1) The document summarizes various gynecological surgical emergencies including acute vaginal bleeding, pelvic pain, infections, and post-operative complications.
2) It describes ovarian torsion in detail including causes, pathophysiology, signs and symptoms, diagnosis, and management focusing on the importance of detorsion to preserve ovarian tissue.
3) It also outlines the diagnosis and treatment of potentially life-threatening complications like necrotizing fasciitis, emphasizing the need for immediate surgical debridement and broad-spectrum antibiotics to manage this infection.
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)
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
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)
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
cEvo Technology as an Artificial General IntelligenceSoheil Engineer
cEvo is a proprietary engine and research project of DreamCraft Private Limited. The goal is to achieve true AGI behaviour with our breakthrough research.
Complicated diverticular disease
Diverticulitis is the most usual clinical complication of
diverticular disease, affecting 10–25% of patients with
diverticular.
The process by which diverticulitis arises has been likened to that of appendicitis, with a diverticulum becoming obstructed by inspissated stool in its neck.
This faecalith abrades the mucosa of the sac, causing inflammation and expansion of usual bacterial flora, with
diminished venous outflow and localised ischaemia.
Bacteria may breach the mucosa and extend the process
through the full wall thickness, ultimately leading to
perforation.
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: June...Sean M. Fox
Dr. Morgan Penzler is an Emergency Medicine Resident and Drs. Raza Ahmad and Ansley Ricker are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
● Abdominal Wall Hematoma
● Walled Off Necrosis Of The Pancreas
● Acute Aortic Thrombosis
Subject: Midwifery and Obstetrical Nursing. Topic: Ectopic pregnancy, Its types, various Implantation sites, Pathophysiology, Risk factors, Diagnosis, Various Managements and Recent Advancements.
Ectopic Pregnancy - Obstetrical & Gynaecological NursingJaice Mary Joy
In ectopic pregnancy, implantation occupies at a site other than the endometrium. Ectopic pregnancies are responsible for approximately 10 percent of all maternal mortality. The prognosis for future reproduction is poor. Only one half of women having an ectopic pregnancy are eventually delivered of a liveborn infant. Various factors contribute to ectopic pregnancies, the most common being infection. Unlike intrauterine spontaneous abortions, genetic factors are not paramount in the etiology of ectopic pregnancy.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
4. Causes of Bleeding by Approximate
Frequency and Age Group
Adolescent Reproductive Perimenopausal Postmenopausal
Anovulation Pregnancy Anovulation
Endometrial lesions,
including cancer (30%)
Pregnancy Anovulation Uterine leiomyomas
Exogenous hormone use
(30%)
Exogenous hormone use Exogenous hormone use
Cervical and endometrial
polyps
Atrophic vaginitis (30%)
Coagulopathy Uterine leiomyomas Thyroid dysfunction
Other tumor—vulvar,
vaginal, cervical (10%)
Cervical and endometrial
polyps
Thyroid dysfunction
5. Management
• Patients who are hemodynamically unstable because of bleeding
must be resuscitated according to standard protocols
• Attempts should be made to localize the source of bleeding. In
women with severe, persistent uterine bleeding, immediate D&C is
usually indicated.
• Uterine packing should be avoided, because it increases the risk of
infection and may hide ongoing blood loss.
• Conjugated estrogens may be used in the ED treatment of life-
threatening hemorrhage that is not caused by pregnancy or tumor
and is not amenable to surgical intervention.
6. Pelvic pain
Ovarian torsion-background
• Torsion involves the twisting of adnexal components
• Most commonly, the ovary and fallopian tube rotate as a single entity
around the broad ligament
• In 50 to 80 percent of cases unilateral ovarian masses are identified
• Adnexal torsion accounts for 3 percent of gynecologic emergencies.
• A disproportionate number of cases of adnexal torsion develop during
pregnancy, and these compose 20 to 25 percent of all torsion cases.
7. Pelvic Pain
Ovarian torsion--pathophysiology
• Adnexal masses with increased mobility have greater torsion rates.
