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.
Presentation on the description of normal and abnormal uterine bleeding, menstrual cycle, FIGO classification with PALM-COEIN, common differentials of AUB, assessment, diagnosis, and management.
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.
Presentation on the description of normal and abnormal uterine bleeding, menstrual cycle, FIGO classification with PALM-COEIN, common differentials of AUB, assessment, diagnosis, and management.
Primary Gastric Actinomycosis: The first ever report of Primary Gastric Actinomycosis from India.
Source: International Journal of Medical Research & Health Sciences
Clinicobacteriological study of Urinary tract infection in pregnant womeniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Description of Urinary tract infections of pediatric age group, signs and symptoms, presentations, diagnosis, investigations, prognosis and management plan
A Case of Postmenopausal Pyometra Caused By Endometrial Tuberculosisiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
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
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
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
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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.
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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.
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
1. Dr. Shashwat Kamal Jani.
M. S. ( Obs – Gynec )
Diploma in Advance Laparoscopy.
Consultant Assistant Professor,,
Smt. N.H.L. Municipal Medical College.
Sheth V. S. General Hospital , Ahmedabad.
Mobile : +91 99099 44160.
E-mail : drshashwatjani@gmail.com
2. Pyrexia…
• Temperature > 38 degree C once or > 37.5 degree C
on 2 occasions 2 hours apart.
(http://www.rcog.org.uk)
• In humans, threshold temperature for
teratogenicity : 38.9 ºC (102ºF)
28-Sep-18 Dr Shashwat Jani.
99099 44160.
2
3. Three periods of prenatal development in human
Pre-implantation period (∼3 weeks)
• Increased pre-implantation loss due to failure to
implantation or embryonic death.
Period of major organogenesis (3∼8 weeks)
• Especially, susceptible to the induction of
developmental defect
• CNS, skeletal, neuromuscular, and cardiac defect
Fetal periods (8∼ weeks)
• Results mainly in reduced growth & functional
defects
28-Sep-18
Dr Shashwat Jani.
99099 44160.
3
4. Pregnant women with febrile illness are
more likely to develop critical outcome and die
than the general population.
The increased severity of infections in
pregnant women is thought to be related to
the normal physiologic changes that occur
during pregnancy.
There is increase in heart rate and oxygen
consumption, lung capacity decreases, and
there is a shift away from cell-mediated
immunity.
28-Sep-18
Dr Shashwat Jani.
99099 44160.
4
5. Clinical manifestations of infections in
pregnant women are similar to those in the
general population.
However, first trimester nausea and
vomiting of pregnancy may mask the warning
signs and this may delay the recognition of
severe disease.
During and after second trimester
physiological hypervolemia, low haematocrit,
generalized vasodilatation, high pulse rate and
low BP may present difficulty in assessing
severity of the disease.
28-Sep-18
Dr Shashwat Jani.
99099 44160.
5
6. Effects Of Fever
On Pregnancy
IUGR
Oligohydramnios
Preterm
Meconium stained amniotic fluid
Fetal distress
Abortion
Postpartum sepsis
Fetal Anomalies
28-Sep-18
Dr Shashwat Jani.
99099 44160.
6
14. UTI
Asymptomatic Bacteriuria
10,000 organisms/ml in 2 consecutive urine
samples in the absence of symptoms .
Occurs in 2.5-11% of pregnant women
Symptomatic Bacteriuria
100 organisms/ml of urine with accompanying
pyuria (>7 WBCs/ml)
28-Sep-18
Dr Shashwat Jani.
99099 44160.
14
15. Acute cystitis :
Occurs in 1% of pregnant women
Acute pyelonephritis :
Occurs in 2% of all pregnancies
1st trimester - 2%
2nd trimester- 52%
3rd trimester- 46%
28-Sep-18
Dr Shashwat Jani.
99099 44160.
