Gestational diabetes (GDM) occurs when a woman without diabetes develops high blood sugar levels during pregnancy. It is caused by hormones from the placenta that interfere with the mother's insulin and metabolism. GDM affects approximately 10% of pregnancies and screening involves a glucose challenge test followed by an oral glucose tolerance test if high blood sugar levels are detected. Untreated GDM can lead to complications for both mother and baby such as preeclampsia, macrosomia, and jaundice. Treatment focuses on medical nutrition therapy, exercise, blood sugar monitoring, and possibly insulin to control glucose levels and minimize risks.
Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy. Rates of GDM are estimated to be 10-14.3% in India, higher than Western countries. Women with GDM and their offspring have an increased risk of developing type 2 diabetes later in life. Treatment for GDM involves medical nutrition therapy, physical activity, blood sugar monitoring, and potentially metformin or insulin therapy if blood sugar levels remain high. Proper management of GDM can help prevent complications for both mother and baby during pregnancy and reduce long-term health risks.
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.
Gestational diabetes and other forms of diabetes that develop during pregnancy can lead to complications for both the mother and baby if not properly managed. Close monitoring of blood sugar levels and insulin therapy if needed are important for treatment. Babies may be born larger than normal or have other issues if the mother's diabetes is not well controlled during pregnancy. Care during labor and delivery and after birth also aims to prevent low blood sugar in both the mother and newborn.
Diabetes in pregnancy Dr.Pasham Sharath ChandraPasham sharath
This document discusses diabetes in pregnancy. It provides information on different types of diabetes including type 1, type 2, and gestational diabetes. It notes the risks of diabetes in pregnancy for both the mother and fetus, including complications like miscarriage, pre-eclampsia, and congenital malformations. The document discusses management of pregestational or overt diabetes in pregnancy, including achieving good glycemic control before and during pregnancy through insulin therapy, medical nutrition therapy, glucose monitoring, and lifestyle modifications.
Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal Lifecare Centre
Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal
Intrahepatic cholestasis of pregnancy (ICP) is characterized by Pruritus and an elevation in serum bile acid concentrations, typically developing in the late second and/or third trimester and rapidly resolving after delivery.
Gestational diabetes affects 2-3% of pregnancies and is characterized by carbohydrate intolerance that develops during pregnancy. Risk factors include maternal age over 25, family history of diabetes, prior macrosomia or stillbirth. Screening involves a glucose challenge test at 24-28 weeks of gestation. A diagnosis requires two abnormal values on a 3-hour oral glucose tolerance test. Treatment focuses on tight glycemic control through diet, exercise and possibly insulin to reduce risks of complications for both mother and baby like macrosomia, birth trauma and neonatal hypoglycemia.
Gestational diabetes (GDM) is glucose intolerance that begins or is first recognized during pregnancy. It can be caused by either pre-existing type 2 diabetes or a new onset of diabetes during pregnancy. The document discusses screening, diagnosis and management of both pre-existing diabetes and GDM during pregnancy. It aims to provide optimal glucose control to support fetal growth while avoiding risks of hyper- and hypoglycemia. Treatment involves medical nutrition therapy, glucose monitoring and may require insulin therapy in some cases. Close monitoring is needed throughout pregnancy and postpartum to support maternal and fetal health.
Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy. Rates of GDM are estimated to be 10-14.3% in India, higher than Western countries. Women with GDM and their offspring have an increased risk of developing type 2 diabetes later in life. Treatment for GDM involves medical nutrition therapy, physical activity, blood sugar monitoring, and potentially metformin or insulin therapy if blood sugar levels remain high. Proper management of GDM can help prevent complications for both mother and baby during pregnancy and reduce long-term health risks.
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.
Gestational diabetes and other forms of diabetes that develop during pregnancy can lead to complications for both the mother and baby if not properly managed. Close monitoring of blood sugar levels and insulin therapy if needed are important for treatment. Babies may be born larger than normal or have other issues if the mother's diabetes is not well controlled during pregnancy. Care during labor and delivery and after birth also aims to prevent low blood sugar in both the mother and newborn.
Diabetes in pregnancy Dr.Pasham Sharath ChandraPasham sharath
This document discusses diabetes in pregnancy. It provides information on different types of diabetes including type 1, type 2, and gestational diabetes. It notes the risks of diabetes in pregnancy for both the mother and fetus, including complications like miscarriage, pre-eclampsia, and congenital malformations. The document discusses management of pregestational or overt diabetes in pregnancy, including achieving good glycemic control before and during pregnancy through insulin therapy, medical nutrition therapy, glucose monitoring, and lifestyle modifications.
Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal Lifecare Centre
Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal
Intrahepatic cholestasis of pregnancy (ICP) is characterized by Pruritus and an elevation in serum bile acid concentrations, typically developing in the late second and/or third trimester and rapidly resolving after delivery.
Gestational diabetes affects 2-3% of pregnancies and is characterized by carbohydrate intolerance that develops during pregnancy. Risk factors include maternal age over 25, family history of diabetes, prior macrosomia or stillbirth. Screening involves a glucose challenge test at 24-28 weeks of gestation. A diagnosis requires two abnormal values on a 3-hour oral glucose tolerance test. Treatment focuses on tight glycemic control through diet, exercise and possibly insulin to reduce risks of complications for both mother and baby like macrosomia, birth trauma and neonatal hypoglycemia.
Gestational diabetes (GDM) is glucose intolerance that begins or is first recognized during pregnancy. It can be caused by either pre-existing type 2 diabetes or a new onset of diabetes during pregnancy. The document discusses screening, diagnosis and management of both pre-existing diabetes and GDM during pregnancy. It aims to provide optimal glucose control to support fetal growth while avoiding risks of hyper- and hypoglycemia. Treatment involves medical nutrition therapy, glucose monitoring and may require insulin therapy in some cases. Close monitoring is needed throughout pregnancy and postpartum to support maternal and fetal health.
Gestational diabetes mellitus by sushantSushant Yadav
This document discusses gestational diabetes mellitus (GDM). It defines GDM as carbohydrate intolerance that is recognized or begins during pregnancy. The document discusses the types, risk factors, pathophysiology, screening recommendations, and classifications of diabetes in pregnancy according to White's groups. It notes that GDM occurs in about 7% of pregnancies globally and prevalence varies between racial/ethnic groups and countries. Screening is recommended between 24-28 weeks of gestation using a 75g oral glucose tolerance test.
This document discusses gestational diabetes and its management. It defines gestational diabetes as glucose intolerance first recognized during pregnancy. It recommends screening all pregnant women with a 50-g glucose challenge test and diagnosing based on thresholds from a 75-g oral glucose tolerance test. Treatment aims to lower risks of macrosomia, cesarean sections, and monitor blood glucose with diet and exercise as first line therapies and sometimes insulin. Diet should provide 30-40% calories from complex carbohydrates and monitor weight gain based on pre-pregnancy BMI.
- Dr. Laxmi Shrikhande is a medical director and chairperson of several organizations focused on obstetrics and gynecology in India.
- She has received numerous national awards for her work in women's health issues like the Nagpur Ratan Award and the Bharat Excellence Award.
