Ultrasound plays a key role in the management of infertile patients. Transvaginal ultrasound provides high resolution images of the cervix, uterus, and ovaries. 3D and Doppler ultrasound can further aid in assessing endometrial thickness and blood flow. Ultrasound is used for ovulation monitoring, evaluating uterine and ovarian abnormalities, predicting assisted reproduction outcomes, and guiding interventional procedures. New techniques like 3D power Doppler and automated follicle counting provide additional information on endometrial receptivity and ovarian reserve that can help manage infertility.
Sonosalpingography. Dr. Sharda Jain, Dr. Jyoti Agarwal Lifecare Centre
Evaluation of fallopian tubes forms an essential part of evaluation
Tubal pathology is a cause of infertility in 30- 35% of infertile patients
Tubal Assessment
Fallopian tubes can be assessed by:
Hysterosalpingography
Hysterosalpingo-contrast-sonography (HycoSy)
Sonosalpingography
Laparoscopy & CHROMOTUBATION
In this presentation we will discuss role of Doppler US in Infertility, fertilization and assisted fertilization.
we will discuss the favorable and unfavorable RI and PI.
We will discuss role of doppler us in various gynecological malignancies.
tubal factor is almost 30% of all female infertility causes.Hence evaluation of tubes is usulally the first of the testings.
this presentation evaluates all the methods for evaluation of fallopian tubes
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
my key note address at AICOG 2013.....for all who missed this one and on request of many who were present and wanted a copy...... if you copy these please do but please acknowledge.....
Sonosalpingography. Dr. Sharda Jain, Dr. Jyoti Agarwal Lifecare Centre
Evaluation of fallopian tubes forms an essential part of evaluation
Tubal pathology is a cause of infertility in 30- 35% of infertile patients
Tubal Assessment
Fallopian tubes can be assessed by:
Hysterosalpingography
Hysterosalpingo-contrast-sonography (HycoSy)
Sonosalpingography
Laparoscopy & CHROMOTUBATION
In this presentation we will discuss role of Doppler US in Infertility, fertilization and assisted fertilization.
we will discuss the favorable and unfavorable RI and PI.
We will discuss role of doppler us in various gynecological malignancies.
tubal factor is almost 30% of all female infertility causes.Hence evaluation of tubes is usulally the first of the testings.
this presentation evaluates all the methods for evaluation of fallopian tubes
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
my key note address at AICOG 2013.....for all who missed this one and on request of many who were present and wanted a copy...... if you copy these please do but please acknowledge.....
Female gynaecologic conditions arising from the endometrium are common and depend on a woman's age, her menstrual history, and the use of medications such as hormone replacement and tamoxifen.
Both benign and malignant conditions affect the endometrium.
Benign conditions must be distinguished from malignant and premalignant conditions.
The most commonly used imaging modality for evaluating the endometrium is pelvic ultrasound with transabdominal and transvaginal techniques. Additional imaging methods include hysterosonography and magnetic resonance imaging
Adherent placenta occurs when there is a defect in the decidua basalis, Resulting in an abnormal invasion of the placenta directly into the substance of the uterus
What do you mean by Anomaly? What are its types? Is Anomaly Scan a ‘MUST’?
In our family there has been no case of Anomaly.
I have already undergone FTS, So will it give any additional information?
Can it guarantee that my fetus is 100% normal? If an abnormality is found, can it be cured?
What options are available if an Anomaly is detected?
Can it Surely (100%) rule out Down’s Syndrome?
Can Anomaly be 100% prevented?
If such questions arise in your mind, please watch my eight small videos on this subject.
MRI offers a great aid in diagnosis of abnormal placentation. This presentation describes the normal MRI appearance of the placenta and the MRI signs of placental adhesion disorders.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
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.
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
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.
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.
