1) Gestational diabetes mellitus (GDM) is a form of diabetes diagnosed during pregnancy that is not clearly type 1 or type 2 diabetes. It results from the body's inability to produce enough insulin or use it effectively, and puts both mother and baby at risk.
2) GDM is tested for between 24-28 weeks of gestation using a glucose challenge test and potentially an oral glucose tolerance test. It is treated through diet, exercise, blood glucose monitoring, and potentially insulin.
3) Both mother and baby can experience risks if GDM is not managed well, such as preeclampsia, macrosomia, and long-term metabolic disorders. Ongoing screening is important after pregnancy to
This talk was delivered for postgraduates and faculty of Dr. TMA Pai Hospital, Udupi on 07 March, 2017. This talk covered pathophysiology, screening, diagnosis, complications and management of diabetes mellitus in pregnancy.
Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity .
Can prevent two generations from developing diabetes in the future.
This talk was delivered for postgraduates and faculty of Dr. TMA Pai Hospital, Udupi on 07 March, 2017. This talk covered pathophysiology, screening, diagnosis, complications and management of diabetes mellitus in pregnancy.
Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity .
Can prevent two generations from developing diabetes in the future.
RECENT ADVANCES IN THE MANAGEMENT OF GESTATIONAL DIABETES AND PRE-ECLAMPSIASyedfahidali
Gestational Diabetes is a highly prevalent condition, which has a great impact on maternal and fetal Health. It a condition triggered by metabolic adaption, which occurs during the second half of pregnancy. The aim of this review to discuss the advances in management of GDM, as well as their implications in the field, the issue of hyperglycemia in early pregnancy. Pre-eclampsia is a multisystemic disease characterized by the development of hypertension after 20 weeks of gestation, with the presence of proteinuria or, in its absence, of signs or symptoms indicative of target organ injury.
Infertility is defined as the inability of a couple to conceive after at least one year of regular unprotected intercourse.
Male infertility refers to a male's inability to cause pregnancy in a fertile female.
IDD situation in our country has improved
A good number of thyroid disorder patients are either undiagnosed and or untreated
Thyroid disorder in pregnancy- Rate high
As a sound thyroid functioning status is crucial for growth, development in children; reproduction, psychological and general wellbeing in adults, we must be proactive in screening, diagnosing and treating our patients.
Over the past several years it has been proved that maternal thyroid disorder influence the outcome of mother and fetus, during and also after pregnancy. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. It is associated with fetal loss, placental abruptions, pre-eclampsia, preterm delivery and reduced intellectual function in the offspring.1 In pregnancy, overt hypothyroidism is seen in 0.2% cases2 and sub clinical hypothyroidism in 2.3% cases3. Fetal loss, fetal growth restriction, pre-eclampsia and preterm delivery are the usual complications of overt hyperthyroidism (low TSH and high T3, T4) seen in 2 of 1000 pregnancies whereas mild or sub clinical hyperthyroidism (suppressed TSH alone) is seen in
1.7% of pregnancies and not associated with adverse outcomes4. Autoimmune positive euthyroid pregnancy shows doubling of incidence of miscarriage and preterm delivery. Worldwide more than 20 million people develop neurological sequel due to intra uterine, iodine deprivation5. Other problems of thyroid disorders in pregnancy are post partum thyroiditis, thyroid nodules and cancer, hyper emesis gravidarum etc. Debates and disputes persist regarding several protocol and management plan in this specific spectrum of diseases.
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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!
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
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.
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
1. Dr Shahjada Selim
Assistant Professor
Department of Endocrinology
Bangabandhu Sheikh Mujib Medical University, Dhaka
Email: selimshahjada@gmail.com, info@shahjadaselim.com
2. Gestational diabetes mellitus (GDM):
Diabetes diagnosed in the second or third
trimester of pregnancy that is not clearly
overt diabetes.
(American Diabetes Association, 2017)
3. *3 to 15% of all pregnancies are complicated
by diabetes
*0.2% to 0.5% of all pregnancies occur in
women with pre-existing diagnosis of type 1
DM
*similar number has pre-existing type 2 DM
4. *Early in pregnancy, maternal estrogen and
progesterone increase and promote pancreatic ß-
cell hyperplasia and increased insulin release
*As pregnancy progresses, increased levels of human
placental lactogen, cortisol, prolactin,
progesterone, and estrogen lead to insulin
resistance in peripheral tissues.
5. *Table 1 describes the diabetogenic potency
and time of peak effect of these hormones.
The timing of these hormonal events is
important in regard to scheduling testing for
GDM
6.