- The document discusses diabetes in pregnancy, including the types of diabetes (pre-existing vs. gestational), prevalence, pathophysiology, screening and diagnostic criteria, management, and monitoring during pregnancy.
- Key aspects of managing gestational diabetes include medical nutrition therapy, exercise, self-monitoring of blood glucose, glycemic targets, fetal monitoring, and insulin treatment if needed to control blood sugar
1) Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that causes pruritus (itching) without a rash and occurs in the second half of pregnancy.
2) Diagnosis involves elevated fasting bile acids and liver enzymes as well as ruling out other causes. Ursodeoxycholic acid is the first line treatment to improve symptoms and liver function.
3) ICP can lead to fetal complications like stillbirth so careful monitoring and early delivery may be considered for severe cases. Management involves treatment with UDCA and rifampicin as well as lifestyle changes to reduce symptoms.
1. Tight glycemic control through medical nutrition therapy, exercise, blood glucose monitoring, and potentially insulin is important to manage diabetes in pregnancy.
2. Close fetal surveillance through growth scans and tests are needed to monitor for complications like macrosomia.
3. Delivery timing and type (vaginal vs c-section) depends on maternal and fetal status and risks like macrosomia.
4. Neonatal risks include hypoglycemia, jaundice, and respiratory distress which requires close monitoring after birth.
5. Counseling on future diabetes risk and appropriate contraception is important in postpartum care.
This document discusses vaginal birth after cesarean (VBAC) and elective repeat cesarean delivery (ERCD). It begins by outlining the history of the "once a cesarean, always a cesarean" dictum and subsequent research challenging this view. It then compares the risks and benefits of VBAC versus ERCD. Key points include a VBAC success rate of 60-80% and increased risks of uterine rupture and emergency cesarean with VBAC. Factors affecting VBAC likelihood of success and failure are also reviewed. The document provides guidance on candidate selection and counseling for VBAC.
This document provides an overview of diabetes in pregnancy. It defines diabetes mellitus and describes the main types: type 1, type 2, and gestational diabetes. Risk factors, screening, and diagnostic criteria for gestational diabetes are covered. The document also discusses complications of diabetes in pregnancy for both mother and baby, as well as management through medical nutrition therapy, exercise, medication and insulin. Postpartum care is also summarized.
Primary amenorrhea is defined as no menstrual periods by age 16. Investigations into primary amenorrhea depend on whether secondary sex characteristics are present or absent. Causes can be physiological, pathological, anatomical, endocrinological, or chromosomal. Common causes include hypothalamic or pituitary disorders, chromosomal abnormalities like Turner's syndrome, congenital adrenal hyperplasia, androgen insensitivity syndrome, or müllerian agenesis. Treatment depends on the underlying cause but may include hormone replacement therapy, vaginal dilation, vaginoplasty, or gonadectomy.
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.
This document provides information on PROM (prelabor rupture of membranes) and PPROM (premature prelabor rupture of membranes). It defines PROM as rupture of membranes beyond 28 weeks of gestation but before labor, while PPROM is rupture before 37 weeks. The document discusses pathogenesis, incidence, causes, signs/symptoms, investigations, complications and management for PROM and PPROM. It provides details on evaluating for chorioamnionitis and managing based on gestational age, including expectant management with antibiotics or induction of labor/C-section depending on the situation.
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
diabetes is very common disorder in all age group i.e from infancy to secondary childhood age so intake of good healthy diet is very important for the production of insulin which is needed for body for regular activities
The cardiovascular system undergoes several changes during pregnancy to support the increased metabolic demands of the mother and fetus. The heart is pushed upward and outward by the enlarged uterus, increasing the cardiac silhouette. Cardiac output increases by 40-50% by 30-34 weeks due to higher blood volume, stroke volume, and heart rate. Blood pressure decreases slightly despite increased cardiac output due to lower systemic vascular resistance from progesterone and other hormones. Venous pressure, especially in the legs, increases significantly due to pressure from the gravid uterus. These cardiovascular changes help increase blood flow to the uterus and other organs to support the nutritional needs of the growing fetus.
This document discusses screening for gestational diabetes mellitus (GDM). It defines GDM and explains that pregnancy increases insulin resistance. There are two approaches to screening - a single step 75g oral glucose tolerance test (OGTT), or a two step approach using a 50g glucose challenge test followed by a 100g OGTT if thresholds are met. Threshold values for diagnosing GDM on OGTT tests are provided. The Seshiah test, recommended in India, performs a 75g OGTT in the non-fasting state, diagnosing GDM if the 2hr value is ≥140mg/dL.
This document provides information from Dr. Kirtan Vyas about fetal growth restriction (FGR). It discusses the challenges in identifying and managing FGR. Key points include:
1) Timely identification of FGR is difficult but crucial for proper management and a favorable neonatal outcome, as it is the second leading cause of perinatal mortality after prematurity.
2) FGR remains extensively studied but still confusing and controversial to researchers.
3) The major concern with FGR is not the small size of the fetus but the possibility of life-threatening fetal compromise.
4) Screening approaches, management recommendations, and postnatal care for babies with FGR are discussed.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
The document discusses three case scenarios involving pregnant women with reactive syphilis serology. It provides details on interpreting syphilis serology, the stages of syphilis infection, and recommendations for treatment and follow up after treatment. The key points are: syphilis should be suspected in pregnant women who are sexually active or have partners with risk factors; reactive nontreponemal and treponemal tests indicate current or past untreated syphilis; and pregnant women with reactive tests should be treated with penicillin to prevent transmission to the fetus.
El documento trata sobre un caso legal largo designado como Caso IIIA. El Caso IIIA parece ser un caso legal complejo que requiere más tiempo y esfuerzo para resolver. El título del documento proporciona poca información sobre los detalles específicos del caso.
The document provides guidance on performing pelvic examinations, including:
1) Instructions for observing and palpating the external genitalia and internal structures using a speculum. Key steps include inspecting for abnormalities, examining the Bartholin's glands, and inserting the speculum.
2) Guidelines for Pap testing according to American Cancer Society recommendations, including screening intervals based on age and risk factors.
3) A list of required equipment for comprehensive pelvic examinations, including speculums, gloves, lubricants, and collection materials for Pap tests and STI screening.
Gestational diabetes mellitus by sushantSushant Yadav
This document discusses gestational diabetes mellitus (GDM). It defines GDM as carbohydrate intolerance that is recognized or begins during pregnancy. The document discusses the types, risk factors, pathophysiology, screening recommendations, and classifications of diabetes in pregnancy according to White's groups. It notes that GDM occurs in about 7% of pregnancies globally and prevalence varies between racial/ethnic groups and countries. Screening is recommended between 24-28 weeks of gestation using a 75g oral glucose tolerance test.
This document discusses gestational diabetes and its management. It defines gestational diabetes as glucose intolerance first recognized during pregnancy. It recommends screening all pregnant women with a 50-g glucose challenge test and diagnosing based on thresholds from a 75-g oral glucose tolerance test. Treatment aims to lower risks of macrosomia, cesarean sections, and monitor blood glucose with diet and exercise as first line therapies and sometimes insulin. Diet should provide 30-40% calories from complex carbohydrates and monitor weight gain based on pre-pregnancy BMI.
