Leucorrhoea
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Leucorrhoea Dr. Yashika Abnormal Vaginal Discharge Frequent complaint. Discharge may vary from excess to normal. Discharge may be blood-stained / contaminated with urine or stool. Characteristics of normal vaginal fluid Nature - watery Colour - white Odour - Odourless pH - 4.0 Microscopically - Squamous epithelial cells, Leucorrhoea Leucorrhoea is defined as excessive normal vaginal discharge. Features of vaginal discharge in leucorrhoea : Excess secretion. Non purulent Non offensive Non irritant Never causes pruritis. Etiology : Physiological excess Cervical causes Vaginal causes Physiologic excess Puberty Menstrual Cycle Pregnancy Sexual excitement Cervical causes: Cervicitis Cervical ectopy Cervical polyp Treatment General health improvement Surgical treatment of cervical factors Pill users are asked to stop pill immediately Local hygiene
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Cervical erosion
Cervical Erosion
Dr. Yashika
Definition
Cervical erosion is a condition where the squamous epithelium of the ectocervix is replaced by columnar epithelium which is continuous with endocervix.
Aetiology
Congenital
Acquired
Clinical features
Symptoms :
Vaginal discharge
Contact bleeding
Associated cervicitis
SIGNS :
Diagnosis
Ectropion
Early carcinoma
Primary Lesion (Chancre)
Tubercular ulcer
Management
Pregnancy
Pill user
Persistent ectopy
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Dr. Yashika
Definition
Cervical erosion is a condition where the squamous epithelium of the ectocervix is replaced by columnar epithelium which is continuous with endocervix.
Aetiology
Congenital
Acquired
Clinical features
Symptoms :
Vaginal discharge
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Associated cervicitis
SIGNS :
Diagnosis
Ectropion
Early carcinoma
Primary Lesion (Chancre)
Tubercular ulcer
Management
Pregnancy
Pill user
Persistent ectopy
Endometriosis
what is endometriosis? Theories in endometriosis, sites of endometriosis. types and clinical presentation. signs and symptoms.
Investigations :TVS, CA125
laparoscopic findings
chocolate cyst and extrapelvic endometriosis.
Classification of endometiosis
Diffential diagnosis
Management :of asymptomatic and symptomatic cases
drugs and minimally invasive surgery
surgey and preventive measures in endometiosis.
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Leucorrhoea
"Treatment and remedies for leucorrhoea and its effective homeopathy treatment.Personalised online consultancy & treatments provided at our clinic by efficient panel of doctors in our center at mumbai,Bombay,Chembur, India.Contact us."
leucorrhoea and its homeopathy treatment in Chembur, Mumbai, India.
"Treatment and remedies for leucorrhoea and its effective homeopathy treatment.Personalised online consultancy & treatments provided at our clinic by efficient panel of doctors in our center at mumbai,Bombay,Chembur, India.Contact us."
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Endometriosis
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uterine fibroid.pptx
Fibroid
Commonest benign tumour in females.
Histologically composed of Smooth muscles fibres and fibrous connective tissues.
Aka lieomyoma, myoma and fibromyoma.
Incidence
Higher incidence in dark coloured females.
More common in nulliparous or child bearing age.
Prevalence is higher in 35 – 45 years.
Aetiology
Aetiology is unclear at present.
Hypothesis
Chromosomal abnormality:
Rearrangement or deletion at chromosome 6 or 7.
Somatic mutations in myometrial cells.
Role of polypeptide growth factors :
Epidermal GF, Insulin-like GF Transforming GF stimulate the growth.
Types of Uterine Fibroids
Pathology
Naked eye appearance:
Enlarged uterus, distorted shape.
Firm appearance on touch.
Cut section :
Smooth, whitish, whorled and trabeculation.
False capsule formation.
Periphery is more vascular.
