This document summarizes the role of progesterone in preventing preterm labor. It discusses international guidelines that recommend daily progesterone supplementation for women with a prior preterm birth or short cervix. Studies show progesterone is effective at maintaining uterine quiescence and preventing preterm birth by regulating stress hormones and limiting prostaglandin production. Progesterone reduces the risk of preterm birth in women with a short cervix, prior preterm birth, or twin gestation with short cervix. It may also be beneficial for maintenance tocolysis after arrested preterm labor when compared to placebo or no treatment.
Dr Sujoy Dasgupta was invited to deliver a lecture at BOGSCON (The Annual Conference of Bengal Obstetric and Gynaecological Society) held at Kolkata in December 2019
Dr Sujoy Dasgupta was invited to deliver a lecture at BOGSCON (The Annual Conference of Bengal Obstetric and Gynaecological Society) held at Kolkata in December 2019
Preterm birth & role of progesterone by dr alka mukherjee dr apurva mukherjee...alka mukherjee
• Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising.
• Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for approximately 1 million deaths in 2015 (1).
• Three-quarters of these deaths could be prevented with current, cost-effective interventions.
• Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born.
Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. There are sub-categories of preterm birth, based on gestational age:
• extremely preterm (less than 28 weeks)
• very preterm (28 to 32 weeks)
• moderate to late preterm (32 to 37 weeks).
Preventing deaths and complications from preterm birth starts with a healthy pregnancy. Quality care before, between and during pregnancies will ensure all women have a positive pregnancy experience. WHO’s antenatal care guidelines include key interventions to help prevent preterm birth, such as counselling on healthy diet and optimal nutrition, and tobacco and substance use; fetal measurements including use of ultrasound to help determine gestational age and detect multiple pregnancies; and a minimum of 8 contacts with health professionals throughout pregnancy to identify and manage other risk factors, such as infections. Better access to contraceptives and increased empowerment could also help reduce preterm births.
Preterm birth occurs for a variety of reasons. Most preterm births happen spontaneously, but some are due to early induction of labour or caesarean birth, whether for medical or non-medical reasons.
Common causes of preterm birth include multiple pregnancies, infections and chronic conditions such as diabetes and high blood pressure; however, often no cause is identified. There could also be a genetic influence. Better understanding of the causes and mechanisms will advance the development of solutions to prevent preterm birth.
More than 60% of preterm births occur in Africa and South Asia, but preterm birth is truly a global problem. In the lower-income countries, on average, 12% of babies are born too early compared with 9% in higher-income countries. Within countries, poorer families are at higher risk.
Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period.
This Presentation is made by Dr.Laxmi Shrikhande
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Antenatal care is the routine health control of presumed healthy pregnant women without symptoms (screening), in order to diagnose diseases or complicating obstetric conditions without symptoms and to provide information about lifestyle, pregnancy and delivery.
Role of progestogens in obstetrics and gynecologyAhmad Saber
The
different progestogens with their overlapping effects on estrogen, androgen, glucocorticoid,
and mineralocorticoid receptors are described in order to allow the clinician to make the most appropriate choice of progestogen.
Role of adjuvants in poor ovarian responders , undergoing infertility treatment , in terms of Intra uterine inseminations ( IUI ) to In Vitro Fertilization ( IVF )
Recurrent pregnancy loss - Uterine factorsAnu Manivannan
recurrent pregnancy loss - uterine factors based on fertility sterility journal - evidence based
Dr.Anu.M - Mch Resident - Department of Reproductive Medicine and Surgery
nitric oxide, preterm labour, preeclampsia, Eclampsia, pregnancy induced hypertention, myometrium, labour process, ripening of cervix, tocolytic drug, onset of labour
Pre-term labour, could it be predicted?
Pre-term labour (PTL) is defined as labour less than 37 completed weeks or 259 days. 15 million PT babies are delivered annually worldwide with a global rate of about 11% with rising trends in most countries. This represents a serious health and economic challenge.
The objective of early prediction of PTL is to Identify women at risk so, delaying preterm birth by Interventions long enough to optimize the outcome for the fetus.
