This document discusses systemic lupus erythematosus (SLE) during pregnancy. It notes that SLE occurs more frequently in women, especially during childbearing years. Pregnancy can cause flares in 40-60% of cases, most likely immediately postpartum. Good pregnancy outcomes require quiescent SLE for at least 6 months before conception with no active renal involvement or antiphospholipid antibodies. Management involves preconception counseling and multidisciplinary monitoring of disease activity and fetal wellbeing. Corticosteroids are the treatment of choice for flares.
Anti-Müllerian Hormone (AMH) is critical for physiologic involution of the Mullerian ducts during sexual differentiation in the male foetus.
In women,AMH is a product of the small antral follicles in the ovaries and serves to function as an autocrine and paracrine regulator of follicular maturation
Anti-Müllerian Hormone (AMH) is critical for physiologic involution of the Mullerian ducts during sexual differentiation in the male foetus.
In women,AMH is a product of the small antral follicles in the ovaries and serves to function as an autocrine and paracrine regulator of follicular maturation
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
Management of SLE with pregnancy ,the difficult missionWafaa Benjamin
Involvement of obstetricians and physicians with experience of managing SLE in pregnancy improves the outcome for the mother and foetus.
MDT
Pre-pregnancy clinics
Triage of low& high risk women
Be alert to detect a flare
Wait for PE & distinguish from L.nephritis
TOP when in 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
Management of SLE with pregnancy ,the difficult missionWafaa Benjamin
Involvement of obstetricians and physicians with experience of managing SLE in pregnancy improves the outcome for the mother and foetus.
MDT
Pre-pregnancy clinics
Triage of low& high risk women
Be alert to detect a flare
Wait for PE & distinguish from L.nephritis
TOP when in risk
Summary:
- Preeclampsia is a syndrome of unknown etiology with multiorgan involvement
- It presents with a wide spectrum of symptoms
- It is sometimes difficult to distinguish from other systemic diseases
- Severe cases may progress to MOF and death
- Delivery of the child and placenta is the only specific treatment – other lines of teatment are only supportive
There are several issues regarding diagnostic techniques and treatment options that need further evaluation
Presented by:
Ahmad mukhtar
MD.,M.B.B.Ch., M.Sc Obstetrics and GynecologyConsultant and Lecturer of Obstetrics and Gynecology, Faculty of
MEDICINE, Zagazig University.
Neonatal sepsis
Made Easy to understand all the students
DR ATIQUR RAHMAN KHAN
MBBS,MD,DCH,MRCPS(GLASCOW),FRCP(UK)
Msc Counselling and Psychotherapy
Member American Academy of Paediatrics(AAP)
Member British Association of Perinatal Medicine(BAPM)
Member British Association for Parenteral and Enteral Nutrition(BAPEN)
Associate Member Royal College of Paediatrics and Child Health(RCPCH)
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.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
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.
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
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
Follow us on: Pinterest
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
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
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
6. Pathogenesis
Cause: Un known
Genetic predisposition
Environmental triggers e.g. ultraviolet light or viral
infection.
Immunological:
polyclonal B-cell activation
impaired T-cell regulation of the immune response
failure to remove immune complexes.
Circulating non-organ-specific autoantibodies.
Deposition of immune complexes: vasculitis.
Aboubakr Elnashar
7. Diagnosis
American Rheumatic Association criteria
Many patients have a lupus-like illness without
fulfilling these.
1. CBC:
Normochromic normocytic anaemia
Neutropenia
Thrombocytopenia.
2. ESR:
raised {high immunoglobulin levels}
3. CRP:
Normal
4. 3rd or 4th components of complement:
low or falling: active disease.
Aboubakr Elnashar
8. 5. Auto-antibody
a. The most common:
Antinuclear antibody (ANA): (96%)
Titres do not change with disease activity.
b. The most specific
antibodies to double-stranded DNA (78%) and
Smith (Sm).
Glomerulonephritis occurs more frequently in
women with these antibodies.
c. Other
anti-Ro and anti-La: (30%)
anticardiolipin antibodies (aPLs): (40%).
Aboubakr Elnashar
9. Effect of pregnancy on SLE
Flares:
Increases:
from 40% to 60%.
When:
at any stage of pregnancy or the puerperium
more likely immediately postpartum: little evidence
Prediction:
not possible
more likely if disease has been active within 6 ms of
conception.
Aboubakr Elnashar
10. Diagnosis during pregnancy:
difficult
{many features such as hair loss, oedema, palmar &
facial erythema, fatigue, anaemia, raised ESR &
musculoskeletal pain also occur in normal
pregnancy}.
most commonly involving the skin& joints
Prevention:
prophylactic steroids or routine increases of dose:
no effect & not recommended
Aboubakr Elnashar
11. Women with lupus nephritis
SLE nephropathy may manifest for the first time in
pregnancy.
Risk of deterioration
Moderate renal impairment (serum creatinine 125-
200 umol/I): uncomplicated pregnancies.
