1. Intrauterine growth restriction (IUGR) is a complication of pregnancy where the fetus does not attain its full growth potential, affecting up to 10% of pregnancies.
2. Risk factors for IUGR include maternal conditions, fetal anomalies, infections, and placental insufficiency. Abnormal umbilical artery Doppler is associated with increased risk of adverse outcomes.
3. Serial ultrasounds and Doppler studies are used to monitor fetal growth and well-being. Timing of delivery depends on gestational age and severity of IUGR.
In this presentation we will discuss
First trimester US especially TVS is an integral part for confirmation of intrauterine pregnancy and to rule out ectopic pregnancy.
First trimester US helps us in suggesting conceptus viability.
First trimester US especially TVS is very efficient in approaching and evaluating the cause of vaginal bleeding.
Fetal growth restriction (FGR), formerly called intrauterine growth restriction (IUGR), refers to a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb.
Mild FGR usually doesn't cause long-term problems. In fact, most babies who have it catch up in height and weight by age 2. But severe FGR can seriously harm a baby before and after birth. The extent of the problems depends on the cause and how severe the growth restriction is. It also depends on what point in the pregnancy it starts.
In this presentation we will discuss
First trimester US especially TVS is an integral part for confirmation of intrauterine pregnancy and to rule out ectopic pregnancy.
First trimester US helps us in suggesting conceptus viability.
First trimester US especially TVS is very efficient in approaching and evaluating the cause of vaginal bleeding.
Fetal growth restriction (FGR), formerly called intrauterine growth restriction (IUGR), refers to a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb.
Mild FGR usually doesn't cause long-term problems. In fact, most babies who have it catch up in height and weight by age 2. But severe FGR can seriously harm a baby before and after birth. The extent of the problems depends on the cause and how severe the growth restriction is. It also depends on what point in the pregnancy it starts.
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.
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 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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
- 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
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
3. Intrauterine growth restriction (IUGR) is a poorly understood complication of pregnancy,
affecting up to 10% of live-born infants.
It is characterized as a rate of fetal growth less than normal for the gestational-age appropriate
growth potential Quantitatively, this poor fetal growth has been defined by the American
College of Obstetricians and Gynecologists as estimated fetal weight of <10th percentile for
gestational age, often times with ultrasound evidence of growth deceleration late in gestation or
abnormal Doppler indexes in the umbilical artery or middle cerebral artery.
4. Fetal growth restriction, (IUGR), is a common complication of pregnancy.
• Pathologic condition where there is a restriction of growth in utero, and the fetus does not attain
its full growth potential.
• Complicates ≈5-10% of pregnancies
• Third leading cause of perinatal mortality after anomalies
and prematurity
Perinatal mortality inversely proportional to percentile growth:
1.5% <10%
2.5% < 5th %
7. IUGR (Intrauterine Growth
Restriction)
SGA (Small for Gestation Age)
30% babies with birthweight <10th
percentile
70% babies with birthweight <10th
percentile
Growth restricted Not growth restricted
Constitutionally and anatomically
abnormal
Constitutionally small but
anatomically normal
↑ Obstetric/neonatal risk NO obstetric/neonatal risk
{Variable} Normal subcutaneous fat
8. • Stage I (Hyperplasia)
• - 4 to 20 weeks
• - Rapid mitosis
• - Increase of DNAcontent
• Stage II (Hyperplasia & Hypertrophy)
• - 20 to 28 weeks
• - Declining mitosis.
• - Increase in cell size.
• Stage III ( Hypertrophy)
- 28 to 40 weeks
- Rapid increase in cell size.
- Rapid accumulation of fat, muscle and connective tissue.
• 95% of fetal weight gain occurs
during last 20 weeks of gestations.
10. Reduce fetal growth support..
EXTRINSIC CAUSES
Reduce fetal growth potential..