Prediction could be done by:
-Pre-conceptual/early prenatal evaluation
- Prenatal Ultrasound markers
- Biomarker predictors
Highlights on diagnosing PTL for women with intact membranes and preterm prelabour rupture of membranes (P-PROM) will be presented plus recommended prophylactic interventions as prophylactic vaginal progesterone, prophylactic cervical cerclage & 'Rescue' cervical cerclage. Treatment essentials of PTL include tocolysis, maternal corticosteroids & Magnesium Sulphate.
Role of Dydrogesterone in Threatened Abortion Dr Sharda Jain Lifecare Centre
*EXPERINCE SHARING By EXPERTS*
Dr Uma Rai(DGF *E*)
Dr Sangeetaa Gupta(DGF *E*)
Dr Neerja Varshney(DGF *E*)
Dr Surjeet Kapoor(DGF *E*)
Dr Rupam arora(DGF *E*)
Dr Meenakshi Ahuja(DGF *S* )
Dr.Harsha khullar(DGF *C* )
Dr Mamta mittal(DGF *N*)
Dr Leena Sreedhar(DGF *D*)
Dr.Dipti Nabh(DGF *E*)
Dr. Shama Batra(DGF *E*)
Dr Poonam Paul(DGF *SW*)
PAN DGF ( DELHI GYNAECOLOGIST FORUM) CME ON DYDROGESTERONE ON 3/2 /22
Preterm birth & role of progesterone by dr alka mukherjee dr apurva mukherjee...alka mukherjee
• Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising.
• Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for approximately 1 million deaths in 2015 (1).
• Three-quarters of these deaths could be prevented with current, cost-effective interventions.
• Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born.
Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. There are sub-categories of preterm birth, based on gestational age:
• extremely preterm (less than 28 weeks)
• very preterm (28 to 32 weeks)
• moderate to late preterm (32 to 37 weeks).
Preventing deaths and complications from preterm birth starts with a healthy pregnancy. Quality care before, between and during pregnancies will ensure all women have a positive pregnancy experience. WHO’s antenatal care guidelines include key interventions to help prevent preterm birth, such as counselling on healthy diet and optimal nutrition, and tobacco and substance use; fetal measurements including use of ultrasound to help determine gestational age and detect multiple pregnancies; and a minimum of 8 contacts with health professionals throughout pregnancy to identify and manage other risk factors, such as infections. Better access to contraceptives and increased empowerment could also help reduce preterm births.
Preterm birth occurs for a variety of reasons. Most preterm births happen spontaneously, but some are due to early induction of labour or caesarean birth, whether for medical or non-medical reasons.
Common causes of preterm birth include multiple pregnancies, infections and chronic conditions such as diabetes and high blood pressure; however, often no cause is identified. There could also be a genetic influence. Better understanding of the causes and mechanisms will advance the development of solutions to prevent preterm birth.
More than 60% of preterm births occur in Africa and South Asia, but preterm birth is truly a global problem. In the lower-income countries, on average, 12% of babies are born too early compared with 9% in higher-income countries. Within countries, poorer families are at higher risk.
Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period.
This Presentation is made by Dr.Laxmi Shrikhande
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Antenatal care is the routine health control of presumed healthy pregnant women without symptoms (screening), in order to diagnose diseases or complicating obstetric conditions without symptoms and to provide information about lifestyle, pregnancy and delivery.
Role of progestogens in obstetrics and gynecologyAhmad Saber
The
different progestogens with their overlapping effects on estrogen, androgen, glucocorticoid,
and mineralocorticoid receptors are described in order to allow the clinician to make the most appropriate choice of progestogen.
Role of adjuvants in poor ovarian responders , undergoing infertility treatment , in terms of Intra uterine inseminations ( IUI ) to In Vitro Fertilization ( IVF )
Recurrent pregnancy loss - Uterine factorsAnu Manivannan
recurrent pregnancy loss - uterine factors based on fertility sterility journal - evidence based
Dr.Anu.M - Mch Resident - Department of Reproductive Medicine and Surgery
nitric oxide, preterm labour, preeclampsia, Eclampsia, pregnancy induced hypertention, myometrium, labour process, ripening of cervix, tocolytic drug, onset of labour
Pre-term labour, could it be predicted?
