For pregnant women diagnosed with uncomplicated malaria caused by chloroquine-resistant P. vivax infection, prompt treatment with artemether-lumfantrine (second and third trimesters) or mefloquine (all trimesters) is recommended. Doxycycline and tetracycline are generally not indicated for use in pregnant women
For pregnant women diagnosed with uncomplicated malaria caused by chloroquine-resistant P. vivax infection, prompt treatment with artemether-lumfantrine (second and third trimesters) or mefloquine (all trimesters) is recommended. Doxycycline and tetracycline are generally not indicated for use in pregnant women
Seizures during pregnancy can cause: Slowing of the fetal heart rate. Decreased oxygen to the fetus. Fetal injury, premature separation of the placenta from the uterus (placental abruption) or miscarriage due to trauma, such as a fall, during a seizure
Please find the power point on Puerperal sepsis. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Malaria in pregnancy is an obstetric, social and medical problem requiring multidisciplinary and multidimensional solution. Pregnant women constitute the main adult risk group for malaria and 80% of deaths due to malaria in Africa occur in pregnant women and children below 5 years. Malaria and pregnancy are mutually aggravating conditions. The physiological changes of pregnancy and the pathological changes due to malaria have a synergistic effect on the course of each other, thus making the life difficult for the mother, the child and the treating physician. P. falciparum malaria can run a turbulent and dramatic course in pregnant women. The non- immune, primi-gravidae are usually the most affected. In pregnant women the morbidity due to malaria includes anemia, fever illness, hypoglycemia, cerebral malaria, pulmonary edema, puerperal sepsis and mortality can occur from severe malaria and haemorrhage. The problems in the new born include low birth weight, prematurity, malaria illness and mortality.
Malaria in pregnancy is a major cause of maternal morbidity worldwide and leads to poor birth outcomes. Pregnant women are more prone to complications of malaria infection than non-gravid women. Pregnant women are more susceptible than the general population to malaria: they are more likely to become infected, suffer a recurrence, develop severe complications and to die from the disease.
The role of a Nurse in the prevention and care of malaria in pregnancy starts in the ante natal clinic. Ante natal care is a critical service delivery point through which control /prevention of malaria in pregnancy takes place. The four (4) key Nursing roles in malaria interventions that are delivered through the ANC are;
1. Focused Antenatal Care & Health Education.
II. Early diagnosis &treatment of symptomatic women.
III. Intermittent preventive treatment (IPT).
IV. Regular& appropriate use of long lasting insecticide treated nets
(LLINs).SSS
Others are --
Evidence-based, goal-directed actions
Individualized, woman-centered care
Early detection and treatment of problems and complications
Prevention of complications and disease
Quality vs. quantity of visits
Care by skilled Nurses and health promotion
Birth preparedness & complication readiness
Seizures during pregnancy can cause: Slowing of the fetal heart rate. Decreased oxygen to the fetus. Fetal injury, premature separation of the placenta from the uterus (placental abruption) or miscarriage due to trauma, such as a fall, during a seizure
Please find the power point on Puerperal sepsis. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Malaria in pregnancy is an obstetric, social and medical problem requiring multidisciplinary and multidimensional solution. Pregnant women constitute the main adult risk group for malaria and 80% of deaths due to malaria in Africa occur in pregnant women and children below 5 years. Malaria and pregnancy are mutually aggravating conditions. The physiological changes of pregnancy and the pathological changes due to malaria have a synergistic effect on the course of each other, thus making the life difficult for the mother, the child and the treating physician. P. falciparum malaria can run a turbulent and dramatic course in pregnant women. The non- immune, primi-gravidae are usually the most affected. In pregnant women the morbidity due to malaria includes anemia, fever illness, hypoglycemia, cerebral malaria, pulmonary edema, puerperal sepsis and mortality can occur from severe malaria and haemorrhage. The problems in the new born include low birth weight, prematurity, malaria illness and mortality.
Malaria in pregnancy is a major cause of maternal morbidity worldwide and leads to poor birth outcomes. Pregnant women are more prone to complications of malaria infection than non-gravid women. Pregnant women are more susceptible than the general population to malaria: they are more likely to become infected, suffer a recurrence, develop severe complications and to die from the disease.