15
16. Increased frequency of UTI in pregnant
women is due to:
Difficult hygiene due to distended gravid
uterus
Immunocompromised state
Urinary stasis (progesterone-induced ureteral
smooth muscle relaxation)
Urinary retention (enlarged uterus)
Loss of ureteral tone
28-Sep-18
Dr Shashwat Jani.
99099 44160.
16
17. 28-Sep-18
Dr Shashwat Jani.
99099 44160.
17
Causes
E.coli- most common
Klebsiella pneumonia
Proteus mirabilis
Enterobacter
Symptoms
Dysuria
Fever with chills
Suprapubic pain
Increased frequency and urgency
Burning micturition
18. Investigations
Blood (CBC, electroytes, BUN, creatinine)
Urine
Midstream urine sample clean catch in 1st antenatal
visit
Culture - Standard method for evaluation.
Positive culture - 2 consecutive voided specimens
with isolation of the same bacterial strain, at a
colony count of 1,00,000 CFU/ml or higher .
28-Sep-18
Dr Shashwat Jani.
99099 44160.
18
19. Treatment
Antibiotic therapy tailored to culture results and
follow up cultures to confirm sterilization…
28-Sep-18
Dr Shashwat Jani.
99099 44160.
19
20. 20
Septic Abortion
• Cause of 12.9% of maternal deaths
• Post abortion care has had tremendous
impact on reducing mortality, particularly with
use of manual vacuum aspiration.
28-Sep-18 Dr Shashwat Jani.
99099 44160.
21. Clinical evidences of infection are-
1. History of pregnancy or Abortion.
2. Fever 38 C or more for at least 24 hrs
3. Offensive or purulent vaginal discharge
4. Lower abdominal pain, tenderness or mass.
5. Tachycardia of more than 100 per min.
28-Sep-18
Dr Shashwat Jani.
99099 44160.
21
22. Clinical Grading
• Grade–I: The infection is localized in the uterus.
• Grade–II: The infection spreads beyond the
uterus to the parametrium , tubes and ovaries or
pelvic peritoneum.
• Grade–III: Generalized peritonitis and/or
endotoxic shock or jaundice or acute renal failure.
Grade-I is the commonest and is usually
associated with spontaneous abortion.
Grade- III is almost always associated with
illegal induced abortion.
28-Sep-18
Dr Shashwat Jani.
99099 44160.
22
23. • Routine Investigations
Haematology:
• Hb : may be low
• Platelets: may be low
• TLC: raised
• DLC: Neutrophil raised
• Blood C/S.
• Blood grouping and cross matching
Urine analysis:
• UPT
• RME and C/S
High vaginal swab is taken prior to internal examination for-
1. culture in aerobic and anaerobic media to find out the dominant micro
organisms
2. sensitivity of the micro organisms to antibiotics
3. smear for Gram stain
28-Sep-18
Dr Shashwat Jani.
99099 44160.
23
24. Special Investigations
• Ultrasonography pelvis and abdomen to detect
intrauterine retained products of conception ,
foreign body- intrauterine or intraabdominal, free
fluid in the peritoneal cavity or in the pouch of
Douglas
• Fibrinogen level, fibrin degradation product and d-
dimer to rule out
DIC
RFT
• Plain chest X-ray to rule out atelectasis and
abdomen to rule out bowel injury or foreign body.
28-Sep-18
Dr Shashwat Jani.
99099 44160.
24
26. 26
Treatment
• Begin antibiotics as soon as possible before
evacuation:
– Ampicillin every 6 hours
– PLUS gentamicin daily
– PLUS metronidazole every 8 hours
• Continue until fever-free for 48 hours
• Manual vacuum aspiration
28-Sep-18
Dr Shashwat Jani.
99099 44160.
27. Chorioamnionitis
• Chorioamnionitis also known as intra-
amniotic infection (IAI) is an inflammation of
the fetal membranes (amnion and chorion)
due to a bacterial infection.
• It typically results from bacteria
ascending into the uterus from the vagina and
is most often associated with prolonged labor.
28-Sep-18
Dr Shashwat Jani.
99099 44160.
