Thank you for the additional details on the Sarnat stages. This information helps provide more context for assessing and managing hypoxic ischemic encephalopathy in newborns.
Hi Guys,
This presentation talks about Tuberculosis diagnosed in mother in the antenatal period, its treatment, implications on mother and fetus, the various protocols available currently regarding the neonatal management . Special focus being in major issues like breastmilk feeding, BCG, AKT prophylaxis, mother-child isolation.
Hope you find it useful.
P.S. - Please checkout my youtube channel - 'NEONATOHUB' & Facebook page 'Neonatohub' for lectures on neonatology.
Hi Guys,
This presentation talks about Tuberculosis diagnosed in mother in the antenatal period, its treatment, implications on mother and fetus, the various protocols available currently regarding the neonatal management . Special focus being in major issues like breastmilk feeding, BCG, AKT prophylaxis, mother-child isolation.
Hope you find it useful.
P.S. - Please checkout my youtube channel - 'NEONATOHUB' & Facebook page 'Neonatohub' for lectures on neonatology.
Neonatal resuscitation also known as newborn resuscitation is an emergency procedure focused on supporting the approximately 10% of newborn children who do not readily begin breathing, putting them at risk of irreversible organ injury and death.
Approach to cardiac murmurs and cardiac examination in childrenVarsha Shah
Cardiovascular examination in children for MBBS undergraduate, Residents, Trainees, pediatricians, GP, family physicians, nursing , dental, allied health students
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.
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.
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!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
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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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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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.
2. Learning Outcomes
Initial Stabilisation and Resuscitation of the Newborn Infant
1. Prevention
1.1 Identify the factors that predispose to the development of
perinatal hypoxia.
1.2 Propose how perinatal hypoxia can be prevented.
2. Principles of Diagnosis
2.1 Describe the pathophysiological changes that occur in hypoxia.
2.2 Recognise an asphyxiated newborn
2.3 Classify an asphyxiated newborn based on the predicted
adverse outcomes (Sarnat staging)
3. Principles of Management
3.1 Resuscitate a newborn who is not adapting to the extra-uterine
transition.
3.2 Describe the principles involved in the management of mild to
moderate asphyxiated newborn.
3. Perinatal Hypoxia-Ischemia
Birth asphyxia - Failure to initiate
and sustain breathing at birth
Causes
5. Fetal and Antepartum (90%)
7. Birth process (10%)
4. Fetal and Antepartum Pathologies
1. Inadequate oxygenation of maternal blood
- anesthesia, cyanotic heart disease,
respiratory failure
3. Inadequate flow of maternal blood
(ischemia/hypotension) – spinal
anesthesia, compression of IVC or aorta
by uterus
5. Abruptio placentae
7. Uterine vasoconstriction (cocaine)
6. Recognition of an Asphyxiated Baby
Oxygen supply to the fetus is
reduced, resulting in
Apnea at birth
2. Low Apgar scores (severe if <5 at five
minutes)
3. Neurologic sequelae (hypoxic-ischaemic
encephalopathy)
4. Metabolic acidosis
7. Apgar Scores
0 1 2
Heart rate 0 <100 >100
Respiration Absent Slow, Good,
irregular crying
Muscle Limp Some Active
tone flexion
Response No Grimace Cough,
to catheter response sneeze
in nostril
Colour Blue Body pink, All pink
extremities
blue
8. Apnea
10 Apnea: When asphyxiated, the infant responds initially
with tachypnea. If insult continues, the infant becomes
apneic and bradycardic. The infant will respond to
stimulation and 02 therapy with spontaneous respirations.
20 apnea: When insult continues after 10 apnea, the infant
responds with a period a gasping respirations, bradycardia,
and falling BP. The infant takes a last breath and then
enters the 20 apnea period. The infant will not respond to
stimulation and death will occur unless resuscitation begins
immediately.
It is impossible to differentiate between 10 apnea and 20
apnea at delivery, assume the infant is in 20 apnea and
begin resuscitation immediately.
23. Neopuff® Positive Pressure Device
T-piece resuscitator
Capable of providing peak
inspiratory pressure (PIP) &
positive end expiratory pressure
(PEEP) for manual ventilation,
Can also be used to provide
continuous positive airway
pressure (CPAP)
Needs a constant gas flow to
work (air or oxygen)
Can be used with the
Resuscitaire ® set-up & gas
supply
24. Neopuff® Positive Pressure Device
Oxygen/air (gas)
supply tubing/ inlet Gas outlet
(to Neopuff®) and tubing
(to patient)
25. Neopuff® Positive Pressure Device
Circuit Pressure Dial
(Pressure Gauge)
MaximumPressure
Gas Outlet Release Knob PIP Knob
Gas Inlet
33. EVALUATION
Respiration Breathing or Apneic?
Heart rate >100 or <100 (auscultate / palpate base of
umbilical cord)
Colour Pink or centrally blue?
34. POSITIVE PRESSURE VENTILATION
Indications: apnea / gasping, HR<100, persistent
cyanosis
Bag and mask (self-inflating) with 100% O2
Adequate chest rise (rather than a particular
manometer reading)
Rate – 40 to 60 breaths per minute
Successful – improving HR and colour
The key to successful neonatal resuscitation is
establishment of adequate ventilation
37. CHEST COMPRESSIONS
If after 30 seconds of adequate PPV with 100% O2 and
HR<60, start chest compressions
Ratio of 3 compressions : 1 breath, to give 90
compressions and 30 breaths per minute (120 events per
minute)
Depth of compression – 1/3 the depth of the chest
Preferred technique – Two thumb-encircling hands
Compressions delivered on the lower third of the sternum
38.
