Postpartum haemorrhage (PPH) is still a major cause of maternal mortality, responsible for 20-25% of deaths. It can be caused by uterine atony, retained placenta, genital tract trauma, or coagulation disorders. Risk factors include previous PPH, obesity, multiple pregnancy, and operative delivery. Proper management of PPH involves early recognition, resuscitation with IV fluids and blood transfusion, identifying and treating the cause, and close monitoring in ICU. Delays in management and transportation significantly increase mortality.
Preterm labor is the labor that starts before the 37th completed week. In this presentation, we will discover causes, pathogenesis, diagnosis, clinical features, and management principles for preterm labor along with the most recent evidence.
Preterm labor is the labor that starts before the 37th completed week. In this presentation, we will discover causes, pathogenesis, diagnosis, clinical features, and management principles for preterm labor along with the most recent evidence.
A brief introduction regarding oxytocics & tocolytics which are the indispensable drugs in obstetrics. It consists of illustrative images, classification of drugs with their dosage, uses & side-effects along with contraindications
Postpartum haemorrhage (PPH) is commonly defined as a blood loss of 500 ml or more within 24 hours after birth.
It affects about 5% of all women giving birth around the world.Globally, nearly one quarter of all maternal deaths are associated with PPH. In most low-income countries, it is the main cause of maternal mortality.
Postpartum haemorrhage (PPH) is commonly defined as a blood loss of 500 ml or more within 24 hours after birth.
It affects about 5% of all women giving birth around the world.
Globally, nearly one quarter of all maternal deaths are associated with PPH. In most low-income countries, it is the main cause of maternal mortality.
Blood loss of >/ 500 ml within 24 hours of vaginal birth or 1000 ml after caesarean section or any blood loss sufficient to compromise haemodynamic instability
MINOR PPH- 500- 1000ml blood loss
MAJOR PPH- > 1000ml Blood loss
MASSIVE PPH- >2000ml Blood loss
The effect of Metformin on endometrial tumor-regulatory genes and systemic metabolic parameters in polycystic ovarian syndrome – a proof-of-concept study
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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.
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
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
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.
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.
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. Major cause of death
PPH is still the largest cause of
maternal death, responsible for 24% in
1995 and 20.0% in 1996.
Over the last 6 report PPH account for
25% of all maternal death.
3. Postpartum Haemorrhage
50% associated with substandard care
3 main factors involved;
1. Home deliveries (46.7%)
2. Delay in resuscitating the mother
3. Delay in transportation to GH
4. National MMR by Ratio 1950-2000
220 PPH
200
180 HDP
160
No. of Deaths
140 Obst.
120 Embolism
100 Medical
80 Condition
60 Obst. Trauma
40
20
Puerperal
0 Sepsis
1991 - 1993 1994 - 1996 1997 - 1999 2000 - 2002 2003 - 2005 2006-2008
5. DEFINITION
1 PPH
BLOOD LOSS FROM THE GENITAL TRACT IN
EXCESS OF 500 ML IN THE FIRST 24 HOURS OF
DELIVERY
2 PPH
EXCESSIVE BLEEDING FROM THE GENITAL TRACT
AFTER THE FIRST 24 HOURS POST PARTUM UNTIL 6
WEEKS AFTER DELIVERY.
