Labia minora adhesions (LMA) are the partial or complete fusion of the labia minora. They occur in 0.6-3.3% of prepubertal girls and are usually asymptomatic, resolving spontaneously during adolescence. Potential causes include microtraumas from overcleaning or chronic irritation/inflammation. Treatment is usually not needed unless causing symptoms like urinary issues. Options include topical estrogen or steroid creams, or manual separation under local anesthesia. Surgery is rarely required and recurrence can be prevented with gentle separation and avoiding irritants.
Presentation on the description of normal and abnormal uterine bleeding, menstrual cycle, FIGO classification with PALM-COEIN, common differentials of AUB, assessment, diagnosis, and management.
Presentation on the description of normal and abnormal uterine bleeding, menstrual cycle, FIGO classification with PALM-COEIN, common differentials of AUB, assessment, diagnosis, and management.
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
Luteal phase insufficiency is one of the most important aspect of fertility treatment . But due to lack of proper understanding many unwanted medications are prescribed . This ppt will give an idea on the best evidence based luteal phase support for an ivf cycle.
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
Luteal phase insufficiency is one of the most important aspect of fertility treatment . But due to lack of proper understanding many unwanted medications are prescribed . This ppt will give an idea on the best evidence based luteal phase support for an ivf cycle.
Parotitis is the inflammation of the parotid glands. It is the most common inflammatory condition of the salivary glands, although inflammation can occur in the other salivary glands as well.
Obstetric fistula is an abnormal opening between the reproductive tract (usually the vagina) and the urinary tract (frequently the bladder) or alimentary tract (usually the rectum) or both. Obstetric fistula typically develops after several days of prolonged or obstructed labour.
science has an evolving nature. what happened today may not be tomorrow, what is not today may happen tomorrow.
No one is complete so reading and thinking may open the door to the hidden ground.
Bladder exstrophy is a congenital (present at birth) abnormality of the bladder. It happens when the skin over the lower abdominal wall (bottom part of the tummy) does not form properly, so the bladder is open and exposed on the outside of the abdomen. In epispadias, the urethra does not form properly.
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.
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
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
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.
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.
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
2. Definition
• Labial agglutination (Adhesion) or “fused
labia”
• It is defined as the partial to complete fusion
of the labia minora (or labia majora).
• In which the opposing epithelial surfaces of
labia minora stick together without any union
of deeper tissues
3. Membranous structure
• Fusion of medial adjacent mucosal surfaces of
labia minora
• Ranging
• From thin , transeparent
• To thick and fibrous
4. • Labial fusion is almost never present at birth,
• usually develops around one to two years of age.
• Labial adhesions are usually an innocent finding
and a trivial problem, are a common finding in
the girls.
• Usually, this condition is asymptomatic
• spontaneously disappears during adolescence
• but its importance is that it is frequently
• misdiagnosed as congenital absence of the vagina
5. • Labial adhesion is relatively common,
• but the condition is little known among
doctors and parents.
• It is a source of great paternal anxiety
• And are commonly misdiagnosed or
unnecessary investigations may be orderd
7. Incidence
• it is estimated to occur in 0.6 – 3.3 % of
prepubertal girls
• However, this may be significantly higher as
many children with this condition are
asymptomatic and remain unreported.
• Rates as high as 21.3% and 38.9% have been
documented
8. Causes Of labial adhesion in
PrePubertal Girls
• Exact cause is uncertain
• Microtraumas l ike overcleaning causing mechanichal mucosal
injury of the perineium == Lead to adhesion of labia minora
Because all mothers were cleaned the perineum of their daughter
too much
• Chonic irritation
• chronic inflammation from fecal soiling, vulvovaginitis
(inflammation around the area of the vagina), eczema or dermatitis
(skin inflammation) from soaps or detergents. Eg
- chemical trauma
-Infections (candida albicans,entobius vermicularis,various bacteria)
-Bad hygiene
-Sexual abuse
• Trigger inflammation of hypoestrogenised vulva
9. The most common causes of labial
adhesion in adult women
(PostPartum, PostMenopausal)
• Oestrogen deficiency associated with atrophic vaginitis
• Vulval lichen sclerosus
• Erosive lichen planus
• Mucous membrane pemphigoid
• Behcet syndrome
• Stevens-Johnson syndrome / toxic epidermal necrolysis
• Vulval cancer
• Complications of childbirth
• Female circumcision operation (illegal in many
countries)
• Complications from vulvectomy
10. Symptoms
• Labial adhesions are usually asymptomatic
• Symptomatic common symptoms or complaints can include:
Urinary dribbling which is due to urine that gets trapped behind the
adhesion or fused labia, later dribbling out.
• Skin or vaginal irritation or redness.