- Dr. Laxmi Shrikhande is a medical director and chairperson of several organizations focused on obstetrics and gynecology in India.
- She has received numerous national awards for her work in women's health issues like the Nagpur Ratan Award and the Bharat Excellence Award.
- The document discusses diabetes in pregnancy, including the types of diabetes (pre-existing vs. gestational), prevalence, pathophysiology, screening and diagnostic criteria, management, and monitoring during pregnancy.
- Key aspects of managing gestational diabetes include medical nutrition therapy, exercise, self-monitoring of blood glucose, glycemic targets, fetal monitoring, and insulin treatment if needed to control blood sugar
1) Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that causes pruritus (itching) without a rash and occurs in the second half of pregnancy.
2) Diagnosis involves elevated fasting bile acids and liver enzymes as well as ruling out other causes. Ursodeoxycholic acid is the first line treatment to improve symptoms and liver function.
3) ICP can lead to fetal complications like stillbirth so careful monitoring and early delivery may be considered for severe cases. Management involves treatment with UDCA and rifampicin as well as lifestyle changes to reduce symptoms.
1. Tight glycemic control through medical nutrition therapy, exercise, blood glucose monitoring, and potentially insulin is important to manage diabetes in pregnancy.
2. Close fetal surveillance through growth scans and tests are needed to monitor for complications like macrosomia.
3. Delivery timing and type (vaginal vs c-section) depends on maternal and fetal status and risks like macrosomia.
4. Neonatal risks include hypoglycemia, jaundice, and respiratory distress which requires close monitoring after birth.
5. Counseling on future diabetes risk and appropriate contraception is important in postpartum care.
This document discusses vaginal birth after cesarean (VBAC) and elective repeat cesarean delivery (ERCD). It begins by outlining the history of the "once a cesarean, always a cesarean" dictum and subsequent research challenging this view. It then compares the risks and benefits of VBAC versus ERCD. Key points include a VBAC success rate of 60-80% and increased risks of uterine rupture and emergency cesarean with VBAC. Factors affecting VBAC likelihood of success and failure are also reviewed. The document provides guidance on candidate selection and counseling for VBAC.
This document provides an overview of diabetes in pregnancy. It defines diabetes mellitus and describes the main types: type 1, type 2, and gestational diabetes. Risk factors, screening, and diagnostic criteria for gestational diabetes are covered. The document also discusses complications of diabetes in pregnancy for both mother and baby, as well as management through medical nutrition therapy, exercise, medication and insulin. Postpartum care is also summarized.
Primary amenorrhea is defined as no menstrual periods by age 16. Investigations into primary amenorrhea depend on whether secondary sex characteristics are present or absent. Causes can be physiological, pathological, anatomical, endocrinological, or chromosomal. Common causes include hypothalamic or pituitary disorders, chromosomal abnormalities like Turner's syndrome, congenital adrenal hyperplasia, androgen insensitivity syndrome, or müllerian agenesis. Treatment depends on the underlying cause but may include hormone replacement therapy, vaginal dilation, vaginoplasty, or gonadectomy.
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.
This document provides information on PROM (prelabor rupture of membranes) and PPROM (premature prelabor rupture of membranes). It defines PROM as rupture of membranes beyond 28 weeks of gestation but before labor, while PPROM is rupture before 37 weeks. The document discusses pathogenesis, incidence, causes, signs/symptoms, investigations, complications and management for PROM and PPROM. It provides details on evaluating for chorioamnionitis and managing based on gestational age, including expectant management with antibiotics or induction of labor/C-section depending on the situation.
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
diabetes is very common disorder in all age group i.e from infancy to secondary childhood age so intake of good healthy diet is very important for the production of insulin which is needed for body for regular activities
The cardiovascular system undergoes several changes during pregnancy to support the increased metabolic demands of the mother and fetus. The heart is pushed upward and outward by the enlarged uterus, increasing the cardiac silhouette. Cardiac output increases by 40-50% by 30-34 weeks due to higher blood volume, stroke volume, and heart rate. Blood pressure decreases slightly despite increased cardiac output due to lower systemic vascular resistance from progesterone and other hormones. Venous pressure, especially in the legs, increases significantly due to pressure from the gravid uterus. These cardiovascular changes help increase blood flow to the uterus and other organs to support the nutritional needs of the growing fetus.
This document discusses screening for gestational diabetes mellitus (GDM). It defines GDM and explains that pregnancy increases insulin resistance. There are two approaches to screening - a single step 75g oral glucose tolerance test (OGTT), or a two step approach using a 50g glucose challenge test followed by a 100g OGTT if thresholds are met. Threshold values for diagnosing GDM on OGTT tests are provided. The Seshiah test, recommended in India, performs a 75g OGTT in the non-fasting state, diagnosing GDM if the 2hr value is ≥140mg/dL.
This document provides information from Dr. Kirtan Vyas about fetal growth restriction (FGR). It discusses the challenges in identifying and managing FGR. Key points include:
1) Timely identification of FGR is difficult but crucial for proper management and a favorable neonatal outcome, as it is the second leading cause of perinatal mortality after prematurity.
2) FGR remains extensively studied but still confusing and controversial to researchers.
3) The major concern with FGR is not the small size of the fetus but the possibility of life-threatening fetal compromise.
4) Screening approaches, management recommendations, and postnatal care for babies with FGR are discussed.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
The document discusses three case scenarios involving pregnant women with reactive syphilis serology. It provides details on interpreting syphilis serology, the stages of syphilis infection, and recommendations for treatment and follow up after treatment. The key points are: syphilis should be suspected in pregnant women who are sexually active or have partners with risk factors; reactive nontreponemal and treponemal tests indicate current or past untreated syphilis; and pregnant women with reactive tests should be treated with penicillin to prevent transmission to the fetus.
El documento trata sobre un caso legal largo designado como Caso IIIA. El Caso IIIA parece ser un caso legal complejo que requiere más tiempo y esfuerzo para resolver. El título del documento proporciona poca información sobre los detalles específicos del caso.
The document provides guidance on performing pelvic examinations, including:
1) Instructions for observing and palpating the external genitalia and internal structures using a speculum. Key steps include inspecting for abnormalities, examining the Bartholin's glands, and inserting the speculum.
2) Guidelines for Pap testing according to American Cancer Society recommendations, including screening intervals based on age and risk factors.
3) A list of required equipment for comprehensive pelvic examinations, including speculums, gloves, lubricants, and collection materials for Pap tests and STI screening.
John Langdon Down was a British physician who first described Down syndrome in 1866 and recognized it as a distinct medical condition; he proposed that it results from reversion to ancestral traits seen in other races. Down syndrome, also known as trisomy 21, occurs when there is an extra chromosome 21 present and results in cognitive impairment and physical characteristics including a flat facial profile, upward slanting eyes, and a short neck. The risk of Down syndrome increases with maternal age and proper prenatal screening and testing can help diagnose the condition before birth.