Cut section of Uterine Fibroid
Secondary changes in fibroids:
Degeneration
Atrophy
Necrosis
Infection
Vascular changes
Sarcomatous changes
Clinical features
Asymptomatic
Menstrual abnormalities menorrhagia, metrorhhagia
Dysmenorrhoea
Dyspareunia
Infertility
Recurrent pregnancy loss
Abdominal enlargement
Pelvic pain
Investigations
USG
Pelvis, TVS
MRI
HSG
Hysteroscopy
Uterine curettage
Medical Management
Objectives :
To improve menorrhagia
To correct anaemia
To reduce vascularity and size of tumour
To postpone surgery
Drug Therapy
Antiprogesterones (Mifeprestone)
Danazol
GnRH analogues
LNG-IUS
Prostaglandin synthetase inhibitors.
Surgical Management of Uterine Fibroids
Myomectomy
Embolotherapy
Hysterectomy
Cervical Fibroids
Symptoms :
Anterior Cervical Fibroids
Posterior Cervical Fibroids
Lateral Cervical Fibroids
Central Cervical Fibroids
Treatment
Supravaginal cervix : Myomectomy
Infravaginal cervix :
Trichomonas vaginitis.pptx
Introduction
Causative agent : Trichomonas vaginalis
Transmission : Sexual contact
Incubation period : 3 – 28 days.
Clinical features
Sudden profuse and offensive vaginal discharge.
Severe irritation and itching around introitus.
Dysuria and increased frequency of urine.
Examination:
Thin, greenish yellow frothy offensive vaginal discharge.
Inflammed vulva
Vaginal examination may be painful.
Diagnosis:
Culture of discharge :
Diamonds TYM or Feinberg
Whittington medium.
Treatment:
DOC : Metronidazole
200mg TDS x 1 week.
Tinidazole
syphilis.pptx
Introduction
Causative agent : Treponema pallidium
Transmission : Abraded skin / mucosal surface.
Spreads through direct contact.
Incubation period : 9 -90 days.
Clinical features
Phases of syphilis :
Primary syphilis
Lesion / Chancre : Single/ Multiple
Site : Labia, fourchette, anus, cervix or
nipples.
Small papule gets eroded into an ulcer. The margins of ulcer are raised and floor is smooth and shiny.
Healing of primary chancre takes place in 1-8 weeks.
Secondary Syphilis
Secondary syphilis is evident in form of Condyloma lata in vulva.
Condyloma lata : coarse, flat topped, moist, necrotic lesions.
Maculopapular rashes : Palms and soles.
Alopecia, lymphadenopathy, mucosal ulcers.
Latent Syphilis
Quiescence phase.
Duration : 2 -20 years.
Tertiary Syphilis
Progression of tertiary syphilis occurs only in condition of untreated syphilis.
Damages CNS, CVS, Musculoskeletal system.
Cranial nerve palsies III, VI, VII and VIII.
Gummatous ulcer : deep punched ulcer with rolled out margins. Painless with moist leather base.
Diagnosis
History of exposure.
Identification of organism.
Serological test
VDRL (Venereal disease research laboratory)
TPHA (Treponoma pallidum haemagglutination)
EIA (Enzyme immunoassay)
FTA (Fluorescent treponomal Antibody)
TPI (Treponoma pallidum immobilisation)
Treatment
Benzathine penicillin IM
Tetracycline 500 mg
Doxycycline 100 mg
Serological test should be performed 1, 3, 6 and 12
month after treatment of syphilis.
pruritis vulvae.pptx
Pruritis vulvae
Etiology:
1. Vaginal discharge : Trichomonas vaginalis, Candida albicans
2. Local skin lesion: Psoriasis, Dermatitis
3. Vulvar infection: Fungal, Viral, Parasitic, STD
4. Medical disorders: Glycosuria
5. Deficiency: Fe, Folic acid, Vit B12 Vit A
6. Psychosomatic causes
Investigations
Age of onset
Intensity of itching
Duration
Vaginal discharge
Contraceptive practice
Allergy- nylon, soap, detergent.
DM
Liver disorder
Thyroid
Hematological disorder
Special Investigations
Microscopic examination: Vaginal discharge / vulval scarping
Urine examination: Sugar, Protein and pus cells.
