This document discusses chickenpox (varicella) infection during pregnancy. It notes that varicella poses risks to both the mother and fetus, with fetal risks being highest between 13-28 weeks gestation when it can cause fetal varicella syndrome. For pregnant women exposed to chickenpox, VZIG immunoglobulin within 10 days of exposure can reduce risks if she is not already immune. Developing chickenpox during pregnancy requires symptomatic treatment and potentially aciclovir. Risks to the newborn are highest if the mother develops chickenpox shortly before delivery.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
Lecture by Dr Sujoy Dasgupta in BOGSCON 2015, the Annual Conference of Bengal Obstetric and Gynaecological Society, held at Hotel Novotel, Kolkata in January, 2015; where he had been invited as FACULTY to deliver his lecture
This topic is a part of Epidemiology of Communicable Diseases. It further falls into the category of respiratory infections. This topic covers important points from Park textbook of Preventive and Social Medicine about chickenpox.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
Lecture by Dr Sujoy Dasgupta in BOGSCON 2015, the Annual Conference of Bengal Obstetric and Gynaecological Society, held at Hotel Novotel, Kolkata in January, 2015; where he had been invited as FACULTY to deliver his lecture
This topic is a part of Epidemiology of Communicable Diseases. It further falls into the category of respiratory infections. This topic covers important points from Park textbook of Preventive and Social Medicine about chickenpox.
Epidemiology and control measures for CHICKENPOX {Varicella} AB Rajar
It is an acute, highly infectious disease caused by varicella-zoster(v-z) virus.
It is worldwide in distribution and occurs in both epidemic and endemic forms.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
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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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. CONTENTS
I. Introduction
II. Maternal risk
III. Fetal risk
IV. Neonatal risk
V. Management of varicella-zoster contact in pregnancy
ABOUBAKR ELNASHAR
3. I. INTRODUCTION
Varicella-zoster virus (VZV)
highly contagious DNA virus of the herpes family.
transmitted by
respiratory droplets
direct personal contact with vesicle fluid.
ABOUBAKR ELNASHAR
5. Incubation period
7-21 days
Person is infectious
48 h before the rash appears
continues to be infectious
until the vesicles crust over
typically 5 days.
ABOUBAKR ELNASHAR
6. In UK:
90% of the antenatal population
Seropositive for VZV-specific IgG antibody
infection is uncommon
1 in 1000 pregnancies.
ABOUBAKR ELNASHAR
7. Following primary infection
virus remains dormant in sensory nerve root ganglia
can become reactivated to give a vesicular
erythematous skin rash in a dermatome distribution,
i.e. shingles.
It is possible to acquire the infection from exposed
sites.
ABOUBAKR ELNASHAR
8. II. MATERNAL
1. Diagnosis
For a woman with
no previous history of chickenpox and
significant history of exposure
risk to the woman can be determined by
serological evidence of VZV IgG.
The diagnosis itself is made from
examination of the classic rash.
ABOUBAKR ELNASHAR
12. 2. PREVENTION
1. Varicella vaccination
prepregnancy or postpartum is an option that should
be considered for women who are found to be
seronegative for varicella-zoster virus
immunoglobulin G (VZV IgG).
2. Postpartum immunisation for
Seronegative women identified in pregnancy
it is safe to breastfeed.
Varicella vaccine
a live attenuated vaccine
pregnancy should be avoided for 1-3 months after
administration.
ABOUBAKR ELNASHAR
13. 3. Women booking for antenatal care
should be asked about previous chickenpox/shingles
infection.
Women who have not had chickenpox, or are known
to be seronegative for chickenpox, should be advised
to
avoid contact with chickenpox and shingles
during pregnancy
inform healthcare workers of a potential exposure
without delay.
ABOUBAKR ELNASHAR
14. 4. When contact occurs with chickenpox or shingles
careful history must be taken to
confirm the significance of the contact and
susceptibility of the patient.
5. Blood test to determine VZV immunity or non-
immunity in Pregnant women with
an uncertain or no previous history of chickenpox, or
who come from tropical or subtropical countries
have been exposed to infection
ABOUBAKR ELNASHAR
15. 6. If the pregnant woman is not immune to VZV and she
has had a significant exposure
she should be offered varicella-zoster
immunoglobulin (VZIG) as soon as possible.
VZIG is effective when given up to 10 days after
contact (in the case of continuous exposures, this is
defined as 10 days from the appearance of the rash
in the index case).
ABOUBAKR ELNASHAR
16. 7. Non-immune pregnant women who have been
exposed to chickenpox
should be managed as potentially infectious
from 8–28 days after exposure if they receive
VZIG and
from 8–21 days after exposure if they do not
receive VZIG.
8. When supplies are limited
issues to pregnant women may be restricted
clinicians are advised to establish the availability of
VZIG before offering it to pregnant women.
ABOUBAKR ELNASHAR
17. 9. Women who have had exposure to chickenpox or
shingles (regardless of whether or not they have
received VZIG)
should be asked to notify their doctor or midwife early
if a rash develops.
10. A pregnant woman who develops a chickenpox rash
should be isolated from other pregnant women when
she attends a general practice surgery or a hospital
for assessment.