27
28. Chorioamnionitis
• Chorioamnionitis, complicates as many as
40–70% of preterm births with premature
membrane rupture or spontaneous labor, and
1–13% of term births.
• 12% of primary cesarean births at term
involve clinical chorioamnionitis, with the most
common indication for cesarean in these cases
being failure to progress usually after
membrane rupture.
28-Sep-18
Dr Shashwat Jani.
99099 44160.
28
29. Risk Factors
1. Longer duration of membrane rupture.
2. Prolonged labor.
3. Nulliparity.
4. African American ethnicity.
5. Internal monitoring of labor.
6. Multiple vaginal exams.
7. Meconium-stained amniotic fluid.
8. Smoking, alcohol or drug abuse.
9. Immune-compromised states.
10. Epidural anesthesia.
11. Colonization with group B streptococcus.
12. Bacterial vaginosis.
13. Sexually transmissible genital infections. Dr Shashwat Jani.
99099 44160. 2928-Sep-18
32. Clinical Features
• Fever is the most important sign.
• Uterine fundal tenderness.
• Maternal tachycardia (>100/min).
• Fetal tachycardia (>160/min).
• Purulent or foul smelling discharge
28-Sep-18
Dr Shashwat Jani.
99099 44160.
32
CBC , CRP , AMNIOTIC FLUID CULTURE
33. 33
Dr Shashwat Jani.
99099 44160.
Management of Amnionitis
• Give combination of antibiotics until delivery:
– Ampicillin every 6 hours
– PLUS gentamicin daily
• If woman delivers vaginally, discontinue
antibiotics postpartum
• If woman has cesarean section:
– Continue above antibiotics
– Add metronidazole every 8 hours
– Continue until fever-free for 48 hours
ACOG 1998.
28-Sep-18
34. 34
Dr Shashwat Jani.
99099 44160.
Management of Amnionitis
(continued)
• If cervix is favorable, induce labor with
oxytocin
• If cervix is unfavorable, ripen with
prostaglandins and infuse oxytocin or deliver
by cesarean section
28-Sep-18
36. A protozoal disease caused by the parasite belonging to the
genus plasmodium.
- It spreads through the bite of female anopheles mosquito,
blood transfusion and transplacental transfer from mother to
fetus during pregnancy.
- The following causative organisms have been recognized ;
P. Vivax , P. Falciparum , P. Malariae and P.Ovale.
- The predominant causal organism in the South-East Asia
region is P . Vivax. Followed by Falciparum . The later accounting
for nearly half mortality.
Malaria
37. Effect on Pregnancy:
The immuno-compromised state of the mother renders her
susceptible to Malaria. There is intense parasitisation (30%- 60%
of cases) of the placenta which gets aggravated with concurrent
HIV and Tuberculosis.
The intervillous space becomes blocked with macrophages
and parasites. And there is diminished pacental blood flow which
is mostly seen with falciparum infection and in the second half of
pregnancy.
Primigravidae are usually more vulnerable to infection than
multiparae.
38. Pregnant mothers living in endemic areas have
high amount of antibody titre and due to passive
transfer to the fetus, congenital Malaria is rare in these
areas.
Pregnant mothers living in non-endemic areas are
particularly vulnerable for developing severe
complications. Congenital malaria has been observed in
such cases.( Less than 5%)
39. Effect on Mother:
The symptoms start after 10 to 12 days of mosquito bite and
include a typical attack which is characterized by 3 stages. The
cold, the hot and sweating stage and this episode recur at 24-48
hours interval.
Intermittent fever with chills and rigors
Headache, nausea and vomiting
Malaise , muscle and joint pains
40. Complications:
Anaemia due to Haemolysis
Hypoglycemia and dehydration
Metabolic acidosis
Jaundice
Acute renal failure
Pulmonary oedema and respiratory distress.
