DEFINITION OR MEANING OF MENSTRUAL (REPRODUCTIVE) CYCLE:-
Menstruation (Greek word, men-month) is monthly uterine bleeding out flowing through vagina into vulva for 4-5 days every 28 days (24-35 days)during reproductive life of a woman from menarche to menopause.
The Menstrual cycle of 28 days starts on day of onset of menstruation and ends at day 28 on start of next mens.
The cycle consists of a series of changes taking place concurrently in the ovaries and uterine lining, stimulated by changes in blood concentration of hormones.
DEFINITION OR MEANING OF MENSTRUAL (REPRODUCTIVE) CYCLE:-
Menstruation (Greek word, men-month) is monthly uterine bleeding out flowing through vagina into vulva for 4-5 days every 28 days (24-35 days)during reproductive life of a woman from menarche to menopause.
The Menstrual cycle of 28 days starts on day of onset of menstruation and ends at day 28 on start of next mens.
The cycle consists of a series of changes taking place concurrently in the ovaries and uterine lining, stimulated by changes in blood concentration of hormones.
DEVELOPMENT OF PLACENTA,PLACENTA AT TERM , DECIDUA,PLACENTAL MEMBRANE , PLACENTAL CICULATION,PLACENTAL ENDOCRINE SYNTHESIS,ABNORMAL PLACENTA,FUNCTIONS.
DEVELOPMENT OF PLACENTA,PLACENTA AT TERM , DECIDUA,PLACENTAL MEMBRANE , PLACENTAL CICULATION,PLACENTAL ENDOCRINE SYNTHESIS,ABNORMAL PLACENTA,FUNCTIONS.
Ovary: Structure and hormonal regulationN K Agarwal
Slides describe the structure of ovary, folliculogenesis, hormonal control of female reproductive cycle, mechanism of ovulation, female sex hormones and their function.
Ovarian cycle (the guyton and hall physiology)Maryam Fida
Ovarian cycle
The germ cells that migrate into the ovaries during early embryonic development multiply, so that by about 5 months of gestation (prenatal life) the ovaries contain approximately 6 million to 7 million oogonia.
Most of these oogonia die prenatally through a process of apoptosis.
The production of new oogonia stops at this point and never resumes again.
The oogonia begin meiosis toward the end of gestation, at which time they are called primary oocytes.
Like spermatogenesis in the prenatal male, oogenesis is arrested at prophase I of the first meiotic division.
The primary oocytes are thus still diploidPrimary oocytes decrease in number throughout a woman’s life.
The ovaries of a newborn girl contain about 2 million Primary oocytes—all she will ever have.
Each Primary oocyte is contained within its own hollow ball of single layer of granulosa cells, the Primordial follicle.
By the time a girl reaches puberty, the number of Primary oocytes and follicles has been reduced to 400,000.
Only about 400 of these Primary oocytes will ovulate during the woman’s reproductive years, and the rest will die by apoptosis.
Oogenesis ceases entirely at menopause
Definition:
“Monthly rhythmical changes in the secretion of the female hormones and corresponding physical changes in the ovaries and other sexual organs”.
Duration: The duration of the cycle averages 28 days. It may be as short as 20 days ar as long as 45 days.
PHASES
Follicular Phase (Proliferative Phase) (1-14 Day)
Menstrual Phase (Day 1-5)
Preovulatory Phase. (Day 6-14)
Ovulation (Day 14)
Post Ovulatory Phase (Secretory Phase). (15-28 Day)
Leuteal Phase (Day 15-26)
Premenstrual phase. (Last 2 Day)
Concept of Hypothalamic-Pituitary-ovarian Axis
Overall, the most advanced follicle reduces the FSH supply to other follicles while at the same time it makes itself more sensitive to the FSH that remains.
The less developed, less sensitive follicles undergo atresia, while the most developed follicle attains a diameter of up to 2.5 cm. This follicle, called a mature (graafian) follicle, protrudes from the surface of the ovary like a blister.
As the follicle matures, the primary oocyte completes meiosis I and becomes a secondary oocyte.
This cell begins meiosis II but stops at metaphase II. It is now ready for ovulation.
FSH and estrogen also stimulate the maturing follicle to produce LH receptors, which are important to the next phase of the cycle
Congenital anomalies of baby are not uncommon. They do occur sporadiacally. They may be major or minor malformations.
They may be lethal and irreparable sometimes.
Human Pelvis anatomy is basic and fundamental and essential topic every obstetrician need to know and learn thoroughly and practice every day to become more perfect.
Corona virus infection is a pandemic infection leading to high mortality and it can affect pregnant women also. They need a special attention since we need to treat mother and newborn also. Though definitive guidelines have not been established still we need to follow few fundamental principles in the management.The guidelines are likely to be introduced in due course of time.
Fetus is another patient needs to be given adequate attention and importance to find out whether it is alright or sick. This presentation will give a brief skeleton of tests to be done.
A great Indian sage and a great disciple of Sri Ramakrishna Parama Hamsa. His quotes are essential for the human-beings for passing through difficult stages of lives
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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.
