Genital tuberculosis (TB) commonly affects females aged 20-40 years. It is usually secondary to pulmonary or other organ involvement. The fallopian tubes are most frequently involved (90-100%), followed by the endometrium (50-60%). Common presenting symptoms include infertility (40-50%), abnormal bleeding (25-30%), and pelvic pain (15-25%). Diagnosis involves clinical suspicion, imaging such as ultrasound or HSG, and microbiological tests on samples from the endometrium or tubes. Treatment consists of a multi-drug regimen containing isoniazid, rifampin, pyrazinamide and ethambutol for 2 months, followed by isoniazid and rif
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
female Genital tuberculosis,TB-PCR, female infertility, veerendrakumar cm
female genital TB poses stiffest challenge in the diagnosis, rapid molecular techniques have helped in arriving at a definitive diagnosis in suspicious clinical setting
this lecture involves full, simple and easy description of cervicitis
including acute and chronic cervicitis and the major causes for it as Neisseria gonorrhea and chlamydia trachomatous
also chronic infection and ectopy
Uterine prolapse (also called descensus or procidentia) means the uterus has descended from its normal position in the pelvis farther down into the vagina.Cervicopexy is fertility conserving surgical management of prolapse.
Urinary Tract Fistulas -(VVF) Etiology, Diagnosis, ManagementVikas V
Urinary Tract Fistulas - Etiology, Diagnosis, Management
Surgical and Relevant Anatomy, Classification, eitiology, VVF in Detail, Examination and Diagnosis, Management of VVF - Both Conservative And Surgical Management - Steps of Surgical Management, Post operative Management.
female Genital tuberculosis,TB-PCR, female infertility, veerendrakumar cm
female genital TB poses stiffest challenge in the diagnosis, rapid molecular techniques have helped in arriving at a definitive diagnosis in suspicious clinical setting
this lecture involves full, simple and easy description of cervicitis
including acute and chronic cervicitis and the major causes for it as Neisseria gonorrhea and chlamydia trachomatous
also chronic infection and ectopy
Uterine prolapse (also called descensus or procidentia) means the uterus has descended from its normal position in the pelvis farther down into the vagina.Cervicopexy is fertility conserving surgical management of prolapse.
Urinary Tract Fistulas -(VVF) Etiology, Diagnosis, ManagementVikas V
Urinary Tract Fistulas - Etiology, Diagnosis, Management
Surgical and Relevant Anatomy, Classification, eitiology, VVF in Detail, Examination and Diagnosis, Management of VVF - Both Conservative And Surgical Management - Steps of Surgical Management, Post operative Management.
genitourinary tb - contains radiological findings of genitourinary tuberculosis including ivp,, hsg, usg and ct findings in kidney, ureter, urinary bladder, uterus and prostate
Tuberculosis (TB) is a very common disease worldwide including India. Tuberculosis of the female genital tract is
common enough to be found in 1% of women with DUB (Sutherland 1949) and in 4% of adolescent with excessive
menstrual loss (Sutherland 1953). The commonest site of involvement is the fallopian tubes (90e100%). The next
common site is endometrium (60%). The infection is from the tubes either by lymphatics or direct spread through
continuity. Symptoms vary according to the severity site and stage of the disease. Anti tuberculosis chemotherapy is the mainstay of tt. Initially drugs are used for 2 months. These are isoniazid, rifampicin, pyrazinamide and ethambutal. Treatment is continued for another 4 months with isoniazid and rifampicin.
• Bio Tech's D3Natal contains 5000IU of Vitamin
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People with dark skin, limited exposure to
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Conclusion: Vitamin D2 potency is less than 1/3 the potency of Vitamin D3 with a shorter duration of action
° "Vitamin D3 Is More Potent than Vitamin D2 in Humans" (Heaney, Recker, Grote, Horst, Armas 201 I)
Conclusion: Vitm in D3 is ~87% more potent in raising and maintaining serum 25(OH)D concentrations and produces 2-3 fold greater storage of Vitamin D3 over D2
Low levels of Vitamin D during pregnancy are associated with poor fetal/infant skeletal formation and growth as well as poor tooth mineralization
• Over 50 Universities, Hospitals and Clinics utilize Bio-Tech Vitamin D3 for their research
• Vitamin D3 is not a Rx. Vitamin D2 is available via Rx only
• Lactation and Vitamin D3
• A reassessment of current Vitamin D intake for mothers is critical as current recommendations result in a high degree of Vitamin D deficiency, especially in the African American population.
