neonatal hypothermia is a very emergency condition. if we identify this in early stage we can save the life of neonate. all should know about the maintaining the temperature if the neonate is in our home.
neonatal hypothermia is a very emergency condition. if we identify this in early stage we can save the life of neonate. all should know about the maintaining the temperature if the neonate is in our home.
Management of hypoxic ischemic encephalopathy (HIE) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Management of hypoxic ischemic encephalopathy (HIE) . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
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
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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
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.
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.
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
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.
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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 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
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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
3. Definition
Birth Asphyxia-defined as the inability to initiate respirations and requiring
resuscitation.
Asphyxia is a biochemical term that is characterized by progressive
hypoxia, hypercarbia and acidosis and is a consequence of compromise
in placental blood flow – the definition that is commonly agreed upon is a
cord arterial pH < 7.00 (severe or pathologic fetal acidemia )
4. Epidemiology
Asphyxia/HIE in 2-9/1000 live births.
Cerebral palsy in 1-2/1000 live births, but only 8-17% of CP explained by
probable perinatal asphyxia.
Death rate ~11% in term infants, severe sequela in 0.3%o
In premature infants incidence of HIE, deaths and handicap much higher
5. Causes of Asphyxia in the neonate
Interrupted umbilical circulation (cord compression)
Inadequate maternal-placental perfusion (hypotension,
hypertension, abnormal uterine contractions)
Impaired maternal oxygenation (cardiopulmonary disease,
anemia)
Altered placental gas exchange (abruption, p. previa,
insufficiency)
Failure of the neonate to accomplish lung inflation and
successful transition from fetal to neonatal cardiopulmonary
circulation (heart, lung, chest, brain, nerves, muscles,
metabolic)
6. Pathophysiology
Adaptive responses: redistribution of blood to brain, heart and
adrenals; term infant more resistant than adults and premature
infants.
Impairment of cerebrovascular autoregulation due to cellular
injury and acidosis/hypercarbia.
Circulatory changes during asphyxia (brain injury occurs only
when asphyxia severe enough to impair cerebral blood flow
(CBF))
Loss of cerebrovascular autoregulation due to hypercapnia,
hypoxemia and acidosis;
Initially secondary increase in CBF
After prolonged asphyxia decrease in CBF
7. Clinical Presentation
The majorities do not exhibit overt neurological
features or subsequent neurological evidence ofbrain
injury.
Occurrence of neonatal neurologic syndrome shortly
after birth is a sign for recent (i.e., intrapartum)
severe insult.
Occurrence of seizures within the first12-24 hrs after
insult
Posturing- opisthotonus, extension
HIE
8. Hypoxic Ischemic Encephalopathy
Stages 1- 24-48 hrs
hyperalert, awakefulness state,
sympathetic stimulation, Increased muscle tone, brisk reflexes
Stage 2- 4-5 days
lethargic, suppressed primitive reflexes,
hypotonic, seizures,
Stage 3- 7-14 days or more
stuporous, comatose, flaccid, posturing
abnormally, seizures, ±↑ICP
Depressed reflexes and cranial nerve palsies are common findings.
F. Hypoxic ischemic injury
+ or – coexistence of skull fracture
+ or -subdural hematoma
+ or – subarachnoid haemorrhage
9. 9
Asphyxia in the Neonate
- Multiple Organ involvement -
CVS: shock, hypotension, TI, myocardial necrosis, congestive
heart failure, ventricular dysfunction
Renal: oligo-anuria, tubular/cortical necrosis, renal failure
Liver: cell injury, hyperbilirubinemia, decreased clotting factors -
bleeding
GIT: paralytic ileus, NEC after 5-7 days
Lungs: RDS, pulmonary hemorrhage, PPHN
Hematologic: thrombocytopenia, DIC, increased nucleated red
blood cells
Metabolic: acidosis, hypoglycemia, hypocalcemia, hyponatremia,
SIADH
10. 10
Asphyxia in the Neonate
- Diagnosis -
FHR patterns, obstetric and delivery history
careful history, physical exam, lab studies
Ultrasonography with Doppler (method of choice for IVH, necrotic
changes in the brain)
EEG (best in first few hours after birth)
CT scan (later valuable)
MRI (best! delayed myelinization, even in mild cases)
11. Management
Optimal management is prevention
Immediate resuscitation
–adequate ventilation
-adequate oxygenation
adequate perfusion (Monitor BP, fluid rescusc, dopaminejkg
correct metabolic acidosis
-A normal serum glucose level
-control of seizures
-prevention of cerebral oedema
12. 12
Asphyxia in the Neonate
- Treatment -
Immediate resuscitation of apneic infant (may be
primary (spontaneous resuscitation possible) or
secondary apnea (spontaneous resuscitation not
possible))
Adequate ventilation (pCO2 35-45 mmHg): Resolve
hypercarbia
adequate oxygenation (pO2 > 40 mmHg in preterm,
pO2 > 50 mmHg in term): hyperoxia may lead to
further secondary damage
13. 13
Asphyxia in the Neonate
- Treatment -
seizures: phenobarbital first choice, use high dose (40
mg/kg), better outcome, prophylactic use
controversial, stop when EEG normal and no seizures
during last 2 months; alternatives - phenytoin
prevent cerebral edema: fluid restriction (60
ml/kg/day), look out for SIADH, steroids and osmotic
agents controversial
support all vital systems: may require ventilation,
pressure support, TPN, diuretics etc.
14. 14
Asphyxia in the Neonate
-Prognosis -
Most survivors do not have any sequelae!
death 12.5%, neurologic handicap 14.3%
low predictive value of depressed FHR, Apgar score, meconium-stained
amniotic fluid, low pH, neurologic depression after birth
15. 15
Asphyxia in the Neonate
-Poor prognosis -
Apgar score 0-3 at 20 min
presence of multiorgan failure (oliguria > 24 hrs)
HIE stage 3: 80% deaths, survivors severely affected
HIE stage 2 beyond 5 days
duration of neurological signs > 1-2 weeks (but ability to nipple feed carries
excellent prognosis)
neonatal seizures in first 12 hrs
abnormal MRI in first 72 hrs
poor EEG patterns (burst-suppression on any day; normal initial EEG good
prognosis)
16. Prevention
Easy access to good ANC.
Optimal Mnx of Labour and Delivery.
Resuscitation equipment and personnel trained in its use to be
available for each delivery!
17. References
Behrman, R. E. (et el) Nelson Essentials of Pediatrics (6th ed). Saunders
Elsevier.,Philadelphia, 2011.
Clayden, G. , Lissauer, T. Illustrated Textbook of Paediatrics (4th ed).
Mosby Elsevier, China, 2012.
Wittenberg D. F. , Coovadia’s paediatrics & Child health (6th ed). Oxford
University press, South Africa, 2009.
Medscape: Hypoxic ischaemic encephalopathy