Pre-term labour (PTL) is defined as labour less than 37 completed weeks or 259 days. 15 million PT babies are delivered annually worldwide with a global rate of about 11% with rising trends in most countries. This represents a serious health and economic challenge.
The objective of early prediction of PTL is to Identify women at risk so, delaying preterm birth by Interventions long enough to optimize the outcome for the fetus.
Prediction could be done by:
-Pre-conceptual/early prenatal evaluation
- Prenatal Ultrasound markers
- Biomarker predictors
Highlights on diagnosing PTL for women with intact membranes and preterm prelabour rupture of membranes (P-PROM) will be presented plus recommended prophylactic interventions as prophylactic vaginal progesterone, prophylactic cervical cerclage & 'Rescue' cervical cerclage. Treatment essentials of PTL include tocolysis, maternal corticosteroids & Magnesium Sulphate.
Role of Dydrogesterone in Threatened Abortion Dr Sharda Jain Lifecare Centre
*EXPERINCE SHARING By EXPERTS*
Dr Uma Rai(DGF *E*)
Dr Sangeetaa Gupta(DGF *E*)
Dr Neerja Varshney(DGF *E*)
Dr Surjeet Kapoor(DGF *E*)
Dr Rupam arora(DGF *E*)
Dr Meenakshi Ahuja(DGF *S* )
Dr.Harsha khullar(DGF *C* )
Dr Mamta mittal(DGF *N*)
Dr Leena Sreedhar(DGF *D*)
Dr.Dipti Nabh(DGF *E*)
Dr. Shama Batra(DGF *E*)
Dr Poonam Paul(DGF *SW*)
PAN DGF ( DELHI GYNAECOLOGIST FORUM) CME ON DYDROGESTERONE ON 3/2 /22
Abstract— Cervical ripening is an essential factor for initiation of normal labour for vaginal delivery. Prior to onset of spontaneous labour the cervix undergoes a gradual process of ripening. But in certain cases it does not occur spontaneously at term and sometimes induction of labour is required. Then cervical ripening means high bishop score in essential for successful induction of labour. This comparative study was conducted at Bikaner to compare induction of labour by vaginal prostaglandin E1 tablet (tablet Misoprostol 25 µg 4 hourly) and Intra cervical Dinoprostone gel 0.5 mg. For this purpose 100 clients were given vaginal prostaglandin E1 tablet (tablet Misoprostol 25 µg 4 hourly) and 100 clients were given Intra cervical Dinoprostone gel 0.5 mg. It was observed in this study that Dinoprostone gel is more efficacious for cervical ripening and labour induction in cases of nulliparous & primiparous at term with unfavourable cervix with intact membranes, as compared to misoprostol in terms of shorter total duration of labour, shorter mean induction delivery interval, more spontaneous vaginal deliveries, and reduced incidence of LSCS as well as instrumental deliveries.
Invited lecture by Dr Sujoy dasgupta in the Annual Conference of the "Academy of Clinical Embryologists" (ACE) held in October 2021 in "Hybrid mode" (Kolkata and Webinar)
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Case Report on Invasive Mole. Gestational Trophoblastic Neoplasia (GTN) encom...Niranjan Chavan
Gestational Trophoblastic Neoplasia (GTN) encompasses a suite of rare but significant gynecological malignancies arising from aberrant placental trophoblast cells. As medical professionals and researchers, our comprehension of GTN's complexities is crucial for accurate diagnosis and effective treatment. This introduction serves to illuminate the key features, diagnostic procedures, and treatment protocols associated with GTN, helping to navigate the intricate landscape of this disease.
Peripartum cardiomyopathy (PPCM) is a rare form of heart failure that occurs during the last month of pregnancy or within the first five months postpartum. It presents significant challenges in diagnosis and treatment due to its overlap with symptoms of normal pregnancy and postpartum changes. This condition varies in incidence across different racial groups and geographical locations, with a notable occurrence in the United States and southern India.
