Carbetocin is a synthetic oxytocin analogue that is longer acting than oxytocin. It has a half-life of 40 minutes compared to 4-10 minutes for oxytocin. Studies show carbetocin is as effective or more effective than oxytocin in preventing postpartum hemorrhage following both vaginal and cesarean deliveries. It requires only a single dose rather than continuous infusion and does not cause uterine receptor desensitization like oxytocin. The WHO recommends carbetocin as an effective first-line uterotonic for preventing excessive bleeding after childbirth.
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
It is considerable cycle variability in the adolescent years. Regular ovulatory menstrual cycles occur every 21 to 35 days and last up to 7 days, with an average blood loss of 25 to 69 mL. Many patients complain of menstrual problems that actually fall within normal variations. In the first year after menarche, 50% of cycles are anovulatory, but 80% still fall in the normal range for duration. By the third year of menarche, 95% of menstrual cycles fall into this range. Charting the menstrual flow on a calendar can be helpful to clarify normal versus abnormal cycles. Cycles that fall outside of the norm should be evaluated for underlying pathology. There are multiple causes for abnormal uterine bleeding in adolescents, the most likely cause is dysfunctional uterine bleeding (DUB) due to an immature hypothalamic-pituitary-ovarian (HPO) axis, causing an ovulatory cycles and irregular bleeding
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
Anti-Müllerian Hormone (AMH) is critical for physiologic involution of the Mullerian ducts during sexual differentiation in the male foetus.
In women,AMH is a product of the small antral follicles in the ovaries and serves to function as an autocrine and paracrine regulator of follicular maturation
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
It is considerable cycle variability in the adolescent years. Regular ovulatory menstrual cycles occur every 21 to 35 days and last up to 7 days, with an average blood loss of 25 to 69 mL. Many patients complain of menstrual problems that actually fall within normal variations. In the first year after menarche, 50% of cycles are anovulatory, but 80% still fall in the normal range for duration. By the third year of menarche, 95% of menstrual cycles fall into this range. Charting the menstrual flow on a calendar can be helpful to clarify normal versus abnormal cycles. Cycles that fall outside of the norm should be evaluated for underlying pathology. There are multiple causes for abnormal uterine bleeding in adolescents, the most likely cause is dysfunctional uterine bleeding (DUB) due to an immature hypothalamic-pituitary-ovarian (HPO) axis, causing an ovulatory cycles and irregular bleeding
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
Anti-Müllerian Hormone (AMH) is critical for physiologic involution of the Mullerian ducts during sexual differentiation in the male foetus.
In women,AMH is a product of the small antral follicles in the ovaries and serves to function as an autocrine and paracrine regulator of follicular maturation
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Abortions and Maternal Termination of Pregnancy pptMichael Kino
Abortion means spontaneous or induced expulsion of products of conception before the period of viability( 28 weeks).
In medical practice, the abortion occurs in 1st trimester, miscarriage in the 2nd trimester and premature labor in the 3rd trimester.
legally all the above terms are synonymous.
Case Report on Invasive Mole. Gestational Trophoblastic Neoplasia (GTN) encom...Niranjan Chavan
Gestational Trophoblastic Neoplasia (GTN) encompasses a suite of rare but significant gynecological malignancies arising from aberrant placental trophoblast cells. As medical professionals and researchers, our comprehension of GTN's complexities is crucial for accurate diagnosis and effective treatment. This introduction serves to illuminate the key features, diagnostic procedures, and treatment protocols associated with GTN, helping to navigate the intricate landscape of this disease.
Peripartum cardiomyopathy (PPCM) is a rare form of heart failure that occurs during the last month of pregnancy or within the first five months postpartum. It presents significant challenges in diagnosis and treatment due to its overlap with symptoms of normal pregnancy and postpartum changes. This condition varies in incidence across different racial groups and geographical locations, with a notable occurrence in the United States and southern India.