Blood examination: CBC, Thyroid profile, Glucose, LFT, RFT
Stool examination: Ova, Parasite, Cyst.
Treatment
Maintain local hygiene.
Loose fitting clothing
Local topical application: antibiotics/ clobetasol propionate
Treat specific disease
Surgery: Neoplasia invasion
POP.pptx
Pelvic organ prolapse
Pelvic Organ Prolapse
Most common gynaecological problem.
Amongst parous women.
A form of hernia.
Anatomy of Uterus
Anteversion and anteflexion position.
Lies between rectum and bladder.
Cervix pierces the vagina at the right angle to the axis of vagina.
Supports of Uterus
Uterus is held in position by 3 tier support system.
Upper tier
Middle tier
Inferior tier.
Upper tier
Primarily, maintains the uterus in anteverted position.
The structures responsible are:
Endopelvic fascia.
Round ligaments.
Broad ligaments.
Middle tier
Constitutes the strongest support of uterus.
Responsible structures are:
Pericervical ring.
Pelvic cellular tissues.
Inferior tier
Indirect support of uterus.
Responsible structures are pelvic floor muscles including:
Levator ani
Endopelvic fascia
Levator plate
Perineal body
Urogenital diaphragm
Anatomical Factors
Gravitational stress.
Parturition stress.
Pelvic floor weakness.
Inherent weakness of supporting structures.
Acquired Predisposing Factors
Trauma of vaginal delivery causing injury :
Ligaments
Endopelvic fascia
Levator muscle
Perineal body
Pudendal nerve and muscle damage due to
repeated child birth.
Congenital Predisposing Factors
Inborn weakness of supporting structure.
Aggravating factors
Post menopausal atrophy
Poor collagen tissue repair with age.
Increased intra abdominal pressure.
Occupational hazards
Asthenia
Obesity
Fibroid/Polyp
Clinical Degrees Of Uterine Prolapse
Symptoms
Feeling of something coming out per vaginum.
Backache or dragging pain in pelvis
Dyspareunia
Urinary symptoms
Bowel symptoms
Clinical examination
Inspection and palpation.
General examination.
Pelvic examination
Uterine prolapse
Management of Prolapse
Preventive
Conservative
Surgery
Preventive Measures
Pelvic floor exercise during puerperium.
Avoid strenuous activities.
Avoiding prolonged cough.
Avoiding constipation.
Avoiding heavy weight lifting.
Avoiding future pregnancy too early.
Conservative Management
Indications :
Asymptomatic women
Mild degree prolapse
POP in early pregnancy
Treatment :
Oestrogen replacement therapy.
Kegel exercise
Pessary treatment
Surgical Management of Prolapse
Restorative
Extirpative
Obliterative
pid.pptx
Definition
PID is a disease of the upper genital tract.
It is a spectrum of infection and inflammation of the upper genital tract organs typically involving the uterus (endometrium), fallopian tubes, ovaries, pelvic peritoneum and surrounding structures.
Epidemiology
Occurs both in the developed and developing
countries.
85 per cent are spontaneous infection in sexually active females of reproductive age.
The remaining 15 per cent follow procedures, which favors the organisms to ascend up.
Two-thirds are restricted to young women of less than 25 years and the remaining one-third limited among 30 years or older.
Risk factors
Menstruating teenagers.
Multiple sexual partners.
Absence of contraceptive pill use.
Previous history of acute PID.
IUD users.
Area with high prevalence of sexually transmitted diseases.
Protective factors
Contraceptive practice
Barrier methods
Oral steroidal contraceptives
Monogamy / Vasectomy
Others
Pregnancy
Menopause
Vaccines
CLINICAL FEATURES
Bilateral lower abdominal and pelvic pain dull in nature.
Fever, lassitude and headache.
Irregular and excessive vaginal bleeding .
Abnormal vaginal discharge (purulent or copious)
Nausea and vomiting.
Dyspareunia.
Pain and discomfort in the right hypochondrium.
Signs
Temperature >38.3°C.
