The document discusses lactation and breastfeeding. It defines lactation as the production and secretion of breast milk after delivery. It describes the five stages of lactation: mammogenesis, lactogenesis, galactokinesis, galactopoiesis, and involution. Mammogenesis involves the development of the breasts. Lactogenesis involves the initiation and maintenance of milk synthesis. Galactokinesis is the ejection of milk from the breasts. Galactopoiesis maintains lactation. Involution is the regression of the breasts after lactation. The document also discusses the composition of breast milk, factors affecting lactation, and medications that can increase or decrease milk production.
Please find the power point on Hyperemesis gravidarum and its managemen. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Please find the power point on Vacuum delivery. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Please find the power point on Hyperemesis gravidarum and its managemen. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Please find the power point on Vacuum delivery. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
When it comes to good positions to use while breastfeeding, your comfort as well as the ease with which your baby will be able to feed is the first and foremost concern. Finding a position that you are most comfortable and happy with will make it easier for your baby to latch on to your breasts and feed with ease. Here are some of the best breast-feeding positions that you might use when you are breastfeeding.
Puerperium is the period following childbirth during which the body tissues, specially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically. puerperium begins as soon as the placenta is expelled and lasts for approximately 6 weeks when the uterus becomes regressed almost to the non-pregnant size.
Maternal Care addresses all the common and important problems that occur during pregnancy, labour, delivery and the puerperium. It covers: the antenatal and postnatal care of healthy women with normal pregnancies, monitoring and managing the progress of labour, specific medical problems during pregnancy, labour and the puerperium, family planning, regionalised perinatal care
This slide share revolves around the anatomy and physiology of an udder including the mechanism of milk production in cows and the hormones involved with their role in milk synthesis.Hope its helpful.
Factor Causing low production and physiology of mamary GlandRcvets
Low production in the mammary glands, particularly in dairy animals, can be influenced by several factors, ranging from genetics to environmental conditions. Understanding these factors is crucial for improving milk yield and overall animal health. Here are some key factors affecting the production and physiology of the mammary glands
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
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
2. OBJECTIVES:
Understand the structure of the breast
Describe the stages of lactation
Composition of breast milk
Factors affecting lactation
Medications that affect lactation
2
3. Definition of lactation
Lactation describes the production of breast
milk and its secretion from the mammary
gland after delivery
3
4. Structure of the breast
Parenchyma consists of 10-15 ducts extending from
the nipple to terminate in grape-like clusters known as
alveoli (basic unit) via ductules from lobules
There are 15-20 pyramid shaped lobes separated by
cooper ligament and each contains lobules which are
further separated by fat and connective
tissue(stroma)
Nipple surrounded by area of hyperpigmented skin –
areola
4
6. Physiology of Lactation.
Lactation can be divided into 5 stages:
1. Mammogenesis-Development of breasts to
a functional state
2. Lactogenesis-Synthesis and secretion of milk
from the breast alveoli
3. Galactokinesis-Ejection of milk outside the
breast
4. Galactopoiesis-Maintenance of lactation
5. Involution-regression and atrophy post
lactation
6
8. 1.Mammogenesis
Growth of ducts and lobuloalveolar systems
This starts from birth to puberty and continues in
pregnancy
Ductal sprouting predominates in 1st trimester and
lobular sprouting occurs more in 2nd trimester
hence the breast will contain more glandular
epithelial cells than stroma
Just before and during parturition there is a new
wave of mitotic activity causing growth growth and
maturation
8
9. Hormonal influence during
mammogenesis
Prepubertal growth-
depends on estrogen and progesterone.
Secretion of prolactin and somatotropin by the
pituatory gland results in mammary growth.
Adrenocorticotrophic hormone(ACTH) and thyroid
stimulating hormone(TSH) acting on the adrenal
gland and thyroid gland also play a minor role in
growth of the mammary gland
9
10. 10
Hormonal influence during
mammogenesis…
Pubertal growth-
When the hypophyseal-ovarian –uterine cycle is
established, there is extensive branching of the duct
system and parenchymal proliferation and canalization
of the lobuloalveolar units controlled by estrogen and
progesterone
11. 11
During pregnancy
In early pregnancy a marked increase in ductular
sprouting, branching and lobular formation is evoked
by luteal and placental hormones.
Progesterone:causes increased growth of alveoli size
and lobes,
Estrogen:Stimulates milk duct system to grow and
differentiate, deposition of fat.
Prolactin:contributes to increased growth and
differentiation of the alveoli and ductal structures
12. Types of lobules
Type 1- (virginal lobule) when an average of 11 alveolar
buds/ductules cluster around a terminal duct, this is
apparent within 1 to 2 years after onset ofmenses
Type 2 - changing levels of estrogen and progesteron
during menstrual cycle stimulates type 1 lobules to
sprout new alveolar buds and evolve to mature
structures, type 2-47 lobules
Type 3- in pregnancy, 80 lobules
Type 4-attained in late pregnancy with breast milk
12
14. 2. LACTOGENESIS(stage 1)
Stage 1: occurs in mid pregnancy
There is initiation of milk synthesis,
alveoli differentiates into secretory cells and prolactin
stimulates mammary secretory cells to produce milk.
insulin and serum growth factor induced cell
division of stem cells of the gland and presence of
cortisol for formation of alveoli is required for
induction of milk synthesis .