Cerebral Malaria- convulsion and coma
DIC
41. Effect on Fetus:
There is abnormal Utero-placental blood flow because of
placental parasitaemia (15%-60%) which result in;
- Midtrimester abortion
- Preterm Labour
- Pre-Maturity
- IUGR
- Fetal Distress
- Stillbirth
- IUFD
- Poor perinatal outcome and perinatal death
43. Choice of Anti malarials in pregnancy
All trimesters:
First line - Chloroquine; Quinine;
Second line – Artesunate Artemether / Arteether
2nd / 3rd trimester: with caution
Pyrimethamine + sulphadoxine;
Mefloquine
Contra indicated:
Primaquine; Tetracycline; Doxycycline; Halofantrine
44. Dose of Anti malarials:
Chloroquine:
- 600mg (base) stat, 300mg after 6 hours, 24 hours & 48 hours
Quinine:
- IV - 20mg/kg infusion over 4 hours, repeat 8 hourly. -
Maintenance: 10mg/kg over 4 hours, 8 hourly. Follow with oral
medication after clinically stable.
- Oral – 600mg 8hourly ( maximum 2 gm / day) for 7 days.
Artesunate:
- Oral-100mg BD on day 1, then 50mg BD for 4-6 days (Total
dose 10mg/kg).
- IM / IV-120mg on Day 1 followed by 60mg daily for 4 days. In
severe cases an additional dose of 60mg after 6 hours on Day 1.
45. Artemether:
- Six amp (480mg) IM in 5 / 3 days.
Arteether:
- One amp (150mg) IM / day for3 consecutive days.
Pyrimethamine 25mg+sulphadoxine 500mg tablets:
- Three tablets single dose.
Mefloquine:
- 15mg / kg body wt., up to 1 Gm in a single dose. OR
Tablets of 250mg, 3 tab stat, then 2 tab after 6-8 hours. With
body wt >60kg, a third dose of 1 tab after 6-8 hours.
46. Don't waste any time
It is better to admit all cases of P. falciparum malaria.
Assess severity-
General condition, pallor, jaundice, B.P., temperature,
haemoglobin, Parasite count, S.G.P.T., S .bilirubin, S.creatinine,
Blood sugar.
Malaria in pregnancy can cause sudden and dramatic
complications. Therefore, one should always be looking for any
complications by regular monitoring.
Monitor maternal and foetal vital parameters 2 hourly.
R.B.S. 4-6 hourly; haemoglobin and parasite count 12 hourly; S.
creatinine; S. bilirubin and Intake / Output chart daily.
47. The physiologic changes of pregnancy pose special
problems in management of malaria.
In addition, certain drugs are contra indicated in pregnancy or
may cause more severe adverse effects.
All these factors should be taken into consideration while
treating these patients.
Choose drugs according to severity of the disease/ sensitivity
pattern in the locality.
Avoid drugs that are contra indicated
Avoid over / under dosing of drugs
Avoid fluid overload / dehydration
Maintain adequate intake of calories
48. Management of Labour
Anaemia, hypoglycaemia, pulmonary oedema, and
secondary infections due to malaria in pregnancy lead to
problems for both the mother and the foetus.
Severe falciparum malaria in term pregnancy carries
a very high mortality.
Maternal and foetal distress may go unrecognised in these
patients. Therefore, careful monitoring of maternal and foetal
parameters is extremely important.
Pregnant women with severe malaria are better managed in
an intensive care unit
28-Sep-18
Dr Shashwat Jani.
99099 44160.
48
49. • Falciparum malaria induces uterine contractions, resulting in
premature labour. The frequency and intensity of contractions
appear to be related to the height of the fever.
• Fetal distress is common and often unrecognised. Therefore only
monitoring of uterine contractions and fetal heart rate may
reveal asymptomatic labour and foetal distress.
• All efforts should be made to rapidly bring the temperature
under control,
– By tepid sponging (cold sponging causes cutaneous
vasoconstriction and can result in core hyperpyrexia).
– Anti pyretics like paracetamol etc.
28-Sep-18
Dr Shashwat Jani.
99099 44160.
49
50. • Careful fluid management is also very important. Dehydration as
well as fluid overload should be avoided, because both could be
detrimental to the mother and/or the foetus.
