The document discusses pelvic infections including pelvic inflammatory disease (PID). PID is caused by bacteria like Neisseria gonorrhoeae and Chlamydia trachomatis. It presents as endometritis, salpingitis, tubo-ovarian abscess, or pelvic peritonitis. Treatment depends on severity but includes antibiotics. Surgery is reserved for severe cases like tubo-ovarian abscess or failure to improve with antibiotics. Surgical site infections are also discussed and may require drainage or antibiotics.
For difficult vaginal delivery,forceps delivery,vacuum application are done to assist the vaginal delivery.Many types of forceps are there divided in 3 categories.
For difficult vaginal delivery,forceps delivery,vacuum application are done to assist the vaginal delivery.Many types of forceps are there divided in 3 categories.
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
I was fortunate to be accepted as an Arthur Ashe fellow to observe HIV Care in New York City, USA for a whole month last October 2016. Here I share my observations on how HIV+ patients are managed, and how our own HACT in Cebu has a long way to go to stop the Philippine HIV/AIDS epidemic.
Pelvic inflammatory disease (PID) is an infection and inflammation of the female reproductive organs. It can scar the tubes that carry eggs from the ovary to the uterus which can lead to infertility, ectopic pregnancy, pelvic pain and other problems. PID is the most common preventable cause of infertility in the United States. Gonorrhea and chlamydia are the most common causes, but other bacteria can also cause PID.
This aims to increase awareness on the Philippine HIV Epidemic, how it affects pregnancy and how it can be managed for prevention of mother to child transmission of HIV.
Revitalize! Indications for Surgery in Pelvic InfectionsHelen Madamba
This was a lecture given during the POGS Cebu chapter 39th Foundation Day Celebration and Postgraduate Course with theme: "POGS Cebu at 39: Revitalize, Reinvigorate, Rejuvenate!" at the Grand Ballroom of the Cebu Country Club
Acute pelvic inflammatory disease by dr alka mukherjee dr apurva mukherjeealka mukherjee
Pelvic inflammatory disease (PID), one of the most common infections in nonpregnant women of reproductive age, remains an important public health problem. It is associated with major long-term sequelae, including tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. In addition, treatment of acute PID and its complications incurs substantial health care costs. Prevention of these long-term sequelae is dependent upon development of treatment strategies based on knowledge of the microbiologic etiology of acute PID. It is well accepted that acute PID is a polymicrobic infection. The sexually transmitted organisms, Neisseria gonorrhoeae and Chlamydia trachomatis, are present in many cases, and microorganisms comprising the endogenous vaginal and cervical flora are frequently associated with PID. This includes anaerobic and facultative bacteria, similar to those associated with bacterial vaginosis. Genital tract mycoplasmas, most importantly Mycoplasma genitalium, have recently also been implicated as a cause of acute PID. As a consequence, treatment regimens for acute PID should provide broad spectrum coverage that is effective against these microorganisms.
Recurrent bacteriuria in pregnancy is common and a serious cause of maternal and perinatal morbidity and mortality.
Clinical presentations include asymptomatic bacteriuria, acute cystitis and pyelonephritis.
This was a joint lecture for the Chong Hua Hospital Postgraduate Course by OB-infectious disease specialist Dr Helen Madamba and IM-infectious disease specialist Dr Mitzi Chua.
The Role of Maternal Immunization in Reducing Infections in InfantsHelen Madamba
A lecture provided for the Immunization for Filipino Women committee of the Philippine Obstetrical and Gynecological Society, Inc (POGS) and the Philippine Infectious Disease Society for Obstetrics and Gynecology (PIDSOG) to encourage vaccination for pregnant women in the Philippines
COVID-19 and COVID-19 Vaccination in PregnancyHelen Madamba
As an update to the management of COVID-19 in Pregnancy based on the PIDSOG Handbook, we have the POGS Practice Bulletin on COVID19 Vaccination for Pregnant and Breastfeeding Women. Vaccines work!
A lecture orientation to first year medical students, this lecture was lifted from the PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
This is a lecture for medical students of the Cebu Institute of Medicine as an orientation on the prevalence of HIV infection in the Philippines, the basic knowledge on HIV and the program on prevention of mother to child transmission of HIV.