1. role of ultrasound in the current
management scenario of the
infertile
patient
DR BHARTI GAHTORI
MBBS MD ( MAMC DELHI)
SPECIAL INTEREST IN HIGHRISK OBSTETRICS , ADVANCE 3D-4D
FETAL ULTRASOUND, FETAL ECHO AND 3D INFERTILITY
ULTRASOUND
2. What is the preferred route
TRANSABDOMINAL
• Low frequency
• Poor resolution
• Good overview
• Scan the abdomen
• Full bladder
Explains organ
interrelationship better
TRANSVAGINAL(RECTA
L)
High frequency
• Superb resolution
• Poor overview
• Abdomen not seen
• Empty bladder
Vaginal ultrasound is dynamic and interactive
examination
• Check the mobility of organs
– fixed organs = adhesions
• Check for site specific tenderness
– which organs are involved in a painful process?
3. KEYPOINTS
What is the correct scanning technique to
image the
cervix, uterus and ovaries effectively?
What are the principal ultrasound features
of:
– the normal cervix
– the normal uterus with endometrium -
orientation,deviation ,dimensions etc
– the normal ovary/adnexae
-The appearance of the normal endometrium and ovary
varies significantly throughout the menstrual cycle in women
of reproductive age.
-It is important to be aware of the expected changes
in order to avoid misinterpreting physiologic changes as
pathologic.
4. The fIVE broad areas where ultrasound is used
include:
Ovulation Monitoring and assessment of reserve
Assessment of endometrial growth with cycle
Diagnosis of uterine, ovarian and other adnexal factors in
the infertile patient
Prediction of outcomes in assisted reproduction
technology (ART) Cycles and
Interventional Procedures
5. PILOT SCAN
• During the first visit of the patient, a Pilot scan is
done. This is done to exclude abnormalities of
uterus, ovaries and tubes.
• TVS combined with Doppler is the investigation of
choice for diagnosis of Mullerian anomalies and
acquired uterine abnormalities like fibroids,
adenomyosis, polyps, synechiae, etc.
• This scan is also done for abnormalities like ovarian
cyst, hemorrhagic cyst, chocolate cyst,dermoid and
also hydrosalpinx.
6. BASELINE SCAN
To determine ovarian reserve—by
counting the antral follicles. (Antral follicle
count).
To determine adequate shedding of
endometrial lining on Day 2
Assess pelvic pathology if any affecting
the OI or ART results
To assess uterine cavity configuration if
not done earlier – IUI/ET
To exclude residual follicle >10mm or
cystic areas prior to ART cycle
To predict response to stimulation—
normal responder/hyper- responder/poor
responder.
Assessment of adequacy of
downregulation after GnRH agonist
treatment.
WHEN – DAY 2-3 of menstrual
cycle
WHY AT THIS TIME : At this time
of the cycle, estrogen and
progesterone are both at low
levels. Hence the ovaries have no
active follicle, endometrium is thin
like a single line as it has shed off
during menstruation. BEST TIME
TO OBTAIN LH/FSH VALUES
11. NORMAL CUL DE SAC FLUID
ANTERIOR CUL DE SAC POSTERIOR CUL DE SAC
12. DAY 3 OVARIAN RESERVE
ASSESSMENT ( AFC)
12 / more immature follicles
( 2 -8mm)
AFC Less than 5 –Poor responder
AFC >20 - PCOD
Total number of antral follicles
achieved the best predictive value
for favourable IVF outcome,
followed by Ovarian stromal FI,
total ovarian stromal area & total
ovarian volume .
Kupesic S et al, Hum Reprod 2002;
17(4):950-55
POLYCYSTIC OVARIAN DISEASE
13. FOLLOW UP SCANS
To monitor the response of
stimulation by assessing the
follicle growth and endometrium
thickness. (day 9-14). Follicles
grows at the rate of 1-2mm per
day
Color Doppler identifies the
functional status of ovaries
and endometrium and thereby
helps in decision making for
timing of (hCG).
Day 7 scan is done sometimes
to confirm selection of
dominant follicle
15. POSITIVE FINDINGS IN UTERINE ASSESSMENT
These included 7 parameters:
1. Endometrial thickness in greatest AP dimension of 7 mm or greater
(full-thickness measurement)
2. A layered (“5 line") appearance of the endometrium
3. Blood flow within Zone 3 using color Doppler technique
4. Myometrial contractions causing a wave like motion of the
endometrium
5. Uterine artery blood flow, as measured by PI, less than 3.0
6. Homogeneous myometrial echogenicity
7. Myometrial blood flow seen on gray-scale examination (internal to
the arcuate vessels)
16. Prediction of ovulation
Dominant Follicle > 14mm
• Grows 2-3 mm/day.
