This document outlines the physiological changes that occur during pregnancy across multiple body systems. Key changes include an increase in total body fluids by 6-8 liters due to fluid retention, a 45-50% increase in plasma volume, and a 20-35% increase in red blood cell mass. The cardiovascular system adapts through a 30-50% increase in cardiac output and decreased systemic vascular resistance. Respiratory changes include diaphragm elevation and decreased lung volumes. The reproductive, urinary, endocrine, gastrointestinal, skin and breast systems all undergo adaptations to support the developing fetus.
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Cardiac conduction defects can occur due to various causes.
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The prostate is an exocrine gland of the male mammalian reproductive system
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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
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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
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.
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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.
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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
2. I. OBJECTIVES
At the end of this session you should be able to:
1. Describe the normal distribution of body fluids
2. Decribe the changes in body fluids during
pregnancy
3. Outline the physiological changes in various
systems during pregnancy
4. Distinguish physiological versus pathologic
changes during pregnancy
5. Diagnostic tests and interpretations during
pregnancy
3. I. BODY FLUIDS WITHOUT PREGNANCY
Total body water
• Average normal weight = 70kg
• 60% of bwt is water = 42L
• Distribution in the fluid compartments
– ⅔ ICV = 28L
– ⅓ ECV = 14L
–¾ interstitial = 10.5L
–¼ intravascular = 3.5L
4. BODY FLUID CHANGES IN PREGNANCY
• Body Fluid - ↑ by 6-8 L
• ⅔ of this increase is extravascular
especially IVFV
• Causes of fluid retention
1.Placenta produces renin which then activates
RAAS
• This causes increased Na+ and H2O
reabsorption in the kidneys
2.Oestrogen has some glucocortocoid activities
that enhance reabsorption of Na+ and H2O
5. BODY FLUIDS AND WEIGHT GAIN
Weight gain
Total normal wt gain 7- 17 kg, average 12.5kg
• Blood =1.5kg
• Extravascular fluid =1.5kg
• Uterus =1.0 kg
• Placenta = 0.5 – 0.7 kg
• Fetus = 3.4kg
• Amniotic fluid = 0.8kg
• Breast = 0.5 kg
• Other stores (fat) = 3.3kg
Note: Appetite ⇈ [effects of estrogen on the appetite
center]
6. HAEMATOLOGICAL CHANGES
• Plasma volume increases by 45 - 50%
– Beginning by the 6th wk
• RBC mass increases by 20-35%
– Moderate erythroid hyperplasia in bone marrow
– Beginning by the 12th wk but more marked after 20 wks
• Disproportionate increase in plasma volume over
RBC volume -- Hemodilution [Physiological anaemia
of pregnancy]
– Despite erythrocyte production there is a physiologic fall
in the hemoglobin and hematocrit readings
7. Iron deficiency anemia
• With erythropoiesis of pregnancy, iron
requirements increase.
• Because large amounts of iron may not be
available from body stores and may not be
in the diet
– Supplementation is recommended to prevent
iron deficiency anemia
– At term, Hemoglobin less than 10.0 is usually
due to iron deficiency anemia rather than the
hemodilution of pregnancy
8. Cardiovascular system
1. CARDIAC OUTPUT (CO) = HR X SV
• CO increase 30-50%
– Initial increase is a function of
• The increase in heart rate (10-20%)
• Reduced systemic vascular resistance by
35%
• By 10- 20 wks the increase in CO is reflected
mainly by the increase in SV
– Fluid retention →↑ECFV →↑SV →↑CO
– The notable increase in plasma volume or
preload contributes to the increase SV
9. As pregnancy advances to term
• The HR continues to increase but the SV falls to
close to normal levels.
• This accounts for the fall in CO to near non-pregnant
levels at term
2. HEART SOUNDS
– ↑ loudness of S1 & S2, S3
– Diastolic murmur in 20%,
10. 3. BLOOD PRESSURE
• Normally: slight decrease in DBP > ↓ SBP
• Despite ↑ CO and ↑ plasma volume
• Indicates significant ↓ peripheral
resistance
11. Interpretation of tests in pregnancy
i. CXR
• Elevation of diaphragm
• Heart to be displaced to the left and upward
• Increase in the cardiac silhouette
• Benign pericardial effusion
ii. Echocardiogram
• Increased left ventricular wall mass
• Increased end diastolic dimensions
• Increase in EDV( end-diastolic volume) and
therefore ⇈in SV
iii. Electrocardiogram
• Slight left axis deviation
12. ESPIRATORY SYSTEM
1. Mechanical changes
Diaphragm rises up to 4 cm
– Less negative intrathoracic pressure
– ↓Functional Residual Capacity (FRC)
• volume after passive expiration
– ↓Expiratory Reserve Volume (ERV)
• max volume expired after passive expiration
– ↓ Residual Volume (RV)
• volume after max expiration
• No impairments in diaphragmatic or thoracic muscle
motion
– Lung compliance remains unaffected
13. CONT. RESPIRATIORY
2. Consumption
• O2 consumption increases by 15-20 %
• 50 % of this increase is required by the uterus.
• Despite increase in oxygen requirements, with the
increase in Cardiac Output and increase in alveolar
ventilation oxygen consumption exceeds the
requirements.