The role of a Nurse in the prevention and care of malaria in pregnancy starts in the ante natal clinic. Ante natal care is a critical service delivery point through which control /prevention of malaria in pregnancy takes place. The four (4) key Nursing roles in malaria interventions that are delivered through the ANC are;
1. Focused Antenatal Care & Health Education.
II. Early diagnosis &treatment of symptomatic women.
III. Intermittent preventive treatment (IPT).
IV. Regular& appropriate use of long lasting insecticide treated nets
(LLINs).SSS
Others are --
Evidence-based, goal-directed actions
Individualized, woman-centered care
Early detection and treatment of problems and complications
Prevention of complications and disease
Quality vs. quantity of visits
Care by skilled Nurses and health promotion
Birth preparedness & complication readiness
An Obstetrics and gynecology presentation: A 20 years old single female undergraduate presents to the emergency unit with fever, lower abdominal pain and abnormal vaginal discharge of 5 days duration. Discuss her management
Menopause: Symptoms, Concerns, and Management StrategiesSummit Health
Presentation about menopause, including information about common symptoms such as hot flashes, sleeplessness, and weight gain as well as other physiologic changes such as bone loss and cardiovascular risks. Dr. Gibbons and Dr. Cummings will offer recommendations on treatment and management options that can help you navigate this important life transition.
Malaria is curable if effective treatment is started early because delay in treatment may lead to serious consequences including death.
Prompt and effective treatment is also important for controlling the transmission of malaria.
A revised National Drug Policy on Malaria has been adopted by the Ministry of Health and Family Welfare, Govt of India in 2010 and these guidelines have been prepared for healthcare personnel involved in the treatment of malaria.
SImplified Malaria overview for practising pediatricians in India - north india more specifically with a low incidence of malaria. By Dr Gaurav Gupta MD Pediatrician, Charak Clinics, Mohali, Chandigarh
Richard's entangled aventures in wonderlandRichard Gill
Since the loophole-free Bell experiments of 2020 and the Nobel prizes in physics of 2022, critics of Bell's work have retreated to the fortress of super-determinism. Now, super-determinism is a derogatory word - it just means "determinism". Palmer, Hance and Hossenfelder argue that quantum mechanics and determinism are not incompatible, using a sophisticated mathematical construction based on a subtle thinning of allowed states and measurements in quantum mechanics, such that what is left appears to make Bell's argument fail, without altering the empirical predictions of quantum mechanics. I think however that it is a smoke screen, and the slogan "lost in math" comes to my mind. I will discuss some other recent disproofs of Bell's theorem using the language of causality based on causal graphs. Causal thinking is also central to law and justice. I will mention surprising connections to my work on serial killer nurse cases, in particular the Dutch case of Lucia de Berk and the current UK case of Lucy Letby.
A brief information about the SCOP protein database used in bioinformatics.
The Structural Classification of Proteins (SCOP) database is a comprehensive and authoritative resource for the structural and evolutionary relationships of proteins. It provides a detailed and curated classification of protein structures, grouping them into families, superfamilies, and folds based on their structural and sequence similarities.
Cancer cell metabolism: special Reference to Lactate PathwayAADYARAJPANDEY1
Normal Cell Metabolism:
Cellular respiration describes the series of steps that cells use to break down sugar and other chemicals to get the energy we need to function.
Energy is stored in the bonds of glucose and when glucose is broken down, much of that energy is released.
Cell utilize energy in the form of ATP.
The first step of respiration is called glycolysis. In a series of steps, glycolysis breaks glucose into two smaller molecules - a chemical called pyruvate. A small amount of ATP is formed during this process.
Most healthy cells continue the breakdown in a second process, called the Kreb's cycle. The Kreb's cycle allows cells to “burn” the pyruvates made in glycolysis to get more ATP.
The last step in the breakdown of glucose is called oxidative phosphorylation (Ox-Phos).
It takes place in specialized cell structures called mitochondria. This process produces a large amount of ATP. Importantly, cells need oxygen to complete oxidative phosphorylation.
If a cell completes only glycolysis, only 2 molecules of ATP are made per glucose. However, if the cell completes the entire respiration process (glycolysis - Kreb's - oxidative phosphorylation), about 36 molecules of ATP are created, giving it much more energy to use.
IN CANCER CELL:
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
introduction to WARBERG PHENOMENA:
WARBURG EFFECT Usually, cancer cells are highly glycolytic (glucose addiction) and take up more glucose than do normal cells from outside.
Otto Heinrich Warburg (; 8 October 1883 – 1 August 1970) In 1931 was awarded the Nobel Prize in Physiology for his "discovery of the nature and mode of action of the respiratory enzyme.
