This document discusses Rh (Rhesus) isoimmunization, which occurs when an Rh-negative pregnant mother develops antibodies against Rh-positive fetal blood cells. The key points are:
- Anti-D antibody is the most common cause, though anti-Kell, anti-c and anti-E can also cause hemolytic disease of the newborn.
- MCA Doppler of the fetal brain and amniocentesis to measure bilirubin levels (delta OD450) can assess the severity of fetal anemia.
- Prevention involves administering Rhogam prophylaxis to sensitized mothers during and after pregnancy to prevent antibody development.
- Clinical management may include monitoring antibody tit
This presentation describes in detail about managing Rh negative pregnancy- to identify and manage Rh non-isommunized and Rh isoimmunized pregnancies, with recent advances
This ppt may help in understanding Rh negative women during pregnancy, labour and postpartum. Great advancements have been made in the detection and management of this condition, and many of our Rh-negative women can now have a happy obstetric career.
This presentation describes in detail about managing Rh negative pregnancy- to identify and manage Rh non-isommunized and Rh isoimmunized pregnancies, with recent advances
This ppt may help in understanding Rh negative women during pregnancy, labour and postpartum. Great advancements have been made in the detection and management of this condition, and many of our Rh-negative women can now have a happy obstetric career.
Rh incompatibility or iso-immunization is very uncommon. This presentation deals with some basics about blood groups and pathogenesis of it. This will be useful for under and postgraduates in the field of obstetrics.
Keith Moore Said "It has been a great pleasure for me to help clarify statements in the Qur'an about human development. It is clear to me that these statements must have come to Muhammad from God, or Allah, because most of this knowledge was not discovered until many centuries later. This proves to me that Muhammad must have been a messenger of God, or Allah."
Rh incompatibility or iso-immunization is very uncommon. This presentation deals with some basics about blood groups and pathogenesis of it. This will be useful for under and postgraduates in the field of obstetrics.
Keith Moore Said "It has been a great pleasure for me to help clarify statements in the Qur'an about human development. It is clear to me that these statements must have come to Muhammad from God, or Allah, because most of this knowledge was not discovered until many centuries later. This proves to me that Muhammad must have been a messenger of God, or Allah."
A presentation on Medically Indicated Deliveries Before 39 weeks.
Includes updated information from ACOG.
Medically indicated late-preterm and early-term deliveries. Committee Opinion No. 560. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:908–10.
A preliminary proposal for an application to the Health Care Innovation Challenge sponsored by CMS. Focus of this proposal include gestational diabetes, maternal obesity, postpartum weight loss, and as well as patient engagement / health literacy
This lecture was originally given as a Prezi presentation at the Women & Infant's OB Conference for Dekalb Medical Center on March 7th, 2011. A full copy of the prezi can be found here: http://prezi.com/wrpz-mgq-nio/hypertensive-emergencies-in-obstetrics/
A brief presentation on some of the factors thought to be related to severe nausea and vomiting during pregnancy (Hyperemesis Gravidarum) with ways to treat this condition.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
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
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.
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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
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.