Abdominal palpation
(1) Tenderness on both the quadrants of lower abdomen.
(2) The liver may be enlarged and tender.
Vaginal examination
(1) Abnormal vaginal discharge (purulent).
(2) Congested external urethral meatus or openings of Bartholin’s ducts through which pus may be seen escaping out on pressure.
(3) Speculum examination shows congested cervix with purulent discharge from the canal.
Clinical diagnostic criteria of PID (CDC-2006)
Minimum Criteria
Lower abdominal tenderness.
Adnexal tenderness.
Cervical motion tenderness.
Additional Criteria
Oral temperature > 38.3°C.
Mucopurulent cervical or vaginal discharge.
Raised C-reactive protein and/or ESR.
Definitive Criteria
Histopathologic evidence of endometritis on biopsy.
Imaging study (TVS/MRI) evidence of tubo-ovarian complex.
Laparoscopic evidence of PID
Investigations
Identification of organisms
Blood: Leucocyte count shows leucocytosis to more than 10,000 per cu mm and an elevated ESR value of more than 15 mm per hour.
Laparoscopy
Complications Of Pid
Immediate
Pelvic peritonitis or even generalized
Septicemia
Late
Dyspareunia
Infertility
Chronic pelvic inflammation
Formation of adhesions or hydrosalpinx or pyosalpinx and tubo-ovarian abscess.
Chronic pelvic pain and ill health.
Ambulatory Management Of Acute PID (CDC-2006)
Patient should have oral therapy for 14 days
Regimen A
Levofloxacin 500 mg (or, ofloxacin 400 mg) PO
Metronidazole 500 PO bid
Regimen B
Ceftriaxone 250 mg IM single dose
Doxycycline 100 mg PO BID with or without
Metronidazole 500 mg PO BID for 14
hsg.pptx
Hysterosalpingography (HSG)
Hystero + Salpingo + Graphy
HSG is a radiological procedure done to assess the interior anatomy of the uterine cavity and the shape and patency of the fallopian tubes.
It is a radiographic study using fluorescent dye to visualise the anatomy of uterus and fallopian tubes.
Indications:
Assessment of tubal patency.
Detection of uterine malformation.
Diagnosis of cervical incompetence.
Detection of translocated IUD.
Diagnosis of uterine synechiae.
Diagnosis of uterine fibroid , uterine polyp.
Diagnosis of abdominal pregnancy.
Uterine Malformation
Steps of operation
The patient is asked to remain empty bladder.
Operation is done under general anaesthesia.
The patient is placed in lithotomy position.
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forcep.
HSG cannula is fitted with a syringe containing radio opaque dye. About 5- 10 ml of dye is slowly introduced.
The passage of the dye is observed by using X-ray intensifier and a video display unit.
Two radiographic X-rays are taken. First one to show the filling of uterine cavity and other one 10-15 mins after the completion of procedure.
Timing of procedure :
HSG is done between D6 and D10 of cycle.
Antibiotics are given one day prior the procedure up to 5 days.
Contrast media
Complications
Peritoneal irritation.
Pelvic pain.
Vasovagal attack.
Intravasation of dye into the venous or lymphatic channels.
Flaring up of pelvic infections.
endo.pptx
Definition
Presence of functioning endometrium (glands and stroma) in sites other than uterine mucosa is called endometriosis.
It is a benign but it is locally invasive.
Prevalence
The real one is due to delayed marriage, postponement of first conception and adoption of small family norm.
The apparent one is due to increased use of diagnostic laparoscopy as well as hightened awareness of this disease complex amongst the gynecologists
Sites
Abdominal: Usually confined to the abdominal structures below the level of umbilicus.
Extra-abdominal: Common sites are abdominal scar of hysterotomy, cesarean section, tubectomy and myomectomy, umbilicus, episiotomy scar, vagina and cervix.
Remote
Pathology
Naked Eye Appearance: The appearance of the lesion depends on the organs involved, extent of lesion and reaction of the surrounding tissues.