WARNBURG EFFECT : cancer cells under aerobic (well-oxygenated) conditions to metabolize glucose to lactate (aerobic glycolysis) is known as the Warburg effect. Warburg made the observation that tumor slices consume glucose and secrete lactate at a higher rate than normal tissues.
Observation of Io’s Resurfacing via Plume Deposition Using Ground-based Adapt...Sérgio Sacani
Since volcanic activity was first discovered on Io from Voyager images in 1979, changes
on Io’s surface have been monitored from both spacecraft and ground-based telescopes.
Here, we present the highest spatial resolution images of Io ever obtained from a groundbased telescope. These images, acquired by the SHARK-VIS instrument on the Large
Binocular Telescope, show evidence of a major resurfacing event on Io’s trailing hemisphere. When compared to the most recent spacecraft images, the SHARK-VIS images
show that a plume deposit from a powerful eruption at Pillan Patera has covered part
of the long-lived Pele plume deposit. Although this type of resurfacing event may be common on Io, few have been detected due to the rarity of spacecraft visits and the previously low spatial resolution available from Earth-based telescopes. The SHARK-VIS instrument ushers in a new era of high resolution imaging of Io’s surface using adaptive
optics at visible wavelengths.
Deep Behavioral Phenotyping in Systems Neuroscience for Functional Atlasing a...Ana Luísa Pinho
Functional Magnetic Resonance Imaging (fMRI) provides means to characterize brain activations in response to behavior. However, cognitive neuroscience has been limited to group-level effects referring to the performance of specific tasks. To obtain the functional profile of elementary cognitive mechanisms, the combination of brain responses to many tasks is required. Yet, to date, both structural atlases and parcellation-based activations do not fully account for cognitive function and still present several limitations. Further, they do not adapt overall to individual characteristics. In this talk, I will give an account of deep-behavioral phenotyping strategies, namely data-driven methods in large task-fMRI datasets, to optimize functional brain-data collection and improve inference of effects-of-interest related to mental processes. Key to this approach is the employment of fast multi-functional paradigms rich on features that can be well parametrized and, consequently, facilitate the creation of psycho-physiological constructs to be modelled with imaging data. Particular emphasis will be given to music stimuli when studying high-order cognitive mechanisms, due to their ecological nature and quality to enable complex behavior compounded by discrete entities. I will also discuss how deep-behavioral phenotyping and individualized models applied to neuroimaging data can better account for the subject-specific organization of domain-general cognitive systems in the human brain. Finally, the accumulation of functional brain signatures brings the possibility to clarify relationships among tasks and create a univocal link between brain systems and mental functions through: (1) the development of ontologies proposing an organization of cognitive processes; and (2) brain-network taxonomies describing functional specialization. To this end, tools to improve commensurability in cognitive science are necessary, such as public repositories, ontology-based platforms and automated meta-analysis tools. I will thus discuss some brain-atlasing resources currently under development, and their applicability in cognitive as well as clinical neuroscience.
Seminar of U.V. Spectroscopy by SAMIR PANDASAMIR PANDA
Spectroscopy is a branch of science dealing the study of interaction of electromagnetic radiation with matter.
Ultraviolet-visible spectroscopy refers to absorption spectroscopy or reflect spectroscopy in the UV-VIS spectral region.
Ultraviolet-visible spectroscopy is an analytical method that can measure the amount of light received by the analyte.
4. Introduction
Malaria is more common in
pregnancy compared to the general
population.
The non- immune, primigravidae are
usually the most affected(prevalence & complications)
The increased risk of contracting
malaria may be due to
Decreased immunity
Hormonal changes
5. Introduction cont..
Malaria and pregnancy are mutually
aggravating conditions.
The physiological changes of pregnancy
and the pathological changes due to
malaria have a synergistic effect on the
course of each other
Thus making the life difficult for the
mother, the child and the treating
physician.
6. Introduction cont..
In pregnancy, malaria tends to be
more atypical in presentation.
This could be due to the hormonal,
immunological and hematological
changes of pregnancy
7. Introduction cont..
Some anti malarial drugs are
contraindicated in pregnancy and some
may cause severe adverse effects.
Therefore Choice of medication becomes difficult.
Management of complications of malaria
may be difficult
8. Pathophysiology
Pathogenesis of malaria relates to the various
host and parasite factors
Starts by inj of Plasmodium sporozoites via a
bite from an infected mosquito
The sporozoites travel through the
bloodstream of the host to the liver, where they
invade hepatocytes.
These cells divide many 1000-fold until mature
tissue schizonts are formed, each containing
thousands of daughter merozoites.
This exoerythrocytic stage is asymptomatic
9. Pathophysiology cont..
The liver schizonts rupture after a week or so
This event releases thousands of merozoites into
the bloodstream, where they invade red blood
cells (the erythrocytic stage)
At the completion of the schizogony within the red
cells,(48hrs for P. falciparum) newly developed merozoites are
released by the lysis of infected erythrocytes
Along with them, numerous waste substances are
also released into the blood.
These include red cell membrane products,
hemozoin pigment, and other toxic factors such as
glycosylphosphatidylinositol (GPI)
10. Pathophysiology cont..
These products, particularly the GPI, activate
macrophages and endothelial cells to secrete
cytokines and inflammatory mediators such as
TNF-alpha, IFN-γ, Il-1, IL-6, IL-8, MCSF, and
lymphotoxin, as well as superoxide and nitric oxide
(NO).
The systemic manifestations of malaria have been
largely attributed to these cytokines
12. Placental Malaria
Caused by P. falciparum–infected erythrocytes
that bind to placental tissue.
Binding is mediated by VAR2CSA, a parasite
antigen which interacts with chondroitin
sulfate A (CSA) on the syncytiotrophoblast
The VAR2CSA is coded by the var2csa gene
By this process, the parasites avoid being
filtered through the spleen
Also it impairs movements of nutrients across
the placenta
13. Placental Malaria cont..
Consequences include maternal
anemia and fetal growth retardation.
Antibodies against VAR2CSA occur
during pregnancy after exposure to
infected erythrocytes sequestering in
the placenta
Concentrations of these antibodies
increase with parity.
Placental changes due to malaria infxn (hemozoin deposition &
increased monocyte deposition) also contribute to placental
15. Clinical presentation cont…
Severe malaria
Presence of one or more of the following
Prostration (extreme weakness),
Impaired consciousness/coma
Change of behavior
Convulsions
Jaundice
Vomiting everything
Circulatory collapse/shock
Hyperparasitemia
Bleeding tendency (DIC)
Respiratory distress
16. Complications
Anemia
Abortion and its
complications
Premature labour
Cerebral malaria
AKI
Pulmonary edema
IUGR
Congenital infection
To the newborn
Premature delivery
Low birth weight
and its
complications
Congenital/neonat
al malaria
To the mother To the fetus
17. Management
Includes
Investigations
Treatment of malaria
Management of complications
Prevention
Treatment of malaria in pregnancy should be
Energetic :
Don't waste any time.
Careful
Choose drugs and dosage carefully
Anticipatory
One should always be looking for any complications by
regular monitoring
18. Investigations
Includes
Antigen detection techniques : - MRDT-(HRP-
2/pLDH(PfPAN))
Peripheral blood smear for MPs( thin & thick films)
PCR based assay
Antibody test
Placental blood smear(postpartum)
Others depending on the clinical presentation
20. Treatment cont…
A: Uncomplicated malaria
In the first trimester,
Pregnant women with uncomplicated
malaria should be treated with quinine
tablets for seven days
The dose is 10 mg/kg every 8 hours for
7days
Do not exceed a maximum dose of
600mg per dose
21. Treatment cont..
In the second and third trimester
Artemether-Lumefantrine should be used as
medicine of choice
The dose is 4 tabs stat then 8hours after the first
dose then 12hourly for 2days (a total of three
days)
Alternatively
Dihydoartemisinin-Piperaquine (DPQ)
Artesunate-Amodiaquine
22. Treatment cont..
B: Severe malaria
The primary objective of treatment in severe malaria is
to prevent death.
The secondary objective is to prevent disabilities and
to prevent recrudescent infection
In the first trimester
The medicine of choice for treatment of severe
malaria in the first trimester is IV Quinine(dose)
23. Severe malaria Rx cont..
In the second and third trimester
The medicine of choice for treatment of
severe malaria in 2nd and 3rd trimester of
pregnancy is Inj. Artesunate
The dose is dose 2.4 mg/kg given at time 0 hour,
then at 12 hours and 24 hours
Followed by ALu for 3days
The first oral dose should start 8hrs after the last injection
Quinine should be used only if Artesunate
injectable is not available.
24. Treatment cont…
According to WHO recommendation,
Treatment of severe malaria is with Inj Artesunate for
both children and adults including infants, pregnant
women in all trimesters and lactating women.