DR. NNC LAPAROSCOPY IN PREGNANCY IAGE VARANASI, 17TH MARCH 2024.pptxNiranjan Chavan
Our journey will navigate the evolution of laparoscopy in the context of pregnancy, detailing key milestones, breakthroughs, and advancements in technology and techniques. The presentation highlights how laparoscopy has revolutionized the diagnosis and treatment of conditions such as ectopic pregnancy, ovarian cysts and other gynecological disorders during pregnancy.
Optimising Delivery Of 1kg Fetus - Special Considerations.pptxNiranjan Chavan
After an uncomplicated vaginal birth in a health facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth.
VACCINE IN WOMEN TOWARDS SDG 2030 DR.N N CHAVAN 10012024 AICOG HYDERABAD.pptxNiranjan Chavan
In our presentation today, we will unravel the transformative power of vaccines in women, aligning with the Sustainable Development Goals (SDGs) for 2030. By exploring the pivotal role of vaccinations, we aim to elucidate how they contribute to women's health, empowerment, and overall well-being. Through this lens, we envision a future where widespread vaccine access propels us closer to achieving the SDGs and ensures a healthier, more equitable world for women globally.
RRRR IN OBSTETRIC HEMORRHAGE 09012024 AICOG 2024 HEYDERABAD.pptxNiranjan Chavan
This presentation focuses on a critical aspect of maternal care: "Reducing Maternal Mortality through Rapid Response in Obstetric Haemorrhage" (RRRR). As we navigate through this presentation, let us collectively work towards advancing our understanding and application of RRRR in obstetric care to safeguard the well-being of mothers during childbirth.
Anemia is a condition in which the number of red blood cells and/OR their oxy...Niranjan Chavan
Anemia is a condition in which the number of red blood cells and/OR their
oxygen-carrying capacity is insufficient to meet the body’s physiological needs.
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It ...Niranjan Chavan
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It usually occurs during the third trimester of pregnancy. But it also can develop in the first week after childbirth
Guidelines & Identification of Early Sepsis DR. NN CHAVAN 02122023.pptxNiranjan Chavan
Here is a highly informative session on guidelines and identification of early sepsis as it is critical for timely intervention and improved patient outcomes.
PAST, PRESENT AND FUTURE IN OBGYN INFECTIONS 01102023.pptxNiranjan Chavan
Today, we face new infectious threats; but also benefit from advanced diagnostics and treatments. Looking ahead, it’s crucial to continue
adapting to emerging pathogens, implement stringent preventive measures, and
leverage cutting-edge technologies to ensure the safety and well-being of our patients in the ever-evolving landscape of obstetrics and gynecology.
Vaccination during pregnancy is crucial to protect both the mother and the developing baby. It helps prevent serious complications and ensures a healthier start in life. #VaccinateForTwo 🤰💉
Explore a comprehensive presentation on Invasive Cervical Carcinoma, shedding light on its causes, symptoms, diagnosis, treatment options, and preventive measures.
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.
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 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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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.
- 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
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
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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of 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
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
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
2. DISCLAIMER
• I do not have any conflict of interest and I have not received any grant, this presentation is
only for academic purposes.