9. Postpartum Haemorrhage:
‘Risk Management’
‘At risk’ patients should deliver in hospital
Active management of 3rd stage
20 - 40 units oxytocin in 500mls of Hartman’s
soln. at 30 dpm
Closer post-natal observation for 2-3 hours
Cases of ragged membranes need at least 24
hours monitoring in hospital and given proper
counseling and appropriate antibiotics
10. CAUSES OF 1 PPH
A. UTERINE ATONY
B. RETAINED PLACENTA
C. TRAUMA
D. COAGULATION DEFECT
11. CAUSES OF 2 PPH
A. RETAINED POC
B. ENDOMETRITIS
C. PLACENTAL SITE TROPHOBLASTIC TUMOUR
12. ESTIMATION OF BLOOD LOSS
1 TAMPON FULLY SOAKED – 30 ML
1 SANITARY PAD FULLY SOAKED – 120 ML
1 SARONG FULLY SOAKED – 500 ML
13. Blood loss,ml Up to 750 750-1500 1500-2000 2000 or more
(Blood loss, %BV) (Up to 15%) (15-30%) (30-40%) (40% or
more)
Pulse rate <100 >100 >120 >140
Blood pressure Normal Normal Decreased Decreased
Respiratory rate 14-20 20-30 30-40 >35
Urine output (ml/hr) >30 20-30 5-15 Negative
Slightly Lethargic, Confusion,
CNS-mental status anxious Mildly confusion lethargy,
anxious coma
Anorexia Anorexia, Ileus
Gastrointestinal vomiting
Fluid replacement Crystalloid Crystalloid Crystalloid Crystalloid
(3:1 rule) + blood + blood
14. MANAGEMENT
I. RECOGNISE PPH
II. CALL FOR HELP(CODE BLUE)
O & G SPECIALIST
ANAESTHETIST
SISTER ON CALL
BLOOD BANK/HAEMATOLOGIST
III. RESUSCITATION !
IV. IDENTIFY AND TREAT SPECIFIC CAUSE
16. RESUSCITATION
TAKE 20 ML OF BLOOD FOR
GXM 4 UNITS PC
FBC
COAGULATION SCREENING
ELECTROLYTES
17. RESUSCITATION
INFUSE FLUIDS (COLLOID/CRYSTALLOID)
MAINTAIN CIRCULATORY VOLUME WHILE
WAITING FOR BLOOD
IN DIRE STATES, USE GROUP SPECIFIC
BLOOD OR UNMATCHED O RH –VE BLOOD
25. RETAINED PLACENTA
RESUSCITATION!
DO NOT CONTINUE WITH CCT WITH SUCH
PATIENT
OXYTOCIN SHOULD BE GIVEN
MRP IN OT UNDER GA WITH ANAESTHETIC
BACK UP FOR RESUSCITATION
LOOK FOR GENITAL TRACT TRAUMA
START OXYTOCIN INFUSION AFTER MRP
ANTIBIOTICS
27. MORBIDLY ADHERENT
PLACENTA
IN CASES OF ACCRETA, IF NO BLEEDING, MAY
TREAT CONSERVATIVELY WITH MEDICATION
OTHERWISE, REQUIRE LAPAROTOMY
HYSTERECTOMY
28. GENITAL TRACT INJURY
INJURY TO
EPISIOTOMY
VAGINA
CERVIX
UTERUS
EXTENSION TO BROAD LIGAMENTS
29. GENITAL TRACT INJURY
RISK FACTORS
INSTRUMENTAL DELIVERY
BIG BABY
SHOULDER DYSTOCIA
PRECIPITATE LABOUR
30. GENITAL TRACT INJURY
EXAMINATION – BEST UNDER ANAESTHESIA IN
OT
‘WALK THE CERVIX’
HIGH INDEX OF SUSPICION OF EXTENSION TO
BROAD LIGAMENTS AND UTERUS IF
LACERATION INVOLVING CERVIX AND
FORNICES
ANTIBIOTICS
31. GENITAL TRACT INJURY
- UTERINE RUPTURE
HIGH INDEX OF SUSPICION
PREVIOUS SCAR
DIFFICULT DELIVERY (INTERNAL PODALIC VERSION)
GRANDMULTIPARA
OBSTRUCTED LABOUR
32. GENITAL TRACT INJURY
- UTERINE RUPTURE
WHAT ARE THE SIGNS?
