This document defines ectopic pregnancy and discusses its causes, signs and symptoms, diagnosis, and treatment options. Some key points:
- Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It requires prompt treatment due to risks to a woman's health.
- Risk factors include previous ectopic pregnancy, pelvic inflammatory disease, assisted reproduction, pelvic surgery, IUD use, smoking, and uterine abnormalities.
- Symptoms may include abdominal pain, amenorrhea, vaginal bleeding, as well as symptoms of early pregnancy like nausea. Advanced cases can cause painful fetal movements.
- Diagnosis involves serum hCG level testing, ultrasound imaging,
Labour induction
Induction of labour
Guidelines on induction of labour
Guidelines on labour induction
induction of labour is not risk free
prostaglandins for induction of labour
Bishop score
Cervical ripening techniques
mechanical and pharmacological induction of labour
Post dates induction
options for cervical ripening
oral vs. vaginal misoprostol
advantages diadvantages and techniques for induction of labour
gynecology & obstetrics
Labour induction methods
review of guidelines for labour induction
Labour induction
Induction of labour
Guidelines on induction of labour
Guidelines on labour induction
induction of labour is not risk free
prostaglandins for induction of labour
Bishop score
Cervical ripening techniques
mechanical and pharmacological induction of labour
Post dates induction
options for cervical ripening
oral vs. vaginal misoprostol
advantages diadvantages and techniques for induction of labour
gynecology & obstetrics
Labour induction methods
review of guidelines for labour induction
Incidence of ectopic pregnancy is rising while maternal mortality from it is falling.
ALWAYS suspect ectopic pregnancy in a woman of a child-bearing age c/o pain and/or p.v. bleeding
it contains a presentation on injuries that occur during baby birth
summary:
Maternal injuries following childbirth process are quite common.
VULVA
PERINEUM
RISK FACTORS FOR THIRD DEGREE PERINEL TEAR
REPAIR OF COMPLETE PERINEAL TEAR
VAGINA
CERVIX
PELVIC HEMATOMA
DIAGNOSIS OF RUPTURE UTERUS
Incidence of ectopic pregnancy is rising while maternal mortality from it is falling.
ALWAYS suspect ectopic pregnancy in a woman of a child-bearing age c/o pain and/or p.v. bleeding
it contains a presentation on injuries that occur during baby birth
summary:
Maternal injuries following childbirth process are quite common.
VULVA
PERINEUM
RISK FACTORS FOR THIRD DEGREE PERINEL TEAR
REPAIR OF COMPLETE PERINEAL TEAR
VAGINA
CERVIX
PELVIC HEMATOMA
DIAGNOSIS OF RUPTURE UTERUS
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
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!
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
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.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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2. DEFINITION
“Any pregnancy where the fertilized ovum gets implanted & develops in a site
other than normal uterine cavity”.
Ectopic pregnancy is accounted for 2% of all pregnancies, and is the most
common cause of maternal death during the first trimester (usually week 6-8
of pregnancy )
It represents a serious hazard to a woman’s health and reproductive
potential, requiring prompt recognition and early aggressive intervention.
3. Sites:
1-Fallopian tubes in 95% of the cases -Ampulla ( most common site) which is the
widest part ( 5-6 cm)
-Isthmus
-Fimbria
2-Uterine Cornua or uterine horns. Which is the meeting point of the uterus and
the fallopian tubes. This site of ectopic pregnancy is the most dangerous of all due
to the high risk of rupture. This case needs around 10 weeks to appear.
3- Cervical Implantation ( 0.2%)
4- Ovarian Implantation (0.2%)
5- Abdominal Implantation (2%) This type may reach term.
4.
5. Risk factors
1-The most important risk factor is previous history of ectopic pregnancy.
(30% risk of recurrence)
2-Pelvic inflammatory disease (PID) and STD infections
Any Assisted Reproductive techniques (ART) for eg, IVF
History of any pelvic or tubal surgeryHistory of any pelvic or tubal surgery
Contraceptive methods like Intrauterine device (IUD) .
Smoking.
Any congenital malformations of the tubes or the uterus
6. Signs and symptoms
The classic clinical triad of ectopic pregnancy is as follows:
Abdominal pain
Amenorrhea
Vaginal bleeding
Unfortunately, only about 50% of patients present with all 3 symptoms.
