PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)Lifecare Centre
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
MODERATOR
DR SHARDA JAIN
DR JYOTI AGARWAL
DR ILA GUPTA
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil BharatiBharati Dhorepatil
What are important factors to be considered important
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of LH
Trigger
Luteal phase support
Pregnancy rate/cycle
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)Lifecare Centre
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
MODERATOR
DR SHARDA JAIN
DR JYOTI AGARWAL
DR ILA GUPTA
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil BharatiBharati Dhorepatil
What are important factors to be considered important
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of LH
Trigger
Luteal phase support
Pregnancy rate/cycle
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
Infertility is typically defined as the inability to achieve pregnancy after
one year of unprotected intercourse. If you have been trying to conceive
for a year or more, you should consider an infertility evaluation.
Ovulation Induction - Simplified - Dr Dhorepatil BharatiBharati Dhorepatil
What are factors to be considered
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of FSH & LH
Trigger
Luteal phase support
Pregnancy rate/cycle
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Healthy Choices are the key!
Healthy diet including raw foods & avoiding processed food or high fat diet is the best way to eliminate toxins from your body. Toxins damage your egg follicles.
Optimization of ovarian stimulation to improve success rate in ‘ART’Apollo Hospitals
ART is defined as the technique used where there is a need for in-vitro preparation or manipulation of gametes. The commonest ARTs are intrauterine insemination (IUI) and in-vitro fertilization (IVF). Ovarian stimulation is required with these procedures to increase the pregnancy rate as ART with natural cycle has a very low pregnancy rate. Optimizing pregnancy rates per cycle is the real basis for ovarian stimulation protocols in ART.
Update on LETROZOLE Current Guidelines for Ovulation Induction Dr. Sharda Jain Lifecare Centre
Update on LETROZOLE Current Guidelines for Ovulation Induction
LET NOT FORGET
WHY
??
LETROZOLE was withdrawn from
Indian market (2012)
“SAFETY ISSUES”
“Could Be Teratogenic In Human”?
Endometriosis still an enigmatic disease dr. sharda jainLifecare Centre
ENDOMETRIOSIS STILL AN ENIGMATIC DISEASE : Introduction DR. SHARDA JAIN DR. JYOTI AGARWAL
DR. JYOTI BHASKER
“Endometriosis remains a riddle wrapped in a mystery inside an enigma”
ENDOMETRIOSIS: THE BITTER TRUTH
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
Infertility is typically defined as the inability to achieve pregnancy after
one year of unprotected intercourse. If you have been trying to conceive
for a year or more, you should consider an infertility evaluation.
Ovulation Induction - Simplified - Dr Dhorepatil BharatiBharati Dhorepatil
What are factors to be considered
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of FSH & LH
Trigger
Luteal phase support
Pregnancy rate/cycle
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Healthy Choices are the key!
Healthy diet including raw foods & avoiding processed food or high fat diet is the best way to eliminate toxins from your body. Toxins damage your egg follicles.
Optimization of ovarian stimulation to improve success rate in ‘ART’Apollo Hospitals
ART is defined as the technique used where there is a need for in-vitro preparation or manipulation of gametes. The commonest ARTs are intrauterine insemination (IUI) and in-vitro fertilization (IVF). Ovarian stimulation is required with these procedures to increase the pregnancy rate as ART with natural cycle has a very low pregnancy rate. Optimizing pregnancy rates per cycle is the real basis for ovarian stimulation protocols in ART.
Update on LETROZOLE Current Guidelines for Ovulation Induction Dr. Sharda Jain Lifecare Centre
Update on LETROZOLE Current Guidelines for Ovulation Induction
LET NOT FORGET
WHY
??
LETROZOLE was withdrawn from
Indian market (2012)
“SAFETY ISSUES”
“Could Be Teratogenic In Human”?
Endometriosis still an enigmatic disease dr. sharda jainLifecare Centre
ENDOMETRIOSIS STILL AN ENIGMATIC DISEASE : Introduction DR. SHARDA JAIN DR. JYOTI AGARWAL
DR. JYOTI BHASKER
“Endometriosis remains a riddle wrapped in a mystery inside an enigma”
ENDOMETRIOSIS: THE BITTER TRUTH
Endometriosis an overview by dr. sharda Jain, Dr. Jyoti Agarwal , Dr. Jy...Lifecare Centre
Endometriosis :An Overview
Presented in Endometriosis update in Delhi June (2016) Hotel Leela
EB Guidelines
RCOG: Evidence-based Clinical, 1999
Endometriosis and infertility. ASRM, 2004.
ACOG. Endometriosis in adolescents, 2005.