DR. NNC LAPAROSCOPY IN PREGNANCY IAGE VARANASI, 17TH MARCH 2024.pptxNiranjan Chavan
Our journey will navigate the evolution of laparoscopy in the context of pregnancy, detailing key milestones, breakthroughs, and advancements in technology and techniques. The presentation highlights how laparoscopy has revolutionized the diagnosis and treatment of conditions such as ectopic pregnancy, ovarian cysts and other gynecological disorders during pregnancy.
Optimising Delivery Of 1kg Fetus - Special Considerations.pptxNiranjan Chavan
After an uncomplicated vaginal birth in a health facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth.
VACCINE IN WOMEN TOWARDS SDG 2030 DR.N N CHAVAN 10012024 AICOG HYDERABAD.pptxNiranjan Chavan
In our presentation today, we will unravel the transformative power of vaccines in women, aligning with the Sustainable Development Goals (SDGs) for 2030. By exploring the pivotal role of vaccinations, we aim to elucidate how they contribute to women's health, empowerment, and overall well-being. Through this lens, we envision a future where widespread vaccine access propels us closer to achieving the SDGs and ensures a healthier, more equitable world for women globally.
RRRR IN OBSTETRIC HEMORRHAGE 09012024 AICOG 2024 HEYDERABAD.pptxNiranjan Chavan
This presentation focuses on a critical aspect of maternal care: "Reducing Maternal Mortality through Rapid Response in Obstetric Haemorrhage" (RRRR). As we navigate through this presentation, let us collectively work towards advancing our understanding and application of RRRR in obstetric care to safeguard the well-being of mothers during childbirth.
Anemia is a condition in which the number of red blood cells and/OR their oxy...Niranjan Chavan
Anemia is a condition in which the number of red blood cells and/OR their
oxygen-carrying capacity is insufficient to meet the body’s physiological needs.
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It ...Niranjan Chavan
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It usually occurs during the third trimester of pregnancy. But it also can develop in the first week after childbirth
Guidelines & Identification of Early Sepsis DR. NN CHAVAN 02122023.pptxNiranjan Chavan
Here is a highly informative session on guidelines and identification of early sepsis as it is critical for timely intervention and improved patient outcomes.
PAST, PRESENT AND FUTURE IN OBGYN INFECTIONS 01102023.pptxNiranjan Chavan
Today, we face new infectious threats; but also benefit from advanced diagnostics and treatments. Looking ahead, it’s crucial to continue
adapting to emerging pathogens, implement stringent preventive measures, and
leverage cutting-edge technologies to ensure the safety and well-being of our patients in the ever-evolving landscape of obstetrics and gynecology.
Vaccination during pregnancy is crucial to protect both the mother and the developing baby. It helps prevent serious complications and ensures a healthier start in life. #VaccinateForTwo 🤰💉
Explore a comprehensive presentation on Invasive Cervical Carcinoma, shedding light on its causes, symptoms, diagnosis, treatment options, and preventive measures.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
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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
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
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.
- 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
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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
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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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.
3. FLOW OF PRESENTATION
• Pre-term labour
• International Guidelines – PTL
• PTL prevention in specific conditions
• Short cervix
• History of pre-term birth
• Twin gestation with short cervix
• Maintenance tocolysis
• Risk of PTL in IVF/ICSI conceived pregnancies
• Which Progesterone is best?
4. INTRODUCTION – PRE-TERM LABOUR
“Contraction (labour) before 37
weeks gestational age”
World:
• ~15 million preterm births
• Contributes to ~ 1 million
neonatal deaths
India:
• Largest number of preterm
births
• 3.5 million/year
Quinn JA, et al. Vaccine. 2016 Dec 1; 34(49): 6047–6056.
World Health Organization. Preterm birth—fact sheet 363. Nov 2015. www.who.int/
Top 5 countries:
India: 3,519,100
China: 1,172,300
Nigeria: 773,600
Pakistan: 748,100
Indonesia: 675,700
More than 1 in 10
babies born early
5. MAJOR CAUSES OF PRETERM BIRTH
Norwitz ER,et al. Rev Obstet Gynecol. 2011 Summer;4(2):60-72.