During the time of COVID-19 use of social media in medicine is as relevant than ever and should be maximized by healthcare professionals as a public health tool for health education and promotion to ensure the impact on healthcare is a positive one.
Use of social media for public health promotionHelen Madamba
A short talk with medical technology students of the Velez College for the seminar on "Cyber Etiquette: A Social Responsibility on Health Promotion for the Society" February 15, 2020 from 1pm to 5pm.
This was a lecture given during the CME activitiy for POGS Region 7 by the Philippine Infectious Disease Society for Obstetrics and Gynecology (PIDSOG) at Casino Espanyol in Cebu City.
As part of the 5th Philippine Healthcare Social Media Summit 2019 #HCSMPH2019 at the Waterfront Hotel in Cebu City, Track B involved choosing platforms for social media depending on one's purpose and based on the target audience.
This is one of the lectures for the POGS Research Forum in Bacolod, mostly based on the chapter on Clinical Practice Guidelines for Ethics Review from the POGS Research Handbook: The Essentials. I hope this can be a guide for residents who are preparing their research proposal for ethical review.
This is a plenary lecture given during the CVCHRD Research and Innovation Conference at CIT-U in Cebu City with the theme "Research innovations for Improved Health and Wellness"
Emerging Issues for Social Workers in dealing with PLHIVsHelen Madamba
This was a talk for ALSWDOPI 2019 at Waterfront Hotel where LGU social workers are challenged to become the government employees who are catalysts of change that the Philippine society needs to address the Philippine HIV epidemic.
These were slides I was not able to use during the lecture I gave for the weekend POGS research workshop because of a mix up in assigned topics. Nevertheless, I think OBGYN residents may find these slides useful in crafting their research proposals.
As a speech during the Public Health Forum 2018, this is a collection of inspirational post from my facebook newsfeed. Talking about how to be a clinical specialist involved in public health, the emphasis is in finding your passion, something you would be willing to do even if you were not paid for it.
This focuses on the Consensus Recommendations on the Prevention and Management of Surgical Site Infections in the Philippine Setting by Saguil, Bermudez, Antonio and Cochon, PJSS 2017.
Public Health Forum - Social Media in Medicine: Etiquettes for the Modern DoctorHelen Madamba
This lecture introduces reasons why healthcare providers should be on social media and the limits of what we should and shouldn't post on social media, remembering that people are on the other end of the public health conversation.
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.
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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
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
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
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.
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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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
3. PELVIC INFLAMMATORY DISEASE (PID)
comprises a spectrum of inflammatory
disorders of the upper female genital tract,
including any combination of
• endometritis
• salpingitis
• tubo-ovarian abscess
• pelvic peritonitis
CDC Sexually Transmitted Diseases Treatment Guidelines 2015.
4. PELVIC INFLAMMATORY DISEASE (PID)
• N. gonorrhoeae and C. trachomatis, are
implicated in many cases
• Microorganisms that comprise the vaginal
flora (e.g., anaerobes, G. vaginalis,
Haemophilus influenzae, enteric Gram-
negative rods, and Streptococcus
agalactiae) have been associated with PID
CDC Sexually Transmitted Diseases Treatment Guidelines 2015.
5. PELVIC INFLAMMATORY DISEASE (PID)
• All women who receive a diagnosis of
acute PID should be tested for HIV, as
well as gonorrhea and chlamydia, using
NAAT.
• Screening and treating sexually active
women for chlamydia reduces their risk
for PID by 60%.
CDC Sexually Transmitted Diseases Treatment Guidelines 2015.
6. ADDITIONAL CRITERIA
• Oral temperature > 38.3ºC
• Abnormal cervical mucopurulent discharge
or cervical friability
• Presence of abundant numbers of WBC on
saline microscopy of vaginal fluid
• Elevated erythrocyte sedimentation rate
• Elevated C-reactive protein
• Laboratory documentation of cervical
infection with N. gonorrhoeae and C.
trachomatic
CDC Sexually Transmitted Diseases Treatment Guidelines 2015.
