Postpartum hemorrhage is the leading cause of maternal mortality. Thereby its appropriate management is of great importance. Here I discuss the surgical management of Postpartum Hemorrhage which is done when medical management fails.
This presentation has a complete description of Vulvo-Vaginal hematoma, its causes , clinical features and management strategy. Hematoma can happen in case of episiotomy given during childbirth
This presentation has a complete description of Vulvo-Vaginal hematoma, its causes , clinical features and management strategy. Hematoma can happen in case of episiotomy given during childbirth
he uterus and vagina are supported by various structures and connective tissues, and the integrity of these supporting factors is crucial for maintaining pelvic organ function and preventing conditions such as pelvic organ prolapse.
Understanding the anatomy and surgical importance of the supporting factors of the uterus and vagina is essential for gynecologists, urogynecologists, and pelvic reconstructive surgeons involved in the diagnosis and management of pelvic organ prolapse and related conditions.
Maternal birth canal injury following child birth process are quite common and significant to maternal morbidity and even to death. Also, a second most frequent cause of PPH.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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.
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
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
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.
2. Case Scenario
A 29-year-old woman (G2P1A0L1) underwent an elective cesarean
delivery at a gestational age of 37 weeks for complete placenta
previa (type IV) in the Obstetrics department of UPUMS, Saifai. During
the procedure, the placenta was delivered by manual removal without
difficulty. There was no evidence of placenta accreta. Prophylactic
oxytocin (3 units) was given to prevent uterine atony. Hemostasis was
achieved, and the uterus was well contracted. However, 2 hours after
the uneventfully completed initial surgery, heavy vaginal bleeding
was observed that was controlled with additional oxytocin (10 units
IV), misoprostol (1000 µg per rectum) and manual compression.
After another 2 hours, bleeding started again. Curettage revealed no
retained placental tissue. The clinical picture was compatible with
uterine atony. What are the next steps in the management?
4. Uterine Packing
• Gauze size- 5m x 8 cm.
• Antiseptic soaked gauze is placed high up in the fundal area. Then rest of the uterine cavity is packed.
• A separate pack is used to fill the vagina.
• Antibiotic is given and the plug is removed after 24 hours.
• Principle- stimulates uterine contractions and exerts direct hemostatic pressure on the open sinuses.
• Done under General Anesthesia.
• This is the first step to do when medical management has failed.
• Also done when the patient has to be transported to the tertiary care center.
5.
6. Balloon Tamponade
• Bakri balloon, Foley catheter, Condom catheter or Sengstaken-Blakemore tube may be used.
• The required capacity should be between 200-500 mL, so Foley catheter may be insufficient.
• Once inserted into the uterus, the balloon has to be inflated with normal saline until the bleeding
stops or for 4-6 hours.
• Principle- stimulates uterine contractions and exerts direct hemostatic pressure on the open sinuses.
• Preferred method over packing due to the ease of use.
• First surgical intervention for most women with atonic PPH.
• This can avoid hysterectomy in 78% cases.
7. Tohamy Said, S. (n.d.). Major Obstetric Hemorrhage and Disseminated Intravascular Coagulation (Content last reviewed: 15th December 2018). In D. James,
P. Steer, C. Weiner, B. Gonik, & S. Robson (Eds.), High-Risk Pregnancy: Management Options (pp. 1985-2013). Cambridge: Cambridge University Press.
9. B-Lynch suture
• Developed by Christopher B-Lynch in 1997.
• In an open uterus, the suture compresses the upper segment but the lower segment remains open.
• Number 2 chromic catgut suture is used.
• Bi manual compression is first tried to assess the potential chance of success of the B‐Lynch suturing
technique.
• Referred to as “Brace suture”.
• Principle- Tamponade of the uterus.
• Success rate is about 80% and can avoid hysterectomy.
10. B‐Lynch, C., Coker, A., Lawal, A.H., Abu, J. and Cowen, M.J. (1997), The B‐Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to
hysterectomy? Five cases reported. BJOG: An International Journal of Obstetrics & Gynaecology, 104: 372-375. https://doi.org/10.1111/j.1471-0528.1997.tb11471.x
11. Hayman suture
• This was developed by Hayman et al to overcome the drawbacks of B-Lynch suture:
1. Hysterotomy is necessary.
2. Difficult to remember in an emergency.
• Uterine compression is achieved by using two longitudinal threads and transfixing the entire uterine
wall.
• The needle transfixes the whole thickness of both uterine walls at the lower uterine segment level,
with the thread being passed over to compress the fundus, and the thread tied at the fundus.
• Referred to as “Simple Brace suture”.
• Number 2 Polyglycolic acid or Vicryl sutures are used.
12. Matsubara, S, Yano, H, Ohkuchi, A, Kuwata, T, Usui, R, Suzuki, M. Uterine compression sutures for postpartum hemorrhage: an overview. Acta Obstet Gynecol Scand 2013; 92:
378– 385.
13. Cho square hemostatic suture
• Cho et al stated, “the purpose of the technique is to approximate the uterine walls until no space is
left in the uterine cavity.”
• A needle transfixes the uterus from anterior to posterior (point a) and then from posterior to anterior
(point b). The same is done (points c and d) to approximate the anterior and posterior uterine walls in
a “square” manner.
• In an atonic uterus, four to five square sutures should be made.
