This document discusses various methods of contraception, including natural methods, barrier methods, intrauterine devices, implants, injections, oral contraceptives, and emergency contraception. It provides details on the mechanisms of action, effectiveness, and side effects of different hormonal contraceptives containing progestins and/or estrogens, such as combined oral contraceptives, progestin-only pills, contraceptive patches, vaginal rings, and injectables. The document also discusses criteria for use and cautions for different contraceptive methods.
short presentation an all the oral as well as injectable hormonal contraceptives, inclusive of their mechanism of actions , adverse effects and advantages.
Combined pill ,phased pill, post cotal pilla and mini pill.
Advantages and disadvantages with a note on adverse effects and contraindications of oral contraceptives with a note synthetic agents.
short presentation an all the oral as well as injectable hormonal contraceptives, inclusive of their mechanism of actions , adverse effects and advantages.
Combined pill ,phased pill, post cotal pilla and mini pill.
Advantages and disadvantages with a note on adverse effects and contraindications of oral contraceptives with a note synthetic agents.
Role of Dydrogesterone in Threatened Abortion Dr Sharda Jain Lifecare Centre
*EXPERINCE SHARING By EXPERTS*
Dr Uma Rai(DGF *E*)
Dr Sangeetaa Gupta(DGF *E*)
Dr Neerja Varshney(DGF *E*)
Dr Surjeet Kapoor(DGF *E*)
Dr Rupam arora(DGF *E*)
Dr Meenakshi Ahuja(DGF *S* )
Dr.Harsha khullar(DGF *C* )
Dr Mamta mittal(DGF *N*)
Dr Leena Sreedhar(DGF *D*)
Dr.Dipti Nabh(DGF *E*)
Dr. Shama Batra(DGF *E*)
Dr Poonam Paul(DGF *SW*)
PAN DGF ( DELHI GYNAECOLOGIST FORUM) CME ON DYDROGESTERONE ON 3/2 /22
Birth control pills (oral contraceptives) are prescription medications that prevent pregnancy.
Birth control (contraceptive) medications contain hormones (estrogen and progesterone, or progesterone alone).
Role of Dydrogesterone in Threatened Abortion Dr Sharda Jain Lifecare Centre
*EXPERINCE SHARING By EXPERTS*
Dr Uma Rai(DGF *E*)
Dr Sangeetaa Gupta(DGF *E*)
Dr Neerja Varshney(DGF *E*)
Dr Surjeet Kapoor(DGF *E*)
Dr Rupam arora(DGF *E*)
Dr Meenakshi Ahuja(DGF *S* )
Dr.Harsha khullar(DGF *C* )
Dr Mamta mittal(DGF *N*)
Dr Leena Sreedhar(DGF *D*)
Dr.Dipti Nabh(DGF *E*)
Dr. Shama Batra(DGF *E*)
Dr Poonam Paul(DGF *SW*)
PAN DGF ( DELHI GYNAECOLOGIST FORUM) CME ON DYDROGESTERONE ON 3/2 /22
Birth control pills (oral contraceptives) are prescription medications that prevent pregnancy.
Birth control (contraceptive) medications contain hormones (estrogen and progesterone, or progesterone alone).
oral contraceptive , definition , before prescribing it , how to use other uses , products in the pharmacy , side effects , drug interactions , contraindications .
benefit of contraception
unmeet need
medical eligibility
tiers of contraception
COC
POP
DMPA
Implant, Nexplanon
IUCD, interuterine device
Sterilization, Male and female
Emergency contraception: Youzups, Plan B, IUCD
Calendar methods
Adolescence
Hormonal contraception refers to birth control methods that act on the endocrine system. Almost all methods are composed of steroid hormones, although in India one selective estrogen receptor modulator is marketed as a contraceptive.
Based on the BPH curriculum of TU and maternal health program of Nepal. All the drugs have not been discussed and remaining drugs will be discussed in subsequent classes
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. Interception in the birth process at any
stage ranging from ovulation to ovum
implantation.