• In cases of very high parasitemia, exchange transfusion may
have to be carried out.
• If the situation demands, induction of labour may have to be
considered.
• Once the patient is in labour, foetal or maternal distress may
indicate the need to shorten the 2nd stage by forceps or vacuum
extraction.
• If needed, even caesarean section must be considered
28-Sep-18
Dr Shashwat Jani.
99099 44160.
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51. Dengue
• Dengue is an arbovirus of the Flavi viridae family
and Flavi virus genus.
• There are four serotypes of the dengue virus
(DEN-1, DEN-2, DEN-3, and DEN-4).
• DV-2 was the predominant serotype circulating
in India.
• Indian isolates of DV-2 were classified into
genotype-V. However recently Genotype IV is
more predominant.
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99099 44160.
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52. Clinical Presentation
Four main characteristic manifestations of
dengue illness are :
(i) Continuous high fever lasting 2-7 days;
(ii) haemorrhagic tendency as shown by a positive
tourniquet test, petechiae or epistaxis;
(iii) thrombocytopoenia (platelet count <100×109/l); and
(iv) evidence of plasma leakage manifested by
haemoconcentration (an increase in haematocrit 20%
above average for age, sex and population), pleural
effusion and ascites, etc .
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99099 44160.
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53. Dengue is fever is classified into three different
phases based
on the symptoms and the severity of the
disease presentation.
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99099 44160.
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54. Obstetric Complications
• Preterm birth
• Low-birth weight
• Oligohydramnios
• Antepartum and postpartum haemorrhage
• Foetal distress
• Miscarriages
• Intrauterine death
• Neonatal death
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99099 44160.
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55. Diagnosis
• NS1 Antigen test,
Primary test done for
diagnosis.
• IgM antibody capture
ELISA (MACELISA)
comes as diagnostic
reagent strips.
• RT–PCR is confirmatory
with 95% specificity.
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99099 44160.
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57. Management Of Labour In Critical
Phase Of Dengue
Blood and blood products should be cross-
matched and saved in preparation for delivery.
Trauma or injury should be kept to the minimum
if possible.
It is essential to check for complete removal of
the placenta after delivery.
Transfusion of platelet concentrates should be
initiated during or at delivery but not too far ahead
of delivery, as the platelet count is sustained by
platelet transfusion for only a few hours during
the critical phase.
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99099 44160.
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58. • Fresh whole blood/fresh packed red cells
transfusion should be administered as soon as
possible.
• Do not wait for blood loss to exceed 500 ml
before replacement, as in postpartum
haemorrhage.
• Do not wait for the haematocrit to
decrease to low levels.
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Dr Shashwat Jani.
99099 44160.
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59. Enteric Fever
• Widal test should be done on Day 5 of fever.
• Multidrug therapy
• Inj Ceftriaxone 1.5 gm 12 hourly till 24 hours after
last fever followed by oral Cefixime 400 mg BD for
14 days
• + Tab Azithromycin 500 mg BID for 5 days ( from
day 1)
• Fleuroquinolones for resistant Enteric fevers.
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Dr Shashwat Jani.
99099 44160.
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60. Puerperal Pyrexia
A rise in temperature reaching
100.4 degree F (38 degree C) or more on
separate occasions at 24 hours apart,
excluding the first 24 hours and within the
first 10 days following delivery
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61. Common Causes
UTI (multiple P/V examinations, multiple
catheterization, untreated bacteriuria)
Wound infection (C-section, trauma during
delivery)
Mastitis (nipple trauma from breast feeding)
Atelectasis (General anaesthesia, smoking, COPD)
Septic Pelvic Thrombophlebitis(Prolonged labour,
prolonged PROM)
Endometritis (Prolonged labour, prolonged PROM)
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99099 44160.
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63. Treatment
IV infusion of broad spectrum antibiotics
Continued for 48 hours after fever is resolved
Supportive care and symptomatic treatment
Heparin therapy in thrombophlebitis
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99099 44160.
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