The document discusses retained placenta, which is the failure to deliver the placenta within 30 minutes of childbirth. It defines different types of morbidly adherent placentas such as placenta accreta, increta, and percreta. Risk factors include previous C-sections and placenta previa. The steps for manual removal of the retained placenta are outlined, including giving anesthesia, antibiotics, and oxytocics. Complications from a retained placenta include hemorrhage, infection, and rarely hysterectomy. Active management of the third stage of labor can help prevent retained placenta.
Retained placenta can be defined as lack of placental expulsion within 30 minutes of delivery of an infant. it is more common in preterm. Retained Placenta can lead to massive PPH and increase maternal morbidity and mortality.
Retained placenta can be defined as lack of placental expulsion within 30 minutes of delivery of an infant. it is more common in preterm. Retained Placenta can lead to massive PPH and increase maternal morbidity and mortality.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
physiology of labor includes the contraction and retraction of the muscles of uterus. I hope this presentation will help the persons of concerned subject.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
physiology of labor includes the contraction and retraction of the muscles of uterus. I hope this presentation will help the persons of concerned subject.
Hope it helps.. This presentation describes about labour induction, its types, methods, management and responsibilities. also the procedure of performing the methods. pictures as per need attached for the reference. like and comment if any suggestion.
INTRODUCTION
DEFINITION
TYPES
CAUSES
MANAGEMENT-Management of 3rd stage bleeding
Actual management
MANAGEMENT OF 3RD STAGE BLEEDING
Steps of management
1. Placental site bleeding-
To palpate the fundus and massage the uterus to make it hard. The massage is to be done by placing four fingers behind the uterus and thumb in front.
To start crystalloid solution (NS or RL) with oxytocin (1L with 20 units) at 60 drops per minute and to arrange for blood transfusion if necessary.
Oxytocin 10 unit IM or methergine 0.2 mg is given intravenously.
To catheterize the bladder.
To give antibiotics (Ampicillin 2gm and Metronidazole 500mg IV)
2. Management of traumatic bleed
The uterovaginal canal is to be explored under general anesthesia after the placenta is expelled and haemostatic sutures are placed on the offending sites.
STEPS OF MANUAL REMOVAL OF PLACENTA
The patient is placed in lithotomy position. With all aseptic measures, the bladder is catheterized.
One hand is introduced into the uterus in cone shaped manner following the cord. While introducing the hand, the labia are separated by the fingers at the other hand.
Counter pressure on the uterine fundus is applied by the hand placed over the abdomens. The abdominal hand should steady the fundus and guide the movement of the fingers inside the uterine cavity till the placenta is completely separated.
The placenta is said to be retained when it is not expelled from the uterus even 30 minutes after the delivery of the baby
Manual placenta removal is a procedure to remove a retained placenta from the uterus after childbirth.
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
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
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
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.
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. Failure of placental delivery
within 30 minutes after
delivery of the fetus.
Longer the placenta remains
in uterus after delivery of
baby, the greater is the risk
of PPH
2
Nirsuba Gurung MSON
3. Morbid Adherence of the placenta
Placenta Acreta (Placenta Accreta occurs
when the placenta attaches too deep in the
uterine wall but it does not penetrate the
uterine muscle. Placenta accreta is the most
common accounting for approximately 75% of
all cases.)
Placenta Increta (Placenta Increta occurs
when the placenta attaches even deeper into
the uterine wall and does penetrate into the
uterine muscle. Placenta increta accounts for
approximately 15% of all cases.) 3
Nirsuba Gurung MSON
4. Placenta Percreta
(Placenta Increta occurs when the placenta
attaches even deeper into the uterine wall and
does penetrate into the uterine muscle. Placenta
increta accounts for approximately 15% of all
cases.)
Uterine Abnormality ,uterine atony
Constriction Ring - reforming cervix
Full bladder
Nirsuba Gurung MSON 4
5. If the placenta is undelivered after 30 minutes
consider:
Emptying bladder
Breastfeeding or nipple stimulation
Change of position - encourage an upright
position
The management is done according to condition of
placenta as
Seperated
Unseparated
complicated
If the placenta is separated and retained
:express placenta by controlled cord traction
Unseparated retained placenta :manual removal
of placenta under general anesthasia 5Nirsuba Gurung MSON
6. Inform Anaesthetist
Insertion of large bore IV (18g) cannula
Insert urinary catheter
Commence/continue oxytocin infusion 20
units in 1 litre / rate – 60drops per
min
Measure and accurately record blood
loss
Prepare and transfer patient to theatre
for manual removal of placenta (MROP)
Nirsuba Gurung MSON 6
8. Manual placenta removal is a procedure to
remove a retained placenta from the uterus
after childbirth
9. Take blood for grouping and cross match and
send for hemoglobin if it has not been done
• Tell the woman (and her support person)
what is going to be done, listen to her and
respond attentively to her questions and
concerns.
• Provide continual emotional support and
reassurance, as feasible.
