what is the Puerperium and Postpartum Period
what's the normal?
what's the abnormal Puerperium?
and what are the most common complications and how to manage it?
what is the Puerperium and Postpartum Period
what's the normal?
what's the abnormal Puerperium?
and what are the most common complications and how to manage it?
Preterm labor is defined as the onset of labor before 37 weeks of gestation. It is a leading cause of neonatal morbidity and mortality, and can lead to long-term health problems for the baby. Risk factors for preterm labor include a history of preterm labor or delivery, multiple gestations, cervical incompetence, uterine anomalies, and infections.
Symptoms of preterm labor can include regular contractions, pelvic pressure or pain, backache, vaginal bleeding or discharge, and a change in vaginal discharge. If preterm labor is suspected, immediate medical attention is required. Treatment may include medications to stop or slow down labor, steroid injections to help speed up fetal lung development, and bed rest.
Prevention of preterm labor can be achieved through good prenatal care, including regular prenatal visits, proper nutrition, and management of underlying medical conditions. Avoiding certain risk factors, such as smoking and substance abuse, can also help reduce the risk of preterm labor.
In cases where preterm labor cannot be prevented, the goal is to delay delivery as long as possible to give the baby the best chance of survival and good health. This may involve hospitalization for bed rest, medication, and close monitoring of the mother and baby.
Preterm labor is a serious and potentially life-threatening complication of pregnancy, but with appropriate management and early intervention, the risk of morbidity and mortality can be minimized.
The loss of pregnancy at any stage - devastating experience, both patient and physician.
Recurrent miscarriage is defined as the occurrence of three or more consecutive spontaneous abortion before 20wks of gestation.
Ectopic, molar and biochemical pregnancies not included.
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
Follow us on: Pinterest
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
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.
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.
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
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 Karnatakaaddon Scans
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!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Evaluation of antidepressant activity of clitoris ternatea in animals
Pathophysiology of preterm labor
1. Dr Majaz Ahmed Khan
Fellow Neonatology
Pathophysiology of Preterm Birth
2. INTRODUCTION
Accounts for 6% to 10% of all births.
Two thirds of all perinatal deaths
> 34 weeks + minor morbidities = 37 weeks.
< 34 weeks accounts for 3-7 % of all preterm births(
75% of neonatal death and 50% of long term
neurologic impairment.)
3. Risk factors for preterm labor-
1. Race
2. Age- low maternal age
3. Socioeconomic status-inadequate nutrition,
substance abuse, psychological factors
4. Body mass index (BMI)-low BMI, poor weight gain,
excess weight gain, obesity.
5. Alcohol consumption
6. Smoking
7. Cocaine exposure
8. Maternal stress— Activates–- maternal, placental
,fetal endocrine system --- promote parturition by
way of an immune or inflammatory pathway.
4. Endocrinology and Biochemistry of Labor-
During pregnancy-PROPREGNANCY-progesterone
and PGI2 –inhibit myometrial contraction.
At end of pregnancy- PROLABOR- Remodeling of
cervix / uterus is stimulated to begin coordinated
contractions.
Labor occurs due to activation of cassette of
contraction-associated proteins (CAPs) / labor
associated proteins—
1. Gap junction proteins
2. Oxytocin
3. Prostanoid receptors
4. Enzymes for prostaglandin synthesis
5. Cell signaling proteins.
5. Inflammation/Infection-
Up-regulation of proinflammatory genes in fetal
membranes/ myometrium / cervix.
Transcription factor nuclear factor kappa B
(NF-кB) is activated in uterus.
Promotes IL-6 and IL-8 and COX-2
cervical ripening Prostglandin
synthesis
6. Transcription factor nuclear factor kappa B (NF-кB)
Down regulates progesterone receptors leading to
functional progesterone withdrawal.
7. Corticotropin-Releasing Hormone-
produced by- Hypothalamus/ placenta / maternal serum.
Rise in the second half of pregnancy
Peak during labor
Rapidly decline post partum.
CRH raised as early as 18 weeks of gestation in PTL.
CRH concentrations could help identify women at high risk
for preterm delivery
CRH antagonists may be useful in preventing preterm labor.
8. Progesterone-
Inhibit labor associated gene expression and inhibit
contractions.
PR antagonist RU486 can be used to ripen the cervix
and induce labor.
PTL occurs if increased expression of PR-A relative to
PR-B.
Oxytocin-
Increase in OTR mRNA concentrations in the
myometrium are associated with up-regulation of OT-
binding sites and causes onset of PTL.
10. 1. Infection-
Activates biochemical pathways leading to
cervical ripening and uterine contractions.
After twin preterm delivery, chorioamnionitis is
more common and severe in the presenting twin
than in the second twin.
Indicating ascending infection-organism identical
to that in the maternal lower genital tract.
11. organism settles in decidua of the lower segment.
leading to deciduitis, chorionitis
extension through the amnion into the amniotic cavity
To fetus from aspiration and swallowing
Most common organisms- Ureaplasma urealyticum,
Fusobacterium, Mycoplasma hominis, Bacterial
vaginosis and Trichomonas vaginalis.
12. chronic periodontal disease reservoir for bacterial
products or inflammatory mediators leading to
infection.
causative pathogens include Prevotella and
Porphyromomas species.