ABOUBAKR ELNASHAR
18. 11. A second dose of VZIG
may be required if
further exposure is reported and
3 w have elapsed since the last dose.
ABOUBAKR ELNASHAR
19. 3. Maternal risks of varicella in pregnancy
1. increased morbidity associated with varicella
infection in adults, including
1. Pneumonia
2. Hepatitis
3. encephalitis.
2. Rarely, it may result in death.
ABOUBAKR ELNASHAR
20. 4. Care of pregnant woman who develops
chickenpox
immediately contact their general practitioner.
1. Avoid contact with potentially susceptible individuals,
e.g. other pregnant women and neonates, until the
lesions have crusted over.
This is usually about 5 days after the onset of the
rash.
ABOUBAKR ELNASHAR
21. 2. Symptomatic treatment and hygiene
{prevent secondary bacterial infection of the lesions}
ABOUBAKR ELNASHAR
22. 3. Oral aciclovir
should be prescribed for pregnant women with
chickenpox if
they present within 24 hs of the onset of the rash
they are 20+0 w of gestation or beyond.
Use of aciclovir before 20+0 w should also be
considered.
seronegative women with
significant contact with varicella-zoster
immunoglobulin
no evidence to prove that it reduces the risk of trans-
mission of VZV to the fetus.
ABOUBAKR ELNASHAR
23. 4. Intravenous aciclovir
should be given to all pregnant women with severe
chickenpox.
VZIG
no therapeutic benefit once chickenpox has
developed
not be used in pregnant women who have
developed a chickenpox rash.
ABOUBAKR ELNASHAR
24. 5. Referral to hospital
The pregnant woman with chickenpox should be
asked to contact her doctor immediately if she
develops
1. respiratory symptoms or
2. any other deterioration in her condition.
Indications:
symptoms or signs of severe chickenpox
ABOUBAKR ELNASHAR
25. 1. Assessment in an area where she will not come into
contact with other pregnant women.
2. multidisciplinary team
an obstetrician
fetal medicine specialist
Virologist
neonatologist.
3. Nursed in isolation from
Babies
potentially susceptible pregnant women or
non-immune staff.
ABOUBAKR ELNASHAR
26. 6. Delivery
The timing and mode
must be individualised.
When epidural or spinal anaesthesia is undertaken
site free of cutaneous lesions should be chosen
for needle placement.
ABOUBAKR ELNASHAR
27. III. FETAL INFECTION
1. Fetal risks
is gestation dependent.
In the first trimester
fetal infection may lead to spontaneous
miscarriage.
3 to 28 w
fetal varicella syndrome (FVS)
1-2% until 20 w
20-28w:
rapidly declining incidence of FVS
after 28 w
No cases
ABOUBAKR ELNASHAR
28. 2. Fetal varicella syndrome
It does not occur at the time of initial fetal infection but
results from a subsequent herpes zoster reactivation in
utero and only occurs in a minority of infected fetuses.
ABOUBAKR ELNASHAR
29. Characterized by one or more of the following:
1. skin scarring in a dermatomal distribution
2. eye defects:
microphthalmia, chorioretinitis, cataracts
3. hypoplasia of the limbs
4. neurological abnormalities
microcephaly, cortical atrophy, mental restriction
and dysfunction of bowel and bladder sphincters
Common manifestations:
limb deformity
Microcephaly
Hydrocephaly
soft tissue calcification
IUGR.
ABOUBAKR ELNASHAR
30. Diagnosis
1. ultrasound findings.
Women who develop chickenpox in pregnancy
should be referred to a fetal medicine
specialist, at 16–20 w or 5 w after infection, for
discussion and detailed ultrasound
examination.
{There is usually a time lag of at least 5 weeks
after the primary infection before fetal
differences are seen}.
ABOUBAKR ELNASHAR
31. 2. Amniocentesis
should not be performed before the skin lesions
have completely healed.
may be performed to confirm the diagnosis with
PCR identification of VZV DNA.
In the absence of ultra-sound scanning finding
positive amniocentesis has a high sensitivity
but low specificity for the development of VZV.
If the PCR is positive but the ultrasound normal at
17-21 w
risk of FVS is low
if repeat ultrasound scanning at 24 w is also
normal then the risk of FVS is almost zero.
The risk, conversely, is very high if there are
ultrasound features and positive PCR [D].ABOUBAKR ELNASHAR
32. 3. Treatment and prevention
no intrauterine treatment currently available.
ABOUBAKR ELNASHAR
33. IV. NEONATAL RISKS
1. If maternal infection occurs in the last 4 w of a
woman’s pregnancy,
there is a significant risk of varicella infection of
the newborn.
A planned delivery
should normally be avoided for at least 7 days
after the onset of the maternal rash
allow for the passive transfer of antibodies from
mother to child
provided that continuing the pregnancy does
not pose any additional risks to the mother or
baby.
ABOUBAKR ELNASHAR
34. 2. A neonatologist
should be informed of the birth of all babies born to
women who have developed chickenpox at any
gestation during pregnancy.
3. Breastfeeding
if they wish to and are well enough to do so.
ABOUBAKR ELNASHAR