• Although easier than B-Lynch sutures, it may completely occlude the blood supply to the uterine
muscle within the square, leading to ischemic necrosis and subsequent complications
• Referred to as “Multiple square suture”.
• Number 1 Chromic Catgut sutures are used.
14. Matsubara, S, Yano, H, Ohkuchi, A, Kuwata, T, Usui, R, Suzuki, M. Uterine compression sutures for postpartum hemorrhage: an overview. Acta Obstet Gynecol Scand 2013; 92:
378– 385.
15. Hackethal suture
• A total of 6–16 transverse transfixing 2‐ to 4‐cm‐long sutures (U‐suture) are made.
• Since there is no simultaneous vertical and horizontal compression, the complication of ischemia, as
in Cho square suture, doesn’t appear here.
• Hackethal et al claimed that “multiple” sutures may provide insurance in case one suture loosens.
• Referred to as “Multiple Transverse U‐suture”.
• Number 0 Vicryl sutures are used.
16. Hackethal, Andreas & Brueggmann, Doerthe & Oehmke, Frank & Tinneberg, Hans & Zygmunt, Marek & Münstedt, Karsten. (2008). Uterine compression U-sutures in primary
postpartum hemorrhage after Cesarean section: Fertility preservation with a simple and effective technique. Human reproduction (Oxford, England). 23. 74-9.
10.1093/humrep/dem364.
17. Uterine Artery Ligation
• The ascending branch of the uterine artery is ligated at the lateral border between upper and lower
uterine segment.
• Suture is passed into the myometrium 2 cm medial to the artery.
• Number 1 chromic suture is used.
• In atonic PPH, B/L ligation is effective in about 75% cases.
Tohamy Said, S. (n.d.). Major Obstetric Hemorrhage and Disseminated Intravascular
Coagulation (Content last reviewed: 15th December 2018). In D. James, P. Steer, C.
Weiner, B. Gonik, & S. Robson (Eds.), High-Risk Pregnancy: Management
Options (pp. 1985-2013). Cambridge: Cambridge University Press.
18. Internal Iliac Artery Ligation
• The anterior division of internal iliac artery is ligated.
• The areolar sheath covering the internal iliac artery is incised longitudinally, and a right-angle clamp is
carefully passed just beneath the artery from the lateral side to the medial side.
• Care must be taken not to perforate contiguous large veins, especially the internal iliac vein.
• Non absorbable sutures are used.
• The most important mechanism of action with internal iliac artery ligation is an 85-percent reduction
in pulse pressure in those arteries distal to the ligation and hence clot formation is facilitated.
• B/L ligation can avoid hysterectomy in 50% patients.
20. Angiographic Arterial Embolization
• May be used if surgical access to bleeding pelvic vessels is difficult.
• Embolization is done under fluoroscopy using gel foam.
• Success rate is more than 90% & avoids hysterectomy.
• Fertility is not impaired, and most women have successful subsequent pregnancies.
• Ischemic necrosis may happen as a complication.
21. Bleich AT, Rahn DD, Wieslander CK, et al. Posterior division of the internal iliac artery: Anatomic variations and clinical applications. Am J Obstet Gynecol 2007;197:658.e1-
658.e5.
22. Hysterectomy
• If all measures fail, hysterectomy is done.
• A second obstetrician should be consulted.
• It may be subtotal or total, depending on the case.
https://www.buckshealthcare.nhs.uk/Downloads/Patient-leaflets-Obstetrics-and-Gynaecology/Laparoscopic%20subtotal%20and%20total%20hysterectomy.pdf
23. Pelvic Umbrella Pack
• Described by Logothetopulos (1926), the umbrella or parachute pack is placed for continuing
pelvic hemorrhage following hysterectomy.
• The pack is constructed of a sterile x-ray cassette bag, filled with gauze rolls knotted together to
provide enough volume to fill the pelvis.
• The pack is introduced transabdominally with the stalk exiting the vagina. Mild traction is applied by
tying the stalk to a 1-liter fluid bag which is hung over the foot of the bed.
• Broad spectrum antimicrobials should be administered, and the umbrella pack is removed vaginally
after 24 hours.
• Regarded as the “last ditch attempt”.
24. Cunningham, F. G., Leveno, K. J., Bloom, S. L., Spong, C. Y., Dashe, J. S., Hoffman, B. L., . . . Sheffield, J. S. (2014). Williams obstetrics (24th edition.). New York: McGraw-Hill
Education.
25. Resources
• Cunningham, F. G., Leveno, K. J., Bloom, S. L., Spong, C. Y.,
Dashe, J. S., Hoffman, B. L., . . . Sheffield, J. S. (2014). Williams
obstetrics (24th edition.). New York: McGraw-Hill Education.
• Steer, Philip & Steer, Philip. (2009). The surgical approach to
postpartum haemorrhage. The Obstetrician &
Gynaecologist. 11. 231 - 238. 10.1576/toag.11.4.231.27525.
• 2018. DC Dutta's Textbook Of Obstetrics. 9th ed. New Delhi:
Jaypee Brothers Medical Publishers, pp.294-301.
• Matsubara, S, Yano, H, Ohkuchi, A, Kuwata, T, Usui, R, Suzuki,
M. Uterine compression sutures for postpartum
hemorrhage: an overview. Acta Obstet Gynecol Scand 2013;
92: 378– 385.