It includes all measures temporary or
permanent designed to prevent
pregnancy due to coital act.
3. 1) To bring down population growth
2) To reduce infant and maternal mortality
rate
3) To prevent pregnancies that are too
early, too frequent and too many.
4. First orally active
synthetic steroidal
estrogen was
synthesized in 1938 by
Hans Herloff &
Walter Hohlweg
Ethinyl estradiol &
Mestranol
10. 1) Combination pills:
A. Monophasic
B. Biphasic
C. Triphasic
2) Minipill / Progestin only pill
3) Post coital / Emergency contraception / Morning
after pill
4) Centchroman
13. B. Biphasic pills: They deliver the same amount of
estrogen each day but level of progestin is increased
about halfway through cycle
Estrogen (mg) Progestin (mg)
Ortho-novum 10/11 , Necon 10/11.
Day 1 – 10 Ethinyl estradiol
0.035
Norethindrone
0.5mg
Day 11 -
21
Ethinyl estradiol
0.035
Norethindrone
1.0mg
Mircette which is biphasic,
changes progeterone
hormone levels twice during
the 28 day pack.
14. C. Triphasic Tablets: Contain high dose of Estrogen in
midcycle with increasing doses of Progestin given over
3 successive phases.
Attempts to mimic the natural female cycle.
DAYS ESTROGEN PROGESTERONE
1-6 Ethinylestradiol-
30microgm
Norgestrel-
0.05mg
7-11 Ethinylestradiol-
40microgm
Norgestrel-
0.075mg
12-21 Ethinylestradiol
30microgram
Norgestrel-
0.125mg
15. Category 1: (no restriction of use)
1. Menarche to <40yrs
2. Postpartum >21 days, Post-
abortion
3. Endometriosis, fibroid
4. Iron deficiency anemia
17. 1. Cigarettes smoking <15/ day in>35
years
2. Postpartum <21 days
3. Cholestatic jaundice
4. Hypertriglyceridemia
18. 1. Stroke & CAD
2. Hypertension( SBP>160 & DBP> !00)
3. Thrombotic patients
4. Suspected pregnancy
5. Breast cancer
6. Hypersensitivity to any component of pill
19. The first pill is taken on 5th day
after start of menses, thereafter,
one pill is to be taken
consecutively for 21days.The next
7 days are Pill Free Period’ & next
course starts after 5th day of
menses.
20. 20
Seasonale Seasonique Lybrel
Aim
• To reduce or even eliminate monthly periods and
thereby prevent the pain and discomfort that often
accompanies menstruation.
• These oral contraceptives contain a combination of
estradiol and levonorgestrel.
21. 21
SEASONALE
Got approved in 2003.
It contains 81 days of active pills followed by 7 days of
inactive pills.
Women who take Seasonale have on average a period
every 3 months.
SEASONIQUE
84 days of levonorgestrol-estradiol pills followed by 7 days
of pills that contain only low-dose estradiol
22. 22
Approved by FDA In 2007
It supplies a daily low dose of
levonorgestrol and estradiol taken 365
days a year.
It completely eliminates monthly
menstrual periods.
29. They may be Mild, Moderate or Severe.
Severe A/E require cessation of therapy .
Mild Adverse Effects include:
1) Nausea , breast tenderness, breakthrough bleeding
2) Headache: Often mild and transient
3) Worsening of Migraine / onset of migraine may be
associated with cerebrovascular accidents.
4) Failure of withdrawal bleeding
Change in the preparation or method of contraception.
30. Moderate Adverse Effects: May require
discontinuation of therapy
1) Break through bleeding
2) Changes in serum lipids :Progestin HDL, LDL ,
Estrogens: HDL, LDL.
3) Weight gain
4) Skin Pigmentation & Hirsutism; with androgenic
progestin.
5) Acne : with androgenic progestin,
improvement with estrogenic prep.