• Therefore, arteriovenous oxygen difference falls and
arterial PCO2 falls.
14. RESPIRATIORY cont
3. Stimulation
• Progesterone is known to directly stimulate
ventilation
• Progesterone increases the sensitivity of the
respiratory center to CO2
• Also, it is thought to reduce total pulmonary
resistance
– Effects of progesterone on smooth
muscles
15. RESPIRATIORY cont
• Physiologic changes
Dyspneoa - increase in desire to breath
– 70 % of pregnant women experience this
– Occurs during 1st trimester without mechanical
factors
– The lower PCO2 then paradoxically causes dyspneoa
– The marked change or marked decline in PCO2
results in the sensation of dyspneoa
16. REPORODUCTIVE SYSTEM
CHANGES
• Increased vascularity and hyperemia
– Vagina, perineum and vulva
• Increased secretions
• Blue coloration of the vagina
– Chadwick’s sign
• Increased length to the vaginal wall
• Hypertrophy of the papillae of the vaginal
mucosa
17. REPORODUCTIVE SYSTEM cont
UTERUS
• Uterine hypertrophy of the myocytes
–Hypertrophy can cause venous
compression
–Can result in fall in venous return hence
aggravating fall in CO
• Physiologic compensation
–Rise in peripheral resistance to minimize
fall in blood pressure
18. REPORODUCTIVE SYSTEM cont
• Supine hypotensive syndrome
Occurs if no physiologic compensation pts
are prone to
Symptoms: nausea, dizziness, syncope
Can be relieved with position changes
• Uterine blood flow is Increased 100 ml/min to
1200 ml/min
19. Amenorrhoea
• ⇈ Ostrogens and progesterone cause
negative feedback mechanism to the
hypothalamus leading to suppress production
of GnRH and consequently suppression of
production of the FSH/LH from the pituitary
gland.
• Decreased FSH/LH leads to amenorrhoea
REPORODUCTIVE SYSTEM cont
20. URINARY SYSTEM
a. Anatomical changes:
Marked dilatation of calyces, renal pelves,
and ureters
More prominent on the right
Partial obstruction of the ureters can
occur at the pelvic brim
Progesterone produces smooth muscle
relaxation which is thought to cause the
relaxation noted
21. b. Physiologic changes:
GFR and renal plasma flow
Increases 40 -50% by mid-gestation,
plateaus, then remains unchanged until
term
Elevated GFR is reflected in the lower
serum levels of creatinine and blood
urea nitrogen
URINARY SYSTEM cont
22. ENDOCRINE SYSTEM
GLUCOSE METABOLISM
• Postprandial hyperglycemia
– To ensure sustained glucose levels for fetus
• Accelerated starvation
– Early switch from glucose to lipids for fuels
• Insulin resistance promotes hyperglycemia
– ↓ peripheral insulin sensitivity and hence ↓ uptake of
glucose. Cause? hPL, insulinase produced by the
placenta, etc
23. 2. CORTISOL
• ACTH levels increase approx. 2 - 3x during
pregnancy.
– This increase is, in part, placental in origin and may be a
local paracrine effect of placental CRH production.
• The stress of labor causes ACTH(Adrenocorticotropic
Hormone) levels to increase rapidly and then decrease
within two days postpartum.
• The stress of labor causes ACTH levels to increase
rapidly and then decrease within two days
postpartum.
24. GASTROINTESTINAL TRACT
Liver
• Liver morphology unchanged
• Lab Tests similar to liver disease
– Alkaline phosphatase doubles
– AST, ALT, albumin and bilirubin are slightly lower
Gallbladder
• Impaired contraction → high residual volumes
• Promotion of stasis
– Stasis associated with increased cholesterol saturation of
pregnancy, supports predisposition of stones
• Intrahepatic cholestasis
• Retained bile salts----pruritus gravidarum
25. Cont. GASTROINTESTINAL TRACT
GI motility decreases
• ⇈progesterone levels relax smooth muscle.
These may lead to:
– Heartburn and belching
• ?caused by delayed gastric emptying and
gastroesophageal reflux due to relaxation of the
lower esophageal sphincter and diaphragmatic
hiatus
• Constipation
– May be caused by enlarged uterus pressing against
the rectum and lower portion of the colon
26. SKIN CHANGES
1. Chloasma or melasma
gravidarum
More common in dark skin
people
Fades a few months after
delivery
Repeated pregnancy can
intensify
Can occur in normal non-
pregnant women with
harmless hormonal
imbalances or women on
OCPs or depo
27. SKIN CHANGES cont.
2. Melasma gravidarum
• These are hyperpigmentations
• Causes:
–Melanocyte stimulating effect of estrogen
and progesterone
–The placenta produces a melanocyte-
stimulating hormone
28. 3. Striae gravidarum
• Related to Stretching with
pregnancy
.- Deep collagen deposits break
apart
• Also associated with increased
ACTH secretion which affects
connective tissue
• Depressed red streaks on the
skin of fatty areas: Abdomen,
breasts and thighs
• Regress after delivery
• Residual white streaks remain
(striae albicantes)
29. BREAST CHANGES
• Oetrogen and progesterone together
suppress milk production during pregnancy.
• Progesterone is important for fetal growth
and breast development
• Appearance of striae gravidarum