High baseline serum creatinine: Inc risk of
deterioration
Aboubakr Elnashar
12. Preconception counseling.
1. Delay pregnancy until at least 6 ms after a lupus
nephritis flare.
2. Prediction of the risks to the woman& fetus:
anti-Ro/La
aPLs
Renal function
Blood pressure
Aboubakr Elnashar
13. Effect of SLE on pregnancy
1. The increased risks
spontaneous miscarriage
fetal death
pre-eclampsia
preterm delivery
IUGR
Related to
1. Age, parity
2. anticardiolipin antibodies
3. lupus anticoagulant
4. lupus nephritis
5. hypertension
6. active disease at the time of conception or
7. first presentation of SLE during pregnancy.Aboubakr Elnashar
14. During pregnancy, lupus
improves in a third of women
remains unchanged in a third
worsens in the remaining third.
Clinical condition can worsen or flare without
warning
(Khamashta and colleagues, 1997).
Risk of major morbidity during pregnancy
7%
(Petri, 1998)
Lupus can be life threatening to both the mother
and her fetus-infant.
Aboubakr Elnashar
15. Good pregnancy outcome if:
1. Lupus activity has been quiescent for at least 6
months before conception
2. No active renal involvement manifest by
proteinuria or renal dysfunction
3. Superimposed preeclampsia does not develop
4. No evidence of antiphospholipid antibody
activity.
Aboubakr Elnashar
16. Renal lupus:
increased risk of fetal loss, PET, IUGR
particularly if there is hypertension or proteinuria.
Women in remission, but without hypertension,
renal involvement or aPLs:
Risk of pregnancy loss& PET is not higher than in
the general population.
2. Chorea
very rare complication of pregnancy in women with
SLE or aPLs.
Aboubakr Elnashar
17. Management
Preconception counseling
1. Prediction of the risks to the woman& fetus:
anti-Ro/La
aPLs
Renal
Blood pressure.
2. Outcome is improved if conception occurs during
disease remission.
Aboubakr Elnashar
18. Multidisciplinary team in combined clinics:
Physicians& obstetricians
Monitor
1. disease activity
2. Fetal growth
3. uterine artery Doppler blood flow at 20-24 w
4. umbilical artery blood flow from 24 w
Aboubakr Elnashar
19. Baseline values in early pregnancy:
1. FBC
2. KFT:
U, creatinine, uric acid, quantify any proteinuria.
3. LFT:
4. anti DNA
5. Complement titres
5. Electrolytes
Serial measurements
at intervals dependent on disease severity
Aboubakr Elnashar
20. Disease flare
Symptoms:
Arthralgia, pleuritic pain, skin rash
Lab:
A. Urine: Red blood cells or cellular casts
B. Rising anti-DNA antibody titre
C. Fall in complement levels
>25% fall in C3 or C4 suggests active SLE.
N.B. elevation of complement split products,
particularly Ba & Bb, often accompanies flares,
so high ratios of CH50: Ba may differentiate
PET from active lupus.
Aboubakr Elnashar
22. Hydroxychloroquine (Plaquenil)
should be continued {stopping may precipitate
flare}.
For control of hypertension:
Drug of choice: methyldopa
2nd -line agents: nifedipine or hydralazine
Although long-term hydralazine& methyldopa use
may rarely induce a SLE-like syndrome, they
are not contraindicated in SLE.
Aboubakr Elnashar
23. Differentiation of active renal lupus from PET
Difficult
1. The two conditions may be superimposed.
2. Hypertension, proteinuria, thrombocytopenia&
even renal impairment are all features of PET
3. A doubling of baseline proteinuria may be
expected in pregnancy but more than this would be
indicative of either worsening lupus nephritis or
PET}
Aboubakr Elnashar
24. How:
1. Hyperuricaemia & abnormal LFT point more
towards PET.
2. Renal biopsy
The only definitive investigation
Rarely undertaken in pregnancy.
More likely to be appropriate prior to fetal viability
Aboubakr Elnashar
25. TT of active lupus nephritis
Increase oral prednisolone
Pulsed IV methyl predisolone
Azathioprine (Imuran).
Cyclophosphamide: Rarely used
Aboubakr Elnashar
26. If lupus flare & PET cannot be dd beyond 24-28
w, when the fetus is viable:
Delivery
{cure PET
allow administration of cyclophosphamide}
Aboubakr Elnashar
27. Conclusions
There is an increased rate of flare during
pregnancy.
Disease flares must be actively managed with
corticosteroids.
Adverse pregnancy outcome is related to the
presence of renal involvement, hypertension,
antiphospholipid antibodies& disease activity at
the time of conception.
These factors increase the risks of spontaneous
miscarriage, fetal death, PET, PTL& IUGR.
Aboubakr Elnashar
28. Pregnancy care is best undertaken in combined
clinics allowing close monitoring of disease
activity, fetal growth& well-being.
In Ro-positive mothers
risk of transient neonatal cutaneous lupus: 5%
risk of CHB: 2%.
Aboubakr Elnashar