6) Vaginal infections
7) Amenorrhea.
33. 1. Analogue of spironolactone
2. Good cycle control
3. Progestogenic activity suppress LH
4. Anti-androgenic activity- beneficial
in acne, seborrhoea & hirsutism
34. 1. Progestin with anti-androgenic
property & weak glucocorticoid
effect
2. Useful in Poly cystic ovarian
syndrome (PCOS) & Acne
35. Levonorgestrel 30 μg, norethisterone 350
μg, norgestrel 75 μg.Desogestrel (75 μg)-
containing minipill (Cerazette®)
POP’s must be taken at the same time
every day.
Good Candidate-
Breastfeeding Woman
36. Lower dose of progesterone
then OCPs
MOA-
1.Thinning of the endometrial
lining
2.Thickening of the cervical
mucus
3.Slowing ovum transport
through ed tubal motility
4.Inhibition of Ovulation
Absolute C/I
1.Pregnancy
2.Breast cancer
PROGESTIN ONLY MINIPILL
A/E:
The most common A/E
is Episodes of
unpredictable
spotting &
breakthrough
bleeding
.
37. WHO (1998)
Emergency contraception
can be provided using
1. Emergency contraceptive pills
(ECPs)
Use within 72 hours
2. Intra-uterine devices (IUDs)
Inserted within 5 days and used
as long term method
38. 39
Mechanism of Action:
Ovulation inhibited or delayed
Alterations in endometrial receptivity
for implantation
Dislodges an implanted Blastocyst.
Production of cervical mucus that
decreases sperm penetration
Alterations in tubular transport of
sperm, egg or embryo
39. 1. Yuzpe regimen:
a) 2 doses of COCPs containing EE
50µg& levonorgestrel250µg-in 72hrs
&next after 12hrs.
b) Effective-90%
2. 2 doses of levonorgestrel 0.75mg each-
1st in 48hrs & 2nd in 12hrs.
EC2, Pill 72, E-Pill, Norlevo, i pill
(available in India)
3. Mifepristone: 600 mg once in 72 hrs.
40
40. 41
Recently approved in 2010,
ULIPRISTAL ACETATE (SPRM) in
a single oral dose of 30mg is more
effective if taken in 120hrs/5days.
If these measures fail, pregnancy
should be terminated to avoid
teratogenic deformities of fetus.
41. 42
SERM, non-steroidal
Once per week, 30 mg
First 3 months - pill twice per week
Later followed by once per week
Also for treatment for DUB
Saheli, Centron & Sevista
Mechanism of action
• Asynchrony between ovulation &
development of uterine lining
• Speeds transport of egg through
fallopian tubes
• Implantation not possible
Pearl Index - 9
42. 43
Progesterone only injectables:
• Intramuscular injection
DMPA: 150 mg every 3 months
300 mg every 6 months
NET-EN: 200 mg every 2 months
Failure rates: DMPA: 0.1/HWY
NET-EN: 0.4/HWY
1992,FDA
approved
43. 44
FDA approval 2004
Sustained absorption of progestin
Low dose of progestin (104 mg instead of 150 mg)
Injections every 3 months
Mechanism of action:
1. Inhibits ovulation
2. Thick cervical mucus
44. 45
COMBINED INJECTABLES-Given at
monthly intervals-IM
• 1.Estradiol valerate5mg+17-hydroxyprogesterone
caproate250mg
• 2.Cyclofem/Cycloprovera/Lunelle(DMPA25mg+Estra
diol cypionate5mg)Failure rate: 0.2 %
• 3.Mesigyna (NET-EN + Estradiol
valerate)FailureR:0.4%
Mechanism of action
1. Suppresses ovulation
2. Thickening of cervical mucus
3. Reduced receptivity of endometrium to blastocyst
45. 1. Single flexible rod 4 cm
long, contains 68mg of
etonogestrel
2. Releases 60 µg/day for
3 yrs
3. Inhibits ovulation within
8 hrs of insertion &
provides contraception
for 3 years
Uniplant: contains 55 mg nomegestrel acetate in
a 4cm silicone capsule with 100ug release per day
IMPLANTS: IMPLANON
46. Each rod measures 2.5
mm in diameter & 4.3 cm
in length containing 75
mg of LNG
Drawbacks IMPLANTS-
Irregular bleeding
Spotting
Amenorrhoea
Occasional removal problems
Failure rate: 0.1/HWY
47. Inserted at any time
during menstrual cycle
Sub-dermally on the
inner aspect of the non-
dominant arm
Removal requires
making 2 mm incision
at distal tip of implant
48. Works trans-dermally by:
1. Combination of progestin & estrogen
2. Slowly releasing
3. Through skin
Types:-
1. Patch
2. Spray-on
3. Gel
49
49. Transdermal contraceptive patch
‘OrthoEvra’ was approved by US FDA in 1992.