ESHRE guideline for the diagnosis and treatment of endometriosis, 2005.
Endometriosis and infertility. ASRM, 2006.
Endometriosis: diagnosis and management.
Fertility: Assessment and Treatment for People with Fertility Problems. NICE, 2013.
ESHRE guideline: management of women with endometriosis,2014.
Endometriosis An Enigmatic Disease, DR. SHARDA JAIN Dr. Jyoti Agarwal Dr. Jyo...Lifecare Centre
ENDOMETRIOSIS STILL AN ENIGMATIC DISEASE
Endometriosis: The Pain That Keeps on Giving
“Endometriosis remains a riddle wrapped in a mystery inside an enigma”
Recurrence of endometriosis is fairly common; some studies suggest the rate of recurrence to be as high as 40%. Most common cause of recurrence is incomplete resection in primary surgery and microscopic foci which escapes detection.
The Newer Concepts forReduced Surgery to preserve fertility in Endometrios...Lifecare Centre
The Newer Concepts forReduced Surgery to preserve fertility in Endometriosis
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DILEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Endometriosis and fertility how and when to treatDr Aditya Keya
Endometriosis can influence fertility in several ways: distorted anatomy of the pelvis, adhesions, scarred fallopian tubes, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy, and altered egg quality.
Endometriosis is known to have a remarkably negative effect on the Quality of Life of the women. Surgery is considered when medical therapy is unsuccessful or in the setting of infertility. A high recurrence rate is reported in advanced stages of endometriosis. Thus, Complete excision and prevention of recurrence is particularly important.
The Newer Concepts In Endometriosis Management : Dr Sharda JainLifecare Centre
The Newer Concepts In
Endometriosis Management
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DELEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Strategies for Improving Success Rates in ART PARTLifecare Centre
Strategies for Improving Success Rates in ART
Part - 2
Strategies for Improving Success Rates in ART
Tailoring Controlled Ovarian Stimulation
Strategies for Luteal Phase in ART cycles
Endometrial Receptivity Array
How to optimize success rates in ART? : Dr Sharda JainLifecare Centre
How to optimize success rates in ART? : Dr Sharda Jain
How to improve success rates in ART?
The big debate कार्य में आनंद
Evolution of In-vitro Fertilization (IVF)
Factors Influencing IVF Success Ist Part
Strategies for Improving Success Rates in ART Second Part
Innovations & Breakthroughs in IVF Part Three
OPEN DEBATE
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda JainLifecare Centre
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
Introduction
Social egg freezing (oocyte cryopreservation for non-medical reasons) has evolved as a proactive option for women looking to extend their reproductive possibilities past their peak childbearing years
It is the process of saving or protecting eggs, or reproductive tissues so that a person can use them to have biological children in future
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New devel...Lifecare Centre
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New development from France for Indian Gynaecologists & public to know :Dr Sharda Jain
CMV is a common herpesvirus that can infect people of all ages, including pregnant women.
CMV is not the same as HSV (herpes simplex virus), although they belong to the same viral family.
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.
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
- 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
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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.
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
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
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.
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.
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
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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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.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. Which symptoms areWhich symptoms are
associated with or predictive ofassociated with or predictive of
the diagnosis ofthe diagnosis of
endometriosis?endometriosis?
?
BIGQUESTION1
3. Delay to Diagnosis
8 to 10 years
Delay of
• 10 years in Germany and Austria
• 8 years in the UK and Spain,
• 7 years in Norway, Italy
• 4–5 years in Ireland and Belgium
INDIA--- ?
4. In the presence of gynaecological symptoms
such as:
• dysmenorrhoea – 40%
• non-cyclical pelvic pain– upto 80%
• deep dyspareunia – 44%
• infertility -- 40%
• fatigue in the presence
of any of the above.
Clinicians should consider the diagnosis of
Endometriosis:
5. In women of reproductive age with
non-gynaecological cyclical symptoms:
• dyschezia
• dysuria
• haematuria
• rectal bleeding
• shoulder pain.
6. What findings during
clinical examination are
predictive for the
Presence and localization
of pelvic endometriosis?
BIGQUESTION2
?
7. Clinicians should perform Clinical Examination
in all women suspected of endometriosis
• It should include both-
• Per Abdomen
• Per Speculum
• Per Vaginum
• Highest predictive value
• -- Menstruation
8. For adolescents and/or women without
previous sexual intercourse
• Rectal examination can be helpful for
the diagnosis of endometriosis.