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
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(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
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. Definition: The visible manifestation of
cyclic physiologic uterine bleeding due to
shedding of the endometrium.
Due to invisible interplay of hormones
through hypo-thalamo-pituitary-ovarian axis.
For menstruation to occur axis should be
active , endometrium should be receptive
and outflow tract should be patent.
3. The period extending from first day of period
until the 1st day of next period.
Normal length of a cycle is between 28-32
days. Mean – 28 days.
It occurs cyclically between 21-35 days.
Menarche: First menstruation
Age of onset – 11-15 years &average is 13
years
4. Ovaries
Reproductive tract
Other targets
Steroids
Feedback
Hypothalamus
GnRH (gonadotrophin
releasing hormone)
Pituitary
LH
FSH
+ (“gonadotrophins”)
Menstruation is an
external indicator of
ovarian events
controlled by the
hypothalamic-pituitary
axis
Roles of the ovary
1. Gametes (ova)
2. Hormones
MENSTRUATION
(oestradiol,
progesterone).
5. Menstruation ceases between 45-50 years.
Duration – 4-5 days
Amount – 20-80 ml
Menstrual discharge consists of blood,
mucus,
epithelial cells, fragments of endometrium,
prostaglandins, enzymes and bacteria.
6. Menstrual cycle is divided into
1] Ovarian
2] Endometrial cycle
7. 0 4 8 12 16 20 24 28
Day 1
Menstruation
Day 1
LH
OVULATION
Days before Days after
Follicular
phase
Luteal
phase
8. Development and maturation of a follicle,
ovulation and formation of corpus luteum
and its degeneration
All these events occur in 4 weeks
1] Recruitment of group of follicles
2] Selection and maturation of dominant
follicle
3] Ovulation
4] Corpus luteum formation and
degeneration
9. Out of many primordial follicles only 20
antral follicles are developed in each cycle.
All these follicles from 2-5 mm size are
influenced by FSH.
Those follicles not influenced by FSH will
become atretic.
Oocyte of each follicle grow out of
proportion.Oocyte is surrounded by acellular
glycoprotein from follicular cells called Zona
pellucida
10. Flattened outer pregranulosa cells will
become Granulosa cells. These cells contain
FSH receptors.
11. Dominant follicle is called as Graafian
Follicle out of 30-50 follicles from many
primordial follicle.
Starts from 5-7 days
Follicle with high oestrogen and with
maximum FSH receptors in granulosa cells
will become a dominant one.
Rest of follicles will become atretic by 8th
day.
12. 0 4 8 12 16 20 24 28
LH
Day 1
Menstruation
OVULATION
Animated ovarian events
Oestradiol
1. Follicular
growth
Key events in the ovarian
cycle
17. Cumulus oophorus or Discus proligerous
anchors the ovum to to the wall of follicle
Corona radiata – radially arranged cells around
the ovum
At this stage FSH induces LH receptors in
granulosa cells of dominant follicle
LH receptor induction is essential for mid cycle
LH surge for ovulation and lutenisation of
granulosa cells to form corpus luteum and
secretion of progesterone
18. Graafian follicle measures 20 mm before
ovulation
It has following layers from outside inward
1] Theca externa
2] Theca interna
3] Membrana granulosa
4] granulosa cell layer
5] discus proligerous
6] corona radiata woth ovum inside
And 7] antrum with fluid
21. Total duration - 3 months
Upto antral stage of 1mm – 2months
Upto 5 mm stage – 2 weeks
Upto 20 mm – 2 weeks
22. Causes:
1] LH surge – secondary to sustained peak
level of estrogens in the late follicular phase.
This will cause completion of reduction
division in the oocyte and lutenisation of
granulosa cells, synthesise progesterone
andprostaglandins.
2] FSH rise- leads to plasminogen and it
helps in lysis of follicle.
23. 3] Stretching factor – Necrobiosis of wall due
to passive stretching
4] Contraction of micromuscles in theca
externa
24. Following ovulation the follicle is changed to
corpus luteum.
Ovum will be picked up by fallopian tube and
may fertilise or degenerate.
25. Life cycle is divided into 4 stages:
1] stage of proliferation
2] stage of vascularisation
3] stage of maturation and
4] stage of regression
26. Stage of Proliferation:
Granulosa cells will become polyhedral and enlarged and
with lipids –looks greyish yellow called granulosa lutein
cells
Stage of vascularisation: small capillaries grow towards
granulosa layer.
Stage of maturation:
After 1 week reaches 1-2cm and a carotene pigment will
give a yellow color
Stage of regression: on 22 -23 day regression starts.Lutein
cells become atrophic and will become white called
Corpus Albicans / if pregnancy occurs it will become
Corpus luteum of pregnancy.
27. 1] FSH induces LH receptors and LH surge
causes lutenisation of granulosa cells and
progesterone secretion.LH scretion should be
continuous for function of corpus luteum
2]17 alfa–OH–progesterone and estradiol
3] Low level of prolactin
Life span of Corpus luteum is 12-14 days.