INTRINSIC CAUSES
PALCENTAL FACTORS
MATERNAL FACTORS
ANEUPLOIDY
INTRA UTERINE INFECTION
More morbidities and mortalities More long term effects
15. : proposed in 1990 by the British epidemiologist
David Barker (b. 1939) that intrauterine growth retardation will increase :.
• Increased risk of adult metabolic syndrome
• Obesity
• Type 2 diabetes mellitus
• Coronary artery disease
• Stroke
• Up to 50% cognitive disability
• Increased risk of cerebral palsy
• <10th percentile at 8 years
• Early IUGR less likely to catch up
17. – Teen age
– High altitude
– Socioeconomic factor
– Smoking , Alcohol , Drugs
– Previous IUGR pregnancy history
– previous IUGR in family
18. Seldom elicited before 28 weeks of gestation:
. Failure of fetus and uterus to grow at the normal rate over a 4 week period;
.Uterine fundal height should be at least 2cm less than
expected for the length of gestation;
.Poor maternal weight gain;
. Diminished fetal movements.
19. Uterine fundal height
Uterine fundus symphysis Pubic
Simple, Safe, Inexpensive for screening
Between 18 and 30 weeks,
the uterine fundal height in centimeters coincides with weeks of
gestation.
If the measurement is more than 2 to 3 cm from the expected height or <
1oth percentile from normal curve, inappropriate fetal growth may be
suspected
21. Initial U/S at 16 to 20 weeks to establish gestational age
and identify anomalies and repeated at 32 to 34 weeks
to evaluate fetal growth
22. The measurements most commonly used to
measure and follow fetal growth are:
Biparietal Diameter
HeadCircumference
Femur Length
Abdominal Circumference
Used between 15-42 weeks. Normal ratio:
<36 weeks = 1:1
>36 weeks - ratio decreases as the AC increases.
23. Mild IUGR – Normal amniotic fluid
Severe IUGR – Oligohydramnios (AFI is ≤ 5) Incidence
40%
24. • Blood flowing through the umbilical arteries originates
from the fetus and enters the placenta.
• The flow of blood through the arteries is dependent upon the strength of the fetal heart contraction and the
health of the placenta.
• Blood returning from the placenta goes throughthe umbilical vein to the fetus.
25. • Doppler principle based on changes in sound waves related to the flow velocity of blood traveling
through these vessels.
• The umbilical artery was first used to study this flow velocity in in 1977.
• The umbilical arterial waveform usually has a "saw tooth" type pattern with flow always in the
forward direction
•The umbilical artery is evaluated by measuring the blood flow velocity at peak
systole (maximal contraction of the heart) and peak diastole (maximal relaxation of
the heart).
• These values are then
computed to derive a
ratio.
26. • As GA advances, increase blood flow at diastole means placenta
less resistant.
27. • In growth-retarded fetuses and fetuses developing intra- uterine distress, there is more
placental resistance and the umbilical artery blood velocity waveform usually changes
in a progressive manner.
• Increased resistance, absent end diastolic flow, reverse flow.
• Increasing RI values and S:D ratios if blood flow during diastole is decreased.
30. • notching in late in pregnancy is an indicator of increased uterine
vascular resistance and impaired uterine circulation’
31. :
– characterized by absent or reversed end-diastolic flow
– associated with fetal growth restriction
A. Normal velocimetry pattern with an S/D ratio of <
3.0
B. The diastolic velocity approaching zero reflects
increased placental vascular resistance.
C. During diastole, arterial flow is reversed (negative
S/D ratio), which is an ominous sign
precede fetal demise
33. Prepregnancy: to prevent it by identifying risk factors and treat as necessary
(e.g. improve nutrition intake, stop smoking or alcohol, ASA in APA syndrome,
and Heparin in thrombophilias)
Antepartum: identify risk factors that can be changed. Fetal surveillance by
ultrasound (BPP) and fetal heart monitoring (Non-Stress Test). To decide on
timing and mode of delivery.