39. Using the Neopuff® to give PPV
When giving PPV, occluding the PEEP valve gives PIP
and uncovering it maintains PEEP.
40. Giving CPAP Using the Neopuff
Do not occlude the PEEP valve when using for CPAP.
41. Medications
1. Adrenaline
– Concentration 1 : 10 000 solution
– Dose 0.1 – 0.3 ml/kg
– Route ETT or intravenous
– Indication if HR < 60 bpm after 30 sec of effective PPV
and chest compressions
• Naloxone
– Dose 0.1 mg/kg, repeat dose if necessary
– Route intramuscular, intravenous, ETT
– For respiratory depression with maternal pethidine in
last 4 hours
3. Volume expanders (normal saline) 10 ml/kg over 10
minutes
5. Sodium bicarbonate
44. Hypoxic-Ischemic Encephalopathy
Sarnat Stages of HIE
Stage One: Mild irritability and hyper-alert
Stage Two: Seizure
Stage Three: Stupor
Outcome
Death or severe neurological sequelae
Stage 1 (mild) 0%
Stage 2 (moderate) 30 -50%
Stage 3 (severe) 90 - 100%
45. Management of the Asphyxiated Infant
• Optimise perfusion
• Optimise oxygenation, CO2
• Restrict fluid
• Normal blood sugar, calcium, acid-base balance
• Treat seizures
• Therapeutic hypothermia
• Cord stem cell infusion?
46. Case 1
You are asked to attend an emergency LSCS
delivery of a 41-weeks gestation infant with non-
reassuring fetal cardio-tocogram (CTG). Mother
is a 33 year old gravida one Chinese lady. She
was admitted to hospital two days ago. Her labor
was induced. She had good prenatal care and her
pregnancy has been uncomplicated. She suddenly
felt sharp pain in lower abdomen. CTG, which was
normal before that showed bradycardia.
47. Case 1
What are the possible conditions that
you can think of in the mother
causing the problem?
Whatresuscitation equipments would
you prepare for delivery?
Wouldyou involve any other medical
personnel?
48. Case 1
Atdelivery, you receive a floppy and
blue male infant. His heart rate was
40/minutes and there is no
spontaneous respiration. Baby does
not respond to stimulation.
Whatis the initial Apgar score in this
baby?
What are the initial steps you would
49. Case 1
You bring him to the radiant warmer,
quickly positioned, dried, stimulated
the baby and give free-flow oxygen.
At 30 seconds of life, he remains
apneic and cyanotic. His heart rate is
still 40 per minute.
What would be the next step in
resuscitation?
50. Case 1
You administer bag and mask
ventilation with 100% FiO2. There is
good chest expansion. After one
minute of bag and mask ventilation
baby remained apneic. His heart rate
is 60 per minute.
What would be your next step?
What are the other possible
51. Case 1
Youstart chest compressions and
decide to intubate the baby.
How would you ensure proper
positioning of ETT?
How would monitor your
resuscitation?
52. Case 1
You check for equal air entry and expansion of
lung field. Baby’s heart rate after two minutes of
ventilation is 100/minutes. The color is still pale
and pulse volume is low.
What could the possible reason for low volume
pulse?
What intervention would you like to consider at
this point?
53. Case 1
You decide to give normal saline bolus 10-15
ml/kg.
How can you secure an intravenous access
quickly?
How fast do you want to administer the normal
saline bolus?
What are other types of fluid you can use?
54. Case 1
You cannulate the umbilical vein and
administer the normal saline over
five minutes. Baby’s heart rate
improve to 150/minute and color and
perfusion are better now. You have
decided to transfer the baby to
intensive care nursery.
Whatare the laboratory test you
want to order?
55. Case 1
ABG shows following parameter
– pH 7.03
– PCO2 52 mm of Hg
– PO2 85 mm of Hg
– Base excess –15
– HCO3 12
– How would you interpret the ABG?
56. Case 1
What are possible consequences in this baby?
– Clue: Organ systems
– Clue: Short term and long term
How would you monitor the baby?
– Symptoms
– Laboratory test
How would you counsel the parents regarding prognosis of
the baby?
57. Case 2
You are requested to ‘stand-by’ for delivery of a
term neonate. The mother is 32-year- old. This is
her first pregnancy. Her antenatal follow-up was
irregular. She was admitted to hospital with labor
6 hours ago. The CTG shows persistent heart rate
of 170/minutes. Amniotic membrane was
ruptured spontaneously and it is heavily stained
with meconium.
58. Case 2
Name few conditions that may give
rise to the problem described.
Whatare the resuscitation
equipments you would need?
Ideally,
how many medical personnel
you would need during resuscitation?
59. Case 2
The baby is delivered vaginally. The
baby was found to covered with thick
meconium. There is no spontaneous
cry. The heart rate is 120/minute and
the baby has some activity.
What would the role of obstetrician?
What would be your first step in
resuscitation?
What are the consequences of
meconium aspiration?
60.
61. Conditions That Requires Different
Resuscitation Approach
Thickmeconium stained liquor
Congenital diaphragmatic hernia
Feto-maternal or feto-placental
hemorrhage
62. Reference and Further Readings
1. Neonatal resuscitation guidelines. Circulation
2005;112:118– 95.
• Volpe J. Neurology of the Newborn. 5 ed.
Philadelphia:W. B. Saunders Company; 2008
(Chapter on Neonatal Encephalopathy)
• Nelson Textbook of Pediatrics 18th ed. 2007
Chapter 99.5: Hypoxia-Ischemia