28. 1] Progesterone
2] Oestrogen
3] Inhibin
4] Relaxin
In absence of pregnancy levels of O+P+I
decreases leading to rise in FSH and this in
turn leads to recruitment of new follicles
29. At 7- 10 weeks corpus luteum function will
be taken up by Placenta
31. 0 4 8 12 16 20 24 28
Menstruation
OVULATION
Oestradiol
causes an
increase in
thickness (the
“proliferative
phase”)
More secretion
from the glands –
hence the term
“secretory phase”
Endometria
l depth
32. 0 4 8 12 16 20 24 28
Menstruation
Characteristic “spiral
arteries”
Terminal differentiation of
stromal cells –
“decidualisation”
Optimal time for
implantation
33. Stratum Basalis:[ 1mm ]
Ocupies 1/3 of endometrium – basal arteries+
Not influenced by hormones
Regeneration occurs from it.
Functional zone:
Responds to hormones like O+P
In an ovulatory cycle four stages are seen.
34. 1] Stage of regeneration
2] Stage of Proliferation
3] Secretory phase
4] Menstrual phase
35. Stage of regeneration:
Starts before menstruation and completes after 2-3
days after periods. Measures 2mm.
Glands are lined by cubical cells
Stage of Proliferation:
Extends from 5-6th day to 14th day due to
Estrogens.Glands are tubular and perpendicular to
surface.
Epithelium is columnar with nuclei at base, stromal
cells are spindle shaped with spiral vessels upto
epithelium. Subepithelial congestion +. Measures 3-
4 mm.
36. Secretory Phase:
Effects of O+P
Oestrogen induces Progesterone receptors and
progesterone is responsible for secretory phase.
Starts at 15th day to 5-6 days prior to
menstruation.
Epithelium is more columnar and ciliated.
Glands increase in size with taller epithelium
with vacuoles formation- subnuclear
vacuolation.
37. First and earliest effect of progesterone is
appearence of subnucleolar vacuolation.It will
persist upto 21 days.
Saw toothed glandular epithelium, glands
become corkscrew shaped with marked spiralling
of vessels.
Measures 6-8 mm.
Regresssion of endometrium starts 24-48 hrs
prior to periods.
Marked spiralling of vessels and withdrawl of
hormones causes tissue hypoxia and anoxia.
38. Degeneration and casting off endometrium
due to regression of corpus luteum with fall
in level of O+P.
Degeneration is due to stasis of blood and
spasm of vessels leading to damage of vessels
with escape of blood.
Proteolytic enzymes from lysosomes causes
local damage.[ Enzymatic autodigestion ]
42. At menstruation Oestrogen and inhibin are at low levels and high
FSH.
Oestrogen increases gradually and FSH decreases and remains
static at day 5.
O+ LH and androgen increases.
Matuaration of follicle is combined effect of FSH and LH/
Peptides –Inhibin, Activin and Follistatin
Growth Facors – IGF, EGF from theca cells – modulate FSH,LH and
peptide actions.
IGF stimulates aromatase activity and progesterone synthesis.
Progesterone will increase in secretory phase until 5 days before
periods.
LH will start declining
43. It occurs after 10-12 hrs following LH surge.
It occurs after 24-36 hrs following Oestradiol
peak of 200 pg/ml
Progesterone peaks at 8th day after LH surge.
44. Datting of endometrium – Examination of
endometrium
Luteal phase defect – A discrepancy of more
than 2 days in the postovulatory phase when
endometrium is examined
A woman can have periods without ovulation.
45. 0 4 8 12 16 20 24 28
Menstruation
OVULATION
Cervical
mucus
Variable
number of
“dry” days
Production
of low
viscosity
mucus
increases
Abundant mucus -
like “raw egg white”
Thick, rubbery, high
viscosity - impenetrable
to sperm.
46. With increasing oestradiol:
1. The mucus becomes more abundant - up to
30x more and its water content increases.
2. Its pH becomes alkaline.
3. Increased elasticity – ("spinnbarkeit test")
5. “Ferning pattern” caused by the interaction of
high concentrations of salt and water with
the glycoproteins in the mucus.
Characteristic fernlike pattern as
the mucus dries on a glass slide.
47. 0 4 8 12 16 20 24 28
Menstruation
OVULATION
LH
36
36.2
36.4
36.6
36.8
37
37.2
37.4
37.6
37.8
38
A small (0.5 oC) rise in BBT
typically follows
ovulation.
Basal body temperature
48. Basal body temperature
Plasma oestradiol
Plasma progesterone
Volume of cervical mucus – and
sperm penetration
Uterine endometrium
49. a) Calendar Method - which is essentially based on
the previous menstrual history.
b) Temperature method - using a midcycle rise in
body temperature as a sign when ovulation has
occurred.
c) Cervical changes - which can be detected by
feeling the cervix and cervical mucus.
d) Hormonal methods - using over-the-counter "kits"
to assess urinary hormone levels.
There are a number of potential ways of trying to
identify the “fertile” period..: