Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
Fetal growth restriction (FGR), formerly called intrauterine growth restriction (IUGR), refers to a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb.
Mild FGR usually doesn't cause long-term problems. In fact, most babies who have it catch up in height and weight by age 2. But severe FGR can seriously harm a baby before and after birth. The extent of the problems depends on the cause and how severe the growth restriction is. It also depends on what point in the pregnancy it starts.
Slides for 3rd and 4th year medical students in Obstetrics and Gynecology- to not overlook the possibility as a diagnosis- still present. Slides highlighting diagnostic and management challenges
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
Fetal growth restriction (FGR), formerly called intrauterine growth restriction (IUGR), refers to a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb.
Mild FGR usually doesn't cause long-term problems. In fact, most babies who have it catch up in height and weight by age 2. But severe FGR can seriously harm a baby before and after birth. The extent of the problems depends on the cause and how severe the growth restriction is. It also depends on what point in the pregnancy it starts.
Slides for 3rd and 4th year medical students in Obstetrics and Gynecology- to not overlook the possibility as a diagnosis- still present. Slides highlighting diagnostic and management challenges
Intussusception - A Comprehensive PresentationJemie Nnanna
A comprehensive presentation on Intussusception, a major cause of intestinal obstruction which could be fatal if not attended to promptly.
Contains - introduction, Epidemiology, Classification, Pathophysiology, Clinical features, Investigation, Management
Globally, over 600,000 new cases and 300,000 deaths were estimated for cervical cancer in 2020 .
Third most common gynecological cancer in Palestine.
Palestine has a higher age-standardized mortality rate than other countries in the region
Cyst Assist: Pancreatic Cyst Evaluation & ManagementPatricia Raymond
Explore the clinical approach to cystic pancreatic lesions, and review recent guidelines directing observation, endoscopic evaluation, and surgical referral for patients with pancreatic cystic neoplasms. Much of our focus will be to understand the natural history and management of the four subtypes of pancreatic cystic neoplasms (PCNs): Serous cystic tumors (SCTs), Mucinous cystic neoplasms (MCNs), Intraductal papillary mucinous neoplasms (IPMNs), and Solid pseudopapillary neoplasms (SPNs). Pseudocyst management will be included in this review of these increasingly frequent and often incidental and asymptomatic CT and MRI findings.
Similar to GENITAL TB - HOW TO DIAGNOSE & WHEN TO TREAT BY DR SHASHWAT JANI (20)
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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
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
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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.
GENITAL TB - HOW TO DIAGNOSE & WHEN TO TREAT BY DR SHASHWAT JANI
1. Dr. Shashwat Jani.
M. S. ( Obs – Gynec ) , FIAOG.
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. TUBERCULOSIS- A MAJOR THREAT
TO DEVELOPING COUNTRIES
Annual cases of T.B world wide - 8 million.
95% occur in developing countries.
Prevalence worldwide is 16-20 million, with 8-10 million
being sputum +ve.
No. of people infected with T.B bacilli approximately,
1.7 billion & 1.3 billion live in developing countries
Greatest burden of T.B.( incidence &mortality) in adults
aged 15-60 years.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
2
3. CONT….
• In India 40% adults infected with T.B ,
1.5 million on Rx every year
• 5,00,000 deaths from T.B occur every year .
• Each smear +ve pt. can infect 10 -15
persons.
Central T.B division -DGHS, Ministry of health
&Family welfare,New Delhi (June, 2000 )
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
3
5. INTRODUCTION
General Incidence – India -- FGTB
• Most common extra pulmonary TB
• 30 % of all extrapulmonary TB
• 18% of infertile women
• 11% of hematospermia
• 5-25 year after primary pulmonary TB
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
5
8. SITES OF INFECTION
• Tub. Salpingitis: almost 100%, primary
focus, often bilateral
• Uterus(Corpus): 50-60%, often
secondary to tube
• Cervix: 4-6%
• Ovaries: 20-30%
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
8
9. Diagnosis
• Despite availability of various diagnostic
techniques, diagnostic dilemma still exists,
especially for genital TB.