Pelvic endometriosis: Small black dots, called ‘powder burns’ seen on the uterosacral ligaments and pouch of Douglas.
Fibrosis and scarring
Symptoms
Dysmenorrhea (70%)
Abnormal menstruation (20%)
Infertility (40–60%)
Dyspareunia (20–40%)
Chronic Pelvic Pain
Abdominal Pain
Urinary— frequency, dysuria, back pain or even hematuria.
Sigmoid colon and rectum—painful defecation (dyschezia), diarrhea, constipation, rectal bleeding or even melena.
Chronic fatigue, perimenstrual symptoms (bowel, bladder).
Hemoptysis (rarely), chest pain.
Surgical scars—cyclical pain and bleeding.
Examination
Abdominal palpation
A mass may be felt in the lower abdomen arising from the enlarged tubo-ovarian mass due to endometriotic adhesions. The mass is tender with restricted mobility.
Pelvic Examination
Pelvic tenderness, nodules in the pouch of Douglas, nodular feel of the uterosacral ligaments, fixed uterus or unilateral or bilateral adnexal mass of varying sizes
Diagnosis
Bichemical parameters:
Serum CA 125
Monocyte Chemotactic Protein (MCP-1)
Imaging:
TVS - ovarian endometriomas
Endorectal USG - Rectosigmoid endometriosis
MRI - deep infiltrating endometriosis.
Colonoscopy, rectosigmoidoscopy and cystoscopy
Differential Diagnosis
Chronic pelvic infection / symptomatic endometriosis. Laparoscopy is helpful in actual diagnosis.
Ovarian endometrioma / benign ovarian tumor / malignant ovarian.
Ultrasonography or Laparoscopy
Rupture of the chocolate cyst / torsion or rupture of the ovarian tumour, disturbed ectopic pregnancy, appendicitis or diverticulitis.
Complications
Endocrinopathy
Rupture of chocolate cyst
Infection of chocolate cyst
Obstructive features:
Intestinal obstruction
Ureteral obstruction → hydroureter
hydronephrosis → renal infection
Endocrinopathy in Endometriosis
Corpus luteum insufficiency
Luteolysis due to ↑ PGF.
Luteinized unruptured follicle (LUF)
Anovulation
Elevated prolactin level
Double LH peak.
Staging
Endometrios is should be staged appropriately.
To predict prognosis.
To choose therapy.
To evaluate the treatment protocol.
The stage is determined by adding specific points given to each.
contraception.pptx
Contraception
Contraception is defined as the intentional prevention of conception through the use of various devices, sexual practices, chemicals, drugs or surgical procedures.
The preventive methods to help women avoid unwanted pregnancies are called contraceptive methods.
Need for contraception
• To avoid unwanted pregnancies.
• To regulate the timing of pregnancy.
• To regulate the interval between pregnancy.
Ideal Contraceptive
• Safe
• Effective
• Acceptable
• Reversible
• Inexpensive
• Long lasting
• Requires little or no medical supervision
Contraceptive methods
Spacing methods
Natural
Barrier
IUDs
Emergency contraception
Terminal methods
Male fertilisation
Female fertilisation
Natural Methods
Coitus inteyrruptus / withdrawal
Rhythm Method
Lactational Amenorrhoea
Barrier Methods
Mechanical
Male : Condom
Female : Condom, Diaphragm, Cervical cap
Chemical
Creams - Deleen
Jelly – Koromex, Volpar paste
Foam tablets – Aerosol foams, Chlorimin T or Contab
Combination
Combined use of Chemical and Mechanical methods.
Male condom
• Most commonly known and used contraceptive.
• Better known in India as NIRODH.
Female condom
Femidom
Diaphragm
Spermicides
Spermicides are surface active agents which attach
themselves to spermatozoa and kill them.
Available in various forms like
Intrauterine Contraceptive Devices
Cu T200
T shaped device Polyethylene frame.
215 mm2 surface area of Cu wire.
Contains 124 mg of copper
Cu is lost at the rate of 50 µg/day.
Polyethylene monofilament tied at vertical stem.
