Endometriosis is the presence of endometrial tissue outside the uterus, most commonly found in the ovaries, pelvic peritoneum, and rectovaginal septum. The exact cause is unknown but theories include retrograde menstruation through the fallopian tubes. Symptoms include dysmenorrhea, dyspareunia, and infertility. Diagnosis involves clinical exam, ultrasound, MRI, and laparoscopy with biopsy. Treatment options include pain medications, hormonal therapy to induce pseudopregnancy or menopause, and surgery to remove lesions and adhesions. Combined medical and surgical approaches may provide the best outcomes.
what is endometriosis? Theories in endometriosis, sites of endometriosis. types and clinical presentation. signs and symptoms.
Investigations :TVS, CA125
laparoscopic findings
chocolate cyst and extrapelvic endometriosis.
Classification of endometiosis
Diffential diagnosis
Management :of asymptomatic and symptomatic cases
drugs and minimally invasive surgery
surgey and preventive measures in endometiosis.
what is endometriosis? Theories in endometriosis, sites of endometriosis. types and clinical presentation. signs and symptoms.
Investigations :TVS, CA125
laparoscopic findings
chocolate cyst and extrapelvic endometriosis.
Classification of endometiosis
Diffential diagnosis
Management :of asymptomatic and symptomatic cases
drugs and minimally invasive surgery
surgey and preventive measures in endometiosis.
Benign growths in the uterus that can develop during a woman's childbearing years.Highest incidence was seen in Pakistani women 78%, then rural Indian women 37.65%, urban India 24% and Nigerian women 30%. Arobosoba from Nigeria has reported prevalence of uterine fibroids in black women was more (26%), in comparison to Caucasian women (17.9%).
complcations of third stage of labour, includes PPH, Inversion of uterus, retained placenta, placenta accreta, increta, percreta, amniotic fluid embolism
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
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
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
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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.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
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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.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
7. Ovarian endomeriosis
• may be either superficial or deep
• The small superficial dark bluish cysts contain
altered blood and from these the escape of
small quantities may result in the formation of
adhesions to surrounding structures. When the
adhesions are broken down the cysts are
damaged and the chocolate material escapes.
8. Ovarian endomeriosis
• may be either superficial or deep
• The small superficial dark bluish cysts contain
altered blood and from these the escape of
small quantities may result in the formation of
adhesions to surrounding structures. When the
adhesions are broken down the cysts are
damaged and the chocolate material escapes.
10. The rectum is involved, most commonly at the
rectovaginal septum, the lesions being seen on
the peritoneal surface and in the muscular
layers but rarely involving the mucosa.
Patients usually present with abdominal pain
and pelvic discomfort
11. obstruction may be partial or complete due
to fibrosis affecting that wall of the bowel,
most commonly seen in the ileal region and the
sigmorectal junction.
13. Lower genital tract
endometriosis
cervix and vagina are bluish in colour and
usually cystic. There is tenderness on
palpation, especially during menstruation. The
referable symptoms are dyspareunia,
dysmenorrhoea and perhaps bleeding
17. Umbilical endometriosis
• usually presents as cyclical umbilical pain with
a blue discoloration at the time of
menstruation. Treatment is by excision.
19. • A swelling in a laparotomy or caesarean
section scar is painful and tender, especially
during menstruation
20. Other sites
Spread to the inguinal region by means of
the round ligament has been reported and
deposits have been found in the limbs when
painful swellings have been excised.
Haemoptysis may be the first sign of
pulmonary endometriosis, especially when it is
cyclical and associated with cyclical chest
pain.
21. PATHOPHYSIOLOGY AND
ETIOLOGY
• Retrograde menustration (sampson’s theory)
first to suggest that menstrual blood
containing fragments of endometrium might
pass along the fallopian tubes in a retrograde
manner and thus reach the peritoneal cavity.
22. • Coelomic metaplasia theory (mayer and
ivanoff)
• Chronic irritation of the pelvis peritoneum by
this menstrual blood may cause coelomic
metaplasia which results in endometriosis.
• Alternatively the mullerian tissue remnants
may be trapped within the peritoneum.
• undergo metaplasia and be transformed into
endometrium.
23. • Direct implantation
According to the theory, the endometrial
or decidual tissues start to grow in
susceptible individual when implanted in
the new sites. Such sites are abdominal scar
following hysterectomy, caesarean section,
tubectomy and myomectomy.
Endometriosis at the episiotomy scar,
vaginal or cervical site can also be explained
with this theory.
24. • Lymphatic and vascular dissemination
(Halban)
• It may be possible for the normal endometrium
to metastasise the pelvic lymph nodes through
draining lymphatic channels of the uterus. This
could explain the lymph node involvement.
25. PATHOGENESIS
• The endometrium in the ectopic sites has got
the potentiality to undergo changes under the
action of ovarian hormones
• While proliferative changes are constantly
evidenced, the secretory changes are
conspicuously absent in many
26. • Cyclic growth and shedding continue till
menopause. The periodically shed may remain
encysted or else, the cyst becomes tense and
ruptures.
• As the blood is an irritant, there is dense tissue
reaction surrounding the lesion with fibrosis. If
it happens to occur on the pelvic peritoneum, it
produces adhesion and puckering of the
peritoneum.
27. • If encysted, the cyst enlarges with cyclic
bleeding. The serum gets absorbed between
the periods and the content inside becomes
chocolate coloured. Hence the cyst is called
chocolate cyst which commonly located in the
ovary
28. Pelvic endometritis
• Typically there are small black dots, the so
called powder burns seen on the uterosacral
ligaments and pouch of Douglas. Fibrosis and
scarring in the peritoneum surrounding the
implants is also a typical finding. Other subltle
appearances are: red flame shaped areas, red
polypoid areas, yellow brown patches, white
peritoneal areas, circular peritoneal defects.