• Ovulation 18-24 mm.
• Sonolucent halo 24 hours prior
to ovulation.
• Cumulus like shadow.
In the hands of experienced
operators, ultrasound alone
suffices for cycle monitoring,
with no necessity for additional
hormonal estimations.
Ovulation 16-24 mm.
• Vascularity - 3/4th of the follicle
• On the day of HCG – If cumulus like
echoes is not seen in all three planes in
the follicle , it is less likely to be mature
fertilizable oocyte.
17. HYDROSALPINX
-Fusiform cystic lesion
Cog wheel sign
Incomplete septae
Cyst wall thicker than 5mm
in almost all acute
inflammations and approx
3 % of chronic lesions
18. 3D ULTRASOUND
One of the main advantages of 3D imaging of the
uterus, on the other hand, is the capacity to reconstruct
the coronal plane.
3D ultrasound involves the acquisition of a series of 2D
images that can then be displayed collectively in a
variety of imaging modalities.
3D ultrasound scanning consists of four basic steps:data
acquisition, volume analysis and processing, image
animation and archiving of volumes.
19. CORONAL PLANE IMAGING IN 3D
ULTRASOUND
This format has been found to be useful for:
- Evaluation of uterine shape abnormalities (e.g
Mullerian duct abnormalities) in conjunction with SIS
- Problem-solving for uterine fibroids (particularily %
submucosal component) and fibroid mapping
- Endometrial polyps
- Intrauterine adhesions( synechie)
- Adenomyosis ( Junctional zone)
21. CONGENITAL
UTERINE
ANOMALIES
• 3D ultrasound has contributed
the most and has become the
investigation of choice
• Ability to show both internal
uterine cavity and external
uterine contour in CORONAL
SECTION
• Accurate, noninvasive,
outpatient diagnosis of
congenital uterine anomalies.
22. FIBROID
• 3D ultrasound has recently been
used to map the exact location of
fibroids in relation to the
endometrial cavity and surrounding
structures.
• This is extremely important in
triaging patients for surgery and
• Potentially useful in monitoring the
reduction in the size of fibroids in
patients receiving gonadotrophin-
releasing hormone analogs or
following uterine artery
embolization.
23. ADENOMYOSIS
• The most specific 2D feature for the
diagnosis of adenomyosis was
presence of myometrial cysts (98%
specificity; 78% accuracy), along with
heterogeneous myometrium
• -On 3D TVS , the best markers
were JZ difference ≥4 mm and JZ
infiltration and distortion (both 88%
sensitivity; 85% and 82% accuracy,
respectively)
• - The JZ may be regular, irregular,
interrupted, not visible,not assessable
on CORONAL VIEW
24. UTERINE
SYNECHIAE
-With SIS ,2D ultrasound may present a
diagnostic clue of adhesions through
the presence of bands seen within the
endometrial echo.
-However, 3D imaging well delineates
the true narrowing or “bands”
adherent across the cavity
-3D ultrasound has better sensitivity
and predicted adhesions and cavity
damage with greater accuracy than
HSG in patients with suspected
Asherman’s syndrome. (Knop man et
al)
26. SONO AVC
• SONO AVC is a 3D software with
automated calculation the no. of
follicles in individual ovaries and
gives good count assessment.
• Very useful for antral follicle count
assessment in IVF protocols.
• For diagnosis of PCOS and early
prediction of ovarian
hyperstimulation when 3D
doppler is employed alongside
27. COLOR DOPPLER IN INFERTILITY
• Doppler ultrasonography can be
utilized to assess the endometrial
receptivity by determination of
endometrial and subendometrial
blood flow which affects embryo
transfer and implantation
• 3D US vascularization gives
schematical information about all
vessels and additionally quantifying
blood flow in the selected volume.
• 3D vascular indices can be
measured: vascular index (VI), flow
index (FI), and VFI (vascular flow
index).
28. 3d Power doppler and volume
POWER DOPPLER FOR
ENDOMETRIAL RECEPTIVITY 3D VASCULARIZATION INDICES