Nirsuba Gurung MSON 9
10. • Prepare the necessary equipment
• Antiseptic solution
• Sterile gloves
Blood and subtitutes
Anasthesia and analgesics
Ergometrine and oxytocin
Antibiotics
11. Give anesthesia (IV pethidine (25-50mg) and
diazepam (10 mg), or ketamine
Give a single dose of prophylactic antibiotics:
Ampicillin 2 g IV PLUS metronidazole 500 mg IV,
OR
Cefazolin 1 g IV PLUS metronidazole 500 mg IV
Put on personal protective equipment.
12. Use antiseptic handrub or wash hands and
forearms thoroughly with soap and water and
dry with a sterile cloth or air dry.
Put high-level disinfected or sterile surgical
gloves on both hands. (Note: elbow-length
gloves should be used, if available.)
Hold the umbilical cord with a clamp
Pull the cord gently until it is parallel to the floor
13. Place the fingers of one
hand into the vagina ih
the shape of cone by
drawing the fingers and
the thumb together and
into the uterine cavity,
following the direction
of the cord until the
placenta is located.
Do not go in and out of
the uterus as these
increase the risk of
infection
14. When the placenta has
been located, let go of the
cord and move that hand
onto the abdomen to
support the fundus
abdominally and to provide
counter-traction to
prevent uterine inversion
Move the fingers of the
hand in the uterus
laterally until the edge of
the placenta is located.
Nirsuba Gurung
MSON 14
Supporting the fundus while
detaching the placenta
15. Keeping the fingers
tightly together, ease
the edge of the hand
gently between the
placenta and the uterine
wall, with the palm
facing the placenta.
Gradually move the hand
back and forth in a
smooth lateral motion
until the whole placenta
is separated from the
uterine wall:
Withdrawing the hand
from the uterus
16. If the placenta does not separate from
the uterine wall by gentle lateral
movement of the fingers at the line of
cleavage, suspect placenta accreta and
arrange for surgical intervention
16Nirsuba Gurung MSON
17. When the placenta is completely
separated:
Palpate the inside of the uterine cavity
to ensure that all placental tissue has
been removed.
Slowly withdraw the hand from the
uterus bringing the placenta with it.
Continue to provide counter-traction
to the fundus by pushing it in the
opposite direction of the hand that is
being withdrawn.
18. Give oxytocin 20 units in 1 L IV fluid (normal
saline or Ringer’s lactate) at 60 drops/minute.
Have an assistant massage the fundus to
encourage atonic uterine contraction.
If there is continued heavy bleeding, give
ergometrine 0.2 mg IM or give prostaglandins.
Examine the uterine surface of the placenta to
ensure that it is complete.
Examine the woman carefully and repair any tears
to the cervix or vagina, or repair episiotomy.
19. Immerse both gloved hands in 0.5%
chlorine solution. Remove gloves by
turning them inside out.
If disposing of gloves, place them in a
leak proof container or plastic bag.
If reusing surgical gloves, submerge
them in 0.5% chlorine solution for 10
minutes for decontamination
20. Use antiseptic hand rub or wash hands thoroughly
with soap and water and dry with a clean, dry
cloth or air dry.
Monitor vaginal bleeding and take the woman’s
vital signs:
Every 15 minutes for 1 hour
Then every 30 minutes for 2 hours
Make sure that the uterus is firmly contracted.
Record procedure and findings on woman’s record.
21. Observe the woman closely until the
effect of IV sedation has worn off.
Monitor the vital signs (pulse, blood
pressure, respiration) every 30 minutes
for the next 6 hours or until stable.
Palpate the uterine fundus to ensure
that the uterus remains contracted.
Check for excessive lochia.
Continue infusion of IV fluids.
Transfuse as necessary.
21Nirsuba Gurung MSON
23. Umbilical vein injection of saline solution
plus oxytocin appears to be effective in
the management of retained placenta.
Saline solution alone does not appear be
more effective than expectant
management. The difficulties in
implementing this intervention are related
to the training of personnel in the
technique of giving injections into the
umbilical vein.
23Nirsuba Gurung MSON
24. The incidence of placenta accreta
has increased 10-fold10-fold in thein the
past 50 yearspast 50 years, to a current
frequency of 1 per 2,5001 per 2,500
deliveriesdeliveries.
largely as a result of the
increase in the number ofincrease in the number of
cesarean sectionscesarean sections
24Nirsuba Gurung MSON
25. Risk factors for placenta accreta include :
1. placenta previa with or without previous
uterine surgery.
2. previous myomectomy.
3. previous cesarean delivery.
4. submucous leiomyomata.
5. maternal age of 36 years and older.
25Nirsuba Gurung MSON
26. Active Mx of third stage can
prevent & reduce the incidence of
retained placenta.
In case of risk factors,always
consider placenta accreta & L/f
usg/doppler features in antenatal
period & plan accordingly.
26Nirsuba Gurung MSON