These lesions are thought to be more active
than the powder burn areas.
29.
30. Peritoneal endometriosis
• Red endometriosis which is characterized by
numerous proliferative glands with a columnar
or pseudo-stratified epithelium and the
glandular component of these lesions has very
similar appearances to that of normal
endometrium. The red appearance is brought
about by the likely recent implantation of
retrogradely menstruated endometrial cells.
31. Ovarian endometriosis
• likely that the endometrial deposit becomes
invaginated into the surface of the ovary or it
may be that an inflammatory response to the
surface of the ovary leads to adhesion
formation
32. • The recurrent shedding of the endometriosis
within the ovarian invagination leads to cystic
formation with menstrual blood collecting over
a period of time, thereby leading to increasing
chocolate cyst formation.
33.
34. Rectovaginal endometriosis
• This form of the disease occurs between the
rectum and the vagina, and has a different
histological appearance.
• These rectovaginal nodules may arise
separately and through a different process to
peritoneal endometriosis, as the presence of
muscle cells almost requires a different origin.
35. CLINICAL MANIFESTATIONS
• Seen in age between 30-40
• Usually asymptomatic
• Symptoms not related to extend of lesion,
sometimes minimal endometriosis can result in
intense symptoms
36. • Depth of penetration is more related to
symptoms rather than the spread. Lesions
penetrating more than 5 mm are responsible
for pain, dysmenorrhoea and dyspareunia.
• ‘powder burns’ lesions produce more
prostaglandin F and hence more painful.
38. • Other symptoms
• Bladder: frequency, dysuria, or even hematuria
• Sigmoid colon and rectum: painful defecation
(dyschezia), diarrhea, rectal bleeding or even
malena.
• Chronic aftifue, perimenstrual symptoms(
bowel and bladder)
39. • Abdominal examination
• A mass may be felt in the lower abdomen
arising from the pelvis- enlarged chocolate
cyst or tubo ovarian mass due to endometriotic
adhesions. The mass is tender with the
restriced mobility.
40. • Pelvic examination
• pelvic tenderness, nodules in the pouch of
Douglas, nodular feel of the uterosacral
ligaments, fixed retroverted uterus or unilateral
or bilateral adnexal mass varying sizes.
• Speculum examination may reveal bluish spots
in the posterior fornix
• Rectal or rectovaginal examination is often
helpful to confirm the findings.
41. DIAGNOSIS
• Clinical diagnosis
progressively increasing secondary
dysmenorrhoea, dyspareunia and infertility.
This is corroborated by the pelvic findings of
nodules feel of the uterosacral ligaments, fixed
retroverted uterus and unilateral or bilateral
adnexal mass.
42. • Serum marker CA 125
• moderate elevation with severe endometriosis
• USG
• TVS can detect ovarian endometriomas.
Transvaginal and endorectal ultrasound are
found better for rectosigmoid endometriosis
• CT & MRI
43. • Laproscopy
powder burns or match stick spots on the
peritoneum of the POD.
• Biopsy
Confirmation of the exicised lesion is ideal but
negative histology does not exclude it.
45. COMPLICATIONS
• Endocrinopathy
• Rupture of chocolate cyst
• Infection of the chocolate cyst
• Obstructive features
– Intestinal obstruction
– Ureteral obstruction
• Malignancy is rare
46. MANAGEMENT
• Preventive
• To avoid tubal pregnancy test immediately
after curettage or around the time of
menstruation
• Forcible pelvic examination should not be
done during or shortly after menstruation
• Married woman with family history of
endomentriosis are encouraged not to delay the
frist conception but to complete the family.
47. Curative
• Expectant management
It is done in
• Minimal endometriosis with no or other
abnormal pelvic finding
• Unmarried
• Young mother who are ready to start family
• Approaching menopause
48. • Observation with administration of NSAIDS
or prostaglandin synthetase inhinbiting drugs
are used to relieve pain. Ibuprofen 800-1200
mg or mefanamic acid 150-600 mg a day is
quite effective.
• The married women are encouraged to have
conception. Pregnancy usually cures the
condition.
49. • Medical treatment
• Hormonal treatment
• endometrial atropy is either by producing
pseudopregnancy (combined oral pills) or by
pseodomenopause( Danazol) or by medical
oopherectomy(GnRH analogues).
50. • Combined estrogen and progestogen
• The low dose contrecptive pills may be
prescribed either in a cyclic or continuous
fashion with advantages in young patients
with mild disease who want to defer
pregnancy. It causes endometrial
decidualization and atropy.
51. • Progestogens
• It causes decidualization of endometrium
and atropy. High doses may suppress
ovulation and induce amenorrhoea. Oral
route is commonly used. Progesterone
antagonists, Mifepristone 50-100 mg /day
has laos found to be effective.
52. • Danazol
• It is started from the day 5 of the menstrual
cycle. The dose 600-800mg daily is variable
and depends upon the extent of the lesion.
53. • GnRH analogues
• When used continuously act as medical
oopherectomy,a state of hypooestrinism and
amenorrhoea.
54. Surgical management
Indications
• Endometriosis with severe symptoms
unresponsive to hormone therapy.
• Severe and deeply infiltrating endometriosis to
correct the distortion of pelvic anatomy.
• Endometriomas of more than 1cm
55. • Conservative surgery
• Laproscopy
• electrodiatherapy or by lazer vapourization
• Laproscopic uterosacral nerve ablation
(LUNA)
56. • Definitive surgery
It is indicated
• No prospect for fertility improvement
• Other forms of the treatment have failed
• Woman with completed family.
58. • Combined medical and surgical
Preoperative hormonal therapy aims at
reduction of the size and vascularity of the
lesion which facilitate surgery.