6. MECHANISM OF ACTION –
PROGESTERONE IN PREVENTION OF
PTL
At placenta,
Regulates timing
of labour via
controlling stress
hormone – CRH
In amniotic fluid,
Limits
prostaglandin
production
At Myometrium &
cervix,
Suppresses
inflammatory
response and
myometrial
contractility
At fetal membrane,
Blocks pro-inflammatory
cytokines induced
apoptosis, preventing
PRROM
In patients at risk of PTL,
Progesterone Maintains uterine quiescence by acting at all 4 sites1
1. Norwitz E R et al, Rev Obstet Gynecol. 2011;4(2):60-72
7. LATEST INTERNATIONAL GUIDELINES
SOGC 2008
ACOG 2012
StratOG by RCOG 2014
FIGO 2015
NICE guideline 2015
French clinical practice guidelines 2016
European Association of perinatal medicine 2017
Western Australia PTB prevention key initiative 2017
8. INTERNATIONAL GUIDELINES - PTL
8
ACOG guideline, 2012
Recommends2
Daily Progesterone
supplementation in a
woman with history
of prior PTB
Woman without
history of prior PTB
but at risk due to
short cervix (≤20mm
at ≤24 weeks)
SOGC guideline
2008
Recommends3
Daily Progesterone
supplementation
for
• Women with
history of
previous PTB
• Women with
short cervix
(≤15mm at 22-
26 weeks)
StratOG: the RCOG’s
online learning
resource, 2014
Endorses1
Use of Progesterone
as an alternative to
cervical cerclage in
women with previous
preterm delivery or
mid-trimester loss
and a short cervix
(<25mm) on
ultrasound at 20-37
weeks’ gestation
1. Rowe T, J Obstet Gynaecol Can 2014;36(4):291–2
2 Committee on Practice Bulletins—Obstetric, ACOG, Obstet Gynecol. 2012 Oct;120(4):964-73
3. Farine D et al, J Obstet Gynaecol Can 2008;30(1):67–71
9. NICE GUIDELINE PTL, NOV
2015
https://www.nice.org.uk/guidance/ng25/resources/preterm-labour-and-birth-pdf-
10. 2015 FIGO GUIDELINE (INTERNATIONAL
FEDERATION OF GYNECOLOGY AND
OBSTETRICS)
FIGO recommends the following:
1. Sonographic cervical length measurement should be performed in all
pregnant patients at 19–23 6/7 weeks of gestation using transvaginal
ultrasound. This can be done at the same time as the ultrasound
performed for the anatomical survey.
2. Women with a sonographic short cervix (<25 mm) diagnosed in the
mid-trimester should be offered daily vaginal micronized
progesterone treatment for the prevention of preterm birth and
neonatal morbidity.
3. The progesterone formulation to be used is vaginal micronized
progesterone (200 mg vaginal soft capsules) nightly or vaginal
micronized progesterone gel (90 mg) each morning.
4. Universal cervical length screening and vaginal progesterone
treatment (90mg vaginal gel or 200mg micronized vaginal soft
capsules) is a cost-effective model for the prevention of preterm birth.
11. PREGNANCY LOSS: FRENCH CLINICAL
PRACTICE GUIDELINES, 2016
• Among women with a threatened late miscarriage, an
isolated undilated shortened cervix (<25 mm on ultrasound)
and no uterine contractions, daily treatment with vaginal
progesterone up to 34 weeks of gestation is recommended
(Grade A).
• Among women with a threatened late miscarriage and an
isolated undilated shortened cervix (<25 mm on ultrasound),
cerclage is only indicated for those with a history of either
late miscarriage or preterm delivery (Grade A).