• Hence, FGTB needs a thorough systematic
clinical examination with high degree of
suspicion and use of intensive investigations.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
9
10. 10
FGTB – DIAGNOSTIC MODALITIES
CLINICAL RADIOLOGICAL LABORATORY
Reliability increases
with
• Progression of
disease
• Multisystem
involvement
Early changes
• Needs confirmation
Advanced disease
• Almost diagnostic
Valuable for
• Early disease
diagnosis
• Rapid diagnosis
• Drugs sensitivity
INVASIVE – Endoscopy / Biopsy / Dye study
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
11. SYMPTOMATOLOGY
• Asymptomatic
• Constitutional Symptoms- Anorexia ,
Malaise, Evening Rise Of Temperature,
Weight Loss
• Infertility Due To Tubal Closure.
Primary -75% Cases
Secondary -14% cases following an
abortion , ectopic or normal delivery.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
11
12. • Schaffer- Two types
a) Silent / Latent type: Symptomless, no clinical finding,
proliferative changes in endosalpinx, adhesions
between rugal folds, labyrinthine mases
b) Advanced: palpable masses
Menstrual Disorders-
• Normal menstruation in 50-85% early cases
• Dysmenorrhoea
• Menorrhagia, menometrorrhagia due to ulcerative
T.B. endometritis
• Late : Oligo-hypomenohea
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
12
13. Contd...
• Amenorrhoea- (7% cases )
Due to destruction of endometrium & ovaries
- Io Amenorrhoea (40%)following 10
peritoneal T.B. in childhood
- II0Amen. (60%) following scanty periods
Diag.: SSC well developed, No response to EP,
No endometrium on D&C, HSG helpful
• Puberty Menorrhagia
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
13
18. X - Ray
• Though it’s secondary ,
but 75 % cases CXR –
Normal .
• May show old healed
lesion in lungs.
• X – ray Spine is also
important for Tb Spine.
• More Confirmatory -
HSG
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
18
19. Tubal changes HSG
• Non specific findings like hydrosalpinx
• Multiple constrictions giving a beaded appearance
• Occlusion either at the isthmus or ampulla
• Pipestem appearance
• Cobblestone appearance
• Leopard skin appearance
• Tubal calcifications
• Golf club appearance - Bilateral distal isthmic obstruction
• Peritubal adhesions
• Caseous ulceration of the mucosa of the tube gives it an
irregular contour and diverticular outpouching surround the
ampulla giving it a tufted appearance
• Same process in the isthmic region gives the typical
appearance of Salpingitis isthmica nodosa (SIN).
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
19
20. Uterine changes on HSG
• Endometritis, Intrauterine adhesions and asymmetrical
cavity- All non specific.
• Collar-stud abscess- Specific
• Tuberculosis T-shaped uterus
• Pseudounicornuate uterus- Unilateral obliteration
followed by unilateral scar in uterine cavity
• Small uterine cavity with irregular contour and resembling
septate appearance
• Complete obstruction of uterine cavity with glove’s finger
appearance
• Due to progressive endometrial lesion contrast medium
may passed through lymphatic and venous systems- Dye
extravasation to vascular channels
• Pelvic node calcification also may be detected
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
20
21. Pipe stem appearance Septate appearance
with small cavity
Salpingitis isthmica nodosa
Golf club appearance Glove’s finger appearance Dye extravasation to
vessels
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
21
22. USG
• Adnexal mass in an adolescent girl (Not
sexually active) especially with ascitis
• Small uterus
• Atrophic endometrium/ calcifications in the
endometrium
• Encysted ascitis
• Saline salpingogram/ sonohysterogram
showing adhesions, tubal block etc.,
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
22
23. CT and MRI and PET scan
• Peritoneal tuberculosis and tubo-ovarian
lesions have usually minimal findings at CT and
frequently misdiagnosed with peritoneal
carcinomatosis.
• MRI is useful for the diagnosis of tubo-ovarian
lesions.
• Regular pattern of small nodularities along the
peritoneum at MRI are helpful findings.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
23
24. Remember
• In spite of significant technological advances
in imaging noted with ultrasonography, CT and
MRI;
HSG remains the gold standard in
evaluating the internal architecture of
the female genital tract and fallopian
tubes.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
24
25. Laparoscopy Findings
• Tubercles on the peritoneal surface
• Inflamed or blue-coloured uterus
• Salpingitis, oophoritis or a tubo-ovarian mass
• Tubal occlusion with hydrosalpinx
• Dye dripping (instead of free flowing) from the
fimbreal opening on chromopertubation
• Free peritoneal fluid looking like blood
• Caseation in the Pouch of Douglas
• “Frozen pelvis”
• Omental adhesions
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
25
26. Right upper quadrant showing dense adhesions of the liver to the anterior abdominal wall
(Fitz-Hugh-Cutis syndrome )
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
26
30. Laboratory Investigations
• CBC & ESR
• Sputum, Urine & G .I Aspirate
• Endometrial biopsy or curettage-
detects latent endometrial T.B.
Premenstrual phase
• Biopsy - Cornual regions show tubercle follicles.
Pseudopregnancy with progesterone ,cyclical
shedding prevented –
biopsy then show tubercles (KISTNER METHOD).
‘‘Absence of signs of T.B endometritis in any
one biopsy is not proof of absence of disease”
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
30
31. Contd..
• Bacteriological examination-
Material- uterine secretions , endometrial biopsy
direct smears-Z N staining
Pap Fluorescein staining
• Guinea pig inoculation -
Best Confirmatory results are with endocervical
secretions
• Culture of menstrual discharge & Cervical mucus -
D2 of menses collected in isotonic saline &
cultured in Loewenstein’s or Petragnani’medium
• Tuberculin Skin Test- indicates presence of prior
infection. + ve results in 90% of cases.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
31
32. CURRENT TRENDS
SCREENING TESTS -
• ADA [ adenine deaminase activity]in body fluids
• Mycobacterium IgG, IgM & IgA antibodies.
• AFB smear by fluorescent microscopy .
• AFB by Zeihl Neilsen stain, Auramine Rhodamine
stain
CONFIRMATORY TESTS -
• RNA detection by Improved PCR
• Radiometric culture by BACTEC.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
32
33. CURRENT TRENDS
• PCR - Detects DNA of mycobacterium T.B.
-Useful for diagnosis paucibacillary forms of
pulmonary or extra pulmonary T.B.
• SEROLOGICAL TESTS-
• IgM & IgG ( immunoblot assay )
98% specificity 40% sensitivity.
• Elisa & sandwich Elisa technique- use of polyclonal
antibodies as primary capture antibodies.
Can detect smear -ve T.B
Rapid ,inexpensive , simple to perform.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
33
34. CURRENT TRENDS
PCR
• Detects Live & dead bacteria
• Nucleic Acid detected: DNA
• False +ve issues encountered very often
• Testing Time : 8-12 hours
• Cannot be used as a therapy monitoring tool,
detects both live & dead bacteria
• + ve Predictive value <75% due to problems of
contamination.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
34
35. CURRENT TRENDS contd...
RNA detection by Improved PCR
• Detects Live bacteria
• Nucleic Acid Detected: r RNA
• No false +ve issue , no contamination
• Testing time : 3 hours
• Can be used as a therapy monitoring tool , because it
detects live bacteria
• + ve Predictive value:100%
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
35
36. CURRENT TRENDS (cont)
• BACTEC 460 ( Mycobacterial culture )
- A liquid media with radiometric growth detection.
- Identification of isolates by nucleic acid probes.
- time required for isolation to 2-3 wks
( routine culture -4-8 wks)
• DNA finger printing from BACTEC for diagnosis of false
+ve cultures.
• Drug Susceptibility Test
-Used for pts who fail to respond to initial therapy or
relapse after Rx.
-Direct testing on liquid medium ( 3 wks).
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
36
37. QuantiFERON-TB Gold
QFTG
• In vitro laboratory diagnostic test
• Indirect test for M. tuberculosis complex
M. tuberculosis
M. bovis, M. africanum, M. microti, M.
Canetti infection
• Tuberculosis disease OR latent tuberculosis infection
(LTBI)- cannot distinguish between them
• Intended for use in conjunction with risk assessment,
radiography, and other medical and diagnostic
evaluations
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
37
38. QuantiFERON-TB Gold ( QFTG )
• Single patient visit - whole blood sample - 4 ml of
heparinised whole blood
• Must be transported to lab to allow initiation of testing
within 12 hours (viable lymphocytes)
• Rapid results (within 24 hours)
• No booster response
• No reader bias (cf Mantoux)
• Not affected by prior BCG vaccination
• Impaired or altered immune function
• ST: 80-95% (Mantoux 75-90%)
• SP: 95-100% (Mantoux 70-95%)
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
38
39. GeneXpert
• The Xpert MTB/RIF is a cartridge-based
nucleic acid amplification test (NAAT)
• For simultaneous rapid tuberculosis diagnosis
and rapid antibiotic sensitivity test.