• Pathologically enlarged ovaries with a diameter >6 cm will typically
rise from the true pelvis. Without these bony confines, mobility and
risk of torsion are increased
• highest rates of torsion are found in adnexal masses from 6 to 10 cm
• Torsion of the adnexa more commonly involves the right adnexa,
likely due to limited mobility of the left ovary caused by the sigmoid
colon
8. Pelvic Pain
Ovarian torsion-pathophysiology
• Adnexa are supplied from the respective adnexal branches of both
the uterine and ovarian vessels
• During torsion, one of these, but not the other, may be involved.
• Although low-pressure veins draining the adnexa are compressed by
the twisting pedicle, high-pressure arteries initially resist
compression.
• As a result of this continued inflow but arrested egress of blood, the
adnexa become congested and edematous, but do not infarct
• With continued stromal swelling, however, arteries may become
compressed, leading to adnexal infarction and necrosis and
necessitating adnexectomy.
10. Pelvic Pain
Ovarian torsion—signs and symptoms
• sharp lower abdominal pain with sudden onset that worsens
intermittently over several hours.
• The pain usually is localized to the involved side, with radiation to the
flank, groin, or thigh.
• Low-grade fever suggests adnexal necrosis.
• Nausea and vomiting frequently accompany the pain.
11. Pelvic Pain
Ovarian Torsion--diagnosis
• Sonography plays an essential role in evaluation.
• Sonographic findings can vary widely depending on
• the degree of vascular compromise,
• the characteristics of any associated intraovarian or intratubal mass, and
• the presence or absence of adnexal hemorrhage.
• Sonographically, torsion may mimic
• ectopic pregnancy,
• tuboovarian abscess,
• hemorrhagic ovarian cyst, and endometrioma.
• Accordingly, rates of correct sonographic diagnosis range from 50 to
75 percent
13. Pelvic Pain
Ovarian Torsion--management
• De-torsion is key
• Within minutes following detorsion, congestion is relieved, and
ovarian volume and cyanosis typically diminish.
• A persistently black-bluish ovary, is NOT pathognomonic for necrosis,
and the ovary may still recover.
14. Cohen SB, Oelsner G, Seidman DS, et al: Laparoscopic detorsion allows sparing of the twisted
ischemic adnexa. J Am Assoc Gynecol Laparosc 6(2):139, 1999
• Reviewed 54 cases in which adnexa were preserved regardless of
their appearance following detorsion
• Reported functional integrity and successful subsequent pregnancy in
almost 95 percent.
15. • 50 patients with 53 cases of ovarian torsion treated between January 1989
and March 2012
• 22 cases ovaries were removed, and in 31 cases the torsion was relieved
and the ovaries left in the abdominal cavity
• In 20 girls with ovaries left behind…long term clinical and ultrasound data
obtained
• 17 of the 20 had multifollicular ovaries
• 2 of the other 3 had sonographically detected ovarian function(at least a few follicles
seen)
• Only one had no ovarian material detectable by ultrasound
• None of the girls had thromboembolism or peritonitis, and no malignant
tumors were found in the operated ovaries.
Geimanaite L, Trainavicius K. Ovarian torsion in children: management and outcomes.
J Pediatr Surg. 2013 Sep;48(9):1946-53.
16. Bar-On S, Mashiach R, Stockheim D, Soriano D, Goldenberg M, Schiff E,
Seidman DS.
Emergency laparoscopy for suspected ovarian torsion:
are we too hasty to operate? Fertil Steril. 2010 Apr;93(6):2012-5
17. Post-op complications
Fascial dehiscence
• Disruption of the deep fascial planes.
• Dehiscence is caused by inadequate closure or intrinsic host factors,
such as malnutrition, glucocorticoid use, or diabetes.
• Dehiscence of abdominal incisions has the potential for evisceration
• Early recognition is key
• IF NO EVISCERATION
• Can manage conservatively with abdominal binders
• If there is any uncertainty about the extent of dehiscence, operative
exploration is indicated.