7. *GDM results when there is delayed or insufficient insulin secretion in the
presence of increasing peripheral resistance
8. Increased lipolysis
Mother uses fat for her caloric needs & serves
glucose for fetal needs
Changes of gluconeogenesis
Fetus preferentially utilizes alanine & other
amino acids deprivng the mother of major
neoglucogenic source
9. *Test for undiagnosed T2DM at the 1st
prenatal visit in those with risk factors. B
*Test for GDM at 24–28 weeks of gestation in
women not previously known to have
diabetes. A
*Screen women with GDM for persistent
diabetes at 4–12 weeks postpartum, using
the OGTT. E
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2016; 39 (Suppl. 1): S13-S22
10. *If GDM is not Dx. repeated at 24-28
wks or at any time a pt. has a
symtoms or signs suggestive of
hyperglycemia
11. *Women with GDM history should have lifelong
screening for development of diabetes or
prediabetes at least every 3 years. B
*Women with GDM history found to have prediabetes
should receive lifestyle interventions or metformin
to prevent diabetes. A
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2016; 39 (Suppl. 1): S13-S22
12. Low risk status:
Age<25 years
Weight normal before pregnancy
Member of an ethnic group with low prevalence
of GDM
No first degree relative of DM
No H/O abnormal glucose tolerance
No H/O poor obstetric outcome
13. High risk status:
Obesity
Advanced maternal age, >25 yrs
Asian origin irrespective of age
Previous H/O DM or abnormal glucose tolerance
Glycosuria
H/O poor obstetric outcome
``
14. *At 24-28 weeks gestation in women not previously dx’d
with overt diabetes
*75-g OGTT; Measure plasma glucose at fasting and at 1
and 2 hours.
*GDM dx’d when plasma glucose exceeds:
*Fasting: 92 mg/dL (5.1 mmol/L)
*1 h: 180 mg/dL (10.0 mmol/L)
*2 h: 153 mg/dL (8.5 mmol/L)
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2016; 39 (Suppl. 1): S13-S22
15. Step 1:
* In women not previously dx’d with overt diabetes,
perform 50-g GLT (nonfasting); Measure plasma
glucose at 1 hour.
* If 1 hour plasma glucose level is ≥140 mg/dL* (7.8
mmol/L), proceed to step 2.
*ACOG recommends 135 mg/dL in high-risk ethnic
minorities with higher prevalence of GDM.
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2016; 39 (Suppl. 1): S13-S22
16. Step 2: 100-g OGTT is performed while patient is fasting. The
diagnosis of GDM is made if 2 or more of the following plasma
glucose levels are met or exceeded:
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2016; 39 (Suppl. 1): S13-S22
Carpenter/Coustan or NDDG
Fasting 95 mg/dL (5.3 mmol/L) 105 mg/dL (5.8 mmol/L)
1h 180 md/dL (10.0 mmol/L) 190 mg/dL (10.6 mmol/L)
2h 155 mg/dL (8.6 mmol/L) 165 mg/dL (9.2 mmol/L)
3h 140 mg/dL (7.8 mmol/L) 145 mg/dL (8.0 mmol/L)
17. Maternal effect:
Associated with poor glycaemic control
Increased maternal mortality
Preeclamsia
Birth canal trauma
Long term- Metabolic syndrome
Increased CVS risk
19. Dietary Therapy
Exercise
Self BG monitoring
Administration of Insulin if target blood glucose
level are not met by diet alone
Fetal surveillance
Intrapartum care
Post partum care
20. Nutritional counseling by a registered nutritionist upon
diagnosis
The goals of Medical nutritional therapy are to:
Achieve normoglycemia
Prevent ketosis
Provide adequate weight gain
Maintain fetal well being
Prevent hypoglycemia
Two weeks for diet therapy
21. Nutritional therapy: cont.
The major components to consider when creating a nutritional
plan for women with GDM are calorie allotment, carbohydrate
intake and calorie distribution.
Callorie allotment is based upon ideal body weight. The
suggested calorie intake is approx:-
30 kcal per kg current weight per day in pregnant women
who are BMI 22-27
24 kcal per kg per for BMI of 27-29
12-15 kcal per kg for BMI of > 30
40 kcal per kg for BMI < 22
22. Calorie intake:
CHO-55%
Protein-20%
Fat-25%
With this calorie distribution, 70 to 80% of women
with GDM will achieve euglycemia
Calorie distribution:
3 meal
3 snacks
however in overweight and obese women the snacks
are eliminated.
Nutritional Therapy: cont.