7. MOST SPECIFIC CRITERIA
• Endometrial biopsy with histopathologic
evidence of endometritis
• Transvaginal sonography or MRI showing
thickened fluid-filled tubes with or without
free pelvic fluid or tubo-ovarian complex
• Laparoscopic findings consistent with PID
CDC Sexually Transmitted Diseases Treatment Guidelines 2015.
8. INDICATIONS FOR HOSPITALIZATION
• Surgical emergencies cannot be excluded
• Tubo-ovarian abscess
• Pregnancy
• Severe illness, nausea and vomiting or high
fever
• Unable to follow or tolerate an outpatient oral
regimen
• No clinical response to oral antimicrobial
therapy
CDC Sexually Transmitted Diseases Treatment Guidelines 2015.
9. RECOMMENDED
PARENTERAL REGIMENS
Cefotetan 2 g IV every 12 hours
PLUS
Doxycycline 100 mg orally or IV
every 12 hours
CDC Sexually Transmitted Diseases Treatment Guidelines 2015.
10. RECOMMENDED
PARENTERAL REGIMENS
Cefoxitin 2 g IV every 6 hours
PLUS
Doxycycline 100 mg orally or IV
every 12 hours
CDC Sexually Transmitted Diseases Treatment Guidelines 2015.
11. RECOMMENDED
PARENTERAL REGIMENS
Clindamycin 900mg IV every 8 hours
PLUS
Gentamicin loading dose IV (2mg/kg)
followed by a maintenance dose
(1.5mg/kg) every 8 hours. Single daily
dosing (3-5mg/kg) can be substituted.
CDC Sexually Transmitted Diseases Treatment Guidelines 2015.
13. DE-ESCALATION 24-48 HOURS AFTER
CLINICAL IMPROVEMENT
Oral doxycycline 100 mg twice daily to
complete 14 days of therapy
CDC Sexually Transmitted Diseases Treatment Guidelines 2015.
14. TUBO-OVARIAN ABSCESS IS PRESENT
Clindamycin 450 mg orally qid
OR
Metronidazole 500 mg bid
PLUS
Oral doxycycline 100 mg bid to complete
14 days of therapy
CDC Sexually Transmitted Diseases Treatment Guidelines 2015.
15. TO MINIMIZE DISEASE
TRANSMISSION
• Abstain from sexual intercourse until
therapy is completed, symptoms have
resolved, and sex partners have been
adequately treated.
CDC Sexually Transmitted Diseases Treatment Guidelines 2015.
16. OPERATIVE TREATMENT OF ACUTE PID
• Operations are restricted to life-
threatening infections, ruptured tubo-
ovarian abscesses, laparoscopic
drainage of a pelvic abscess, persistent
masses in some older women for whom
future childbearing is not a consideration,
and removal of a persistent symptomatic
mass.
Katz, Lentz, Lobo, Gershenson 2007. Comprehensive Gynecology.
17. CONSERVATIVE TREATMENT
• Unilateral removal of a tubo-ovarian
complex or an abscess
• Drainage of a cul-de-sac abscess via
percutaneous drainage or culpotomy
incision
• Percutaneous aspiration or drainage
under CT or ultrasound guidance
Katz, Lentz, Lobo, Gershenson 2007. Comprehensive Gynecology.
18. CONSERVATIVE TREATMENT
• Laparoscopic aspiration of tuboovarian
complexes.
• Operative intervention in a
postmenopausal woman should be
considered early in the disease,
especially if the condition does not rapidly
improve with medical therapy.
Katz, Lentz, Lobo, Gershenson 2007. Comprehensive Gynecology.
20. PELVIC SURGICAL SITE INFECTIONS
IN GYNECOLOGIC SURGERY
SSIs are infections occurring within 30 days
of an operation occurring in one of 3
locations:
• superficial at the incision site
• deep at the incision site
• in other organs or spaces opened or
manipulated during an operation
Lachiewicz, Moulton, Jaiyeoba, 2015. Pelvic Surgical Site Infections in Gynecologic Surgery.
21. VAGINAL CUFF CELLULITIS
Moderate, but increasing, lower abdominal
pain with purulent yellow vaginal discharge
Lachiewicz, Moulton, Jaiyeoba, 2015. Pelvic Surgical Site Infections in Gynecologic Surgery.