• Consider broad spectrum antibiotics
18. Post-op complications
Fascial dehiscence
• Management of evisceration
• An abdominal binder with sterile towels soaked in saline to replace abdominal
contents and temporize the situation.
• Broad spectrum antibiotics
• Final goal of treatment is closure
• For critically ill patients with significant edema—maintain abdominal wall integrity until pt
stable enough to take to OR
• Before correcting dehiscence, debride necrotic and infected tissue.
19. Fascial dehiscence
Management cont’d
• Interrupted mass closure using permanent suture typically recommended
• If primary closure is under tension, may need to use mesh bridge
• If the subcutaneous wound is left open, wet-to-dry dressing changes may be
performed until the decision has been made to proceed with a delayed primary
closure or allow secondary intention to compete the process
20. Post-op complications
Fascial dehiscence
• Tilou et al, 2003, Am Surg
• Looked at 55 trauma patients with FD
• 71% of FD patients had intraabdominal infection (compared to 4.6%
of all trauma laparotomies)
• No clinical or laboratory factors help to predict which FD patients
have intra-abdominal infection
• Recommendation from the study:
• FD should be viewed as sign of possible underlying infection
• Before you manage the dehisced fascia—image or directly visualize the entire
abdominal cavity
22. Post-operative complications
Necrotizing fasciitis
• Arguably the most feared complication
• Etiology: direct contamination of the wound with group A streptococci
or S. aureus.
• Risk factors include diabetes mellitus, alcoholism,
immunosuppression, and peripheral vascular disease,
23. Necrotizing fasciitis—Three types based on
etiology
• Type 1: a mixed infection from aerobic and anaerobic bacteria,
including group A [beta]-hemolytic streptococci, Staphylococcus
aureus, Escherichia coli, Clostridium and Bacteroides species
• Type 2: is caused by group A [beta]-hemolytic streptococci, possibly
with a coinfection by S aureus, and primarily affects the extremities
• Type 3: NF is associated with Vibrio vulnificus, which enters the
subcutaneous tissues via puncture wounds from fish or marine insects
• When NF is present in genitalia/perineum it’s called : Fournier’s
gangrene
24. Necrotizing fasciitis--Diagnosis
• The diagnosis is clinical—the condition has a rapidly progressive course
• Hallmarks of fasciitis are
• The presence of marked systemic toxicity
• Pain out of proportion to local findings.
• Early in the course of infection, findings of cellulitis (erythema, edema, and pain) may
predominate, making the early diagnosis difficult or impossible
• X-ray is poor screening tool
• CT is more sensitive (80%) and can demonstrate fascial thickening and edema, deep
tissue collections, and gas formation
• IV contrast provides no additional benefits
• MRI most sensitive but would impose delays to treatment
• WBC>14,000 and serum sodium less than 135 a good predictor of necrotizing infection
• Rapid strep screen can identify Group A beta hemolytic strep
26. Post-operative complications
Necrotizing fasciitis
• Treatment:
1. Avoid vasoconstrictors
2. Should include antibiotics –
• The tissue ischemia produced in necrotizing soft tissue infections impedes immune system
destruction of bacteria and prevents adequate delivery of antibiotics.
• Antibiotics alone RARELY effective
3. immediate surgical debridement—cornerstone of management.
4. Tetanus prophylaxis as indicated
5. Mortality skyrockets if treatment delayed>24hrs
• The mortality rate remains 25% to 35%
• Bacteremia is a strong predictor of mortality
27. Necrotizing fasciitis—antibiotic considerations
• Common regimen:
• combination of
• penicillin for gram-positive cocci, an
• aminoglycoside for gram-negative aerobes,
• a third-generation cephalosporin,
• and clindamycin or metronidazole for anaerobes.
• Clindamycin suppresses the production of both streptococcal toxin and M protein
• Vancomycin is added when methicillin-resistant S aureus is suspected
or penicillin allergy present.
• In immunocompromised patients, cover for pseudomonas