Pelvic organ prolapse is the descent of pelvic organs from their normal position. It is caused by weakness in the pelvic floor muscles and supporting tissues. Prolapse can affect the bladder, uterus, rectum, or small intestine and is graded based on the degree of descent. Risk factors include childbirth, age, obesity, and chronic coughing. Symptoms vary depending on the affected organ but may include pressure, pain, urinary issues, or bowel dysfunction. Treatment ranges from pelvic floor exercises to pessaries to surgery based on severity. Surgical options aim to restore anatomy and support the pelvic organs.
Presentation on the description of normal and abnormal uterine bleeding, menstrual cycle, FIGO classification with PALM-COEIN, common differentials of AUB, assessment, diagnosis, and management.
Classification & conservative surgeries for prolapseIndraneel Jadhav
Stage 0
no prolapse
- Aa,Ba,Ap,Bp are all at -3
- C or D between tvl and < tvl -2
Stage I
most distal portion > 1cm above level of hymen
Stage II
<1cm proximal to or distal to the plane of hymen
Stage III
>1cm below the plane of the hymen
Stage IV
complete eversion, distal portion at least (tvl -2 cm)
Urinary Tract Fistulas -(VVF) Etiology, Diagnosis, ManagementVikas V
Urinary Tract Fistulas - Etiology, Diagnosis, Management
Surgical and Relevant Anatomy, Classification, eitiology, VVF in Detail, Examination and Diagnosis, Management of VVF - Both Conservative And Surgical Management - Steps of Surgical Management, Post operative Management.
Presentation on the description of normal and abnormal uterine bleeding, menstrual cycle, FIGO classification with PALM-COEIN, common differentials of AUB, assessment, diagnosis, and management.
Classification & conservative surgeries for prolapseIndraneel Jadhav
Stage 0
no prolapse
- Aa,Ba,Ap,Bp are all at -3
- C or D between tvl and < tvl -2
Stage I
most distal portion > 1cm above level of hymen
Stage II
<1cm proximal to or distal to the plane of hymen
Stage III
>1cm below the plane of the hymen
Stage IV
complete eversion, distal portion at least (tvl -2 cm)
Urinary Tract Fistulas -(VVF) Etiology, Diagnosis, ManagementVikas V
Urinary Tract Fistulas - Etiology, Diagnosis, Management
Surgical and Relevant Anatomy, Classification, eitiology, VVF in Detail, Examination and Diagnosis, Management of VVF - Both Conservative And Surgical Management - Steps of Surgical Management, Post operative Management.
Pelvic organ prolapse
Etiology of pelvic organ prolapse
Vaginal vault prolapse
Etiological factors of vault prolapse
Signs and symptoms of vaginal vault prolapse
Diagnosis of vaginal vault prolapse
Treatment measures
Uterine prolapse occurs when weakened or damaged muscles and connective tissues such as ligaments allow the uterus to drop into the vagina. Common causes include pregnancy, childbirth, hormonal changes after menopause, obesity, severe coughing and straining on the toilet.
Seminar presentation by 5th-year medical students under the supervision of in house lecturer. He was previously working as a consultant surgeon in Syria. Reference as mentioned in the slides.
Seminar presentation by 5th year Medical Student under the supervision of a pediatric surgery specialist from HRPZ II. Reference as mentioned in the slide.
Seminar presentation by group C 5th year medical student under supervision Dato Imi, endocrine specialist in HRPZ II.
Reference as mentioned at the end of the slide presentation
4th year medical student's seminar presentation under supervision of orthopedic lecturer. Reference is from Dr. Sameh Doss Textbook of upper and lower limb, and also other multiple websites.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Hot Selling Organic intermediates
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.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
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
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. WHAT IS PELVIC ORGAN
PROLAPSE?
Pelvic organ prolapse is the descent of the genital organs
beyond their normal anatomical confines. It is caused by
herniation through deficient pelvic fascia or due to
weakness or deficiency of the ligaments or muscles or
blood or nerve supply to the pelvic organs.