European Journal of Obstetrics & Gynecology and Reproductive Biology 201 (2016) 18–26
11
12. PRETERM LABOR AND BIRTH MANAGEMENT:
RECOMMENDATIONS FROM THE EUROPEAN
ASSOCIATION OF PERINATAL MEDICINE 2017
Summary of recommendations
• Sonographic cervical length measurement is
recommended in all pregnant patients regardless of
obstetrical history at 18–23 6/7 weeks of gestation
using transvaginal ultrasound
• Asymptomatic women with a sonographically short
cervix (25 mm) at mid gestation,
• Either with singleton or twin pregnancy and
• Regardless of their obstetrical history should be
offered vaginal progesterone treatment for the
prevention of preterm birth and neonatal
morbidity.
Di Renzo GC et al, J Matern Fetal Neonatal Med. 2017 Sep;30(17):2011-2030.
14. PTL PREVENTION IN SPECIFIC
CONDITIONS
1. Short cervix
2. History of pre-term birth
3. Twin gestation with short cervix
4. Maintenance tocolysis
5. Risk of PTL in IVF/ICSI conceived pregnancies
6. As an alternative to cervical cerclage
15. 1. SHORT CERVIX
• Relative Risk of SPTD < 35 wks by % of cervical length
at 24 wks
Iams JD, et al, N Engl J Med. 1996 Feb 29;334(9):567-72.
17. 1. SHORT CERVIX
• Result
Conclusion:
Intravaginal progesterone enhances preservation of
cervical length in women at high risk for preterm birth.
18. 1. SHORT CERVIX – UPDATED
META-ANALYSIS 2016
• 5 trials, n=974 women
• Inclusion: Women with a singleton gestation and a mid-trimester
sonographic CL ≤25mm
• Progesterone dosage: Progesterone gel 90mg, Progesterone
capsules 200mg or 100mg
19. 1. SHORT CERVIX – UPDATED
META-ANALYSIS 2016
Conclusion:
• This updated systematic review and meta-analysis
reaffirms that vaginal progesterone reduces the risk of
preterm birth and neonatal morbidity and mortality in
women with a singleton gestation and a mid-trimester
CL ≤25mm, without any deleterious effects on
neurodevelopmental outcome.
• Clinicians should continue to perform universal
transvaginal CL screening at 18–24weeks of gestation
in women with a singleton gestation and to offer
vaginal progesterone to those with a CL ≤25mm.
20. 2. PATIENTS WITH PRIOR
PRE-TERM BIRTH
• Risk of recurrent pre-term birth
LS et al,: Epigemiology of preterm birth: Results from a longitudinal study of births in
Norway. In Elder MG: Preterm Labor. London, Butterworths, 1981, p17.
21. ORAL MICRONISED PROGESTERONE
PREVENTS RECURRENT
SPONTANEOUS PTB (RSPB)
• Randomised, double-blind study
• N=33 patients with prior PTB
• Dosage: Oral 400mg progesterone daily from 16 to 34 weeks
Progesterone gp Placebo gp
Recurrent
spontaneous PTB
26.3% 57.1%
Mean serum P4 level
at 28 wks
122.6 pg/mL 90.1 pg/mL
Micronised Progesterone was associated with a trend
toward a reduction in RSPB and an increase in the
maternal serum progesterone
Am J Perinatol. 2011 May;28(5):377-81.
22. Acta Obstet Gynecol Scand. 2013 Feb;92(2):215-22
PROGESTERONE & 17-OHPC FOR
PREVENTION OF PTB
• Prospective randomised study on 580 women with prior history
of PTB
• Duration: Treatment started from 14-18 weeks until 36 weeks
Group Vaginal
Progesterone
(n=238)
Hydroxyprogesteron
e caproate Inj
(n=226)
Formulation 90mg gel daily 250mg IM inj once
weekly
Treatment
compliance
94.1% 90.8%
All deliveries ≥34
weeks
83.4% 74.3%
All deliveries <34
weeks
16.6% 25.7%
Adverse effects 7.5% 14.1%
Vaginal progesterone was more effective than
intramuscular 17-OHPC for the prevention of preterm birth
and had fewer adverse effects
23. 3. TWIN GESTATION WITH
SHORT CERVIX
• Meta-analysis of 6 RCT
• N=303 patients – Twin gestation & short-cervix
25. 3. TWIN GESTATION WITH
SHORT CERVIXResult:
• Vaginal progesterone, compared with placebo/no treatment, was
associated with a statistically significant reduction in the risk of
preterm birth <33weeks’ gestation (31.4% vs 43.1%; RR, 0.69
moderate-quality evidence).