Inj Artesunate should be given for at least 24hrs and
until patient can tolerate oral medication, then they
should complete treatment with 3days of ACT
If Artesunate is unavailable, Inj Artemether (IM) should
be given
If Artemether is unavailable, Inj Quinine should be
given(loading dose 1st)
25. Artesunate for injection
Descpription
Artesunate is a water-soluble derivative of
Artemisinin.
The only Artemisinin analogue that can be
given intravenously
It produces rapid parasite clearance in
falciparum malaria.
Superior to Quinine in preventing death
26. Artesunate for injection cont..
Three formulations are available:
30mg,
60mg and
120mg of Artesunate for injection.
27. Table 14: Artesunate for injection
package by strength
Strength 30mg 60mg 120mg
Artesunate for
injection
1 vial of 30mg 1 vial of 60mg 1 vial of
120mg
5% Sodium
bicarbonate
1 Ampoule of
0.5mls
1 Ampoule of
1ml
1 Ampoule of
2.5mls
Sodium
chloride
1 Ampoule of
2.5mls
1 Ampoule of
5mls
1 Ampoule of
10 mls
28. Administration and dosage (60 mg
strength)
Injectable Artesunate has 2-steps dilutions.
Step 1:
The powder for injection should be diluted with 1ml of 5%
sodium bicarbonate solution (provided in each box) and
shaken vigorously 2-3 minutes for better dissolving till the
solution becomes clear.
Step 2:
For slow intravenous infusion (3-4 minutes): Add 5 ml of
5% dextrose or normal saline, to obtain a Artesunate
concentration of 10 mg/ml
For deep intra-muscular injection: Add 2 ml of 5%
dextrose or normal saline to obtain a Artesunate
concentration of 20 mg/ml
29. Quantity for dilution of Artesunate for
injection
ROUTE IV INJECTION IM INJECTION
STRENG
TH
30mg 60mg 120mg 30mg 60mg 120mg
5%
NaCO3
0.5mls 1ml 2mls 0.5mls 1ml 2mls
NS/5%
dextrose
2.5mls 5mls 10mls 1ml 2mls 4mls
TOTAL
(mls)
3mls 6mls 12mls 1.5mls 3mls 6mls
Artesunate
concentrati
on (Mg/ml)
10 10 10 20 20 20
30. Caution;
The powder form for injection is difficult to
dissolve, care should be taken to ensure that it
is completely dissolved before parenteral
administration.
If the solution is cloudy or a precipitate is
present, the parenteral preparation should be
discarded.
Dissolved artesunate should always be used
immediately after 2nd dilution
Never store diluted Artesunate for further use
31. Supportive treatment in the
Management of malaria in
pregnancy
Treatment of anemia (BT, FA)
Correction of electrolyte imbalance
Oxygen + Diuretics in pulmonary oedema
Dialysis for ARF
Anticonvulsants
ICU care for CM
Monitoring of the fetal growth & health
32. Prevention
Available options are:-
Vector control
Insecticide Treated Nets (ITNs)
Residual house hold spraying
Environmental management
Drug prophylaxis
Intermittent preventive treatment (IPTp)
Alternative- DPQ (not yet adopted)
Vaccine?? –Still under development
33. Intermittent preventive treatment (IPTp)
The medicine of choice for IPTp is
Sulfadoxine/Pyrimethamine (SP)
Reduses the risk of
Placental malaria
Low birth weight and
Maternal illness
Dosing should start as early as possible in the sec
trimester
Should be given at least 1 month apart, at least
3doses
SP can be administered up to the time of delivery
34. Conclusion
Diagnosis and Management of malaria during pregnancy
can be challenging
The primary objective in the management of severe malaria
is to prevent death
Malaria preventive package during pregnancy includes:
Intermittent preventive treatment with SP during antenatal clinic
visits
Use of ITNs throughout pregnancy and in the postpartum period
Prevention must be complemented by effective case
management of malaria for all women of reproductive age
35. References
National Guidelines for Diagnosis and Treatment of Malaria-December
2014
The diagnosis and treatment of malaria in pregnancy-Royal College of
Obstetricians and Gynecologists-April 2010
A Review of Malaria Diagnostic Tools: Microscopy and Rapid Diagnostic
Test (RDT)-American journal of tropical medicine and hygiene
http://www.uptodate.com/contents/pathogenesis-of-malaria
http://www.malariasite.com/pathophysiology/
https://malariajournal.biomedcentral.com/articles/10.1186/1475-2875-7-
133
https://en.wikipedia.org/wiki/Pregnancy-associated_malaria
https://malariajournal.biomedcentral.com/articles/10.1186/s12936-015-
0576-8