Cu is radio opaque so additionally barium is
incorporated in the device.
Supplied in a sterilised sealed packet.
Lifetime 4 years.
Cu T 380A
380 mm square surface area of copper wire.
Replacement 10 years.
Multiload Cu 250
60-100 ug/day
Replacement 3 years
Multiload - 375
Mode of action
Biochemical and histological changes in endometrium.
Increased tubal motility.
Endometrial inflammatory response.
Prevents implantation.
Contraindication for insertion of IUCD
Presence of pelvic infection
Genital tract bleeding (undiagnosed)
Suspected pregnancy
Uterine fibroid
Severe dysmenorrhoea
Ectopic pregnancy history
Caesarean section
Cu allergy
Time of insertion
Interval
2-3 days after menstrual phase.
During lactational amenorrhoea.
Postabortal
Done immediately following termination of pregnancy.
Postpartum
After 6 weeks of delivery.
Postplacental delivery
Post delivery of placenta.
Method of Insertion
Preliminary steps:
History taking and examination
Patient is informed and consent is obtained.
Insertion is done in OPD aseptic conditions.
Placement of device in inserter.
Steps of operation
The patient is asked to remain empty bladder.
The patient is placed in lithotomy position.
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forcep.
The device is placed in the inserter and introduced through cervical
BARTHOLINS.pptx
Bartholin’s Gland
Function :
The production of mucoid secretion that lubricates the
distal end of the vagina during intercourse.
The glands become active after menarche and are non
palpable.
Bartholinitis
Causative agent:
Gonococcus
Streptococcus
Staphylococcus
E. coli
End result :
Complete resolution
Recurrence
Abscess
Cyst formation
Clinical features :
Local pain discomfort.
Difficulty in walking / sitting.
Examination :
Tenderness
Induration of post half of vagina.
Secretion coming out from the duct when pressed.
Treatment
Local :
Systemic:
Ampicillin 500 mg TDS
Bartholin’s Abscess
End result of acute Bartholinitis.
Clinical features:
Severe local pain and discomfort.
Difficult / painful walking and sitting.
On examination:
Unilateral tender swelling.
Oedomatous red overlying skin.
Treatment:
Rest.
Sitz bath.
Systemic antibiotic Ampicillin 500 mg.
Drainage of abscess.
Bartholin’s cyst
The content is colourless glairy liquid.
C/f :
Small cyst : usually unnoticed.
Larger cyst : Local discomfort and dyspareunia.
Examination:
Unilateral swelling on post half of labia majora.
Projection on vulval cleft into S-shape.
Overlying skin is shiny and thin.
Cyst remains non tender and fluctuant.
Treatment:
Marsupilisation.
Moniliasis(Candida vaginitis)
Candida vaginitis
Dr. Yashika
Introduction:
Causative agent: Candida albicans (Gram positive fungus)
Clinical features:
Intense vulvovaginal discharge
Dyspareunia
On examination:
Thick, curdy white discharge.
Cottage cheese type flakes discharge often adherent to the vaginal wall.
Red swollen vulva.
Tender PV examination.
Diagnosis:
Wet smear
Treatment:
Removal of predisposing factors.
Local anti fungal prep.
Creams, ointments, pessary.
Single dose oral therapy
Fluconazole/ itraconazole
Thank you
Lgv (Lymphogranuloma Venereum)
Lymphogranuloma Venereum
Dr. Yashika
Causative agent : Chlamydia trachomatis
Incubation period: 3-30 days
Clinical features :
Initial phase:
Painless papule, pustule or ulcer in vulva, urethra,
rectum or cervix.
Involved inguinal nodes feels rubbery.
Acute lumphangitis and lymphadenitis.
Necrosed glands and abscess formation.
Rupture of abscess occurs within 7-15 days.
Sinus and fistula formation.
Intense fibrosis with lymphatic drainage.
Secondary phase : Painful adenopathy.
Classical clinical sign:
Groove sign
A depression between the groups of inflammed nodes.
Complication:
Vulval elephantiasis
Perineal scarring
Rectal stricture
Sinus and fistula formation.