Sites:
Buttocks, Upper outer arm
Lower abdomen, back,
upper torso.
50. 3-patch system
Apply 1 patch each week for 3 weeks
Apply each patch the same day of the week
1 week is patch-free
Week 1 Week 2 Week 3 Week 4
Patch #1 Patch #2 Patch #3
28-day cycle
Patch-free
Week 5
Start next cycle
28-day cycle
51. Nestorone - Metered Dose Transdermal
System (MDTS)
In phase I trial as of Feb 2009
Absorbed instantaneously
MDTS® daily skin spray formulations
Hormone collects as reservoir with in
the skin and slowly diffuses into the
blood stream
52. First generation
• Inert, non
medicated
• Polyethylene/o
ther polymers
Second
generation
• Addition of
metallic
copper
• Cu- anti
fertility effect
• Smaller
devices, easier
to fit
Third generation
• Hormone
releasers
Intra-Uterine Devices
53. • Third generation: Hormone
releasers
1. Progestasert – 38 mg progesterone
2. Mirena/LNG IUD:
- Effective life of 5 yrs
- 52 mg of levonorgeterel
3. Fibroplant
LNG released@14ug/day
Suitable in peri-menopausal women.
Effective for 3 years.
54
55. The first vaginal contraceptive ring ‘NuvaRing’
was approved by FDA in 2001 & marketed in
2002
• Releases 15ug EE &
120ug etonogestrel
over 24hrs
56. Soft polymer device
NuvaRing:
Monthly
Used for 21 days followed by 7 day hormone-
free interval
Completely inhibits ovulation
ADRs
Vaginitis,Leucorrhoea,Headache,Expulsion
57
Failure rate: 1-2/HWY
54 mm
4 mm
Vaginal ring
59. Non-steroidal
Derived from cotton seed
and used in China.
Dose: 20mg/day for initial
2-3 months followed by
50-60 mg/week for not
more than 2 yrs.
Mechanism Of Action:
Decreases sperm count and
sperm motility. 61
61. 63
Desogestrel : Approved in 1998, Mircette was the first
oral contraceptive to offer a low estrogen dose and a new
type of dosing regimen. Some studies suggest an increased
risk for blood clots with desogesterel.
Levonorgestrel : is used in Seasonale and Seasonique,
as well as many other oral & non-oral contraceptives.
62. 64
86% success rate for 1st time
placements of micro-inserts
3 months of alternative
contraception
Follow up HSG procedure
65. 67
HCG IMMUNOCONTRACEPTIVES
• The most advanced immuno-contraceptives are those
based on hCG.
• Three main types have been developed:
1. hCG-beta subunit conjugated to tetanus toxoid (hCG-TT)
2. hCG beta subunit - ovine LH alpha subunit conjugated to tetanus
toxoid and diphtheria toxoid (HSD-TT-DT)
3. hCG beta subunit C-terminal 37 residue conjugated to diphtheria
toxoid (CTP-DT).