Thyroid disease in_pregnancy
Presented by: Dr. Ahmad mukhtar
M.B.B.Ch., M.Sc Obstetrics and GynecologyAssistante lecturer of Obstetrics and Gynecology
Faculty of Medicine, Zagazig University
Thyroid disease in_pregnancy
Presented by: Dr. Ahmad mukhtar
M.B.B.Ch., M.Sc Obstetrics and GynecologyAssistante lecturer of Obstetrics and Gynecology
Faculty of Medicine, Zagazig University
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
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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
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
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.
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.
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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. • Types of Hypertension in Pregnancy
• Pre-eclampsia
• Prevention of HTN & Pre-eclampsia
• Management of Hypertension
• Emergent treatment for severe hypertension
3. Hemodynamic changes in Pregnancy
• Cardiac output increases by 30-50%
• Most of the increase due to an increase in stroke volume.
• Heart rate increases by ~10 beats/min (20% above
baseline) during the third trimester.
• In the second trimester SVR decreases
• Blood pressure falls
• Venous pressure in lower limbs rises (Pedal edema)
4. Hypertension in Pregnancy
• Hypertension is most common medical problem in
pregnancy
• Chronic Hypertension
• Gestational Hypertension
• Preeclampsia (de novo or superimposed on chronic
hypertension)
• Antenatally unclassifiable hypertension
5. Chronic Hypertension
• Hypertension (SBP ≥140 mm Hg or ≥ 90 mm Hg diastolic)
• Predating pregnancy or diagnosed before 20 weeks of
gestation
• May have associated family history of hypertension or
overweight or obesity
• Secondary causes of hypertension need to be excluded
• Usually persists beyond post-partum period
6. Gestational Hypertension
• New hypertension (SBP ≥140 mm Hg or ≥ 90 mm Hg
diastolic)
• Arising after the 20th week of pregnancy and without any of
the abnormalities that define preeclampsia
• Progresses to preeclampsia in about 25% of cases
• Blood pressure often normalizes by 12 weeks post-partum
7. Preeclampsia
• SBP ≥140 mm Hg or ≥ 90 mm Hg diastolic measured on
two occasions at least 4 hours apart
OR
SBP ≥160 mm Hg or ≥ 110 mm Hg diastolic
• Arising after the 20th week of gestation
AND
• Proteinuria : 300 mg per 24-hour urine collection or
albumin/creatinine ratio ≥ 30 (mg/mmol) [or ≥ 0.3 mg/dL]
8. Preeclampsia (In absence of Proteinuria)
New-onset hypertension with new onset of any of the
following:
• Thrombocytopenia: Platelet count <100,000/mL
• Renal insufficiency:
– Serum creatinine >1.1 mg/dL or doubling of serum creatinine in the absence
of other renal disease
• Impaired liver function:
– Serum liver transaminases elevated twice normal
• Pulmonary edema
• Cerebral or visual symptoms
9. Preeclampsia
• Cause is not entirely known
• Endothelial dysfunction with abnormal remodeling of spiral
arteries of placenta
• Placental production of antagonists to both VEGF and
TGF-beta
More commonly in:
• Nulliparous women
• BMI of more than 30 kg/m2
• Age younger than 20 years or older than 35 years
• Preexisting medical conditions (HTN,CKD,DM,SLE,APLA)
• History of preeclampsia, fetal growth restriction, or placental
abruption
• Multifetal pregnancies.
10. Antenatally unclassifiable hypertension
• When BP is first recorded after 20 weeks of gestation and it
is unclear if hypertension was pre-existing.
• Reassessment 6 weeks post-partum will help distinguish
pre-existing from gestational hypertension.
11. Classification as per Severity
• Mild (140 –159 / 90 –109 mmHg)
• Severe (≥ 160/110 mmHg)
12. • Maternal risks:
– Placental abruption, stroke, multiple organ failure, and DIC
• Foetus:
– High risk of IUGR (25% of cases of pre-eclampsia),
– Prematurity (27% of cases of preeclampsia)
– Intrauterine death (4% of cases of pre-eclampsia)
• Preeclampsia cause about 15% of maternal deaths
• Preeclampsia constitutes an important major CV risk factor
for later life.
• 10-fold increased risk for CV disease in later life
Effect of hypertension on Pregnancy
13. Diagnosis
• ABPM is superior to office BP measurement & predicts
outcome
• BP measured in the sitting position (or the left lateral
recumbent position during labour)
• All HTN cases should be tested for proteinuria, A dipstick
test of ≥ 1+ should prompt evaluation of ACR in a single
spot urine sample and a value <30 mg/mmol can reliably
rule out proteinuria.
• Serum uric acid: Hyperuricaemia indicates increased risk of
adverse maternal and foetal outcomes
14. Diagnosis
• Doppler ultrasound of uterine arteries (after 20 weeks of
gestation):
– Detects those at higher risk of gestational hypertension, pre-
eclampsia, and intrauterine growth retardation.