1. Chukwuma I. Onyeije, M.D. Atlanta Perinatal Associates Rh (Rhesus) Isoimmunization:Perinatal Implications and Management
2. A copy of this lecture can also be found at:http://onyeije.net/present/rhdis
3. Objectives Review Terminology Review Major Blood Group Antigens Review Minor Blood group antigens Overview of Clinical Management Discuss Prevention Strategies Q&A
9. INTRODUCTION: Four blood types ( A, B, AB, and O) Each blood type is additionally classified according to the presence or absence of the Rh factor
10. Rh Incompatibility Occurs when there is a different Rh blood type between that of the pregnant mother (Rh negative) and that of the fetus (Rh positive)
18. Pathophysiology After first antigenic exposure, memory B lymphocytes recognize appearance of RBC’s containing the antigen in subsequent pregnancies
19. Pathophysiology- Fetal Events Maternal antibodies cross the placenta & attach to fetal RBC’s- leading to RBC destruction Sequestration by macrophages in fetal spleen (extravascularhemolysis) produces fetal anemia
24. CDE (Rhesus) System Clinically Important Includes c, C, D, e, E Rh negative status indicates the absence of D antigen 87% of Caucasians carry the D antigen
25. Other Antibodies Antigens such as A, P, Le (a), M, I, IH, and Sd (a) are innocuous Most are IgM Lewis antibodies and cold agglutinins of I are prevalent but not clinically significant “Lewis Lives”
27. Antibodies Associated with HDFN RhoGAM has decreased HDFN caused by anti-D Anti-D antibody is still MOST COMMON CAUSE of red cell isoimmunization
28. Minor RBC Antigens Kell is most common of minor Responsible for 10% of cases of severe antibody-mediated anemia Mechanism of anemia two-fold 1. Hemolysis 2. Suppression of erythropoiesis **Transfuse women with Kell(-) blood**
29. Minor RBC Antigens Duffy antigens Fy(a) and Fy(b) Only anti-Fy(a) antibody associated with HDFN- may range from mild to severe “Duffy Dies” We treat sensitization to minor RBC antigens similar to those with Rhisoimmunization
30. Minor Antigens MNS system = M, N, S, s, U antigens Anti-M and anti-N naturally occurring- no clinical significance Anti-S, anti-s, and anti-U antibodies ~ mild to severe HDFN
31. Clinical Management Routine blood type screen Repeat Ab screen at 24-28 weeks for Rhnegative women PRIOR to receiving RhoGAM If Abscreen is (+), identify antibody and potential for HDFN
32. Clinical Management For Positive Antibody Screen Determine risk factors for isoimmunization Past pregnancies Transfusions Shared needles Determine father’s RBC antigen status and zygosity If paternity unknown or father is (+) for antigen, fetus is at RISK
33. Clinical Management For Positive Antibody Screen Obtain antibody titer Consider invasive testing at titer of 1:32 or greater by indirect Coombs (1:16 most often used)
34. Clinical Management For Positive Antibody Screen If AB titer remains below critical titer… Invasive testing can be deferred Evaluate serial Ab titers Serial titers are NOT necessary before 18-20 weeks If critical titer noted at first visit, amnio for delta OD450 at 22-24 weeks
35. Clinical Management Fetal Testing Obtain amniocytes to determine fetal blood type When father is heterozygous for the antigen responsible for alloimmunization When paternal status is unknown MCA-PSV can be used as early as 18 weeks~ if greater than 1.5 MoM, consider fetal blood sampling
37. The Middle Cerebral Artery Should be examined close to its origin in the internal carotid artery. The angle of the ultrasound beam and the direction of blood flow should be zero degrees. The risk of anemia is highest in fetuses with a peak systolic velocity of 1.5 times the median or higher.
38.
39. MCA Doppler and Fetal Anemia Fetuses with anemia show an increased peak velocity of systolic blood flow in the middle cerebral artery (MCA) MCA Doppler is useful in the determination of fetal anemia in Rh-isoimmunizedpregnancies MCA Doppler is also used to follow fetal response to intrauterine transfusion and to assist in timing subsequent transfusions.
40. MCA Doppler and Fetal Anemia Method: MCA closest to the maternal skin should be measured using a minimal angle of insonation The Doppler gate is placed over the vessel as it bifurcates from the carotid siphon. Serial MCA Doppler studies can be used to generate a curve that plots MCA peak systolic velocity as a function of gestational age. After 35 weeks' gestation, accuracy in determining MCA PSV appears to decrease; therefore, at this gestational age amniocentesis for deltaOD450 is indicated.