CTG CHANGES
MATERNAL TACHYCARDIA
PER VAGINAL BLEEDING
SCAR TENDERNESS
DECREASE UTERINE CONTRACTION
HAEMATURIA
34. SECONDARY PPH
USUALLY PRESENTS IN THE 2ND AND 3RD WEEK POST
PARTUM
HVS FOR CULTURE
START ANTIBIOTICS
IF DIAGNOSIS OF RETAINED POC, FOR EXPERIENCED
PERSONNEL TO PERFORM EVACUATION – HIGH RISK
OF PERFORATION
DIFFICULT TO DIFFERENTIATE POC AND BLOOD
CLOT BY US IN 1ST 2 WEEKS POSTPARTUM
35. MONITORING
ICU/ HDU MONITORING
VITAL SIGN MONITORING EVERY 15 MINUTES
- BP, PR, RR, SA O2, CVP
FLUID RESUSCITATION DOCUMENTED
URINE OUTPUT
ON GOING HAEMORRHAGE NOTED
DRAIN, PAD
RESULTS TRACED STAT
INFORM PATIENT AND RELATIVES
36. Case illustration
A 35 year old Malay lady in her 4th pregnancy, had
a history of PPH in her previous pregnancies. She
was diagnosed to have pre eclampsia during this
pregnancy and was on oral antihypertensive
medication. At 38 weeks of gestation she was
admitted to a private facility and was induced with
prostaglandins.
37. The labour was uneventful and she delivered a 3.9kg
baby. There was massive bleeding after her delivery.
Exploration did not reveal any retained products.
The uterus remained atonic despite repeated
injections of ergometrine and an oxytocin infusion.
No blood or blood products were available.
38. She was transferred to a general hospital for further
resuscitation but arrived in a moribund state and
succumbed soon after.
39. Case illustration
A 30 year Malay lady in her third pregnancy at 38
weeks of gestation came in labour at a district
hospital. Her antenatal period had been uneventful.
She delivered vaginally at 7.02pm. Active
management of 3rd stage instituted and the placenta
was delivered via CCT. Her delivery was conducted
by a staff nurse.
40. After the placenta was delivered it was noted that
there was active bleeding from the vagina. A green
branula was inserted and the on-call doctor was
informed. Over the phone the doctor ordered for
uterine massage to be done, to give patient iv
ergometrine 0.5mg and iv Pitocin 40 unit in
500mls NS started while awaiting for him to come.
41. On examination, the patient was alert, the blood
pressure was normal but the pulse rate was 96b/min.
Abdominal examination done showed that the uterus
was contracted.Despite that the patient was still
actively bleeding. Another iv line was inserted and
blood was sent for FBC, GXM and PT/PTT. She was
given NS running fast.
42. Another doctor was called to help manage the patient.
Further examination showed a cervical laceration which the
doctor tried to repair but failed. The patient continued to
bleed, so vaginal packing was done and she was planned for
transferred to the general hospital.The placenta was also
re-examine for it’s completeness. By this time, the patient’s
blood loss was about 1 L. the patient was conscious but
lethargic, her BP was 90/60mmHg and PR was 110b/min.
43. While awaiting for arrangements for transfer to the referral
center to be made, another 2 iv lines inserted and she was
rapidly infused with NS and later transfused with blood. A
Foley’s catheter was inserted to monitor urine output and
her vital signs was monitored every 15 minutes.
44. She arrived at the general hospital at 10.20pm
accompanied by a doctor and 2 staff. Upon arrival
the estimated blood loss was about 2L and she had
4 iv lines (all green). 2 unit of blood has already
been transfused plus the crystalloids and the 3rd
and 4th unit of blood transfusion was still in
progress.
45. Examination upon arrival showed very pale patient,
drowsy but still responding to call, the BP was
80/40mmHg and the PR was 130b/min. The uterus
was contracted and she was still actively bleeding
from the vagina.
46. EUA was done and the cervical laceration was
sutured. Despite that patient continued to bleed. A
laparotomy was done and it showed that there was
another cervical laceration which extended up to the
lower segment of the uterus. As it was not able to be
repaired, a hysterectomy was performed.
47. Post operatively she was managed for 2 days in ICU.
The estimated blood loss through out was 5.4L and
she was transfused a total of 21 unit of blood and 4
cycles of DIVC regime. She was discharged well on
day 6 post delivery.