3. DR. NIRANJAN CHAVAN
MD, FCPS, DGO, MICOG, DICOG, FICOG, DFP,
DIPLOMA IN ENDOSCOPY (USA)
Professor and Unit Chief, L.T.M.M.C & L.T.M.G.H, Sion Hospital
Joint Treasurer Elect, FOGSI (2021-2024)
Vice President, MOGS (2021-2022)
Member Oncology Committee, SAFOG (2020-2022)
Dean AGOG & Chief Content Director, HIGHGRAD & FEMAS Courses
Editor-in-Chief, FEMAS & JGOG Journal
National Co-Ordinator, FOGSI Medical Disorders in Pregnancy Committee (2019-2021)
Chair & Convener, FOGSI Cell Violence Against Doctors (2015-16)
Member, Oncology Committee AOFOG (2013-2015)
Co-Ordinator of 11 batches of MUHS recognized Certificate Course of B.I.M.I.E at
L.T.M.G.H (2010-16)
Member, Managing Committee IAGE (2013-17), (2018-20)
Editorial Board, European Journal of Gynaec. Oncology (Italy)
Course Co-Ordinator of 3 batches of Advanced Minimal Access Gynaec Surgery (AMAS) at LTMGH
(2018-19)
4. Postpartum haemorrhage or PPH is defined as a cumulative blood loss
• ≥500ml following vaginal delivery or
• ≥1000ml following cesarean delivery
• or any amount of blood loss within 24hours after birth evidenced by a rise in pulse rate, and falling
blood pressure
• Primary PPH: First 24 hrs of delivery
• Secondary PPH: 24 hrs to 12 weeks after delivery
POSTPARTUM HAEMORRHAGE (PPH)
5. CAUSES OF PPH: FOUR “T”
Medicine (Baltimore). 2019 Nov; 98(47): e17911, Am Fam Physician. 2017 Apr 1;95(7):442-449
The most common cause of postpartum hemorrhage is uterine atony, which results from
poor contraction of the uterus after childbirth
6. RISK FACTORS OF PPH
• Prolonged labor
• Grand-multipara
• Augmented &/ Precipitated labor
• History of PPH
• Overdistended uterus (Macrosomia, Twins, Polyhydrominos)
• Operative delivery
• Chorioamnionitis
7. CASE 1
• 33 yr G4P3L3, Previous 3 normal deliveries with 37.5 weeks
gestation came with c/o pain in abdomen and leaking PV since
2 hours.
• On examination –
• Patient was vitally stable, afebrile
• P/A- Uterus full term size, Cephalic floating, FHS present,
140bpm, regular.
• P/V- Cervical os 8cm dilated, 80% effaced, Vertex, Station +2,
Liquor clear.
8. • Patient progressed normally and delivered
vaginally a male baby of 2750g.
• Placenta and membranes expelled
completely and spontaneously.
• Patient was given 10units oxytocin i.m.
• After 15 minutes, patient started bleeding
profusely with passage of 200 to 300cc of
clots
9. • On examination, Patient was conscious, oriented with
pulse of 110bpm and BP of 90/60 mm Hg. She was
immediately started on iv colloids.
• P/A - Uterus was flabby -> Inj Pitocin 40IU drip started.
• P/S – Cervical tracing done, no cervical or vaginal tear
present.
• P/V – Clots of 500cc present
10. • Uterus was still flabby
• Inj Carbetocin 100microgram 1 dose iv given
• Continuous Bimanual Uterine Massage given.
11. • Uterus tone gained back.
• Patient vitally stable.
• Patient observed for every 15minutes for 2 hours to watch for
any bleeding
12. ACTIVE MANAGEMENT OF 3RD STAGE OF
LABOUR
• Active management of Third Stage of labour includes:
• Administration of uterotonics after delivery of anterior
shoulder i.e. Inj Oxytocin 10 IU i.m. stat
• Controlled cord traction
• Bimanual uterine massage
13. CASE 2
• 25year old, G2P1L1prev 1 FTND with DCDA twins with 36.5 weeks gestation came with c/o
Pain Abdomen with scan showing 1st twin in breech.
• On Examination
• Patient was conscious, oriented, afebrile, vitally stable
• P/A- Uterus was fullterm size, multiple fetal parts felt, FHS 1 present/150bpm/regular, FHS 2
present/138bpm/regular, Activity ++
• P/V – Cervical os 3 cm dilated, 40% effaced, breech, station +1, No leak
14. • Patient shifted for Emergency Lower segment
caesarean section .
• Patient delivered a female baby of 2020g and another
female baby of 2000g.
• Placenta and membranes delivered completly.
• Uterus atonic after taking uterine sutures, bleeding
present.