Diagnosis
Culture and isolation
Detection of LGV
Treatment:
Doxycycline 100 mg BID x 21days.
Azithromycin 1 gm PO weekly x 3 weeks
Abscess aspiration
Hysterectomy
HYSTERECTOMY
Hysterectomy
Hysterectomy
Term origin:
hyster + ectomy
uterus surgical removal
Definition:
Hysterectomy is defined as the surgical removal of uterus.
Routes for Hysterectomy
Abdominal Hysterectomy
Vaginal Hysterectomy
Laparoscopic Hysterectomy
Caesarean Hysterectomy
Types of Hysterectomy
Total Hysterectomy
Removal of entire uterus.
Subtotal Hysterectomy
Removal of body or corpus leaves behind the cervix.
Panhysterectomy / Hysterectomy with bilateral salpingo oophorectomy
Removal of uterus along with tubes and ovaries of
both sides.
Indications
Hsv Herpes Genitalis
Herpes Genitalis
Dr. Yashika
Introduction
Causative organism : Herpes Simplex virus type 1 and 2
Transmission : Orogenital contact
Incubation period : 2 – 14 days.
Clinical features:
First attack with 7 days of sexual contact.
Red painful inflammatory area around clitoris, labia, vestibule, vagina, cervix and perineum.
Appearance of multiple vesicles which progress into ulcers then heals up by crusting
Lymphadenopathy
Fever, malaise and headache.
Diagnosis:
Virus tissue culture and isolation
ELISA
Fluorescent method
PCR test
Treatment
Specific treatment is yet to b explored.
Acyclovir 200 mg 5 times x 5days.
Saline water bath.
Hsg
Hysterosalpingography
Dr. Yashika
Hysterosalpingography (HSG)
Hystero + Salpingo + Graphy
HSG is a radiological procedure done to assess the interior anatomy of the uterine cavity and the shape and patency of the fallopian tubes.
It is a radiographic study using fluorescent dye to visualise the anatomy of uterus and fallopian tubes.
Indications:
Assessment of tubal patency.
Detection of uterine malformation.
Diagnosis of cervical incompetence.
Detection of translocated IUD.
Diagnosis of uterine synechiae.
Diagnosis of uterine fibroid , uterine polyp.
Diagnosis of abdominal pregnancy.
Uterine Malformation
Steps of operation
The patient is asked to remain empty bladder.
Operation is done under general anaesthesia.
The patient is placed in lithotomy position.
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forcep.
HSG cannula is fitted with a syringe containing radio opaque dye. About 5- 10 ml of dye is slowly introduced.
The passage of the dye is observed by using X-ray intensifier and a video display unit.
Two radiographic X-rays are taken. First one to show the filling of uterine cavity and other one 10-15 mins after the completion of procedure.
Timing of procedure :
HSG is done between D6 and D10 of cycle.
Antibiotics are given one day prior the procedure up to 5 days.
Contrast media
Complications
Peritoneal irritation.
Pelvic pain.
Vasovagal attack.
Intravasation of dye into the venous or lymphatic channels.
Flaring up of pelvic infections.
Human Immunodeficiency Virus - Acquired Immuno Deficiency Disease
AIDS
Dr. Yashika
Introduction
Causative agent : Human Immunodeficiency Viruses (HIV)
HIV belongs to retrovirus family (double stranded RNA).
Mode of transmission
Sexual intercourse
IV drug abusers
Blood transfusion
Use of contaminated needles
Breastfeeding
Perinatal transmission
Immunopathogenesis
Immunological Markers
CD4 T lymphocyte count
RT-PCR
Raised P-24 antigen titre
Raised serum β2 microglobulin
Clinical Presentation
Development of Ab marks the stage of seroconversion aka flu-like syndrome.
Acute infection syndrome characterized by fever, skin rash, arthralgia, lymphadenopathy and diarrhoea. This is called seroconversion illness lasts upto 2-3 weeks and gets resolved itself spontaneously.
Gynaecological Symptoms
Infections of genital tract.
Neoplasm of genital tract.
Menstrual abnormalities.
Fertility and pregnancy are not affected.
Diagnosis
Detection of IgG antibody.
ELISA
Western blot
PCR
Treatment
Gonorrhoea
GONORRHOEA
Dr. Yashika
Introduction
Causative agent : Neisseria gonorrhoea (gram negative diplococcus).
Incubation period : 3-7 days.
Site of invasion : columnar and transitional epithelium of the genitourinary tract.
Primary sites of infection : endocervix, urethra and Bartholins gland.
Other sites of infection : Oropharynx, anorectal and conjuctiva.
Clinical features :
Local:
Excessive irritant vaginal discharge
Dysuria
Acute unilateral pain
Swelling over labia.
Pharyngeal infection
Intermenstrual bleeding.
Rectal discomfort.
Signs :
Swollen labia and inflammed.
Mucopurulent vaginal discharge.
Speculum examination reveals congested endocervix.
Distant symptoms :
Perihepatitis
Septicaemia
Complications:
PID
Infertility
Ectopic pregnancy
Chronic pelvic pain
Tubo ovarian mass
Bartholins gland abscess.
Diagnosis
Nucleic acid amplification test (NAAT)
urine culture
Drug sensitivity test.
Treatment
Adequate therapy for gonococcal infection.
To treat both the partner simultaneously.
To avoid multiple sex partner.
To use condom till free from disease.
Dilatation and Insufflation
Dilatation and Insufflation
Dr. Yashika
Dilatation and Insufflation (D&I)
Also known as Rubin’s test.
Operation for dilatation of cervix and insufflation of air (CO2) in to the uterine cavity to know the patency of fallopian tubes.
Indications of D&I
Investigation for fertility.
Following tuboplasty.
Contraindication : Pelvic infections.
Steps of operation
The patient is asked to remain empty bladder.
Operation is done under general anaesthesia.
The patient is placed in lithotomic position
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forceps.
7. Uterine sound is introduced to confirm the position and to note the length of cervical canal.
Cervical canal is dilated with graduated dilators.
After the desired dilatation, the insufflation cannula is introduced into the cervical canal.
10. Air is introduced in the uterus and the hissing sound is auscultated over the flanks.
Test
Positive Test:
An audible hissing sound on the flanks due to exit of air.
Patient complains of shoulder painon sitting.
Negative Test:
No hissing sound over the flanks.
Complications
Complications
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Human Immunodeficiency Virus - Acquired Immuno Deficiency Disease
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Prix Galien International 2024 Forum Program
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
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ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
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.
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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
Flu Vaccine Alert in Bangalore Karnataka
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!
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
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
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(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
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
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.
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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
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Leucorrhoea
- 2. Abnormal Vaginal Discharge • Frequent complaint. • Discharge may vary from excess to normal. • Discharge may be blood-stained / contaminated with urine or stool.
- 3. Abnormal Vaginal Discharge Non Infective Leucorrhoea Vaginal Cervical Infective Specific Non- specific Neoplastic Foreign body
- 4. Characteristics of normal vaginal fluid • Nature - watery • Colour - white • Odour - Odourless • pH - 4.0 • Microscopically - Squamous epithelial cells, Lacto bacilli, Gram negative bacteria.
- 5. Leucorrhoea • Leucorrhoea is defined as excessive normal vaginal discharge. Features of vaginal discharge in leucorrhoea : • Excess secretion. • Non purulent • Non offensive • Non irritant • Never causes pruritis.
- 6. Etiology : 1. Physiological excess 2. Cervical causes 3. Vaginal causes
- 7. Physiologic excess 1. Puberty 2. Menstrual Cycle 3. Pregnancy 4. Sexual excitement
- 8. Cervical causes: Cervicitis Cervical ectopy Cervical polyp Vaginal causes: Retroverted uterus Uterine prolapse PID
- 9. Treatment • General health improvement • Surgical treatment of cervical factors • Pill users are asked to stop pill immediately • Local hygiene