• Amoxicillin/clavulanate 875/125 mg po bid
• Ciprofloxacin 500 mg po bid + metronidazole 500
mg bid
• TMP-SMX DS po bid + metronidazole 500 mg po
bid
22. PELVIC CELLULITIS AND ABSCESS
Pelvic cellulitis and pelvic hematoma spread
into parametrial soft tissue: fever, vague
abdominal pain, regional tenderness, mass
Lachiewicz, Moulton, Jaiyeoba, 2015. Pelvic Surgical Site Infections in Gynecologic Surgery.
• clindamycin 900 mg IV q8h OR metronidazole 500
mg IV q12h +
• penicillin 5 million units q6h OR ampicillin 2 g IV
q6h +
• gentamicin 5 mg/kg body weight q24h OR
aztreonam 2 g IV q8h
23. DRAINAGE OR SURGICAL THERAPY
• Routine drainage of pelvic abscesses can
decrease prolonged hospitalizations and
improve reproductive outcomes.
Lachiewicz, Moulton, Jaiyeoba, 2015. Pelvic Surgical Site Infections in Gynecologic Surgery.
24. DRAINAGE OR SURGICAL THERAPY
• Drainage should be performed if an
adequate response to antibiotic therapy is
not registered within 2-3 days or if the
pelvic abscess is >8cm
Lachiewicz, Moulton, Jaiyeoba, 2015. Pelvic Surgical Site Infections in Gynecologic Surgery.
25. CRITERIA FOR FAILURE
• patients with <50% radiological reduction
in abscess size
• patients whose abscess progressively
increased in size
• new onset fever or persistent fever
• clinical deterioration with persistent or
worsening abdominal / pelvic tenderness
despite appropriate antibiotic therapy
• sepsis
• ruptured abscess
Lachiewicz, Moulton, Jaiyeoba, 2015. Pelvic Surgical Site Infections in Gynecologic Surgery.
26. WOMEN WITH ABSCESSES >8CM
OR WHO SHOW NO SIGNS OF
IMPROVEMENT
• Clinically worsening patients, suspected
rupture, and septic patients require
immediate laparotomy which may be life-
saving.
• Laparoscopy has several advantages
compared to laparotomy, if the patient is
hemodynamically stable.
Lachiewicz, Moulton, Jaiyeoba, 2015. Pelvic Surgical Site Infections in Gynecologic Surgery.
27. DRAINAGE
• Percutaneous drainage guided by CT or
ultrasound even with large abscesses
• No required anesthesia
• Immediate pain relief
• Reduced duration of hospital stay
• Pelvic cuff abscess by ultrasound guided
transvaginal aspiration
Lachiewicz, Moulton, Jaiyeoba, 2015. Pelvic Surgical Site Infections in Gynecologic Surgery.
28. REFERENCES
• Kimberly A. Workowski, Bolan GA. Sexually Transmitted
Diseases Treatment Guidelines. Morbidity and Mortality Weekly
Report (MMWR). 2015. 1-137 p. Accessed at
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm on
June 6, 2016
• Mark P. Lachiewicz, Laura J. Moulton, and Oluwatosin Jaiyeoba,
“Pelvic Surgical Site Infections in Gynecologic
Surgery,” Infectious Diseases in Obstetrics and Gynecology, vol.
2015, Article ID 614950, 8 pages, 2015.
doi:10.1155/2015/614950. Accessed at
http://www.hindawi.com/journals/idog/2015/614950/ on June 7,
2016.
29. REFERENCES
• Eckert and Lentz “Infections of the Upper Genital Tract” in Katz,
Lentz, Lobo, Gershenson 2007. Comprehensive Gynecology
Fifith Edition. Mosby Elsevier, Philadelphia, USA: 607-631.
30. #HealthXPH tweetchat
Healthcare Conversations on Twitter
Saturdays 9:00 p.m. to 10:00 p.m.
@helenvmadamba
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31.
32. Helen V. Madamba, MD MPH-TM FPOGS FPIDSOG
AOGIN-RP CME Lecture, Zamboanga
June 8, 2016
SURGERY FOR PELVIC INFECTIONS:
INDICATIONS AND APPROACHES