• Only after Counselling and Verbal
Consent
9. Suspect Deep Endometriosis
• Women with (painful) induration and/or
nodules of the Rectovaginal wall found
during clinical examination or
• Visible vaginal nodules in the posterior
vaginal fornix
11. Be Obsessed with Endometriosis
• In women suspected of the disease
even if the clinical examination is
NORMAL
12. Can the diagnosis ofCan the diagnosis of
endometriosis be made byendometriosis be made by
application of specificapplication of specific
medical technologies?medical technologies?
?
BIGQUESTIONNO.3BIGQUESTIONNO.3
13. The Diagnosis of Endometriosis
Based on the
• History
• Symptoms and signs,
• Corroborated by physical examination &
imaging techniques
• And finally proven by histological
examination of specimens collected during
laparoscopy
14. Laproscopy & Histology
– Gold Standard
• Perform a laparoscopy to diagnose endometriosis
• Confirm a positive laparoscopy by histology, since
positive histology confirms the diagnosis of
endometriosis even though negative histology does not
exclude it.
• Clinicians should obtain tissue for histology to exclude
rare instances of malignancy.
17. Ultrasound for Rectal Endometriosis
• TVS is highly operator dependent, and
experience is often lacking
• TVS is not recommended for diagnosis of
rectal endometriosis
• 3D ultrasound to diagnose rectovaginal
endometriosis is not well established
18. • Clinicians should assess ureter, bladder and
bowel involvement by additional imaging if
there is a suspicion based on
history or physical examination of deep
endometriosis.
• Barium enema, Transvaginal sonography
(TVS), Transrectal sonography and MRI
DEEP ENDOMETRIOSIS
19. Magnetic Resonance Imaging
????
• Clinicians should be aware that the usefulness
of magnetic resonance imaging (MRI)
to diagnose Peritoneal Endometriosis
is not well established
20. Biomarkers ????
Clinicians are recommended not to use
biomarkers to diagnose endometriosis in
• endometrial tissue,
• menstrual or uterine fluids
• and/or immunological biomarkers, including
CA-125, in plasma, urine or serum
22. Empirical treatment of pain ?Empirical treatment of pain ?
?
BIGQUESTIONNO.4BIGQUESTIONNO.4
23. Clinicians should
• Counsel women with symptoms presumed
to be due to endometriosis thoroughly
• Empirically treat them with
1. adequate analgesia,
2. combined hormonal contraceptives or
progestagens.
24. Are hormonal therapiesAre hormonal therapies
effective for painful symptomseffective for painful symptoms
associatedassociated
with endometriosis?with endometriosis?
?
BIGQUESTIONNO.5BIGQUESTIONNO.5
25. Clinicians are recommended
• Prescribe hormonal treatment as one of the options
1. Hormonal contraceptives
2. Progestagens
3. Anti-progestagens
4. GnRH agonists
• To take patient preferences, side effects, efficacy,
costs and availability into consideration when
choosing hormonal treatment
26. Progestagens and anti-progestagens.
PROGESTAGENS [medroxyprogesterone acetate
(oral or depot), dienogest, cyproterone acetate,
norethisterone acetate or danazol] or
ANTI-PROGESTAGENS (gestrinone) as one of the
options, to reduce endometriosis-associated pain
• To take the different side-effect profiles of
progestagens and anti-progestagens into account
27. LNG-IUS
• To consider levonorgestrel-releasing
intrauterine system (LNG-IUS) as one of the
options to reduce endometriosis-associated
pain
28. GnRH Agonist
• Use GnRH agonists (nafarelin,leuprolide,
buserelin, goserelin or triptorelin), although evidence
is limited regarding dosage or duration of treatment
• Prescribe hormonal add-back therapy to
coincide with the START of GnRH agonist therapy
• To give careful consideration in young women
and adolescents
29. Aromatase inhibitors
• In women with pain from rectovaginal
endometriosis, refractory to other
medical or surgical treatment,
Consider prescribing aromatase
inhibitors in combination with oral
contraceptive pills, progestagens or GnRH
analogues
30. Are analgesics effective forAre analgesics effective for
symptomatic relief of painsymptomatic relief of pain
associated withassociated with
endometriosis?endometriosis?
BIGQUESTIONNO.6BIGQUESTIONNO.6
31. The GDG recommends that
clinicians should consider NSAIDs
or other analgesics to reduce
endometriosis-associated pain.
NSAIDS
32. Is surgery effective for painfulIs surgery effective for painful
symptoms associated withsymptoms associated with
endometriosis?endometriosis?
?