3. DEFINITION AND CLASSIFICATION
A prolapse is protrusion of an organ or structure beyond its
normal confines. Prolapses are classified according to their
location and the organs contained within them
Anterior vaginal
wall prolapse
POSTERIOR
vaginal wall
prolapse
APICAL vaginal
prolapse
Urethrocele
Urethral descent
Cystocele
Bladder descent
Cystourethrocele
Descent of bladder and urethra
Rectocele
Rectal descent
Enterocele
Small bowel descent
Uterovaginal
Uterine descent with inversion
of vaginal apex
Vault
Post-hysterectomy inversion of
vaginal apex
5. PREVALENCE
41-50 % of women over age of 40 years.
Lifetime risk:
- 7% operation for prolapse
- 11% operation for incontinence/prolapse
The annual incidence of surgery for pelvic organ
prolapse within 15-49 per 10000 women.
6. GRADING
1ST Degree
Descent within the vagina
2nd Degree
Descent to the introitus
3rd Degree
Descent outside the introitus
8. The connective tissue, levator ani and intact nerve
supply are vital for the maintenance of the position of
the pelvic structures and are influenced by pregnancy,
childbirth and ageing.
Whether congenital or acquired, connective tissue
defects appear to be important in the aetiology of
prolapse and urinary stress incontinence.
AETIOLOGY
9. AETIOLOGY
1. Congenital
2% of symptomatic prolapse occurs in nulliparous women
Genital prolapse is rare in Afro-Caribbean women
2. Childbirth and Raised Intra-Abdominal Pressure
Major factor – vaginal delivery
Nerve and mechanical damage resulting from vaginal delivery
Parity is associated with increasing prolapse
Prolapse during pregnancy is rare, but may be mediated by the effects
of progesterone and relaxin
Increase in intra-abdominal pressure will put an added strain on the
pelvic floor
Conditions such as constipation or chronic cough can also raised intra-
abdominal pressure
10. 3. Ageing
Loss of collagen and weakening of fascia and connective tissue
Particularly during the post-menopause as a consequence of
oestrogen deficiency
4. Postoperative
Poor attention to vaginal vault support can lead to vault prolapse
Usage of mechanical displacement such as colposuspension may lead
to development of rectocele or enterocele
AETIOLOGY
11. PATHOPHYSIOLOGY
There are three components that are responsible for
supporting the position of the uterus and vagina
LIGAMENTS AND FASCIA
LEVATOR ANI MUSCLES
POSTERIOR ANGULATION OF THE VAGINA
By suspension from pelvic side walls
By constricting thereby maintaining the position of the organ
Which is enhanced by rises in intra-abdominal pressure
causing closure of the ‘flap valve’
15. NORMAL CONDITION
At rest, tonic contraction of levator ani muscles provides support
to pelvic organs with their activity adjusting to variation in posture,
increased vaginal distension, and intra-abdominal pressure.
In presence of normal support by levator ani muscle, the supportive
connective tissues of vagina pulled the vagina superiorly and back
towards the sacrum placing the upper vagina at a nearly horizontal
orientation over the levator ani muscle.
With presence of intra-abdominal pressure, the upper vagina is
compressed against the levator ani muscles and pelvic organ
support is maintained.
16. PELVIC ORGAN PROLAPSE
Damage to any component of vaginal connective tissue support
changes the vaginal axis to a vertical position directly over the
genital hiatus.
Thus with increase in intra-abdominal pressure, the vagina is no
longer compressed against the levator ani muscles but directed
downward toward the genital hiatus thus can cause pelvic organ
prolapse.
19. Non-specific clinical features
Pressure, pain or “fullness” in vagina or rectum or both
Sensation of ‘your insides falling out’ – vaginal tissue bulge
Urinary incontinence
Urine retention
Fecal incontinence
Chronic constipation
Back or pelvic pain
Tampons pushing out
Dyspareunia (painful / difficult sexual intercourse)
Apareunia (inability to perform sexual intercourse)
Coital incontinence (leakage of urine or stool during intimacy)
21. EXAMINATIONS
ABDOMINAL EXAMINATION
VAGINAL EXAMINATION
COMBINED RECTAL AND VAGINAL EXAMINATION
To exclude organomegaly / abdominopelvic mass
Examine in dorsal position (if protrude beyond introitus)
Assess with ptt straining in left lateral position & Sims speculum
To differentiate rectocele from enterocele
25. There is no single way to
COMPLETELY prevent these
problems.
MANAGEMENT
1. Overweight women are at a significantly increased risk.
2. Avoid constipation and chronic straining – increase fiber and fluid intake.
3. Seek medical attention if chronic cough which increases abdominal and
pelvic pressure.