• Current recommendations of 200-400 ILJ/d for pregnant and lactating women are grossly inadequate, especially in minority populations. A growing body a research suggests that dosing with over 2000 ID/d is required to maintain robust normal levels.
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Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
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students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
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Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
2. Genital T.B. 1st recognized by MORGAGNI
in 1744.
Incidence in infertility clinics:-
5% in world and 19% in India.
80% – 90% in females aged 20 – 40 years.
3. Almost always secondary usually primaries are
pulmonary other sites renal, GIT, bone, etc.
occasionally part of miliary T.B.
MODE OF SPREAD:- 1. Hematogenous
2. Lymphatic
3. Direct
Evidence suggest if primary infection occurs
close to menarche increased chance of genital
T.B.
4.
5. Tubercular adenitis of mesenteric or pelvic
lymph nodes.
Superficial involvement of serosa does not
impair reproductive function.
Pelvic T.B. is not the same disease as Genital
T.B.
7. Usually the ampullary region shows the earliest and most
extensive changes.
The fimbrial processes become greatly swollen and Ostia
remain open or closed.
Gross appearance – 1. TOBACCO POUCH
APPEARANCE.
2. PRODUCTIVE
ADHESIVE FORM.
Gross appearance varies and is non-diagnostic.
Microscopy, hyperplastic adenomatous pattern may be
confused with adenocarcinoma.
8. Gross size and shape of uterus may appear normal.
Endometrium on gross appearance may show
ulcerative, granular or fungating lesion resembling
carcinoma.
Endometrial cavity may be obliterated with
intrauterine adhesions.
Microscopy classic lesion is the non caseating
granuloma.
The granulomatous lesions are best recognized on 24
– 26 cycle days or within 12 hrs. of onset of menses.
10. High degree of suspicion.
20% have history of T.B. in immediate family.
4 major presenting complaints:-
1. Infertility.
2. Abnormal
bleeding .
3. Pelvic pain.
4.Amennorrhea.
11. H/o primary infertility with no apparent cause on
examination & family H/o or personal H/o T.B.
H/o vague lower abdominal discomfort with low grade
fever/undue fatigue/persistent ill health over months to
years associated with weight loss.
Adolescent female presenting with ascites pain and low
grade fever.
Menopausal female enlarged uterus that is tense and
tender on examination (pyrometra formation)
Recurrent Pelvic inflammatory disease not responding
to antibiotic therapy.
12. Most common initial symptom.
In most large studies:
Infertility presenting c/o in 40% - 50%.
85% never became pregnant & 15%
developed symptoms of genital T.B.
within a year of last pregnancy.
13. Second common symptom.
Pain present for several months which is not usually
severe.
M/b associated with swelling of abdomen.
Episodes of acute lower abdominal pain owing to
secondary infection by pyogenic org.
In advanced disease pelvic pain becomes severe and
gets aggravated by coitus, exercise & mensus.
No. of women c/o pain is proportional to no. of women
having abdominal findings on physical examination.
14. Third common symptom.
Menorragia/ Menometrorragia/ Intermenstrual
bleeding/ Oligomenorrhoea/ Postmenopausal
bleeding.
Menstrual cycle may be normal. Superficial
T.B. Endometritis does not interfere with
secretory response of endometrium to
hormonal stimulation.
15. Advanced active pulmonary T.B. produce
amen. but concomitant genital T.B. is rare.
Complete destruction of ovary by genital T.B.
seldom occurs so ovarian failure is not the
cause.
End organ failure secondary to endometrial
caseation.
16. Normal in 50%..
Bi manual examination-adenexal mass/fixation
of pelvic organs less tender.
Abdominal examination-doughy feeling.