BIGQUESTIONNO.7BIGQUESTIONNO.7
33. Laparotomy and laparoscopy are equally
effective
Laparoscopic surgery is usually associated
• with less pain,
• shorter hospital stay
• quicker recovery
• better cosmetic outcome,
Laparoscopy is usually preferred
34. • When endometriosis is identified at
LAPAROSCOPY, clinicians are recommended to
surgically treat endometriosis,
as this is effective for reducing endometriosis-
associated pain, i.e.
‘SEE AND TREAT’
35. • Clinicians may consider both ablation and
excision of peritoneal endometriosis
• Excision of lesions could be preferential
PERITONEAL ENDOMETRIOSIS
36. Ovarian Endometrioma
CYSTECTOMY
• PERFORM CYSTECTOMY instead of drainage
and coagulation, as cystectomy reduces
endometriosis-associated pain
• CYSTECTOMY NOT CO2 laser vaporization
because of a lower recurrence rate of the
endometrioma
37. Deep Endometriosis
• Clinicians can consider performing
Surgical removal of deep endometriosis,
as it reduces endometriosis-associated pain
and improves quality of life
38. Hysterectomy
• Hysterectomy with removal of the ovaries
and all visible endometriosis lesions
1. in women who have completed their family
2. failed to respond to more conservative
treatments.
.
Women should be informed that
hysterectomy WILL NOT
necessarily cure the symptoms or the disease.
39. Surgical interruption of pelvic nerve pathways.
• Clinicians should not perform laparoscopic
uterosacral nerve ablation (LUNA)
• Clinicians should be aware that presacral
neurectomy (PSN) is effective to reduce
endometriosis-associated midline pain,
but it requires a high degree of skill and is a
potentially hazardous procedure
40. Are preoperative hormonal therapies effective
for treatment of pain?
• Clinicians should not prescribe preoperative
hormonal treatment to
improve the outcome of surgery for pain in
women with endometriosis
41. Are short-term post-operativeAre short-term post-operative
hormonal therapies effective forhormonal therapies effective for
treatmenttreatment
of pain?of pain?
?
BIGQUESTIONNO.8BIGQUESTIONNO.8
43. Is there a role for secondaryIs there a role for secondary
prevention of disease and painfulprevention of disease and painful
symptoms in women treated forsymptoms in women treated for
endometriosis?endometriosis?
?
BIGQUESTIONNO.9BIGQUESTIONNO.9
44. Secondary Prevention
• Interventions to prevent the recurrence of pain
symptoms or the recurrence of disease in the long-
term, defined as more than 6 months after surgery.
• The GDG states that there is a role for prevention of
recurrence of disease and painful symptoms in
women surgically treated for endometriosis.
• The choice of intervention depends on patient
preferences, costs, availability and side effects.
45. • In women operated on for an endometrioma (≥3
cm),
Ovarian Cystectomy,
instead of drainage and electrocoagulation
• After cystectomy in women not immediately
seeking conception, prescribe combined
hormonal contraceptives
Secondary Prevention of Ovarian
Endometrioma
46. • Post-operative use of a LNG-IUS or a
combined hormonal contraceptive for at
least 18–24 months,
SECONDARY PREVENTION
OF ENDOMETRIOSIS
Endometriosis-associated dysmenorrhoea,
not for non-menstrual pelvic pain or Dyspareunia
48. • Surgical removal of symptomatic extragenital
endometriosis, when possible, to relieve
symptoms
• When surgical treatment is difficult or
impossible,
Medical treatment of extragenital
endometriosis to relieve symptoms
EXTRAGENITAL ENDOMETRIOSIS
49. CASE STUDY
Our Experience at Lifecare
• CASE 1
• A 19 old girl with pain abdomen.
• P/A – a mass upto 16 weeks.
• USG – Bilateral Ovarian endometrioma
50. • Patient and parents counselled
1. Modality of treatment – NEEDS SURGERY
2. Loss of Ovarian tissue
3. Recurrence ( 20% in 2 years, 50% in 5 years)
• Underwent laproscopy bilateral cystectomy.
• Put on combined continuous oral contraceptives.
• Two year follow up – no recurrence.
51. Case 2
• 26 year old , P2 , does not want a child
• Dysmenorrhea and dyspareunia.
• P/V – fixed retroverted uterus, tender
• TVS – adherent ovaries , restricted mobility
adenomyosis
52. • Treatment Offered:
Laparoscopy with ablation of deposits and
adhesiolysis
• Mirena inserted at same sitting
• Patient is asymptomatic at 1 year follow up.
53. TAKE HOME MESSAGE
• High Suspicion of Endometriosis
• Emperical Medical Treatment can be started
without confirmation by Laproscopy
• Laproscopy with histology is the gold
standard.
• Always SEE and TREAT on Laproscopy
• Use modalities for Secondary Prevention after
surgery