15. • Inj Oxytocin 10 IU i.m. and 40 IU iv infusion started
• Uterus tone not regained
• B Lynch sutures taken and concomitantly Inj Carbetocin 100micro gram slow iv given
• Bleeding controlled, Patient stable
17. PPH AFTER CAESAREAN DELIVERY
PPH is more likely to happen after caesarean as compared to vaginal deliveries
Approx 36% of caesarean deliveries are complicated by PPH1
1. BMC Pregnancy Childbirth 17, 399 (2017)
2. Anaesthesia 2019; 74: 1219–22,
It is common practice to give a uterotonic drug following delivery of the neonate during caesarean
section
And therefore….
International consensus
statement on the use of
uterotonic agents during
caesarean section
2019
Uterotonic agents like Oxytocin/ Carbetocin are recommended for routine
administration immediately after delivery of the fetus during caesarean section
to prevent postpartum haemorrhage2
18. UTEROTONIC DRUGS
Posterior pituitary hormone &
analogues
Ergot alkaloids Prostaglandins $ analogues
• Oxytocin
• Carbetocin
• Ergometrine
• Methylergometrine
• PGE2
• Misopristol
• Carboprost
First-Line Agents Second-Line Agents
Oxytocin considered as a gold standard
treatment for the prevention of PPH
19. OXYTOCIN IS…
half-life of 4–10 min;
Duration of action: 15-20 mins
It must be administered as a continuous
intravenous infusion to attain sustained
uterotonic activity throughout the surgical
procedure & immediate postpartum period
Short acting
Oxytocin is used for inducing or augmenting
labour may desensitize the oxytocin receptors,
thereby impairing oxytocin’s post-delivery effects
on uterine contractility
Causes Receptor desensitization
BMC Pregnancy Childbirth. 2017; 17: 399
WHO recommendations: Uterotonics for the prevention of postpartum haemorrhage.
Geneva: World Health Organization; 2018. Web annex 7, Choice of uterotonic agents
20. Various International bodies and trials have used/
recommended different doses of Oxytocin, thus
there is no consistency in dosage regimen, which
results into errors in its administration
Variation in dosage
The Institute for Safe Medication Practices (ISMP)
added IV oxytocin to their list of high-alert
medications meaning minor errors can cause
significant harm to patient
Oxytocin: High alert medication
21. NEED OF THE HOUR..
Longer acting
Single dose of administration-No variation in dosage regimens
Devoid of repeated administration, Ease of one time administration
Superior efficacy or similar efficacy as that of Oxytocin
Devoid of receptor desensitization
Superior side effect profile over oxytocin
22. WHAT IS CARBETOCIN?
Carbetocin is a synthetic analogue of human oxytocin with some structural modifications as
shown below
These structural modifications increases half life of carbetocin thereby prolonging its
pharmacological effects
BJOGJuly 2010 Volume117, Issue8,Pages 929-936
23. WHAT IS CARBETOCIN??
Has been added to the WHO Essential Medicines List of uterotonics
for the prevention of excessive bleeding after childbirth
Press releases
TUESDAY, 09 JULY 2019
The safest and most effective
medicines needed in a health
system
24. It acts by acting through Oxytocin receptors which causes the Uterus to contract
1. Oxytocic
2. Uterotonic
3. Antihaemorrhagic (causes slight thickening of blood)
HOW CARBETOCIN WORKS?
