The document discusses Doppler ultrasound findings for a 25-year-old pregnant female with uncontrolled hypertension. Key findings include oligohydramnios, elevated head circumference to abdominal circumference ratio, and abnormal Doppler readings of the umbilical artery, middle cerebral artery, and ductus venosus indicating fetal hypoxia and intrauterine growth restriction. The summary provides an overview of the patient details and significant ultrasound findings reported in the document.
In this presentation we will discuss
First trimester US especially TVS is an integral part for confirmation of intrauterine pregnancy and to rule out ectopic pregnancy.
First trimester US helps us in suggesting conceptus viability.
First trimester US especially TVS is very efficient in approaching and evaluating the cause of vaginal bleeding.
ultrasonography in obstetrics, usg in obstetrics, ultrasound in obstetrics, doppler in obstetrics, usg doppler in obstetrics, signs in ultrasound, anomaly scan, pregnancy scan, ultrasound in pregnancy,
In this presentation we will discuss role of Doppler US in Infertility, fertilization and assisted fertilization.
we will discuss the favorable and unfavorable RI and PI.
We will discuss role of doppler us in various gynecological malignancies.
In this presentation we will discuss
First trimester US especially TVS is an integral part for confirmation of intrauterine pregnancy and to rule out ectopic pregnancy.
First trimester US helps us in suggesting conceptus viability.
First trimester US especially TVS is very efficient in approaching and evaluating the cause of vaginal bleeding.
ultrasonography in obstetrics, usg in obstetrics, ultrasound in obstetrics, doppler in obstetrics, usg doppler in obstetrics, signs in ultrasound, anomaly scan, pregnancy scan, ultrasound in pregnancy,
In this presentation we will discuss role of Doppler US in Infertility, fertilization and assisted fertilization.
we will discuss the favorable and unfavorable RI and PI.
We will discuss role of doppler us in various gynecological malignancies.
Intra uterine growth restriction (iugr) Doppler sudy Ryan Mulyana
Intra Uterine Growth Restriction (IUGR) and SGA:
Doppler Management and Prediction of Outcome
Ryan Saktika Mulyana, dr, M.Biomed, SpOG(K)
Maternal and Fetal Medicine, Obstetrics and Gynecology Department,
Udayana University Hospital, Udayana University
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
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
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
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
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.
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!
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.
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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
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2 Case Reports of Gastric Ultrasound
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
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
1. Presented by
Dr. Sandeep Garg (Resident)
Department of Radiodiagnosis
CMS
3rd Nov, 2011
2. 25 yrs female with 30 wks of POG and
uncontrolled hypertension was referred from
gynae/obsc dept for doppler.
USG and doppler findings include
◦ >HC/AC ratio 1.32
◦ Severe oligohydraminos (AFI 3 cm)
◦ MCA PI 1.27
◦ UA PI 1.39
◦ MCA/UA PI ratio – 0.91
Impression: fetal hypoxia/ IUGR
3. IUGR: fetus with birth weight <10th
percentile for gestational age due to
pathologic process.
SGA: fetus with birth weight <10th
percentile for gestational age in the
absence of pathologic process
5. Symmetrical : Uniformly small,
HC:AC,FL:AC-Normal
seen in chromosomal anomalies
Asymmetrical : fetal abdomen is
disproportionately small
(Head sparing effect)
HC>AC
HC:AC, FL:AC-Elevated
6. elevated HC/AC ratio (positive predictive
value 62%)
elevated ratio of femur length to abdominal
circumference (FL/AC)
presence of oligohydramnios without
ruptured membranes
presence of advanced placental grade
(Grannum grade 3)
7.
8. Typically, scores of 6 or below are considered
frankly abnormal, and scores of 7 and 8 are
considered suspicious.
Reduced biophysical profile scores are found
in growth restricted pregnancies that already
demonstrate abnormal umbilical and fetal
Doppler findings.
9. Most of these fetuses are constitutionally
small, and are not suffering from
uteroplacental insufficiency.
An inter-twin growth discrepancy of 20–25%
is considered to be significant.
Twin-to-twin transfusion syndrome (TTTS)-
Color Doppler findings in the donor are
usually typical of uteroplacental insufficiency
10. Quantitative analysis
◦ Pulsatility index (PI)
◦ Resistance index (RI)
◦ Systolic/diastolic ratio
Qualitative analysis
◦ Uterine artery: presence or
absence of early diastolic
notch
◦ UA : normal, with reduced
diastolic flow, absent EDF,
reversed EDF
11. Uterine arteries branch into arcuate arteries, leading
to spiral arteries within myometrium.
