This document discusses prenatal diagnosis and screening for fetal abnormalities. It defines prenatal diagnosis as detecting abnormalities in the fetus before birth through various screening and testing methods. The goals of prenatal diagnosis are to provide informed choices for couples at risk, provide reassurance, allow for confirmation of disorders, and enable prenatal management or treatment when possible. Several screening modalities are described that use biomarkers like alpha-fetoprotein, human chorionic gonadotropin, unconjugated estriol, and nuchal translucency measurements to detect disorders like Down syndrome, neural tube defects, and chromosomal abnormalities. Integrated screening combining tests is noted to have the lowest false positive rates.
Majority of fetal deaths occur in the antepartum period.
There is progressive decline in maternal deaths all over the world. Currently more interest is focused to evaluate the fetal health. The primary objective of antenatal assessment is to avoid fetal death.
prostaglandin, labour, pregnancy, obstetrics, delivery, normal labour, normal delivery, first stage of labour, induction of labour, pph, post partum haemorrhage, bleeding in pregnancy, abortion
Majority of fetal deaths occur in the antepartum period.
There is progressive decline in maternal deaths all over the world. Currently more interest is focused to evaluate the fetal health. The primary objective of antenatal assessment is to avoid fetal death.
prostaglandin, labour, pregnancy, obstetrics, delivery, normal labour, normal delivery, first stage of labour, induction of labour, pph, post partum haemorrhage, bleeding in pregnancy, abortion
Mandeep Kaur. Associate Professor in a Nursing College.
Modalities of diagnosis of pregnancy. It includes routine personal tests and other pregnancy tests. RH test, Alpha Protein test, Triple test, Fetal Ultrasound, CFTS, Amniocentesis, CVS, Non-Stress Test, And Other so many tests , Contraction Stress Test, Fetal Bio physical Profile,
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This presentation will give a insight into the recent advances in fetal therapy. Hope it might help you
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Presentation for Progesterone Amp. 100 mg/ml and Progesterone pessaries 400mg for treatment of PTB, Recurrent miscarriage, Threatened abortion, Post-natal psychosis.
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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
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
- 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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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.
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
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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!
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
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
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
2. Definition:
‘Prenatal diagnosis is defined as the detection of
abnormalities in the fetus, before birth’
Screening is the process of surveying a population,
usinga specific marker or markers and defined
screening cut-off levels, to identify the individuals
in the population at higher risk for a particular
disorder.
3. The purpose of prenatal diagnosis is not simply to detect
abnormalities in fetal life and allow termination.It rather
have following goals :
Provide a range of informed choice to the couples at risk of
having a child with abnormality.
Provide reassurance & remove anxiety, especially among
high risk groups.
Allow couples at high risk to know that the presence or
absence of the disorder can be confirmed by testing.
Allow the couples the option of appropriate management
( psychological, pregnancy/delivery, postnatal)
To enable prenatal treatment of the fetus.
4. Some Disorders for which PRENATAL DIAGNOSIS is
available:
1. Congenital malformations
2. Chromosomal disorders
3. Non genetic Fetal disorders
Fetal infections, Immune hydrops, DM,Fetal effects of maternal drugs
e.g valproic acid
4. Single gene disorders
-Multiple malformation synd
*Holt oram, Craniosynostosis, Orofacial digital synd
-Hematological disorders
*Thalassemias, Hemoglobinopathies, Hemophilia
-Metabolic Disorders
*Tay sach, Wilson,
-Neuromuscular disorders
*Huntington chorea, Myotonic dystrophy, Fragile X
6. Down’s Syndrome
– Down’s syndrome (DS) is a congenital disorder,
caused by a trisomy of chromosome 21
– risk increases with the mother’s age
7. Incidence of Down’s Syndrome
Down syndrome is a chromosomal disorder caused by
an error in cell division, the likelihood of such an error
occuring increases with maternal age.
This means that an older mother is more likely to give
birth to a child with Down sydrome than her younger
counterpart.
The likelihood of a woman under 30 years of age giving
birth to a child with Down syndrome is less than
1:1000, but increases the older the woman gets (see
chart below), with an incidence of about 1:100 and 1:30
at 40 and 45 years of age respectively.