4. Avoid heavy lifting and learn how to lift safely
5. Do not smoke.
6. Avoid repetitive strenuous activities.
26. MANAGEMENT
To avoid injuries to
supporting
structures during
time to vaginal
delivery either
spontaneously or
instrumental.
Encourage early
ambulation and
encourage pelvic floor
exercise by squeezing
the pelvic floor
muscles during
puerperium
Avoid strenuous
activity and avoid
pregnancy too soon
and too many by
contraceptive
practice
Antenatal and
Intranatal Care
POSTNATAL Care
GENERAL
MEASURES
27. REMEMBER!
1. Antenatal physiotheraphy & relaxation exercises (attention to weight gain
and anemia)
2. Proper supervision and management of second stage of labour
3. A generous episiotomy
4. Low forceps delivery if there is delay in second stage
5. Suture perineal tear
6. Postnatal exercises and physiotherapy
7. Early postnatal ambulation
8. Adequate spacing of births
9. Avoid multi-parity
10. Prophylatic HRT in postmenopausal women
28. REMEMBER!
1. Antenatal physiotheraphy & relaxation exercises (attention to weight gain
and anemia)
2. Proper supervision and management of second stage of labour
3. A generous episiotomy
4. Low forceps delivery if there is delay in second stage
5. Suture perineal tear
6. Postnatal exercises and physiotherapy
7. Early postnatal ambulation
8. Adequate spacing of births
9. Avoid multi-parity
10. Prophylatic HRT in postmenopausal women
29. REMEMBER!
If symptoms are mild,
practice pelvic floor
physiotherapy (Kegel
Exercise).
Once prolapse has
developed, Kegel will not
correct the problem but
may prevent the
prolapsed from worsen.
32. Silicon rubber
based ring
pessaries most
popular form
Ring pessary is
made of soft
plastic polyvinyl
chloride & available
in different sizes.
33. INDICATIONS?
A young woman planning a
pregnancy
During early pregnancy
Puerperium
Temporary use while clearing
infection and decubitus ulcer
A woman unfit for surgery
In case a woman refuses for
surgery
34. LIMITATIONS
It is never curative and only be palliative
It can cause vaginitis
Pessary needs to be changed every 3 months
The wearing of pessary is not comfortable to some women and may cause
dyspareunia
If the vaginal orifice is very patulous, the pessary is often not retained.
A forgotten pessary can be the cause of ulcer, rarely carcinoma of vagina and
vesicovaginal fistula
A pessary does not cure urinary stress incontinence
36. TYPES OF SURGERY
OFFERED TO PATIENTS WITH
PROLAPSE DEPENDS ON:
1. The age of patient
2. Desire to retain the uterus
3. Menstrual history
4. General condition
5. Degree of uterine prolapse
6. Uterine abnormality
39. 2. Perineorrhaphy / Colpoperineorrhaphy
To repair the prolapse of
posterior vaginal wall
40. UTEROVAGINAL PROLAPSE
UTERINE PRESERVING SURGERY
1. Hysterosacropexy
Open or laparoscopic route
Mesh is attached to the isthmus of cervix and uterus to other part of
anterior longitudinal ligament on sacrum
2. Manchester repair
Accessing uterus vaginally
Amputate cervix
Use uterosacral cardinal ligament complex to support uterus
Rare method
3. Le Fort colpocleisis
Partial closure of vagina while preserving the uterus
42. PROCEDURE INVOLVING HYSTERECTOMY
To proceed as that of anterior
colporraphy up to pushing up of bladder
The UV fold of peritoneum incised
The cervical incision is extended
posteriorly along the cervicovaginal
junction and the pouch of douglas is
opened
Uterus is delivered anteriorly
First clamp on utero sacral and cardinal
ligaments, tissues cut and ligated on
both sides
Second clamp involves uterine vessels
which are cut and ligated
1. VAGINAL HYSTERECTOMY
43. PROCEDURE INVOLVING HYSTERECTOMY
Third clamp on round ligament, fallopian
tube and ovarian ligament which are cut
and ligated
Uterus removed
Peritonium closed by purse string suture
Enterocele correction done by McCall’s
culdoplasty
Anterior colporrhaphy is completed
Posterior colpoperineorrhaphy
performed if there is rectocele