This document discusses maternal care access in Sudan. It provides background information and summarizes the current status of reproductive health services, national monitoring indicators of maternal health, and the health status in Sudan. Key points include that maternal mortality in Sudan is extremely high at 1,107 deaths per 100,000 live births, access to primary health care services is limited for about 35-65% of the population, and interventions to make motherhood safer are known but not widely available in Sudan.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
12 Month Millionaire Audio Coaching Sessions With Vincent James
A program called 12 month millionaire was recently released by Russell Brunson, which is a 6 part audio interview with direct mail marketer. This program is based on Vince James now out of print book 12 Month Millionaire.
The total soccer fitness guide for soccer players provides information about strength and power conditioning, aerobic and anaerobic endurance conditioning, speed, agility and quickness conditioning, flexibility, warming up and cooling down and testing our level of fitness use scientific methods.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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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
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Maternal care access
1. Maternal Care Access
in Sudan
Geneva Foundation for Medical
Education and Research
GFMER Sudan 2012
Forum No: ( 1 )
2. Name of presenter
Name Position Institution
Sawsan Mustafa Abdalla Associated Professor National Ribat University
Name of contributors
Name Position Institution
Sawsan Mustafa Abdalla Associated Professor National Ribat University
3. Content of the presentation
Background
RH services current status
National monitoring indicators
Health status
Safe motherhood: A human right yet to be fulfilled
Previous studies
References
4. Maternal Care Access
The International Conference on Population and
Development, drawing on the WHO definition
of health, defined reproductive health as a
‘state of complete physical, mental and social
wellbeing and not merely the absence of
disease or infirmity, in all matters relating to
the reproductive system and to its functions
and processes’(1).
6. Maternal Care Access
The availability of good quality reproductive
health (RH) services is a vital social and
economic investment.
provision of efficient, equitable and quality
reproductive and sexual health services will go
a long way in improving the health of the
population.
7. Maternal Care Access
the national policy of RH Stated that: shall
provide maternity and child care and medical
care for pregnant women’.
8. Maternal Care Access
The policy document provides direction to
Sudan national health system setting an
agenda for reforms assuring the reproductive
health services are available not only
throughout a woman’s life-cycle but ensuring
her the right to survive pregnancy and
childbirth and enjoy a good family life
9. Maternal Care Access
Maternal mortality figures for Sudan are one of
the highest in the world. On average,
according to Sudan Household Health Survey
(2006), every day about forty women die due
to causes associated with birth
10. Maternal Care Access
While in certain parts of country, situation could
even be worse, these figures might only be a
tip of the iceberg due to underreported
maternal deaths and or incorrectly attributed
and classified as cause. High maternal
mortality is also an indication of high infant
mortality
11. Maternal Mortality Ratio in the EMR: 2006
1800
16001600
1600
1400
1200 1107
1000
800
600 546
465
395
350 366 370
400 294
227
200
68 104
0 0 7 13 18 21 23 37 40 41 45 65
0
KUW
UAE
EGY
JOR
SUD
TUN
LEB
IRQ
AFG
DJI
BAA
SYR
IRA
MOR
PAK
QAT
LIY
YEM
SOM
OMA
SAA
PAL
AVG(90)
AVG(00)
AVG(04)
12. National monitoring indicators
• % pregnant women who have at least one
antenatal visit 94.8%
• % of pregnant women who have a trained
attendant at delivery 89%
• % of pregnant women immunized against
tetanus 74%
13. National monitoring indicators
Contraceptive prevalence rate 20%
% of infants weighing less than 2500 g at birth
prevalence of female genital mutilation 70.3%
Maternal mortality ratio 1107/100.000
14. Health status
-Sudan is lagging behind the target for achieving
MDGs, particularly for the health
related MDGs.
-The national maternal mortality ratio averages
1,107 deaths per 100,000 live births with wide
interstate variations
15. Health status
The infant mortality rate is estimate at 81 per 1000
live births and about half of these are neonatal
deaths (41/1000 live birth)
occurring during the first month of life
(SHHS, 2006).
Under 5 mortality is 105 and 126 per 1,000 live
births in north and south respectively, while
comparable figures for infant mortality are 70
and 89.
16. Health status
Sudan has three layers of care provision.
At the apex of pyramid are the teaching, general
and specialist hospitals rendering
secondary and tertiary care
For primary care, the rural hospitals are first
referral care with indoor and diagnostic
facilities.
17. Health status
Primary care is provided through a variety of
outlets:
PHC unit:- staffed by a community health
worker.
dressing station:-staffed by a trained nurse or
experienced community health worker.
Dispensary:-
staffed by a medical assistant and a nurse, and
provide PHC services.
18. Health status
The health centers:- which are referral for
primary health care facilities
staffed by two medical officers, and paramedics,
i.e. medical assistant, health visitor, nutrition
instructor and vaccinator
19. Health status
45-65% of population has access to PHC
services, i.e. on average, 1 facility serves
12,000 people.
20. Health status
The policy supports comprehensive reproductive
health care which is accessible, affordable,
appropriate, efficient and effective; and for
that purpose, it can be delivered through
21. The Reproductive Health Package
Safe motherhood services
family planning
harmful practices
unwanted pregnancy
unsafe abortion
reproductive tract infections including sexually
transmitted diseases and HIV/AIDS
gender-based violence
infertility
reproductive tract cancers
Violence against women
Women empowerment
22. Health status
it can be delivered through:
Integration of reproductive health services with
mainstream primary health care
23. The neglected tragedy of maternal
mortality
Safe motherhood: A human right yet to be
fulfilled
• “When reporting on the right to life
protected by article 6, States Parties should
provide data on …..pregnancy and childbirth-
related deaths of women……..”
UN Human Rights Committee, General Comment 28 (2000): Equality of rights between
Men and Women (Article 3). 10
24. Safe motherhood: A human right yet
to be fulfilled
• Mothers have a right to life
• Maternity is not a disease
• Motherhood can be made safer
• Millions of women are denied exits from the
maternal death road
• A question of how much a woman’s life is
considered worth
25. Motherhood can be made safer
The interventions that make motherhood
safe are known and the resources needed are
obtainable. The necessary Services are
neither sophisticated nor very expensive,
and reducing maternal mortality is one of the
most cost-effective strategies available in the
area of public health.
Message from WHO Director-General, World Health Day, 1998
26. Previous study
• A cross-sectional community-based study was
carried out in Kassala, eastern Sudan.
• The aim of this study was to investigate
coverage of antenatal care and identify factors
associated with inadequacy of antenatal care
in Kassala, eastern Sudan
27. Previous study
811(90%) women had at least one visit. Only
11% of the investigated women had ≥ four
antenatal visits, while 10.0% had not attended
at all. Out of 811 women who attended at
least one visit, 483 (59.6%), 303 (37.4%) and
25 (3.1%) women attended antenatal care in
the first, second and third trimester,
respectively.
28. Previous study
Antenatal care showed a low coverage in
Kassala, eastern Sudan. This low coverage was
associated with high parity and low husband
education.
29. References
1-Programme of Action of the International Conference on
Population and Development (ICPD), New York, United Nations,
1994
2-National health policy, Sudan 2007
3-UNDP, MDGs in Sudan, http://www.sd.undp.org/mdg_sudan.htm
accessed on 27 March, 2010
4-Federal Ministry of Health (2007), Annual Health Statistical Report,
2007, National Health Information Centre, Federal Ministry of Health
Khartoum