34. Near term
Prompt delivery
Recommend delivery at 34 weeks or beyond if there is clinically significant
oligohydramnios
• Growth Restriction Intervention Trial
• Only published randomized trial to assess the timing of delivery of the early preterm (less
than 34 weeks of gestation) growth-restricted fetus.
• Randomized to either the early delivery group (delivery within 48 hours) or to the
expectant management group (with antepartum surveillance until it was felt that delivery
should not be delayed any longer)
• Betamethasone administration were the same in both groups
35. • Prospective Observational Trial to Optimize Pediatric Health in
Intrauterine Growth Restriction (IUGR) (PORTO STUDY)
• National prospective observational multicenter study
• Evaluate which sonographic findings were associated with perinatal
morbidity and mortality in pregnancies affected by growth restriction
(defined as estimated fetal weight (EFW) <10th centile)
• Am J Obstet Gynecol. 2013Apr;208(4)
36. • STUDY DESIGN:
• Over 1100 consecutive ultrasound-dated singleton pregnancies with EFW <10th centile
were recruited from January 2010 through June 2012.
• A range of IUGR definitions were used, including EFW orabdominal
circumference <10th, <5th, or <3rd centiles
• with or without oligohydramnios
• with or without abnormal umbilical arterial Doppler
• Adverse perinatal outcomes included intraventricular hemorrhage, periventricular
leukomalacia, hypoxic ischemic encephalopathy, necrotizing enterocolitis,
bronchopulmonary dysplasia, sepsis, and death
• Am J Obstet Gynecol. 2013Apr;208(4)
37. • RESULTS:
• N=1116 fetuses
• 312 (28%) were admitted to neonatal intensive care unit
• 58 (5.2%) were affected by adverse perinatal outcome including 8
mortalities (0.7%)
• The presence of abnormal umbilical Doppler was significantly associated with adverse outcome,
irrespective of EFW or abdominal circumference measurement.
• The only sonographic weight-related definition consistently associated with adverse outcome
was EFW <3rd centile (P = .0131), all mortalities had EFW <3rd centile.
• Presence of oligohydramnios was clinically important when combined with EFW <3rd centile
(P = .0066).
• Am J Obstet Gynecol. 2013 Apr;208(4)
38. • CONCLUSION:
• Abnormal umbilical artery Doppler and EFW <3rd centile were strongly
and most consistently associated with adverse perinatal outcome.
• Stricter IUGR cutoffs may be warranted and future studies should
comparing various definitions of IUGR and management strategies
39. • Management
• Serial US q 2-4 weeks is indicated
• Antenatal surveillance with umbilical artery Doppler velocimetry and
antepartum testing (NST,BPP)
• Delivery depends on the underlying etiology and estimated
gestational age
• Eunice Kennedy Shriver National Institute of Child Health and Human Development/Society
for Maternal-Fetal Medicine/American College of Obstetricians and Gynecologists Joint
Conference
• Dx fetal growth restriction:
• Delivery at 38 0/7–39 6/7 weeks of gestation isolated fetal growth restriction
• Delivery at 34 0/7–37 6/7 weeks of gestation in cases of fetal growth restriction with additional
risk factors for adverse outcome (eg, oligohydramnios, abnormal umbilical artery Doppler
velocimetry results, maternal risk factors, or co- morbidities)
40. • Delivery for fetal growth restriction before 34 weeks:
• Planned at a center with a neonatal intensive care unit and consultation
with a maternal–fetal specialist.
• Antenatal corticosteroids should be administered
• For cases in which delivery occurs before 32 weeks:
• Magnesium sulfate should be considered for fetal and neonatal
neuroprotection.
41.
42. • Heads are disproportionately
large for their trunks and
extremities
• Facial appearance has been
likened to that of a “wizened
old man”.
• Long nails.
• Scaphoid abdomen
43. • Way of characterizing the relationship of height to mass for an individual.
• PI = 1000 x cubed root of Mass (kgs)
Height (cms)
• Typical values are 20 to 25.
• PI is normal in symmetric IUGR.
• PI is low in asymmetric IUGR