With advancing pregnancy, due to trophoblastic
invasion of uterine spiral arteries, it dilates and result
in fall in resistance to blood flow.
Uterine blood flow in non pregnant women is 50
ml/min and increase to over 700 ml/min in 3rd
trimester.
Hence, in normal pregnancy diastolic component is
transformed from one of low peak flow velocity and
early diastolic notch , to one of high flow and no
diastolic notch by 18 to 22 wks, PI value <1.2
PI >1.45 with bilateral notches (abnormal) is s/o
clinically significant uteroplacental vascular
ischaemia.
12.
13.
14.
15.
16.
17. Characteristic umbilical artery waveforms
have also been correlated to various degrees
of fetal hypoxemia and acidemia.
Absent end-diastolic frequencies
◦ 75% of the placental vascular bed has been
obliterated
◦ 85% chance that the fetus will be hypoxemic and
a 50% chance that it will also be acidemic.
Reversed end-diastolic frequencies
◦ ten-fold increase in perinatal mortality
18.
19.
20.
21. Fetal arterial waveforms are acquired from the
thoracic aorta and middle cerebral arteries.
With fetal hypoxemia, there is conservation (or
increase) of blood flow to the fetal brain, heart
and adrenal glands with concomitant decrease in
flow to the splanchnic bed and extremities. This
phenomenon is termed ‘arterial redistribution of
blood flow’, and serves to deliver oxygen and
nutrients to vital organs in the face of impaired
placental function.
Hence, fetal arterial Dopplers can be used to
monitor fetal compensatory responses to
progressively deteriorating placental function.
22. MCA can be easily demonstrated by color
doppler in transverese fetal head position.
At 28-32 wks, MCA is characterized by high
systolic velocities and minimal diastolic
velocities, resulting in high PI values (>1.45).
In fetal hypoxia, vascular tone is increased in
MCA resulting in increased diastolic velocity
and reduced PI values.
23.
24. Normal
With hypoxia there is cerebral
vasodilatation, so initially the
diastolic flow may be in the
normal range ,when the
vasodilatation ability is
exhausted as with fetal
acidosis the resistance starts
increasing again.
25.
26.
27. A longitudinal view of
the fetal thoracic aorta
is obtained with color
flow imaging.
The pulsed Doppler
sample gate should be
placed on the linear
portion of the
descending thoracic
aorta, above the level
of the diaphragm
28. The ductus venosus is the main vessel through
which oxygenated blood returning from the
placenta is directed to the fetal heart and
circulation.
With worsening fetal hypoxemia, abnormal
umbilical artery waveforms and severe fetal
arterial redistribution develop.
In addition, there is also increased redistribution
of highly oxygenated umbilical vein blood
through the ductus venosus to the fetal heart.
When the fetal condition becomes critical,
abnormal ductus venosus flow waveforms are
seen.
31. Biometry
◦ EFW 640 g (<10th centile)
◦ HC/AC ratio 1.35 (normal <1.2)
◦ AFI 7 cm (normal 10-20 cm)
Doppler
◦ Uterine arteries- B/L early diastolic notch
◦ Lt uterine artery PI 1.97, Rt PI 1.65
◦ UA- absent EDF in both
◦ Smooth umbilical venous cord flow, peak vel 16cm/sec
◦ MCA- PI 1.12 (redistribution)
◦ Ductus venosus – positive A wave 32 cm/sec (normal)
Biophysical profile score- 8/8 normal
Anatomic evaluation- short femurs, mildly
echogenic bowel
32. Gramellini et al (1992) studied that in 30-41
wks POG, MCA/UA PI ratio (cerebro-umbilical
flow) <1.08 is better predictor of fetal
insufficiency than MCA PI or UA PI alone.
Diagnostic accuracy for the cerebral-
umbilical ratio was 90%, compared with 78.8%
for the middle cerebral artery and 83.3% for
the umbilical artery.
33.
34. 1990 G.Mari proposed the use of MCA
dopplers for the diagnosis of anemia
The sensitivity of the peak systolic velocity for the
prediction of moderate anemia and severe anemia
in the fetuses without hydrops was 100 percent
, with a false positive rate of 12 percent. The
positive and negative predictive values were 65
percent and 100 percent, respectively.
35. The risk of anemia was high in fetuses with a
peak systolic velocity of 1.50 times the
median or higher. Fetuses with values below
1.50 either did not have anemia or had only
mild anemia.
36.
37. the MCA PSV is effective for accurate
diagnosis of fetal anemia and can avoid about
70% of invasive procedures.