• A soluble fms-like tyrosine kinase 1:placental growth factor
ratio of ≤ 38
– excludes the development of preeclampsia in the next week when
suspected clinically.
16. Prevention of HTN & Preeclampsia
• ESC guidelines:
High or moderate-risk of pre-eclampsia should be advised
to take 100–150 mg of aspirin daily from weeks 12–36
• ACOG guidelines:
Low-dose (81 mg/ day) aspirin initiated between 12 weeks
and 28 weeks of gestation (optimally before 16 weeks of
gestation) and continuing until delivery
• Investigational drugs for Prophylaxis:
– Metformin
– Statins
– Addition of Heparin to Aspirin
– Sildenafil
– Calcium suppliments
17. Management of Hypertension
• All cases with BP ≥ 150/95 mm Hg should receive
treatment
• Start treatment if BP ≥ 140/90 mm Hg
AND
– Women with gestational hypertension (with or without
proteinuria)
– Pre-existing hypertension with the superimposition of
gestational hypertension
– Hypertension with subclinical HMOD
*ESC HTN Guidelines 2018
18. Management of Hypertension
• Women with pre-existing hypertension may continue their
current antihypertensive medications
• ACE inhibitors, ARBs, and direct renin inhibitors should be
discontinued
• Beta-blockers should be used cautiously (foetal
bradycardia, IUGR), with atenolol best avoided
• Diuretics: generally avoided as plasma volume is reduced
in women with pre-eclampsia
• Labetalol , Nifedipine & Methyl Dopa are the drugs of
choice.
19. Management of Hypertension
• In mild HTN (140-159 / 90-109 mm Hg) target should be <
140 / 90 mm Hg.
• Initial regimen of Labetalol at 200 mg orally every 12 hours
and increase the dose up to 800 mg orally every 8–12
hours as needed (maximum total 2,400 mg/ day [ACOG],
max 800 mg /Day [ESC])
• If the maximum dose is inadequate to achieve the desired
blood pressure goal, or the dosage is limited by adverse
effect, then sustained release oral nifedipine or methyl
dopa can be added
20. Management of Hypertension
• Methyldopa (0.5–3 g/day PO in 2 divided doses)
• Long-acting Nifedipine can be given as a sustained release
tablet in doses of 30–90 mg once daily. (maximum dose of
120 mg a day)
• Methyldopa has largest data regarding safety & efficacy,
but mild antihypertensive effect & slower onset (also post-
partum depression)
• Short acting Nifedipine may cause severe hypotension, is
an option for emergent treatment of severe HTN
21. Management of Severe Hypertension
HTN ≥ 160/110 mm Hg
persisting for > 15 mins
First Line
• IV Labetalol
• IV Hydralazine
• Oral Nifedipine (Immediate
release)
Second Line
• IV Nicardipine
• IV Esmolol
IV Glyceryl trinitrate (if Pulmonary Edema)
IV Sodium Nitroprusside (for extreme emergencies as
last measure)
22. Management of Severe Hypertension
If IV access can not be obtained OR as first line approach
• Oral immediate release Nifedipine Capsule 10 mg stat
• Repeat 20 mg after 20 mins if BP > 160/105
• Repeat 20 mg after 20 mins if BP > 160/105
• Switch to IV Labetalol if Target not achieved
• If Oral Nifedipine is not available Oral Labetalol 200 mg stat
• Repeat after 30 mins if BP > 160/105
*Updated ACOG Guidelines 2019
23. Management of Severe Hypertension
If IV Labetalol as first line approach
• IV Labetalol 20 mg over 2 min
• If target not achieved after 10 mins,
IV Labetalol 40 mg over 2 min
• If target not achieved after 10 mins,
IV Labetalol 80 mg over 2 min
Switch to IV Hydralazine if Target is not achieved
24. Management of Severe Hypertension
IV Hydralazine
• IV Hydralazine 5 mg or 10 mg over 2 min
• If target not achieved after 20 mins,
IV Hydralazine 20 mg over 2 min
Switch to IV Labetalol if Target is not achieved
25. Management of Severe Hypertension
• Drug of choice when pre-eclampsia is associated with
pulmonary edema is nitroglycerin (glyceryl trinitrate)
• Given as an i.v. infusion of 5 microgram/min, and gradually
increased every 3–5 min to a maximum dose of 100
microgram/min
26. Management of Severe Hypertension
• Intravenous sodium nitroprusside is contraindicated in
pregnancy because of an increased risk of foetal cyanide
poisoning.
• Can still be used in extreme situations for resistant HTN
• Dose of IV Esmolol :
Load 0.25-0.5 mg/kg IV over 1 min, THEN
0.05-0.1 mg/kg/min IV for 4 min