7. Patients may present with other symptoms common to early pregnancy (eg,
nausea, breast fullness). The following symptoms have also been reported:
Painful fetal movements (in the case of advanced abdominal pregnancy)
Dizziness or weakness
Fever
Flulike symptoms
Vomiting
Syncope
Cardiac arrest
8. The presence of the following signs suggests
a surgical emergency:
Abdominal rigidity
Involuntary guarding
Severe tenderness
Evidence of hypovolemic shock (eg, orthostatic blood pressure changes,
tachycardia)
9. Findings on pelvic examination may include
the following:
The uterus may be slightly enlarged and soft
Uterine or cervical motion tenderness may suggest peritoneal inflammation
An adnexal mass may be palpated but is usually difficult to differentiate from
the ipsilateral ovary
Uterine contents may be present in the vagina, due to shedding of
endometrial lining stimulated by an ectopic pregnancy
10. INVESTIGATIONS:
Serum β-HCG levels
In a normal pregnancy, the β-HCG level doubles every 48-72 hours until it
reaches 10,000-20,000mIU/mL. In ectopic pregnancies, β-HCG levels usually
increase less. Mean serum β-HCG levels are lower in ectopic pregnancies than
in healthy pregnancies.
No single serum β-HCG level is diagnostic of an ectopic pregnancy. Serial
serum β-HCG levels are necessary to differentiate between normal and
abnormal pregnancies and to monitor resolution of ectopic pregnancy once
therapy has been initiated.
11. *Progesterone level - greater than 20 micrograms/ml indicates good
pregnancy and
less than 5 micrograms/ml is a bad indicator ( ectopic or abortion)
Anything in between 5-20 microgram/ml is a grey zone and not indicative.
-Ultrasound imaging: it is usually inconclusive but the U/S findings
suggestive of ectopic preg;
- ABSENT intrauterine sac and the presence of ectopic sac
- complex adnexal mass
-Free fluid in cul de sac ( ruptured ectopic pregnancy)
VALUES of discriminatory beta HCG:
On ABDOMINAL U/S 6,000-6,500 m IU/ml
On Transvaginal U/S 1,500-1,800 m IU/ml
13. Differential diagnosis:
Differential diagnosis of first trimester bleeding :
-Ectopic pregnancy
-Recent Abortion
-Molar pregnancy
the symptomatic picture of ectopic pregnancy:
Appendicitis, salpingitis, ruptured corpus luteum…
14. Management:
The method of management depends greatly on the hemodynamic stability of
the patient, so the vital signs indicates instability (hypotension) or decreased
level of consciousness or life threatening bleeding Laparotomy is indicated.
observation:
Indicated when: the patient is stable without any significant bleeding or pain/
the site of implantation is the tube/ size of gestational sac< 4 cm , FALLING
beta HCG levels .
15. Medical management
(METHOTREXATE):
If the patient is stable, no IUP ,gestational sac < 3.5 cm and no FHA, but suffering of
significant pain or bleeding, METHOTREXATE is the drug of choice.
MTX is an antimetabolite (folate antagonist). Usually, it is given as a single shot at a
dose of 50
mg/m2 IM. Then Beta HCG is followed after 3-7 days a drop in the levels of beta HCG
of about 15% indicates successful treatment.
Beta HCG levels should be followed up till levels are 0-5.
If serum levels were in plateau or the drop was less than 15%, a second dose of MTX
should be given after 2 weeks.
However if the level increased or if the patient became symptomatic, Surgery is
indicated.
16. Surgical Management:
It is indicated if the patient was hemodynamically unstable (laparotomy) or failure of
medical treatment, or if FHA is present, or gestational sac size is > 4cm. If the patient is
stable, but has one of these indications, laparoscopy is done.
Salpingectomy; removal of the tube. no need for follow up of beta HCG levels.
Salpingostomy; Incision on the antimesentric portion of the tube is made, then after
removal of products of conception, the tube is sutured. Used for unruptured distal tube
ectopic preg.
Salpingotomy : The same procedure as salpingostomy however the incision is not sutured
and is left to heal by secondary intention.
In Salpingostomy and salpingiotomy, beta HCG levels should be followed up as in medical
treatment. ( till levels are 0-5 )
17. Contraindications of Methotrexate:
-Unstable patient
Beta HCG levels > 5,000
-Fetal heart activity or any intrauterine pregnancy evidence
-free fluid in cul de sac ( indicating ruptured ectopic preg. )
-Active Peptic ulcer disease
-Active pulmonary/ renal/ hepatic disease
-Breast feeding
- MTX sensitivity
- Moderate/severe Anemia/ Thrombocytopenia / Leukopenia
-Leukemia
Note: Do not use MTX with NSAID, since this combination may potentiate
nephrotoxicity