Tuberculous meningitis is a meningoencephalitis caused by Mycobacterium tuberculosis infection of the membranes surrounding the brain and spinal cord. It most commonly affects children aged 0-4 years. The signs and symptoms progress slowly over weeks and can be divided into 3 stages - nonspecific symptoms in stage 1, more severe symptoms like seizures and focal neurologic signs in stage 2, and eventual coma, paralysis and death in stage 3 if untreated. Diagnosis involves examination of cerebrospinal fluid which shows lymphocytosis, low glucose and high protein. Treatment consists of a combination of antitubercular medications over several months. Prognosis depends on the clinical stage at diagnosis.
This document provides an overview of the topic "Anaesthesiology: Basic Aspects" for a study guide. It covers the history and evolution of anaesthesiology from ancient practices using plant-derived drugs, to the development of modern inhalation, intravenous and local anaesthetics. Key events and discoveries discussed include the first use of ether, chloroform and nitrous oxide, the isolation of cocaine and development of local anaesthesia, and the synthesis of barbiturates, benzodiazepines and other intravenous agents. The document also briefly outlines neuromuscular blocking agents and their role in facilitating modern surgery.
Thalassemias are blood disorders caused by reduced or abnormal production of hemoglobin chains. There are two main types - quantitative thalassemias involve reduced production of chains, while qualitative involve structural changes. Thalassemias range from minor to major depending on severity of anemia symptoms. Major thalassemia requires lifelong blood transfusions while minor causes no symptoms. Diagnosis involves hemoglobin electrophoresis and management depends on classification and transfusion requirements.
This document discusses special circumstances that can occur during labor such as induction of labor, augmentation of labor, prolonged labor, and delayed second stage of labor. It defines these circumstances and discusses their indications, causes, management, and potential complications. Induction techniques covered include cervical ripening using prostaglandins or dilators, amniotomy to rupture membranes, and intravenous oxytocin administration. Instrumental delivery options like forceps delivery and vacuum extraction are also outlined, including their indications, prerequisites, and potential complications.
Gestational diabetes is a form of diabetes that develops during pregnancy and usually resolves after giving birth. It occurs when hormones produced during pregnancy interfere with the mother's body's ability to produce and use insulin properly. This can cause high blood glucose levels. Left untreated, gestational diabetes can increase the risk of complications for both mother and baby, such as preeclampsia in the mother, and macrosomia, shoulder dystocia, and jaundice in the baby. It is diagnosed through a glucose tolerance test between 24-28 weeks of gestation. Treatment may involve lifestyle modifications like diet and exercise or insulin therapy if needed. Close monitoring during pregnancy and screening for diabetes after pregnancy is important.
This document discusses gestational diabetes, including its challenges, diagnosis, treatment, and prevention. Some key points:
- Gestational diabetes requires a comprehensive multidisciplinary approach to improve maternal and neonatal outcomes.
- Screening guidelines and diagnostic criteria for gestational diabetes are controversial and lack consensus.
- Treatment involves lifestyle modifications like diet, exercise and glucose monitoring, and may require insulin or other medications if needed.
- Both mother and baby are at risk for short-term and long-term complications if gestational diabetes is not properly managed.
- Preventing and treating gestational diabetes can help reduce the future risk of diabetes for both mother and child.
This document discusses gestational diabetes, including screening, management, and postpartum care. It recommends screening all pregnant women for gestational diabetes, providing lifestyle management and medication if needed to control blood glucose levels. After delivery, women should receive postpartum screening to determine diabetes risk and be monitored long-term due to high risk of developing type 2 diabetes later in life. Lifestyle changes and medication can help prevent or delay diabetes onset in high risk women.
This document discusses gestational diabetes, including its definition, causes, importance of treatment, and treatment guidelines. Gestational diabetes is a form of diabetes that develops during pregnancy due to insulin resistance. Left untreated, it can lead to complications for both mother and baby like increased birth weight. Treatment aims to control blood sugar levels and can involve lifestyle changes as well as insulin if needed. Guidelines recommend screening and treatment according to established evidence-based protocols.
This document provides information on gestational diabetes mellitus (GDM), including its definition, pathophysiology, risk factors, diagnosis, complications, management, and postpartum follow up. GDM is defined as diabetes diagnosed during the second or third trimester of pregnancy that is not clearly type 1 or 2 diabetes. It results from the pancreas not being able to produce enough insulin to overcome insulin resistance during pregnancy. Management involves glucose monitoring, medical nutrition therapy, exercise if appropriate, and insulin treatment if needed to control blood glucose levels and prevent complications for both mother and baby. Women with GDM require testing after delivery and ongoing screening due to increased risk of developing diabetes.
Ueda2016 woman’s health & diabetes - lobna el toonyueda2015
This document discusses how diabetes differs and is managed for women at various life stages including puberty, pregnancy, and menopause. It notes that diabetes has more severe health impacts and higher mortality for women compared to men. During puberty, diabetes can delay menarche and cause menstrual disturbances. Gestational diabetes requires screening and treatment during pregnancy to prevent complications for mother and baby. Women with a history of gestational diabetes have a high risk of developing type 2 diabetes later in life. The document provides guidance on managing diabetes throughout these various stages.
Gdm rcog diagnosis and treatment of gestational diabetes 2011Diabetes for all
This document summarizes recent evidence on the diagnosis and treatment of gestational diabetes. It finds that:
1) Several large studies including HAPO have demonstrated a linear relationship between maternal glucose levels and fetal growth outcomes like birthweight.
2) Two major trials, ACHOIS and MFMU Network, showed treating gestational diabetes according to different diagnostic criteria significantly reduced adverse outcomes.
3) While lifestyle changes are usually effective, 7-20% of women require medication like metformin or insulin to control glucose.
This document summarizes a presentation on diabetes and pregnancy. It discusses gestational diabetes, including risk factors and challenges. It summarizes findings from the HAPO study on associations between maternal glucose levels and pregnancy outcomes. It also discusses guidelines for screening and diagnosing gestational diabetes. Additionally, it covers topics like shared care of diabetes in pregnancy, pre-conception counseling, risks to mothers and offspring, fasting during Ramadan for pregnant women with diabetes, and safety of oral diabetes medications in pregnancy.
This document discusses gestational diabetes, including its definition, epidemiology, consequences for both mother and fetus, screening recommendations, management, and controversies around diagnostic criteria. Some key points:
- Gestational diabetes is defined as carbohydrate intolerance first recognized during pregnancy and can include undiagnosed preexisting diabetes.
- It affects 2-9% of pregnancies and screening is recommended for at-risk women between 24-28 weeks using a 75g oral glucose tolerance test.
- Risks for the fetus include macrosomia, jaundice, and hypoglycemia. Risks for the mother include preeclampsia, infections, and long-term risk of type 2 diabetes.
This document provides information on gestational diabetes mellitus (GDM), including its definition, risk factors, pathophysiology, screening methods, complications, and management. GDM is glucose intolerance that develops during pregnancy and can cause issues for both the mother and baby if not properly managed. The key aspects discussed are:
- GDM is caused by defects in insulin secretion/action leading to abnormal carbohydrate and lipid metabolism.
- Risk factors include family history of diabetes, previous large baby, and obesity.