24. SMBG (daily self monitoring of blood glucose)
superior to intermittent office monitoring
Blood glucose report should be written in a glucose
dairy
Blood glucose measured 4 times a day- On awakening,
1-2 hrs after each meal
Hba1c is a helpful ancillary test
Should be checked at 4 weeks interval
25. Recommendations for starting Insulin: (ADA guideline)
FPG> 5.8mmol/l or
1 hr PG> 8.6 mmol/l
2hr PG > 7.2 mmol/l
Target blood glucose:
Pre prandial <5.3mmol/l
1 hr post prandial <7.8 mmol/l
2 hr post prandial <6.7 mmol/l
26. Calculating dose:
Total insulin- 20-30 U/day
2/3rd
intermediate acting (NPH)
1/3rd
regular Insulin
Calculated daily dose of insulin:
1st
trimester-0.8 unit ×kg BW
2nd
trimester- 1 unit ×kg BW
3rd
trimester- 1.3 unit×kg BW
27. The dose and type of insulin used is calculated
according to the blood glucose level
If the FBG is high then, an intermediate- acting
insulin, is given before bedtime.
If postprandial blood glucose levels are high, then
regular rapid-acting insulin are added before meals.
Insulin Therapy cont.
28. If both preprandial and postprandial blood glucose levels are
high,then initiate a four injection per day regimen.
The insulin is divided according to the following schedule: 45%
as NPH insulin(30% before breakfast & 15% before dinner) and
55% as preprandial regular insulin(22% before breakfast,18%
before lunch and 14% before dinner).
A four-times daily regimen improved glycemic control and
prenatal outcome compared to a twice- daily regimen.
Insulin Therapy cont.
29. Regular Insulin is withheld during labor ; a sliding scale of
soluble insulin should be started (or infusion pump as may
be fit)
Maternal hyperglycemia should be avoided during labor to
prevent fetal hyperinsulinemia and subsequent neonatal
hypoglycemia
Maternal blood glucose should be maintained between 4- 5
mmol/L.
Peripartum MX:
30. Blood glucose should be measured on the day after
delivery to using criteria established for nonpregnant
women.
A women with GDM should be able to resume a regular
diet postpartum.
Screen women with GDM for persistent DM 6-12 weeks
post partum
Lifelong screening at list every 3 years
Peripartum MX: cont.
31. Nearly all women(90%) with GDM are normoglycemic
after delivery. However they are at risk for recurrent GDM,
impaired glucose tolerance and overt diabetes.
2/3rd
of women with GDM will have GDM in a subsequent
pregnancy.
Future Risk:
32. Should be consulted with health care provider
Glucose tolerance test should be done prior to
conception
33. GDM offers an important opportunity for the
development, testing and implementation of clinical
strategies for diabetes prevention.
Screening all pregnant women, achieving
euglycemia in them and ensuring adequate nutrition
may interrupt the vicious cycle of glucose intolerance
from one generation to another.
Editor's Notes
Recommendations for the detection and diagnosis of gestational diabetes mellitus (GDM) are summarized on two slides;
First, because of the number of pregnant women with undiagnosed type 2 diabetes, it is reasonable to test women with risk factors for type 2 at the first prenatal visit, using standard diagnostic criteria. [CLICK]
Test for GDM at 24–28 weeks of gestation in pregnant women not previously known to have diabetes. [CLICK]
Screen women with GDM for persistent diabetes at 6–12 weeks postpartum, using the OGTT and clinically appropriate nonpregnancy diagnostic criteria.
[SLIDE]
And finally,
Women with a history of GDM should have lifelong screening for the development of diabetes or prediabetes at least every 3 years. [CLICK]
Women with a history of GDM found to have prediabetes should receive lifestyle interventions or metformin to prevent diabetes.
[SLIDE]
First, the one-step strategy, which consists of a 75g OGTT.
In women between 24 and 28 weeks gestation not previously diagnosed with overt diabetes, perform a 75-g OGTT in the morning after an overnight fast of at least 8 hours.
Measure plasma glucose measurement fasting and at 1 and 2 hours.
Gestational diabetes is diagnosed if the fasting glucose is higher than 92 mg per dL, if the 1 hour glucose is higher than 180, or if the 2 hour is over 153.
[SLIDE]
And here’s the 2-step strategy recommended by NIH.
First, perform a 50-g GLT (nonfasting), with plasma glucose measurement at 1 h, at 24–28 weeks of gestation in women not previously diagnosed with overt diabetes
If the plasma glucose level measured 1 h after the load is ≥140 mg/dL, proceed to Step 2, the 100-g OGTT
It’s worth noting here also that the American College of Obstetricians and Gynecologists (ACOG) recommends a lower threshold of 135 in high-risk ethnic minorities with higher prevalence of GDM.
[SLIDE]
If the non-fasted 1-hour glucose is 140 or above, then perform the 100-g OGTT. This one is fasting, and GDM is diagnosed if at least two of the following four criteria are met or exceeded.
[SLIDE]