14. 3.Cervical Incompetence-
Normal uterus is composed of collagen arranged in fibers
and embedded in proteoglycans. Other components
include a small amount of smooth muscle (10%) and
some fibroblast cells.
At onset of labor-Decrease in collagen associated with
an increase in cervical prostaglandins, proinflammatory
cytokines, leukocytes, cell adhesion molecules, and nitric
oxide synthase production.
Ascending infection- increased inflammatory response
leading to cervical shortening and dilation.
15. 4.Multiple Pregnancies/ polyhydramnios-
Over distention of the uterus
up-regulation of contraction-associated proteins
Increase the expression of COX-2 and PGE2
synthesis.
Multiple pregnancy-multiple placenta increased
CRH earlier higher rates of preterm birth.
16. 5.Genetics-
SNP of Matrix metalloproteinases (MMPs) causes
extracellular matrix degradation leading to rupture of
membranes and cervical ripening and dilatation.
• 3 fold increase if 1st delivery is a preterm birth
• 1/3rd increase if two previous deliveries are preterm
births
• Risk transmission to off springs.
17. Management of Preterm Labor
The key aspects in management are-
1. Establishment of diagnosis
2. Need to inhibit/deliver
3. Investigation about causes of labor
4. Assessment of gestational age, expected fetal
weight and associated fetal complications
5. Tocolysis/steroids in selected cases
6. Choosing of mode of delivery and place of delivery
7. Provision of necessary neonatal back up.
18. Diagnosis of Preterm Labor-
For documenting true preterm labor the following
criteria should be met–
i. Regular uterine contractions after 20 weeks and
before 37 weeks which are 5-8 minutes apart or
less and accompanied by one or more of the
following:
ii. progressive change in cervix
iii. cervical dilatation of 2 cm or more
iv. cervical effacement 80 percent or more.
19. PREDICTION OF PRETERM LABOR
1. Fetal fibronectin-
Location- deciduas basalis next to the placental
intervillous space.
Function- fetal membranes to the uterine decidua.
Mechanical/inflammatory changes- leaked into the
cervicovaginal fluid.
Strong negative predictive value:0.5% deliver within
7 to 10 days after a negative test result.
If > 50 ng/ml greatest odds ratio for preterm delivery
before 35 weeks gestation.
20. 2.Cervical Length Measurement-
Cervical Length-30 mm risk < 1%
Cervical Length-5 mm risk > 80%.
Inhibition of Preterm Labor
The commonly used drugs are beta-mimetics,
calcium channel blockers, prostaglandin
synthetase inhibitors and magnesium sulfate.
21. Contraindications to Inhibition of Preterm Labor
Absolute
1. Congenital fetal malformation incompatible with life
2. Intrauterine fetal death
3. Chorioamnionitis
4. Abruptio placentae
5. Fetal distress
6. Uncontrolled diabetes and thyrotoxicosis
Relative
1. Placenta praevia
2. Intrauterine growth retardation
3. Maternal hypertension
22. PREVENTION OF PRETERM LABOR
1. Cerclage-
NNT is 25, so indication is > 3 2nd trimister losses(halved
the incidence of PTL before 33 weeks)
TRANSVAGINAL TRANSABDOMINAL
McDonald Shirodkar failed vaginal cerclage.
Suture at junction of
vagina and cervix
Suture at cervico
isthmic junction
Suture placed above
cardinal and
uterosacral ligament.
Suture removed at 37-38 weeks to allow NVD -
23. 2. Progesterone-
100 mg of progesterone as a vaginal suppository
between 24 and 34 weeks.
Significant reduction in preterm delivery rates before
37 weeks and before 34 weeks in high-risk
populations.
Reduction in the incidence of birth weight less than
2500 g, necrotizing enterocolitis, intraventricular
hemorrhage, and the need for supplemental oxygen.
No reduction in perinatal death or respiratory
distress syndrome.
NNT is 7.
24. 3.Role of Antibiotics in Preterm Labor-
In meta-analysis of 13 randomized studies about
efficacy of antibiotics benefit was found with regards
to chorioamnionitis, neonatal sepsis and
prolongation of pregnancy by 7 days.
But severe neonatal morbidity in the form of
necrotizing enterocolitis, respiratory distress and
intracranial hemorrhage and neonatal survival were
not improved.
25. 4. Measures to Prevent Intraventricular Hemorrhage-
1. Corticosteroids are beneficial in reducing Periventricular
hemorrhage.
The other interventions that are considered are
i. Antenatal Vit K: Periventricular hemorrhages are shown to
be reduced by Antenatally administered Vit K.
ii. Antenatal phenobarbitone: Phenobarbitone when given to
mothers Antenatally is shown to reduce postnatal
intraventricular hemorrhages in the infant.
However, in a recent report the combination of vitamin K and
phenobarbitone was found to cause a small and insignificant
reduction in intraventricular hemorrhage.
26. Exact mechanism and cause of idiopathic preterm
labor is still largely unknown.
However, the role of antenatal steroids and
antibiotics is largely established in improving
perinatal outcome
Provided when such deliveries are conducted at a
well appointed maternal unit of a institution with
appropriate neonatal units equipped and trained for
such eventualities.