- Screening typically occurs between 24-28 weeks using a 75g oral glucose tolerance test.
- Complications for the mother include preeclampsia and operative delivery, while risks for
—Gestational Diabetes Mellitus (GDM) is a problem which may occur during pregnancy. For treatment of GDM either the Metformin or Insulin is used. So this prospective randomized multicenter trial in women with GDM was conducted to compare the treatment outcomes of metformin and insulin. This study was conducted at Rajkiya Mahila Chikitsalaya, in Obstetrics & Gynaecology Department of Jawaharlal Nehru Medical College, Ajmer. This study was done on 110 women who were diagnosed GDM by DIPSI criteria with a singleton pregnancy and meet entry criteria are randomized to insulin or metformin treatment (55 cases in each group).It was observed that metformin is equally efficacious and safe as insulin with a lot of advantages like less costly, better compliance, less weight gain, less change of hypoglycaemic attack and more feasible as insulin require several daily injection with not much difference in perinatal outcome except statistically significant difference in baby weight, mean cord blood sugar level at birth, large for gestation age. So it can be concluded that Metformin treatment is suitable for non-obese as well as obese type 2 diabetes patients in pregnancy without complications. Metformin is a safer alternate to insulin in GDM management with no adverse maternal and fetal outcome.
This document discusses fuel metabolism in diabetic pregnancy. It notes that in the fed state, there is underutilization of exogenous fuel and facilitated anabolism is reduced, while in the fasted state there is over-production from endogenous sources and hyperaccelerated starvation. Early signs of pregnancy in diabetics can include early morning fasting ketonuria in the first week. Gestational diabetes is also discussed, along with its definition and detection/diagnosis. Consequences of changes in fuel metabolism during diabetic pregnancy include an increased risk of congenital malformations, fetal macrosomia, hypoglycemia, and respiratory distress in infants.
This document provides an overview of diabetes mellitus in pregnancy. It defines diabetes in pregnancy and gestational diabetes, and discusses their incidence rates. It describes the screening, diagnosis, and management of diabetes in pregnancy. The document outlines the maternal and fetal effects of diabetes during pregnancy and notes increased risks of complications. It emphasizes the importance of glucose monitoring and medical nutrition therapy in managing diabetes in pregnancy.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
This document discusses gestational diabetes mellitus (GDM), including its definition, types, risk factors, screening recommendations, and pathophysiology. GDM is a type of diabetes that develops during pregnancy and usually resolves after giving birth. However, women with GDM and their babies are at higher risk for developing type 2 diabetes later in life. The document recommends screening all pregnant women for GDM between 24-28 weeks of gestation using a 75g oral glucose tolerance test. A diagnosis of GDM is made if one plasma glucose value meets or exceeds the threshold.
Ueda 2016 2-pathophysiology ,classification & diagnosis of diabetes - kha...ueda2015
This document outlines an agenda and presentation on the pathophysiology, screening, diagnosis and classification of diabetes given at a mini-course in Aswan, Egypt in February 2016. The presentation covers:
1. The normal physiology and definition of diabetes and its chronic hyperglycemia-related complications.
2. The clinical classes of diabetes including type 1, type 2, gestational diabetes and other specific types.
3. The pathophysiology, risk factors, screening and diagnosis of type 1, type 2 and gestational diabetes are discussed in further detail.
4. The goals of the course are to help participants in advance of an upcoming conference on diabetes.
Pregestational diabetes a major obstetrical problem now a days. These PPT contains modern as well as Ayurveda aspect for preventing a pregnant women & her baby from developing complications.
Gestational diabetes is glucose intolerance first recognized during pregnancy. It occurs due to placental hormones causing insulin resistance. Risk factors include obesity, family history of diabetes, and advanced maternal age. It is screened for and diagnosed using a 75g oral glucose tolerance test. Treatment involves lifestyle modifications like diet and exercise as well as insulin therapy if needed. Close monitoring of blood glucose and fetal well-being is required. Management aims to prevent complications in both mother and baby.
Invited lecture by Dr Sujoy Dasgupta in the Webinar on “PCOS Advocacy” by Endocrinology Committee of FOGSI (Federation of Obstetric and Gynaecological Societies of India), held in September, 2020
HIV discrimination among health providers in Malaysia by Dr RubzDr. Rubz
Although doctors took oath that they will treat everyone the best they can and without judging anyone but discrimination still exist especially in HIV affected people. Due to this issue, Pertubuhan Advokasi Masyarakat Terpinggir Malaysia has taken a step to engage with doctors at government sector and desensitize them and find the line to stand together.
HIV/AIDS data Hub Asia Pacific -Malaysia 2014Dr. Rubz
This document provides a summary of HIV/AIDS data for Malaysia across multiple indicators:
- HIV prevalence is highest among key populations like people who inject drugs, female sex workers, and men who have sex with men. Condom use and safe injection practices have increased over time but remain below optimal levels.
- The number of reported HIV infections and AIDS-related deaths has declined in recent years. Most HIV transmissions are through heterosexual contact and injecting drug use.
- Vulnerability remains high as many key populations lack comprehensive HIV knowledge and access to prevention programs, testing, and treatment.
- Government spending on HIV has increased but more funding needs to be directed towards programs for key populations at higher
This document provides a regional overview of HIV/AIDS trends in Asia and the Pacific from 1990-2013. It summarizes that there are currently 4.8 million people living with HIV in the region, with new infections declining significantly since 2001 but remaining largely unchanged in the past 5 years. Treatment coverage has increased substantially, with 1.56 million people now on ART, however this is still only about one-third of those in need. The challenges ahead include addressing gaps in prevention for key populations and along the treatment cascade.
1. The document summarizes Malaysia's HIV/AIDS situation and recommendations for interventions. It reports that while HIV transmission is declining overall, sexual transmission now accounts for over 50% of new cases, especially among heterosexuals and men who have sex with men. 2. Key recommendations include expanding access to antiretroviral treatment, strengthening prevention services for at-risk groups, and implementing proven interventions like condom promotion and harm reduction programs. 3. Achieving the UNAIDS 90-90-90 targets of diagnosing 90% of HIV cases, treating 90% of those diagnosed, and virally suppressing 90% of those treated is an important goal.
The document announces an e-mail auction to raise funds for the United Learning Centre, which provides education and meals to 140 refugee children in Malaysia. The auction includes donations of a Rado watch, porcelain vases, paintings, a lamp, and other items. Proceeds will help the learning center continue offering refugee children education, nutrition, and boarding for those whose parents work far away. The auction encourages supporting this charity auction to help children in need.
Testicular cancer for public awareness by Dr RubzDr. Rubz
A presentation prepared for Charity Dinner with Fun Charity. All the profits of the event will go to FReHA (a NGO which supports women's and reproductive health.)
Prostate cancer for public awareness by DR RUBZDr. Rubz
A presentation prepared for Charity Dinner with Fun Charity. All the profits of the event will go to FReHA (a NGO which supports women's and reproductive health.)
Breast Cancer for public awareness by Dr RubzDr. Rubz
This document provides information from a presentation on breast cancer given by Dr. Ruby Bazeer. It discusses the anatomy of the breast and lymphatic system. Breast cancer is the most common cancer in women, with over 1.5 million new cases diagnosed annually. While breast cancer can be fatal if not detected early, it is curable when found early through methods like breast self-exams, clinical exams, ultrasound and mammography. The document outlines risk factors, signs and symptoms, screening recommendations, cancer stages and types of treatment for breast cancer. It aims to educate about this disease and the importance of early detection.
This is the first phase (qualitative) of the current project we are working on with the supervision of University Malaya and Yale School of Medicine.It will be publish as IBBS 2013 by end of the year. This slide is just a rough picture of what we are doing at the moment. This is copyright protected!
This document appears to be a set of slides for a lecture or teaching session on rapidly interpreting electrocardiograms (ECGs) given by Dr. James Smitt of Monash University on July 25, 2013 for third year medical students. The slides provide instruction on efficiently analyzing ECG readings to identify potential cardiac issues or abnormalities.
The document summarizes key details about the inguinal canal and inguinal hernias. It describes the anatomy of the inguinal canal including its entrance, exit, roof, floor, and walls. It then discusses direct and indirect inguinal hernias, their causes, signs and symptoms, examination findings, and surgical repair techniques like Lichtenstein and Shouldice repairs. Femoral hernias are also briefly covered.
The document describes the anatomy and physiology of the breast as well as common breast conditions. It discusses the structure of the breast including lobes, lobules, ducts, and surrounding tissues. It then covers common benign and malignant breast diseases like fibroadenomas, cysts, mastitis, and ductal carcinoma in situ. The document concludes with descriptions of clinical exam findings, imaging tests, biopsy procedures, and management of various breast abnormalities.
This document discusses techniques for breast examination and signs of breast cancer. It describes various types of lumps, skin changes, and nipple disorders that may indicate breast cancer, including hard or soft lumps, skin dimpling or redness, nipple inversion or discharge. It also summarizes ductal carcinoma in situ, invasive ductal carcinoma, invasive lobular carcinoma, and how cancer can spread through lymph or blood vessels. Risk factors like genetics, lifestyle, and environment that may contribute to breast cancer development are outlined. Diagrams depict breast anatomy and different stages of cancer progression.
The document discusses various conditions that can affect the male genital tract including hydrocele, hematocele, spermatocele, varicocele, testicular tumors, testicular torsion, epididymo-orchitis, and undescended testis. It provides information on the presentation, risk factors, investigations, management, and complications of each condition. The document is a reference for doctors on evaluating and treating various scrotal and testicular issues.
This document discusses different types of hernias, including ventral, incisional, and Spigelian hernias. It defines a hernia as an abnormal protrusion of an organ outside its normal cavity. It classifies hernias based on their location, such as inguinal or femoral. Incisional hernias occur through a previous surgical wound. Signs and symptoms vary from a painless lump to a painful, swollen protrusion. Management typically involves surgical repair to excise the hernia sac and close the defect.
1. Orchitis and epididymo-orchitis are usually caused by blood-borne infections like Chlamydia, gonorrhea, or E. coli. They present with acute pain and swelling of the testes or epididymis.
2. Undescended testes occur in 1% of boys after 1 year of age and can lead to infertility if not treated. Risk factors include prematurity and family history. Treatment is orchidopexy to bring the testes into the scrotum.
3. Testicular torsion occurs when the spermatic cord twists, cutting off blood supply to the testes. It requires urgent surgery to untwist the cord or
Malaria is the most commonly imported tropical disease in the UK, with 1,500-2,000 cases reported annually. Three-quarters of cases are caused by Plasmodium falciparum, which can rapidly cause severe multi-organ disease if not treated promptly. Diagnosis relies on examination of blood films by an expert microscopist to detect parasites, though rapid diagnostic tests can also identify P. falciparum. Treatment depends on the Plasmodium species and severity of illness. Uncomplicated non-falciparum malaria is usually treated with chloroquine, while uncomplicated P. falciparum is treated with atovaquone-proguanil, quinine,
Tuberculosis is caused by infection with Mycobacterium tuberculosis. It typically affects the lungs but can spread to other organs. Primary TB occurs after initial exposure and may result in an asymptomatic Ghon focus or spread to lymph nodes and other sites. Secondary TB occurs from reactivation of a dormant lesion, usually in the apices of the lungs. Diagnosis involves testing sputum, blood, or other fluids for acid-fast bacilli on smear or culture. Chest x-ray may show consolidations, cavities or fibrosis. Treatment involves a multi-drug regimen over 6-9 months to prevent resistance, with monitoring of side effects like hepatitis and optic neuritis. Contact tracing and screening of household members is
This document summarizes different types of shock including hypovolemic, cardiogenic, neurogenic, septic, anaphylactic, and obstructive shock. It provides details on definitions, signs and symptoms, investigations, and management for each type of shock. General management includes maintaining the airway, providing oxygen, establishing intravenous access, monitoring vital signs, and administering fluids with or without vasopressors depending on the type and severity of shock. Specific investigations and treatments are outlined for each shock type.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
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You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
This presentation was provided by Racquel Jemison, Ph.D., Christina MacLaughlin, Ph.D., and Paulomi Majumder. Ph.D., all of the American Chemical Society, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Training: ISO/IEC 27001 Information Security Management System - EN | PECB
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Level 3 NCEA - NZ: A Nation In the Making 1872 - 1900 SML.pptHenry Hollis
The History of NZ 1870-1900.
Making of a Nation.
From the NZ Wars to Liberals,
Richard Seddon, George Grey,
Social Laboratory, New Zealand,
Confiscations, Kotahitanga, Kingitanga, Parliament, Suffrage, Repudiation, Economic Change, Agriculture, Gold Mining, Timber, Flax, Sheep, Dairying,
Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
The chapter Lifelines of National Economy in Class 10 Geography focuses on the various modes of transportation and communication that play a vital role in the economic development of a country. These lifelines are crucial for the movement of goods, services, and people, thereby connecting different regions and promoting economic activities.
2. INTRODUCTION DIABETES IN PREGNANCY [1] PREGESTATIONAL (10%) GESTATIONAL (90%) Defined as glucose intolerance of variable severity with onset or first identified during the present pregnancy. Generally occurs in the latter half of the pregnancy; hence there is no effect on organogenesis and does not cause congenital defects. Generally disappears after delivery as the hormonal levels revert back to normal. It is pregnancy in a known or overt diabetic. May either be Type 1 or Type 2 DM. Type 1 occurs in a younger age group and end organ complications are likely to be more in these patients. Type 2 is rare during pregnancy except in those women who are obese or above 35 years old. Buchanan TA, Coustan DR. Diabetes mellitus. In Burrow GN, Ferris TF, eds, Medical Complications in Pregnancy. 4th ed. Philadelphia, Pa: WB Saunders; 1995: 29-61.
4. GESTATIONAL DIABETES MELLITUS Pregnancy is a diabetogenic state. Maternal metabolism is altered to ensure there is an appropriate supply of glucose to the foetus.
5. GESTATIONAL DIABETES MELLITUS 3. Normal pregnancy is characterised by; a) Mild fasting hypoglycaemia b) Postprandial hyperglycaemia c) Hyperinsulinaemia 4. Due to peripheral insulin resistance which ensures an adequate supply of glucose for the baby.
7. GESTATIONAL DIABETES MELLITUS 6. Anti-insulin hormones a) Oestrogen b) Progesterone c) Prolactin d) Cortisol e) Human Placental Lactogen (hPL)
8. GESTATIONAL DIABETES MELLITUS These hormones; a) oppose the action of insulin less effective. b) This subsequently causes a state of insulin resistance. c) There is progressive decline in insulin sensitivity. 8. Further aggravated by increased body weight and caloric intake during pregnancy.
9. HUMAN PLACENTAL LACTOGEN (hPL) Produced by syncytiotrophoblastof the placenta. Affects protein, fat and carbohydrate metabolism. Promotes lipolysis and the available free fatty acids (FFA) are used for the mother’s own metabolism as to ensure adequate glucose supply to the foetus. Primary chorionic vili
10. HUMAN PLACENTAL LACTOGEN (hPL) Elevated FFAs also increase insulin resistance. As a result, the circulatory glucose level is raised to meet the foetal needs.
11. INSULIN In response of these physiological changes, the maternal pancreas increases the production of insulin to maintain a stable carbohydrate metabolism. However, the increase in insulin is ineffective peripheral resistance of its action by the ‘anti-insulin’ hormones. 3. GDM develops when the pancreas, despite the production of insulin, cannot overcome the effect of these counter-regulatory hormones.
12. PREGNANCY DIABETOGENIC HORMONES PANCREAS Placental hormones Insulin production Cortisol MATERNAL BLOOD SUGAR Oestrogen Progesterone Prolactin Antagonise insulin action and peripheral resistance Carbohydrate Metabolism hPL FFAs (used for maternal metabolism ) Lipolysis Glucose spared for foetus
14. SCREENING FOR GDM GDM is asymptomatic and hence, the need for screening. However, there is NO CONSENSUS regarding the method or the type of screening tests. Two methods of screening that are commonly practised nowadays are: a) Selective screening b) Universal screening
15. SELECTIVE SCREENING 1. The selective screening protocol is done only in the presence of risk factors [2] Berger H, Crane J, Farine D, Armson A, de la Ronde S, et al. Screening for gestational diabetes mellitus. SOGC Clinical Practice Guideline, No. 121, November 2002.
16. SELECTIVE SCREENING However, if the selective screening alone is adopted, majority of GDM can be missed Risk factors are only present in 30% of those who develop glucose intolerance in pregnancy [3] 3. Gillmer MDG: Diabetes in Pregnancy, In: Weatherhall DJ, Ledingham JGG, Warrel DA (Eds) Oxford Textbook of Medicine, 3rdEdn, Vol 2, Oxford, Oxford Medical Publications 2: 1752-58, 1996.
17. UNIVERSAL SCREENING Through this protocol, all pregnant mothers are screened. This method may not be cost-effective in populations with a low prevalence (0.5-1%) of GDM. However, since the GDM rate in our Malaysian population is at least 11.4% [4] (another Malaysian study recorded a prevalence of 18.3% [5] for gestational diabetes mellitus in its population-based subjects) the universal screening appears to be superior for the detection of GDM. Tan PC, Ling LP, Omar SZ. Screeninng for gestational diabetes at antenatal booking in a Malaysian university hospital: The role of risk factors and threshold value for the 50g glucose challenge test. Aust N Z J ObstetGynaecol. 2007;47(3):191-7 IdrisN, CheHatikah CH, Murizah MZ, Rushdan MN. Universal versus selective screening for detection of gestational diabetes mellitus in a Malaysian population. Malaysian Family Physician. 2009;4(2&3):83-7
18. SCREENING TEST The screening test that is commonly used is the Glucose Challenge Test (GCT). 50 g of oral glucose is given between 24 to 28 weeks of gestation irrespective of the time or the meal. Blood glucose is determined 1 hour later.
19. SCREENING TEST The ACHOIS trial [6], a large multicentre trial, uses a GCT threshold of 7.8mmol/l. However, it is possible that the sensitivity of GCT can be further improved if the threshold of the glucose level be reduced as suggested by Tan et al who studied 1600 patients at the antenatal clinic in a local university hospital setting. In fact, a value of 7.2 mmol/L (130 mg/dL) will identify 90% of women with GDM [7,8]. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS, for the Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group: Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 352:2477–2486, 2005 Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus.TheOrganizing Committee. Diabetes Care 1998;21(Suppl 2): B161–7. O’Sullivan JB, Mahan CM, Charles D, Dandrow RV. Screening criteria for high-risk gestational diabetic patients. Am J ObstetGynecol1973;116:895–900.
20. SCREENING TEST Hence, in UMMC, a plasma value of 7.2 mmol/L is considered significant to perform the confirmatory diagnostic test. Though this test is generally done in the second trimester, a high risk patient can be tested during the earlier booking visit.
21. DIAGNOSTIC TEST Oral glucose tolerance test (OGTT) is performed for the diagnosis of gestational diabetes mellitus. There are many guidelines that delineate various cut-off values. The two common guidelines that are used nowadays are from the: a) American Diabetes Association (ADA) b) World Health Organisation
22. DIAGNOSTIC TEST The WHO[9] recommends the 2 hour 75 g OGTT while the ADA [10,1112, 13] after the 4th International Workshop-Conference on GDM, uses the 3 hour 100 g OGTT. WHO Consultation: Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO consultation. Part 1: Diagnosis and classification of diabetes mellitus. Geneva, WHO/NCD/NCS/99.2,World Health Organization; 1999. O’Sullivan JB, Mahan CM: Criteria for the oral glucose tolerance test in pregnancy. Diabetes 13:278, 1964 Carpenter MW, Coustan DR: Criteria for screening tests for gestational diabetes. Am J ObstetGynecol 144:768–773, 1982 American Diabetes Association. Gestational diabetes mellitus. Diabetes Care 2000;23(Suppl. 1):S77–S79. Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus.TheOrganizing Committee. Diabetes Care 1998;21(Suppl 2): B161–7.
35. Maternal Hyperglycaemia Hypoglycaemia Placenta blocks maternal insulin Foetal Hyperglycaemia Hypertrophic cardiomyopathy Foetal Islet Hyperplasia HYPERINSULINAEMIA Insulin inhibits acc of surfactant of protein Insulin acts like a growth factor Insulin stimulates EPO and the process also occurs as a response to hypoxia Macrosomia Foetal metabolism Lung surfactant Compounded by delayed lung maturity Fat deposition at insulin-dependant areas in the foetal trunk. Oxygen supply and acidosis Erythropoiesis RDS Disproportionate increase in trunk size Jaundice Hyperviscosity syndrome IUD PEDERSON’S MATERNAL HYPERGLYCAEMIA-FOETAL HYPERINSULINISM HYPOTHESIS Head size remains normal Intestinal blood flow Slugging of RBC NEC Renal vein thrombosis Shoulder dystocia and birth injuries
37. A team approach is ideal for managing women with GDM .The team would usually comprise an obstetrician, diabetes physician, a diabetes educator, dietitian, the midwife and paediatrician. The importance of educating women with GDM (and their partners) about the condition and its management cannot be over-emphasised. Compliance with the treatment plan depends on the patient's understanding of: a) The implications of GDM for her baby and herself; b) The dietary and exercise recommendations; and c) The how and when as well as the goals of self monitoring of blood glucose level. Care should be taken to minimise the anxiety of the women.
38.
39. PRE-CONCEPTION Planning the pregnancy 3 months prior to conception Good diabetic control from the pre-conceptional period decrease the chances of fetal anomalies among pregestational diabetics. During the early antenatal booking HbA1c should ideally be less than 8%. High dose folic acid supplements. Type 1: 4-5 insulin injection/day; long acting at night and short acting after each meal. Type 2: switch from OHA to twice daily mixture of short acting and long acting insulin. 6. Visit fortnightly until Week 32 and once weekly after Week 34.
40. ANTENATAL Dietary therapy is the primary therapeutic strategy for the achievement of acceptable glycaemic control in GDM. This is prescribed to all patients with diabetes and is called medical nutrition therapy. The total calories = 24-30 kcal/kg of present body weight. Carbohydrates should be distributed throughout the day. Eating 3 small-to-moderate sized meals and 3 snacks per day is recommended.
41. ANTENATAL Bedtime snack prevents fasting ketosis. Glycaemic control needs to be monitored. Self monitoring of blood glucose level is the optimal method and is well tolerated by most women. If self monitoring is not possible, fasting and 1 or 2 hour postprandial laboratory capillary blood or venous plasma glucose levels should be investigated regularly (at 1 to 2-weekly intervals).
42. ANTENATAL 9. Self Blood Glucose Monitoring (SBGM): Diet control: Four points fasting, post-breakfast, lunch, dinner On insulin: Seven points pre and post breakfast, pre and post lunch, pre and post dinner and also pre-bedtime 10. ADA recommends the minimum goals for glycaemic control are: • Fasting capillary (venous plasma) blood glucose level <5.8 mmol/L • 2 hour postprandial capillary (venous plasma) blood glucose level <6.7 mmol/L.
43. ANTENATAL Oral hypoglycaemic agents drugs are generally not recommended during pregnancy as they cross the placental barrier and cause foetal hypoglycaemia.
44. INSULIN THERAPY 1. Insulin therapy should be considered if the blood glucose goals have exceeded on two or more occasions within a 1 to 2 week interval, particularly in association with clinical or investigational suspicion of macrosomia. 2. However, the benefit of instituting insulin therapy after 38 weeks of gestation is unproven. 3. Human insulin should be used. No insulin preparations has a pregnancy category listing, except for the new, rapidly-acting insulin analogue Lispro.
45. INSULIN THERAPY HOW TO START INSULIN THERAPY? The daily insulin requirement is 0.5-0.7 units/kg/day Q: How do we tailor the insulin regime for a 60kg pregnant lady with GDM? A: Since her daily requirement is 30 units/day, we can calculate the amount that should be given via the formulae below. 1) BD Dosage: (2/3 Day + 1/3 Night) Day Amount : 2/3 x 30 =20 units (Short Acting-13 units & Long Acting-7 units) Night Amount : 1/3 x 30 = 10 units Short Acting-7 units & Long Acting-3 unit *Roughly divide 2/3 of each dosage :SHORT ACTING whereas 1/3 of it for LONG ACTING. 2)QID Dosage : (30 Units/4 times) Hence, it is 8 units per jab Prior to the 3 main meals : 8 units of Short Acting Prior going to bed : 8 units of Long Acting
46. INSULIN THERAPY It is important to note that insulin requirements fall dramatically after delivery of the placenta and insulin doses will need to be reduced.
47. ANTENATAL Foetal surveillance and investigations: Maternal serum alpha-fetoprotein Ultrasound Doppler of the umbilical artery
48. OBSTETRIC MANAGEMENT The decision to deliver is based on the degree of diabetes, nature of control, superimposed risk factors and foetal well-being. Pregnancy is not allowed to go beyond due dates even in well-controlled diabetics. There are high chances of a Caesarean Section in a diabetic mother due to pregnancy complications or macrosomia. However, a C-Sec is not indicated for diabetes alone.
49. IN LABOUR In women in labour, maintaining good glucose control (blood glucose levels between 4 and 10 mmol/l) with s/c insulin may be possible throughout the labour. HOWEVER if the labour is prolonged / the women vomits / is not keen to eat / unable to eat due to risk factors precluding eating in labour (eg. the risk under GA) then intravenous insulin will be necessary IV insulin using the sliding scale is necessary for Type 1 women if: a) the blood glucose exceeds 10 mmol/L; or b) if she is unable to eat; or c) vomiting and not later than 6 hours after their last short-acting insulin injection IV insulin using the sliding scale is necessary for Type 2 women or women with GDM if: a)the blood glucose exceeds 10 mmol/l during labour
50. DIK REGIME Used for spontaneous labour/C-Sec On the day of delivery, no breakfast or s/c insulin. Hourly blood sugar on admission (RBS) if <4 mmol/L or >10 mmol/L : take venous blood for lab blood glucose. Start DIK Regime: a) Dextrose infusion: 500mL 10% Dextrose with 10 mmol/L KCl (potassium chloride; start at 100 mL/h) * Amount of K+ added depends on serum K+
51. DIK REGIME b) Insulin infusion-use the 50 mL syringe pump: 50 units soluble insulin in 50 mL normal saline. Adjust insulin dose according to blood sugar level.
52. DIK REGIME Maintain blood sugar : 5-10 mmol/L When placenta is delivered, For all patients, discontinue the DIK Regime . Check BS and adjust insulin accordingly. 7. Do a reassessment of the blood sugar profile.
53. SHOULDER DYSTOCIA Call for help McRoberts’ Manoeuvre Increase Outlet Diameter Decrease Pelvic Angle Episiotomy Increase AP Diameter 4. Give Suprapubic Pressure 5. Delivery of posterior shoulder 6. Cockscrew Manoeuvre 7. Fracture the clavicle. 8. Reversal of process Push the head back in and shift to OT
54. FOLLOW-UP It is important that women with GDM be counseled with regards to their increased risk of developing permanent diabetes. They should be made aware of the symptoms of hyperglycaemia. Advice should be given about the importance of healthy eating and exercise patterns. Contraceptive advice should be given in the puerperium, and women should be advised to plan future pregnancies and be reviewed medically by their general practitioner before conception (a pre-conception OGTT should be considered). All women with previous GDM to be offered testing for diabetes with a 75 g OGTT 6-8 weeks after delivery;
55. FOLLOW-UP Repeat testing should be performed every 1-2 years among women with normal glucose tolerance and the potential for further pregnancies. If pregnancy is not possible, follow-up testing should be performed every 3 years, with more frequent re-testing, depending on clinical circumstances (eg, ethnicity, past history of insulin treatment in pregnancy, recurrent episodes of GDM). Impaired glucose tolerance merits careful follow-up, which should include at least twice-yearly checks for frank diabetes in addition to assessment of other risk factors for macrovascular disease.