• Vaginal progesterone administration was associated with a
significant decrease in
• The risk of preterm birth <35, <34, <32 and <30weeks’ gestation
(RRs ranging from 0.47 to 0.83),
• Neonatal death (RR, 0.53),
• Respiratory distress syndrome (RR, 0.70),
• Composite neonatal morbidity and mortality (RR, 0.61),
• Use of mechanical ventilation (RR, 0.54) and
• Birth weight<1500 g (RR, 0.53) (all moderate-quality evidence).
26. 3. TWIN GESTATION WITH
SHORT CERVIX
Conclusion:
• Administration of vaginal progesterone to
asymptomatic women with a twin gestation and a
sonographic short cervix in the mid-trimester reduces
the risk of preterm birth occurring at <30 to<35
gestational weeks, neonatal mortality and some
measures of neonatal morbidity, without any
demonstrable deleterious effects on childhood
neurodevelopment.
27. 4. MAINTENANCE TOCOLYSIS AFTER
ARRESTED PRETERM LABOR
• A systematic review and meta-analysis of 9 randomized
controlled trial. (2016)
• Result: Nifedipine and progesterone were used for
maintenance tocolysis.
• Compared to placebo treatment or no treatment,
maintenance tocolysis with progesterone could significantly
prolong the delivery gestational weeks [standard mean
difference (SMD) 1.64; 95% confidence interval (CI), 1.21,
2.07; p < 0.00001], reduce the proportion of patients with
delivery before 37 weeks (risk ratio 0.63; p= 0.001), and
increase the birth weight (SMD 317.71; p < 0.0001).
However, no such benefits were observed after
maintenance tocolysis with nifedipine.
Taiwan J Obstet Gynecol. 2016 Jun;55(3):399-404
28. CONCLUSION
• :
• Our results with maintenance tocolysis with progesterone
may be useful for patients who had an episode of threatened
preterm labor successfully treated with acute tocolytic
therapy.
29. 4. MAINTENANCE TOCOLYSIS
• A double-blind, randomized, placebo-controlled trial
• Patients: Pregnant women at 24–34 weeks of singleton
pregnancy were recruited after successful tocolysis with
nifedipine therapy
• Preterm labor was defined as 4 contractions per 20 minutes
or 8 per 60 minutes associated with progressive change in
cervix or cervical dilation of more than 1 cm or at least 80%
cervical effacement
• All women with threatened preterm labor received
intravenous hydration therapy (500 mL of intravenous
lactated Ringer solution), betamethasone (12 mg
intramuscularly, followed by another 12 mg after 24 hours),
and tocolysis with nifedipine per hospital protocol (initial
dose of 20 mg, followed by 10–20 mg every 4–6 hours)
M. Choudhary et al. / International Journal of Gynecology and Obstetrics 126 (2014) 60–63
30. 4. MAINTENANCE TOCOLYSIS
M. Choudhary et al. / International Journal of Gynecology and Obstetrics 126 (2014) 60–63
30
Tocolytics
Nifedipine tocolysis was
continued until uterine
contractions had subsided for at
least 12 hours. After the arrest
of preterm labor, patients were
recruited for the studywithin 48
hours of acute tocolysis.
Arrested preterm labor was
defined as no uterine
contractions for at least 12
hours on nifedipine tocolysis.
Maintenance Tocolysis
One group was offered 200mg
Oral Micronised Progesterone
daily, other group was offered
placebo
31. 4. MAINTENANCE
TOCOLYSIS
Result
• The mean latency period was significantly longer in Progesterone
group (33.29 ± 22.16 vs 23.07 ± 15.42 days; P = 0.013).
M. Choudhary et al. / International Journal of Gynecology and Obstetrics 126 (2014) 60–63
32.