Further differentiation is inhibited by high levels of
progesterone from the placenta and loss of
progesterone receptors in the lactating breast
14
15. Prolactin:
exerts its effects through receptors for initiation of milk
secretion located on the alveolar surfaces.
stabilizes and promotes transcription of mRNA and
stimulates synthesis of lactoalbumin, which is a
regulatory protein of the lactose synthetase enzyme system
Increases lipoprotein activity in the mammary gland
In conjunction with estrogen and progetserone it attracts
and retain Ig-A immunoblasts
estrogen enhances prolactin production by 10-20 fold. This
is regulated by human placental lactogen which has an
inhibitory effect
Its inhibited by prolactin inhibiting factor under control
of catecholamines in the hypothalamus.
15
16. LACTOGENESIS-stage 2
Stage 2: from late pregnancy to day 8.
This is triggered by rapid drop in progesterone
levels after placental delivery
requires the presence of elevated levels of prolactin
and cortisol , insulin, growth hormone and
parathyroid hormone to facilitate mobilization of
nutrients and minerals
there is a switch from endocrine to autocrine
control
16
17. 2. Lactogenesis. Pathways for milk secretion
by the mammary epithelial cell
I - Exocytosis : milk protein and lactose are
transported in Golgi-derived secretory
vesicles, with water and electrolytes in to the
alveolar lumen
II – Reverse Pinocytosis: lipid formed in
smooth ER forms droplets and covered by
phospholipid membrane transported as milk-fat
globule
III – Apical transport: Direct movement of
monovalent ions, water, and glucose across
the apical membrane of the cell.
17
18. Lactogenesis……
IV – Transcytosis. sodium, potassium,
chlorides, some monosaccharides, and
water
V - The paracellular pathway for some
interstitial fluid components and
leukocytes to pass by diapedesis through
the tight junctions.
18
19. Pathways for milk secretion by the
mammary epithelial cell
I. Exocytosis
II. Reverse
pinocytosis
III.Apical transport
IV.Transcytosis
V. Paracellular
pathways
19
21. galactokinesis
• Depends on the suckling mechanism of the
baby and the contractile action which will
express milk from the alveoli into the ducts.
• This contraction is brought about by the
action of Oxytocin
• Milk let down reflex/milk ejection reflex
• Inhibited by psychic condition /pain /breast
engorgement
21
22. oxytocin:
Released from posterior lobe of the pituatory gland
during nipple stimulation or sensory stimulation(
visual, tactile , olfactory or auditary)
Causes ejection of milk from the alveoli gland by
contraction of the myoepithelial cells into ductules
and ducts
22
23. During suckling, a conditioned reflex is set up:
Ascending impulses from the nipple and areola
thoracic sensory (4, 5 and 6) afferent neural arc
paraventricular and supra optic nuclei of the hypothalamus
Oxytocin from the posterior pituitary produces contraction of
the myoepithelial cells of the alveoli and the ducts containing
milk. ("milk ejection" or "milk let down" reflex)
Milk is forced down into the ampulla of lactiferous ducts,
wherefrom it can be expressed by the mother or sucked by
The baby. This occurs between 30sec. to 60sec.
23
25. Galactopoiesis.
Prolactin is the hormone for maintenance of
lactation
And suckling is essential for maintenance of
milk secretion
Periodic breast feeding relieves pressure in
the ducts and promotes more secretion
Controlled by autocrine system(supply-demand)
25
26. 5. Involution
Apoptotic cell death and tissue remodelling
post lactation
Requires a combination of lactogenic
hormone deprivation and local signals to
undergo regression and atrophy
26
27. Variations in composition :
Colostrum(1-5 days) – is reacher in proteins ,minerals,
immunoglobulins , anti inflammatory factors(PGE1 and
PGE2, cytokines), phagocytes and lymphocytes.
Mature milk(>30 days)-larger quantity than colostrum,
Foremilk –thin, proteins, lactose, water and other
nutrients.
Hindmilk –more fat therefore whiter, provides much of
the energy of a feed.
Other components include human growth factors, cortisol,
insulin, thyroxine and prolactin
27
29. FACTORS AFFECTING LACTATION
Maternal problems:
stress(post c/s,stressful vaginal delivery or other psychosocial
stresses) opiates and beta-endorphins are released that block
the stimulus-secretion coupling thus reducing oxytocin release
polycystic ovarian syndrome,
theca lutein cysts,
obesity,
labour analgesia,
dm type 1,
placental retention-increased circulating progesterone
Alcohol dependence
12/7/2014 6:55 PM 29
30. FACTORS AFFECTING LACTATION..
Infrequent suckling/failure to empty breast
causes Elevated intrammary pressure also disrupts
connections between cells and their attachment to
the basement membrane disrupting synthesis and
secretion of milk components.
Premature infants-prolactin may not be
sufficient
30
31. MEDICATIONS AND LACTATION
Medications that increase lactation-
metoclopramide
domperidone
phenothiazine neuroleptics -chlorpromazine
risperine
Hypoglycemics
H2 antagonists-cimetidine
Antihypertensives-methyl dopa, b blockers
31
33. Advise to the mother to improve
lactation
Good health;
Early and sufficient
treatment of illnesses;
Proper balance between
rest and exercise;
Freedom from worry
Care of the breast
/nipples during
pregnancy
Post natally frequent
breast feeding
Avoid breast
engorgement
Plenty of fluids
Adequate nutrition.
33
36. References
E-medicine – Human milk and lactation.
Breastfeeding and human lactation-Jones and Bartlett
Series.
Breast feeding, guide for medical proffesion by Ruth
Lawrence.