20. Diagnostic role of a positive Mantoux (PPD) is
controversial
Almost 45% of infertile women with strong indirect evidence
of pelvic TB, such as laparoscopic findings (thickened tubes,
areas of caseation, etc) - negative Mantoux
In 27 infertile women with a positive Mantoux, only 11 had
clear laparoscopic findings suggestive of FGTB
Mantoux test in women with laparoscopically diagnosed
tuberculosis
sensitivity - 55%
specificity - 80%
22. Decisive step for diagnosis, treatment &
control of TB
Combination of solid & liquid media- “gold
standard” for primary isolation
Recommended turn around time (CDC)
14 days (culture)
21-30 days (identification & susceptibility)
24. CO2 released by mycobacteria detected by sensor
Color changes - increase in reflectance units
Positive broth - 106-107 orgs/ml
Higher biomass - direct inoculation of
identification panels & susceptibility tests
25. In vitro laboratory diagnostic test (May ’05)
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
26. 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 (measured by subsequent tests -
which can happen with Mantoux)
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%)
28. Uses
Rapid diagnosis in smear negative samples
65 kDA protein encoding gene
mpt64 gene
Differentiate M. tb / NTM
Species specific IS6110
Genetic markers for drug resistance
Rifampicin – rpoB
INH – codon 315 of katG
False positives & false negatives (inhibitors)
Negative result cannot rule out TB & positive result is
not always confirmatory
29. Based on hybridisation of nucleic acids
4 steps
Sample preparation
Hybridisation
Selection of the hybrid
Detection of the hybrid
30. Mycobacteriophage detection system
M. smegmatis lytic cycle: 90 mins
Not expensive; safe
Viable bacilli, intact phage receptors
Affected by effective ATT – monitor trt success
Phage inhibitory substances
Analytical ST: 100-300 bacilli/ml
Mixed results
Good sp (96-99%)
Less st (70-87%)
31. Rigid pipe-stem tubes
A clubbed ampulla with retort-shaped
hydrosalpingx
Vascular or lymphatic intravasation of contrast
Small shrunken uterine cavity with filling
defects
Long and dilated cervical canal & dye in
cervical crypts
Bilateral cornual block
Punctate opacification of crypts and
diverticulae in lumen of tubes
32.
33.
34.
35.
36.
37.
38. A combination of PCR with the other available
techniques is the best method of achieving sufficient
sensitivity and specificity for the diagnosis of female
genital tuberculosis
PCR positive + culture negative – warrants therapy
as PCR can detect very few bacilli & even dead
bacilli.
PCR negative + culture positive – this result cannot
be dismissed as contamination carry false negative
rate of PCR. Culture remains gold standard.
40. Subfertility & Infertility- Residual damage of the
fallopian tubes is often irreversible even following
medical regimens, unless genital T.B. is diagnosed
and treated early in its course. Symptoms of pain and
menstrual disorder respond to medical treatment.
Ectopic pregnancy- Risk of ectopic pregnancy
following medical treatment is estimated to be 33%-
72%.
Congenital T.B.- Rare but potentially serious
complication. Over whelming systemic infection in
the new born has considerable morbidity &mortality.
41. Once diagnosed a gynecologist must consider
following points:-
Rule out active T.B. at any other site.
Know the extent of genital lesion.
Will medical management cure the lesion?
Is pregnancy possible following treatment?
42. Experts suggest that it is easier to treat these
cases because they are paucibacillary.
3 basic principles for chemotherapy for T.B.
Regimen must contain multiple drugs to which
organism is susceptible.
Drugs are to be taken regularly.
Drugs should continue for a sufficient period of
time.
43. For patients who are compliant and the
organism is fully susceptible.
INH+RIF+PZA--- 2 months
INH+RIF --- 4 months
For patients who cannot tolerate PZA
INH+RIF--- 9 months
Ethambutol or SM should be included in above
regimen till results of drug susceptibility are
available.
Add pyridoxine 25-50mg in regimen including
INH.
Multi drug resistance drug used are-
PAS/cycloserine/capreomycin/kanamycin/amikacin/thioac
etazone
44. Indications:-
Persistent & recurrent disease/pelvic masses/pelvic
pain/abnormal bleeding despite adequate treatment
Persistent non healing fistula
Multi drug resistant disease
Concomitant neoplasia of genital tract
Chemotherapy should precede surgery by 1-2 weeks.
Surgery should be done at mid cycle in premenopausal.
C.T. should be continued for 6-12 months post op.
Premenopausal-save ovaries if normal, otherwise TAH
with BSO followed by HRT.