33. 5. RISK OF PTL IN IVF/ICSI CONCEIVED
PREGNANCIES
• The frequency of spontaneous preterm birth is higher in singleton
pregnancies conceived by IVF/ICSI as compared with
spontaneously conceived singleton pregnancies.
• In twin IVF/ICSI pregnancy, there is a 10-fold increased age and
parity-adjusted risk of delivery before 37 weeks and 7.4-fold
increased risk before 32 weeks as compared with singleton
pregnancy
• N=250 pregnant IVF/ICSI patients
• Dosage: 200mg BID
Reprod Biomed Online. 2012 Aug;25(2):133-8.
34. 5. RISK OF PTL IN IVF/ICSI
CONCEIVED PREGNANCIES
35. Conclusion
The administration of 400 mg vaginal natural
progesterone from mid trimester reduced the incidence
of preterm birth in singleton, but not in twin, IVF/ICSI
pregnancies.
37. Rowe T, J Obstet Gynaecol Can 2014;36(4):291–2
6. PROGESTERONE AS AN
ALTERNATIVE TO CERVICAL
CERCLAGE
StratOG: the RCOG’s online learning resource, 2014 endorses1
Use of Progesterone as an alternative to cervical cerclage in women
with previous preterm delivery or mid-trimester loss and a short
cervix (<25mm) on ultrasound at 20-37 weeks’ gestation
38. 6. PROGESTERONE AS AN ALTERNATIVE
TO CERVICAL CERCLAGE – AN INDIAN
EXPERIENCE
PREGNANCY OUTCOME IN SHORT CERVIX: PROGESTERONE VS
CERVICAL ENCERCLAGE
The present study was conducted to compare the outcome of pregnancy
with short cervix with natural micronized progesterone and cervical
cerclage
A prospective, randomized comparative study - total of 50 cases of short
cervix. Out of 50 cases, 25 cases each were divided in two groups
Group A: Given natural micronized progesterone 200mg Cap BID /
300mg SR
Group B: Underwent cerclage procedure.
39. 6. PROGESTERONE AS AN ALTERNATIVE
TO CERVICAL CERCLAGE – AN INDIAN
EXPERIENCE
Conclusion:
Natural Micronized Progesterone is as effective as cervical cerclage in
prevention of premature labour in a women with singleton pregnancy with
short cervix.
Use of NMP is more preferable in clinical practice because it is non-
invasive technique, easy to administer and the patients do not suffer from
surgical and anaesthesia procedure related adverse effects such as pain,
headache, vomiting and other complications.
It is also not associated with any hospital stay and is very economical.
Using vaginal progesterone saves time for patients as well as doctors.
44. DYDROGESTERONE – NOT
EFFECTIVE IN PTL
• Various studies have shown that Dydrogesterone is not effective in
prevention of PTL and Dydrogesterone is not approved for PTL
prevention
• A randomized, double blinded, placebo controlled trial of oral
dydrogesterone supplementation in the management of preterm
labor - 2016 article
• The primary aim of this study was to evaluate the effect of oral
dydrogesterone on the recurrent uterine contraction in PTL. The
secondary aims were to evaluate latency period, gestational age at
delivery, pregnancy outcomes, neonatal outcomes, compliance and
side effects. A randomized, double blinded, placebo controlled trial
was conducted. 48 pregnant women at 24–34 weeks gestation with
PTL were either randomized to study group receiving tocolytic
treatment combined with oral dydrogesterone (20 mg daily) or to
placebo group receiving tocolytic treatment combined with oral
placebo.
45. DYDROGESTERONE – NOT
EFFECTIVE IN PTL
• Recurrent rates of uterine contraction were comparable between
groups (87.5% vs 91.7%, p = 0.64). Latency periods were not
different between dydrogesterone and placebo group
(32.7 ± 20.2 days vs 38.2 ± 24.2 days, p = 0.39). There were also
no differences in gestational age at delivery, pregnancy
outcomes, neonatal outcomes, compliance and side effects.
• Adjuvant treatment with oral dydrogesterone 20 mg/day could
not decrease the rates of recurrent uterine contraction and
prolong latency period in preterm labor management when
compared to placebo.