and induced
abortion, both safe and unsafe, and address a woman’s
related health care needs.
Aim of PAC:
-Reduce maternal morbidity and mortality
-Improve women’s sexual and reproductive health
and lives
Ovulation may resume as early as 2 weeks after an
early pregnancy loss.
35. PAC consists of five elements:
1) Treatment-of unsafe and incomplete abortion and abortion
related complications that are potentially life threatening.
2) Counseling-to identify and respond to women’s emotional
and physical health needs and other concerns.
3) Contraceptive and family planning services-to help women
prevent unwanted pregnancy or practice birth spacing.
36. 4)Reproductive and other health services
-Testing and treating of STI, including HIV/AIDS and
reproductive tract infection
-Preconception care if women wants to become
pregnant
-Infertility screening and treatment
-Screening and counseling for women who experienced
violence
-Counseling for nutritional needs
-Cancer screening-cervical
-ovarian
-endometrial
37. 5)Community and service provider partnership
-to prevent unwanted pregnancy and unsafe abortion
-mobilize resources to help women receive appropriate
and timely care for abortion and its complications.