8. Risk of DS and Chromosomal Abnormalities
at Term
Maternal Age at
Delivery (yr)
Risk of DS Risk of Any
Chromosomal
Abnormality
20 1/1650 1/530
25 1/1250 1/480
30 1/950 1/390
35 1/385 1/180
40 1/100 1/65
45 1/30 1/19
9. Neural tube defects
NTD (Neural tube defects) can affect 1 in 500 infants
– Commonest forms of NTD known as anencephaly or
spina bifida
– Neural tube beneath the backbone fails to develop
definitive diagnosis relies on amniocentesis
– high levels of AFP (Alphafetoprotein) seen in NTD
10. BIOCHEMICAL MARKERS PRENATAL DIAGNOSIS
1- Alpha-fetoprotein (AFP)
a protein synthesized by the fetus is detectable in
maternal serum from week 6 of pregnancy,with a
peak in week 34 of gestation (4 mg / ml), its value
decreasing in 8-12 months after birth.
Measurement of alpha-fetoprotein can be done
from amniotic fluid or from maternal blood.
11. Elevated values of alpha-fetoprotein are found in:
Multiple pregnancies
Skin diseases;
Organ failure;
Congenital nephropathy;
Cystic higroma;
Hepatic necrosis;
Neural tube defects
Abdominal wall defects.
12. Low values of alpha-fetoprotein are recorded in cases
Chromosomal abnormalities
Defects of the placenta
Fetal hydrops
Trophoblastic disease
Diabetic mothers
13. BIOCHEMICAL MARKERS PRENATAL DIAGNOSIS
2-Human Chorionic Gonadotropin
The hormone human chorionic gonadotropin (better
known as HCG) is produced during pregnancy. It is
made by cells that form the placenta, which nourishes
the egg after it has been fertilized and becomes
attached to the uterine wall.
Levels can first be detected by a blood test about 11
days after conception and about 12 - 14 days after
conception by a urine test.
In general the HCG levels will double every 72 hours.
The level will reach its peak in the first 8 – 11 weeks of
pregnancy and then will decline and level off for the
remainder of the pregnancy.
14. There are two common types of HCG tests. A
qualitative HCG test detects if HCG is present in
the blood. A quantitative HCG test (or beta HCG)
measures the amount of HCG actually present in
the blood.
15. What can a low HCG level mean?
A low HCG level can mean any number of things and
should be rechecked within 48-72 hours to see how
the level is changing. A low HCG level could indicate
1- Miscalculation of pregnancy dating
2-Possible miscarriage or blighted ovum
A blighted ovum (also known as “anembryonic pregnancy”) happens when a
fertilized egg attaches itself to the uterine wall, but the embryo does not
develop. Cells develop to form the pregnancy sac, but not the embryo itself.
A blighted ovum occurs within the first trimester, often before a woman
knows she is pregnant. A high level of chromosome abnormalities usually
causes a woman’s body to naturally miscarry.
16. 3- Ectopic pregnancy
An ectopic pregnancy occurs when
the fertilized egg attaches itself in a
place other than inside the uterus.
Almost all ectopic pregnancies
occur in a fallopian tube, and are
thus sometimes called tubal
pregnancies. The fallopian tubes
are not designed to hold a growing
embryo; the fertilized egg in a
tubal pregnancy cannot develop
normally and must be treated. An
ectopic pregnancy happens in 1 out
of 50 pregnancies
17. What can a high HCG level mean?
A high level of HCG can also mean a number of
things and should be rechecked within 48-72
hours to evaluate changes in the level.
Miscalculation of pregnancy dating
Molar pregnancy
A molar pregnancy is an abnormality of the placenta,
caused by a problem when the egg and sperm join
together at fertilization. Molar pregnancies are rare,
occurring in 1 out of every 1,000 pregnancies. Molar
pregnancies are also called gestational trophoblastic
18. Can anything interfere with my
HCG levels?
Nothing should interfere with an HCG level except
medications that contain HCG. These medications
are often used in fertility treatments.
All other medications such as antibiotics, pain
relievers, contraception or other hormone
medications should not have any effect on a test
that measures HCG.
21. BIOCHEMICAL MARKERS IN PRENATAL DIAGNOSIS
4-Unconjugated estriol
Estriol (E3) is one of the three major naturally occurring
estrogens, the others being estradiol (E2) and estrone (E1).
In non-pregnant females, the major estrogen is estradiol
produced by the ovaries.