25. CARBETOCIN VS OXYTOCIN
Half life for carbetocin (40 mins) is 10 folds higher than Oxytocin (4mins)
Duration of action of carbetocin longer than IV & IM oxytocin
(It was found that a single intravenous bolus injection of carbetocin was at least as effective
as 16 hours of continuous oxytocin infusion)
Carbetocin need no repeated administration
No dose variation/ single dose of carbetocin is found to be effective in controlling PPH,
unlike oxytocin
26. CARBETOCIN is recommended by WHO as a
effective uterotonic in its 2018 guidelines
CARBOPROST is not recommended by WHO
(Since they are associated with increased risk of diarrhoea & vomiting)
27. CONTRAINDICATION
• Epilepsy
• Eclampsia
• Before delivery(May cause respiratory or cardiac distress in mother or
baby)
• To be used with caution in Hypertensive patients
28. Clinical studies: Oxytocin Vs. Carbetocin
A. Management of 3rd stage of labor
During vaginal delivery
B. Prevention of PPH following
caesarean delivery
29. Bangladesh Journal of Obstetrics & Gynecology, 2016, 30(1
A. Management of 3rd stage of labour
During vaginal delivery
1. Clinical studies: Carbetocin Vs. Oxytocin
Asia
30. N= 110 women with single pregnancy
IV 100 mcg
Carbetocin
IM 10 IU oxytocin
C O
Outcome measures
• amount of blood loss in 24 hours, primary
PPH,
• massive blood loss,
• need for additional uterotonic therapy,
blood transfusions
• adverse effects
Results:
Outcomes C group O group
Primary PPH None 6.4%
Massive blood loss None 8.5%
Immediate blood
transfusion
None 6.4%
Need of Additional
uterotonics
None 10.6%
Avg amount of blood loss 325ml 389ml
No significant differences regarding side effects
between the group
Bangladesh Journal of Obstetrics & Gynaecology, 2016, 30(1),
1. Clinical studies: Carbetocin Vs. Oxytocin
Conclusion: Carbetocin appears to be an effective new drug in the active management of
third stage of labour in vaginal delivery. carbetocin can be considered as a good
alternative to oxytocin in the active management of third stage of labour in
vaginal delivery
32. Int J Gynaecol Obstet. 2016 Sep;134(3):324-8
2. Clinical studies: Carbetocin Vs. Oxytocin Vs. Misoprostol
B. Prevention of PPH following
caesarean delivery
Africa • Ahmed E. H. Elbohoty, Walid E. Mohammed, Mohamed Sweed et al.
33. N= 263patients with a singleton pregnancy scheduled
for an elective cesarean deliver
IV 100 mcg
Carbetocin
IV 10 IU oxytocin
following neonatal
delivery
20IU in 500ml saline IV
over 4 hrs
C O
Primary Outcome
• occurrence of uterine atony necessitating
additional uterotonics
Results:
Outcomes C group O group M group
Additional uterotonics (%) 6% 13% 22%
Blood loss (ml) 437ml 439ml 583ml
Bleeding b/w 500ml to
1000ml
20% 34% 47%
Req. of Blood transfusion 0 1 1
Conclusion: Additional uterotonics were needed less frequently by patients treated with
carbetocin.
carbetocin appears to be an attractive alternative to compared to oxytocin and misoprostol
for the prevention of atonic PPH following cesarean delivery
No significant differences regarding side effects
between Oxytocin & carbetocin, sides effects are reported highest
in misopristol group
400mcg
Misopristol
sublingually
M
Int J Gynaecol Obstet. 2016 Sep;134(3):324-8
2. Clinical studies: Carbetocin Vs. Oxytocin Vs. Misoprostol
34. Egyptian Journal of Anaesthesia (2016) 32, 117–121
B. Prevention of PPH following
caesarean delivery
3. Clinical studies: Carbetocin Vs. Oxytocin
Africa
• Naveen Gerges Fahmy, Hend Mohamed Yousef & Hany Victor Zaki
35. N= 60 twin pregnancy patients
undergoing elective C.S.
IV 100 mcg
Carbetocin in
10ml saline
IV 20 IU oxytocin
in 10ml saline
C O
Outcome measures
• Need for additional uterotonic
(Methergine)
• blood loss
• Req of blood transfusions
Results:
13.3
83.3
0
10
20
30
40
50
60
70
80
90
Need of additional uterotonic drugs (%)
Carbetocin Oxytocin
Egyptian Journal of Anaesthesia (2016) 32, 117–121
3. Clinical studies: Carbetocin Vs. Oxytocin
36. Results:
Carbetocin needed less add on Uterotonics Carbetocin has less atonic PPH
Conclusion: Carbetocin is more potent long-acting oxytocic with less need for other
additional uterotonic drugs and less occurrence of uterine atony
3. Clinical studies: Carbetocin Vs. Oxytocin
37. Authors’ conclusions
• For women who undergo caesarean section,
carbetocin resulted in a statistically significant
reduction in the need for therapeutic
uterotonics compared to oxytocin.