41. Clinical Management (cont) Perform serial amniocenteses to measure delta OD450 AND Plot values on Liley Curve “Belt and Suspenders” Approach
42. Delta OD450 Spectral analysis of amniotic fluid at 450 nm measures change in OD Measures the level of bilirubin and predicts severity of hemolytic disease after 27 weeks Delivery or intrauterine transfusion if delta OD450 falls into zone III or upper zone II
44. Cordocentesis Gold standard for detection of fetal anemia Complications 2.7% total risk of fetal loss Reserved for patients with increased MCA-PSV or delta OD450
45. Advantages of MCA-PSV Non-invasive NO risk for worsening isoimmunization Utility with alloantibodies other than Rh-D, including anti-Kell antibodies
47. Review of Management for RhIsoimmunization Monthly indirect coombs titer (in first sensitized pregnancy) If critical titer reached, determine paternal and fetal antigen status Amniocentesis and delta OD450 OR MCA-PSV ** For 2nd or greater sensitized pregnancy, initiate amnio or MCA at 18-20 weeks**
48. Prevention (cont) Give 300 mcg dose within 72 hrs of delivery to unsensitizedRh (-) women (Rh positive infant) ACOG: 300 mcg at 28 weeks UNLESS father known to be Rh(-)
49.
50. Prevention Test for excessive fetal-maternal hemorrhage after blunt trauma, abruption, cordocentesis, and bleeding assoc. with previa KleihauerBetke Give RhoGAM for partial molar pregnancy, SAB, TAB, ectopic, chorionic villus sampling, amniocentesis, external version
51. SUMMARY Remember the instances in which to consider RhoGAM SAB, TAB, threatened AB (controversial), ectopic, previa/bleeding, abruption, partial molar, CVS, blunt trauma, cordocentesis Clinically important antibodies: Anti-c, Anti-D, Anti-E, and Anti-Kell, Rarely Anti-Duffy Fy(a) Usually not associated with severe HDFN: , ABO incompatibilities, Anti-Duffy(Fy-b) antibodies, (Duffy Fy-a causes mild to severe HDFN), Anti-A, Anti-P, Anti-M, Anti-I, Anti-IH, Anti-Sd(a)
52. SUMMARY Anti-D still most common cause of red cell alloimmunization, despite RhoGAM Kell = most common minorantigen Critical titer most often used is 1:16 by indirect Coombs Amnio with delta OD450 & MCA-PSV Antibody screens and indications for RhoGAM
53. References Gabbe Obstetrics – Normal and Problem Pregnancies, 4th edition. Creasy R., Resnik R., Iams J., Maternal Fetal Medicine Principles and Practice, 5th edition. ACOG Compendium 2005 Harkness U., Spinnato J., Prevention and Management of RhDisoimmunization. Clinics in Perinatology, Dec 2004 31:4. Pereira L., Jenkins T., Conventional management of maternal red cell alloimmunization compared with management by Doppler assessment of MCA-PSV. American Journal of Obstetrics and Gynecology, Oct 2003 189:4. Cohen D., Hemolytic disease of the newborn: RBC alloantibodies in pregnancy and associated serologic issues. Up to Date, Oct 2004. Barss V., Moise K., Significance of minor red blood cell antibodies during pregnancy. Up to Date, Apr 2005. Online resources: www.austincc.edu/mlt/bb/bb_HDN.ppt http://www.perinatology.com/Archive/Isoimmunization.htm http://emedicine.medscape.com/article/273995-overview http://www.nlm.nih.gov/medlineplus/ency/article/001600.htm
54.
55. Kleihauer-Betke Test % fetal RBC in maternal circulation Fetal erythrocytes contain Hbg F which is more resistant to acid elution than HbgA so after exposure to acid, only fetal cells remain & can be identified with stain 1/1000 deliveries result in fetal hemorrhage > 30ml Risk factors only identify 50%
56.
57. Kleihauer Calculations Fetal red cells = MBV X maternal Hct X % fetal cells in KB newborn Hct MBV – maternal blood volume (usually 5000ml) Fetal cells X 2 = whole blood