• It is an automated diagnostic test that can
identify Mycobacterium tuberculosis (MTB)
DNA and resistance to rifampicin (RIF).
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
39
40. • GeneXpert MTB/RIF has potentially led to
revolution in diagnosis of active tuberculosis
disease and MDR-TB (multidrug resistance
tuberculosis)
• The negative predictive value (NPV) is greater
than 98%
• The sensitivity of Xpert MTB/RIF in detecting
TB is quite high (88%)
• When XPERT MTB/RIF does not detect
M.tuberculosis, the disease can be ruled out in
most cases unless there is still a strong suspicion
of TB
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
40
41. • Recently, GeneXpert MTB/RIF assay has
been endorsed by the WHO for worldwide
application that permits the simultaneous
detection of M. tuberculosis and resistance to
rifampicin.
• GeneXpert is a useful diagnostic
test for all forms of EPTB and provides
results in less than two hours.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
41
42. D & C
One must do a thorough curettage, including both
cornual regions (common sites for TB endometritis)
Entire endometrium is collected and divided in two
parts:
Half in for formalin: for histopathological
examination to look for tuberculous granulomas.
Other half in saline for smear / culture / guinea pig
inoculation. Smear: Ziehl Neelson stain.
In unmarried adolescent girls menstrual discharge
collected within 12 hours of onset of menses can be
used for culture.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
42
46. Keystones In Management
• Sound Understanding Of Disease
• Proper Evaluation
• CAREFUL PLANNING OF Rx
• Help Of Specialists
• Counselling / Reassurance
• Dietary Modification
• Advice -Long Term Follow Up
• OPHTHALMIC EXAMINATION ( Due To ETHAMBUTOL)
Treatment of FGTB is similar to Pulmonary TB.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
46
47. The Essential Anti Tb Drugs
Recommended dose (mg/kg)
Intermittent
Essential Anti-
TB drugs Mode of
action Potency
Daily
3/ wk 2/ wk
Isoniazid (H) Bactericidal High 5 10 15
Rifampicin (R) Bactericidal High 10 10 10
Pyrazinamide(Z) Bactericidal Low 25 35 50
Streptomycin (S) Bactericidal Low 15 15 15
Ethambutol (E) Bavteriostatic Low 15 30 45
Thiacetazone (T) Bacteriostatic Low 3 Not applicable
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
47
48. Drugs Used In The Treatment Of Tuberculosis
Drug Daily dose (adult) Major toxicity
Isoniazid (INH) 300 mg oral Hepatitis, peripheral
neuropathy
Rifampicin 450-600 mg oral Hepatitis, flu-like syndrome,
interstitial nephritis,
thrombocytopenia (rare)
Streptomycin 0.75-19 IM Deafness, renal failure,
vestibulopathy
Pyrazinamide 1.5-29 oral Hepatitis, hyperuricaemia
Ethambutol 5mg/kg oral Optic neuritis (rare at this
dose)
PAS 12mg oral Diarrhoea, hepatitis, ,
hypersensitirity reactions
Ethionamide 19 oral Hepatitis
Cycloserine 19 oral Depression, personality
changes psychosis, seizures
Thiacetazone 150 mg oral Exfoliative dermatitis,
hepatitis
Kanamycin 19 IM Deafness, renal failure,
vestibulopathy (rare)
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
48
49. Basic Protocol
• Intensive Phase:
3-4 drugs for first 2-4 months
• Maintenance Phase:
2 drugs for 5-12 months
• Change of drugs acc. To response,
severity, toxicity, sensitivity report
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
49
50. Alternative Treatment Regimens For Each
Patient Treatment Category
TB treatment
category
TB pateitns Alternative TB treatment
regimens
Initial phase Continuation
phase
1 New smear positive
PTB & seriously ill
extrapulmonary or
(smear TB)
2SHRZ (EHRZ)
2SHRZ (EHRZ)
2SHRZ (EHRZ)
2E3H3R3Z3*
6HE
4HR
4 H3R3
4 H3R3*
2 Sputum smear
positive relapse
Treatment failure &
return after default
2 SHRZE/1 HRZE
2 SHRZE/1 HRZE
2S3H3R3Z3/
1 H3R3Z3E3*
5H3R3E3
5 HRE
5H3R3E3*
3 Smear negative PTB
& extra pulmonary
TB (less severe)
2HRZ or 2 H3R3Z3
2HRZ or 2H3R3Z3
2HRZ or 2H3R3Z3
2 H3R3Z3*
6HE
2HR/4H
2 H3R3/4H
4 H3R3*
4 Chronic case
(still sputum positive
after supervised
treatment)
Not applicable
(refer to special centre if second-
line drugs available)
* Directly observed treatment regimens applied in the Revised National Tuberculosis