During pregnancy, estriol is secreted by the placenta and fetus
and becomes the dominant estrogen form.
The primary form of estriol measured during pregnancy is
unconjugated estriol (also referred to as “free” estriol or uE3).
Maternal serum uE3 levels have been used as a functional
marker of the fetal-placental unit and in the evaluation of
pregnancy complications.
22. BIOCHEMICAL MARKERS OF PRENATAL DIAGNOSIS
5- Inhibin - A
Inhibins are glycoprotein hormones of which there are two
molecular forms, inhibin A and inhibin B.
Classically, inhibin is known to have a negative feedback
effect on pituitary follicle-stimulating hormone secretion.
Inhibin A is the predominant molecular form of inhibin in
maternal circulation from 4 weeks of gestation.
The precise biological function of inhibin A in pregnancy is
could be a better marker of placental function than human
chorionic gonadotropin because of its shorter half-life.
The possible clinical applications for the measurement of
inhibin A in early pregnancy could be in predicting
miscarriage, Down's syndrome, preeclampsia, and fetal
growth restriction in the first and/or second trimester
before the onset of the clinical symptoms.
23. BIOCHEMICAL MARKERS OF PRENATAL DIAGNOSIS
6- Pregnancy-associated plasma protein-A
It largest of the pregnancy associated proteins produced
by both the embryo and the placenta during pregnancy
This protein is thought to have several different functions,
including preventing recognition of the fetus by the
maternal immune system, matrix mineralization and
angiogenesis.
Detection of this protein is also suggested as a first and
second trimester diagnostic test for aneuploidies,
including Trisomies 21 or Down’s Syndrome
24. Prenatal Screening Modalities for DS and
trisomy 18
Integrated Prenatal Screening (IPS)
Serum Integrated Prenatal Screening (Serum IPS)
First Trimester Screening (FTS)
Quadruple maternal serum screening (Quad)
Maternal serum screening (Triple)
What is available in your community?
26. Nuchal Translucency
Subcutaneous fluid-filled space located
between back of fetal neck and skin. At
minimum an NT scan will measure CRL to
determine gestational age (GA) and the NT
Crown-rump length (CRL) is the
measurement of the length of human
embryos and fetus from the top of the
head (crown) to the bottom of the
buttocks (rump)
Measured on U/S between 11–13+ 6/7
weeks, measurement is not valid outside
of this time period
NT increases with gestational age
Age CRL
6.1Weeks 0.4 cm
7.Weeks: 1.0 cm
8.Weeks: 1.9 cm
9.Weeks: 2.5 cm
10.Weeks 4.0 cm
12.Weeks 5.5 cm
13.Weeks 6.90 cm
14.Weeks 8.0 cm
27. Nuchal Translucency
Increased NT associated with:
Trisomies 21, 18, 13, triploidy and
Turner syndrome
Spontaneous fetal loss
With normal chromosomes:
cardiac defects, diaphragmatic
hernia, pulmonary defects, skeletal
dysplasias, congenital infection,
metabolic/haem disorders, rare
single gene disorders
Normal pregnancy – chance of a
normal birth varies with size of NT
measurement
NT
measurement
Chance of
normal birth
≤ 3.4mm 95%
3.5 – 4.4mm 70-86%
4.5 – 5.4mm 50-77%
5.5 – 6.4mm 67%
≥ 6.5mm 31%
31. Serum Integrated Prenatal Screening (SIPS)
Serum only - 2 step approach
Combines first and second trimester serum
markers to produce single risk assessment
T1
PAPP-A: 11-13+6/7 weeks
11 weeks is ideal
T2
AFP, uE3, hCG, Inhibin-A: 15–20 weeks
15-17 weeks is ideal
Consider when NT not available
False positive rate lower with a dating ultrasound
32. First Trimester Screening (FTS)
NT measurement: 11 to 13+6/7 weeks
T1 serum markers
PAPP-A, free beta hCG: 11-13+6/7 weeks
11 weeks ideal
NTD screening with MS-AFP and/or
ultrasound is still recommended in T2
33. Quadruple Screening – Quad test
Second trimester maternal serum screening
15-20 weeks – 15-17 weeks optimal
AFP, uE3, HCG, Inhibin-A
Maternal Serum Screening (Triple)
Same as Quad screening but without Inhibin-A
False positive rate lower with a dating ultrasound