• Carbetocin is associated with less blood loss in
the prevention of PPH for women who have
vaginal deliveries and is associated with
significantly fewer adverse effects.
The Cochrane Library 2012, Issue 4
38. J Obstet Gynaecol Canada 2011;33(11):1099–1104
N= 60 women with severe
preeclampsia
Carbetocin 100 μg +
Ringer’s lactate
solution 10 mL
injected directly into
the vein over two
minutes
Oxytocin 20 U in 1L of
Ringer’s
lactate solution,
administered
intravenously at a rate
of 125 mL/hour
C O
Result:
America
Osvaldo A. Reyes, MD; Geneva M. Gonzalez, MD
39. J Obstet Gynaecol Canada 2011;33(11):1099–1104
Result:
Conclusion: Carbetocin is an appropriate alternative to oxytocin for the prevention of
postpartum hemorrhage in women with severe preeclampsia.
America
Osvaldo A. Reyes, MD; Geneva M. Gonzalez, MD
40. CARBEPROST VS CARBETOCIN
Carboprost Carbetocin
2nd line agent in PPH 1st line agent in PPH
Not recommended by WHO in management of
PPH
Recommended by WHO in management of PPH
Associated with severe vomiting and diarrhoea
incidences
No such severe incidences with carbetocin
Contraindicated in Asthma Should be used with caution in Asthma
41. Management of 3rd stage of labor
during vaginal delivery
Prevention of PPH following
caesarean delivery
In patients with singleton pregnancy
In patients with high risk pregnancy
In patients with elective C-section delivery
In patients with high risk C-Section
In patients with twin pregnancy
Carbetocin is proved to be superior over Oxytocin & other uterotonics with respect to
Prevention of PPH
Estimated blood loss after delivery
Need of additional uterotonic agents
Decrease in Haemoglobin levels
Need of blood transfusion
Perception of pain
Side effect profile
42. CARBETOCIN – INDIAN SCENARIO
N Engl J Med 2018; 379:743-752
CHAMPION Trial
This is a Trial carried out by WHO for Carbetocin Vs Oxytocin, across the 23 centres in 10 countries
including INDIA
Centres in India
• Sriram Chandra Bhanja Medical College, Cuttack (S.M.),
• S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical
Research Center,
• Karnatak Lingayat Education Academy of Higher Education and Research,
• Jawaharlal Nehru Medical College (S.S.G., Y.V.P.),
• Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka,
• Lata Medical Research Foundation and Daga Women’s Hospital, Maharashtra
(A.B.P.),
• The Department of Obstetrics and Gynecology,
• Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.)
Carbetocin proved to be
non-inferior to oxytocin
with ease of single dose
administration
43. Carbetocin is superior over Oxytocin
With respect to
Prevention of PPH
Blood loss after delivery
Need of additional uterotonic agents
Deviation in Haemoglobin levels
Need of blood transfusion
Perception of pain
Side effect profile
Carbetocin is superior over Ergot alkaloids
with respect to
Prevention of PPH
Blood loss after delivery
Need of additional uterotonic agents
Need of blood transfusion
Better side effect profile
SUMMARY
44. Carbetocin is superior over prostaglandin analogues
(Misoprostol, Carboprost)
With respect to
Prevention of PPH
Blood loss after delivery
Need of additional uterotonic agents
Drawbacks of PG analogues
2nd line agents
Need multiple dose
Not recommended by WHO
Associated with significant increase in
vomiting & diarrhea
Most efficient Uterotonic
&
Was MOST AWAITED
Uterotonic
&
It has Arrived now in INDIA
SUMMARY