Programme in India.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
50
52. Drug Resistant T.B.
• Usually the result of monotherapy or the negligence
of the pt
• Resistance to INH & R’cin commonest
• Chosen regime must include mixture of essential
and second line drugs
• ESSENTIAL ANTI TB DRUGS:
Streptomycin, Pyrazinamide, Ethambutol
& Thiacetazone.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
52
53. • Role of steroids-in combination with
AKT
50mg cortisone / 5mg Prednisolone daily in
conjunction with AKT X 3-4 months particularly to
preserve tubes
Treatment of occluded tubes in T.B. Salpingitis
Transuterine insufflation of 50-100mg of
Hydrocortisone+Streptomycin(1gm).
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
53
54. Supportive Treatment
General health improvement
HPD- good diet, hematinics, vitamins
Environmental improvement
Psychological support
Personal / family counseling
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
54
55. Infertile women without tubal or
endometrial damage given early anti-
tuberculosis treatment based on a
positive endometrial TB-PCR test had an
excellent chance of early spontaneous
conception.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
55
56. Schaefer And Sutherland Criteria For
Surgical Intervention
• Persistence of adnexal mass after 4-6 months
of antibiotic therapy
• Persistent pelvic pain
• Primary unresponsiveness to AKT.
• Difficulty in obtaining patient cooperation for
long term therapy
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
56
57. Desiring Pregnancy ?
• Tuboplasty contraindicated in badly affected tubes
• In partially occluded tubes with a past H/O of
abdominal T.B, tubal cannulation (salpingoscopy)
possible with help of Laparo-hysteroscope.
• HYSTEROSCOPIC adhesiolysis in cases of dense
uterine synechiae (after AKT completion) HRT for
2-3 cycles helps in regeneration of endometrium
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
57
58. Prevention
Aim to decrease overall incidence of TB MT screening
BCG immunization
Detection of TB mothers in pregnancy & treatment
Routine health check up (schools, community)
Suspected cases - MT / X Ray chest
Early diagnosis - timely treatment
Therapeutic Trial - ?
Prevention of AIDS
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
58
59. To ConClude…
FGTB is in the important cause of infertility
being responsible for up to 16% cases of infertility in
developing countries while infertility is seen in up to
40-50% cases of genital TB.
FGTB can cause destruction of ovaries, tubo-
ovarian masses or poor ovarian reserve with poor
quality of embryos and need of a high dose of
gonadotropins.
Endometrial TB causes poor endometrial
receptivity, endometrial adhesions, and recurrent
implantation failure.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
59
60. Laparoscopy and hysteroscopy may be helpful in
early diagnosis and to see the severity of disease for
prognostication for fertility .
Medical treatment using DOTS strategy under
direct observation and using quality assured drugs in
appropriate dosage and for the adequate time is the
mainstay of treatment .
Surgical treatment is rarely required and should
only be done in exceptional circumstances and
should be in the form of limited surgeries like
laparoscopy, hysteroscopy and drainage of abscess,
etc., as surgery in genital and peritoneal TB can be
difficult and hazardous.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
60
61. The prognosis for fertility is poor. However, for
tubal disease in absence of endometrial disease,
ART especially IVF-ET may give good results if
performed on time after giving full course of ATT
and in fact may be the only hope for such women.
There is the role of gestational surrogacy in
women with Asherman's is syndrome due to
endometrial TB with a viable pregnancy rate of
about 50% .
Stem cell therapy may play a role in the
regeneration of endometrium and tubal mucosa in
FGTB in future.
05-Sep-18
Dr Shashwat Jani.
+91 99099 44160.
61