• Frequent urinary tract infections as a result of the adhesions.
• Eg
-UTI
-Pain or discomfort during activity
-Post voiding dribbling
-Abnormal urinary stream
-Urinary retension
11. Signs
Labial fusion is diagnosed by visual inspection
• • Fusion of the labia minora in the midline (extends
from just below the clitoris to the posterior fourchette)
until onley a small opening is left superiorly through
which urine is passed
• No urethral or vaginal opening are seen in complete
type
• Adhesion between a labium minor and corresponding
labium major results in resorption, shrinking or
disappearance of the labium minor.
• • Retention of urine in the vestibule or vagina resulting
in irritation, discharge, and odor
12. Workup and Evaluation
• Laboratory: No evaluation indicated.
• Imaging: No imaging indicated.
• Special Tests: None indicated. Although an
endoscopic examination is frequently performed
in the diagnosis and treatment of lower and
upper urinary tract disease, the use of cystoscopy
in patients with labial fusion and urinary
retention has not been reported
• Diagnostic Procedures: History and physical
examination.
13. Spontaneous resolution
• 50% in cases within 6 monthes
• 90% in cases within 12 monthes
• 100% in cases within 18 monthes
14. Differential Diagnosis
• Labial adhesive should be distinguished from
congenital deformities,
• as visually there is a mid-line raphe (line of
fusion) present with labial adhesion
• that would not be apparent in a congenital
condition.
• Eg an imperforate hymen or Intersex
• DD from-- Female circumcision
• DD From--Sexual abuse
15.
16. Mangement
• If there are no symptoms and no problems in
urinating, the doctor might want to wait for the
girl to reach puberty and start to produce
estrogen
• Topical estrogen
• Topical betamethazone
• Manual separation (manual adhenolysis ) under
local anaesthesia
• Surgical separation ( surgical adhenolysis )under
general anaesthesia
17. Leaving It alone
• Leaving labial fusion alone is the safest and
most effective treatment.
• for the girl to reach puberty and start to
produce estrogen
18. Topical Estrogen
• If the adhesions cover a large area, or are causing
problems,
• apply cream containing estrogen for about a month.
• It is important to apply the cream in the right amounts.
• Side effects of treatment could include bleeding,
breasts starting to grow, and irritation.
• These things generally disappear when the cream is
stopped. If the cream works to separate the lips,
• Apply petroleum jelly or some other ointment for
another period of time.
19. Topical Steroid
• betamethasone 0.5%.
• in addition to estrogen,
• or in place of estrogen.
• Betamethasone use should be limited to a
certain period of time, such as 3 months.
20. Manual or surgical separation
• If creams do not work, it is usually because the
adhesion is thick. In very few cases, separation
might be needed if the adhesions are causing
problems, such as blocking urine or causing many
infections. Only doctors who are experienced
should do a manual separation. The procedure
calls for local anesthesia and possibly sedation.
Surgical separation generally is only needed if the
girl cannot urinate or if other treatments do not
work. Surgery is also suggested for the rare labial
adhesion that occurs after a pregnancy.
21. Manual separation
• applied local anaesthetic cream and
• then used manual separation ,
• cotton buds,
• a probe or
• tenaculum
• Post-surgical aftercare with oestrogen is
recommended for 1 – 2 weeks, and with
vaseline for 6 – 12 months
22. Surgical technique
• Surgery was performed under general anaesthesia
• Adhesions were incised sharply and the cut edges were
reapproximated with 7-0 chromic.
• or
• During surgery labial fusion was separated by sharp
• dissection
• Saline infusion tube cut to the length
• of the raw area of the separated labial adhesions were
• sutured on to the edges using 3/0
• The tubes were removed on day 7.
• This effectively
• prevented contact of the raw surfaces until
epitheLialisation
• Other surgical techniques
• like
• amniotic membrane and
• rotational skin flaps have been tried to prevent
recurrentlabial adhesions with varying success
23. Adhesion tend to recur
• Preventive measures
• Gentle labial separation to visualse introitus
• Daily bath
• Avoidance of irritants ( soapy water, bubble
bath )
• Vulvar airig ( daily period of time when diaper
is removed or not wear underwear with night
clothes
24. Conclusion
• There is no clear-cut effective treatment for labial adhesion, and
• there is no reason to treat girls in the absence of symptoms
• . The condition resolves spontaneously in all, at puberty if not
before.
• Any child with symptoms that may be due to the adhesion should
be referred to a paediatrician.
• Healthcare professionals at public health clinics are advised to look
for adhesion at check-ups in children aged two years and under.
• It is important to provide sufficient information – to ensure that
parents do not become alarmed if an adhesion is discovered
subsequently.
• It is also important to avoid unnecessary investigation and
treatment.