This document discusses toxoplasmosis in pregnancy. It defines toxoplasmosis as a disease caused by the obligate intracellular parasite T. gondii. The prevalence of toxoplasmosis varies by country from 25% to 75% depending on factors like age, eating habits, and exposure. Acute infection during pregnancy can complicate 1-5‰ of pregnancies and poses risks to the fetus. Screening practices for toxoplasmosis in pregnancy vary between countries depending on cost and benefit considerations. Treatment aims to prevent localization of the parasite in the placenta and modification of neonatal infection.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
Red blood cells (RBCs), also called erythrocytes, are the most common type of blood cell and the vertebrate organism's principal means of delivering oxygen (O2) to the body tissues—via blood flow through the circulatory system.
Torch infections during pregnancy by dr alka mukherjee nagpur ms indiaalka mukherjee
TORCH Syndrome refers to infection of a developing fetus or newborn by any of a group of infectious agents. "TORCH" is an acronym meaning (T)oxoplasmosis, (O)ther Agents, (R)ubella (also known as German Measles), (C)ytomegalovirus, and (H)erpes Simplex. Infection with any of these agents (i.e., Toxoplasma gondii, rubella virus, cytomegalovirus, herpes simplex viruses) may cause a constellation of similar symptoms in affected newborns. These may include fever; difficulties feeding; small areas of bleeding under the skin, causing the appearance of small reddish or purplish spots; enlargement of the liver and spleen (hepatosplenomegaly); yellowish discoloration of the skin, whites of the eyes, and mucous membranes (jaundice); hearing impairment; abnormalities of the eyes; and/or other symptoms and findings. Each infectious agent may also result in additional abnormalities that may be variable, depending upon a number of factors (e.g., stage of fetal development
A miscarriage, or spontaneous abortion, is an event that results in the loss of a fetus before 20 weeks of pregnancy. It typically happens during the first trimester, or first three months, of the pregnancy. Miscarriages can happen for a variety of medical reasons, many of which aren't within a person's control.
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
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
7. FORMS
1. Oocyst:
excreted in farces of cats,
sporulate in the soil to form sporocyst.
2. Tissue cyst:
latent form,
contain bradyzoites,
represent chronic stage,
persist for life in humans Aboubakr Elnashar
8. 3. Tachzoites:
invasive form,
multiplies intracellularly,
found in tissues in acute stage or during
reactivation of the chronic infection
spread in blood & lymph,
disappear with development of the normal
immune response
Aboubakr Elnashar
9. TRANSMISSION OF INFECTION
1. ORAL:
Tissue cysts: 10 % of lamb, 25 % of pork, beef, poultry. Pork
and lamb carry a higher risk of infection than beef or poultry.
Oocyst: 30 - 80 % of cats (low parasite dose)
2.TRANSPLACENTAl:
Primary acute infection during pregnancy
Maternal parasitaemia [Tachyzoites] (limited to 3 W): Placentitis:
Fetal infection
3 . BLOOD or LEUCOCYTES TRANSFUSION
(Tachyzoites) or
ORGAN TRANSPLANTATION (Tissue cysts): (Rare)
Aboubakr Elnashar
10. Soil contact (cat
feces):17%
Eating infected
meat: 65%
Cook et al BMJ 2000;321:142-147(Multicenteric) [Evidence level 3]
Inadequately cooked meat is the main risk factor
Aboubakr Elnashar
14. •Incidence of fetal infection: greater in late
pregnancy
•Severity of fetal infection: greater in early
pregnancy
• Cl. forms: Triad
1 Attenuated:
chroretinitis, microphthalmia, hypotonia
2. Serious: 10%
IC calcification, icterus, encephalopathy
3. Latent:
convulsions, hydrocephalus, chorioretinitis
Aboubakr Elnashar
15. Transmission risk
(mother to fetus)
Severity of
Damage to fetus
15% 25% 65%
Most less least
1st
Trimester
2nd
Trimester
3rd
Trimester
[Evidence level 3] Foulon et al. A.J. of Obst&Gynecology 1999;180:410–5
Hydrocephalus.
Intracranial calcification,
Retinochoroiditis
60% 20% 5%
Transmission To The Fetus
Aboubakr Elnashar
16. As in rubella, toxoplasmosis
1. Is dangerous for the fetus only if the initial
infection occurs during pregnancy
2. Infection confers lasting immunity
(Fields,1990)
Aboubakr Elnashar
19. Appear Maximum Disappear
Ig M
Ig G
1week
2 weeks
Few months
± few years
(6 mo to 6 yr)
Not
disappear
Individuals who have recovered from prior
toxoplasmosis may demonstrate Anamnestic spike in
IgG titer during subsequent episodes of other infections.
-ve IgM excludes acute infection
1 month
2 month
Aboubakr Elnashar
20. Diagnosis of acute infection
1. IgG: dye test > 1/ 1000.
The gold standard test (sensitive & specific)
IFA > 1/ 512
Titer Increase 4 folds over 3 w
Seroconversion
Avidity: low
2. IgM: ELISA. Remains high for many yr after acute infection
IFA > 1/ 80. Remains elevated for 6 mo after acute
infection, then rapidly drops. More useful than ELISA
ISA > 6
The presence of IgM is suggestive but not diagnostic.
3. IgA or IgE: more sensitive than IgM
Aboubakr Elnashar
21. Negative Negative No serological evidence of infection
Negative Positive Possible acute infection or false-positive IgM result
Positive Negative Infection for more than 1 year.
Positive Positive Possible recent infection within the last 12 months.
IgG IgM Report/Interpretation for All Except Infants
Equivocal IgG or IgM: obtain a new specimen for both IgG and IgM testing.
Aboubakr Elnashar
22. IgG
Neg: Not infected, retest/ 1-3 ms for
seroconversion Pos: Infected
Neg: Infected for >1 y Pos: Infection within last 2 ys or
false positive
IgM
IgG avidity
High: Infected at >12 ws previously low: Recent infection possible
Obtain 2nd sample 2 ws after 1st; send both samples to toxoplasma
reference lab for confirmation before any intervention.Aboubakr Elnashar
23. The IgG avidity test
Discriminate between past and recently acquired
infection. Avidity (functional affinity) of toxoplasma-
specific IgG antibodies. Following an antigenic
challenge, the antibodies produced usually have a low
average affinity. During the course of the immune
response, there is maturation of antibody affinity that
increases progressively over weeks or months.
The avidity tests are helpful primarily to rule out that a
patient’s infection occurred within the prior 4 to 5
months. This is most useful in pregnant women in their
first months of gestation who have a positive test for
both IgG and IgM toxoplasma antibodies.
Aboubakr Elnashar
24. Diagnosis of fetal infection
1. U/S
No findings: 80%
Specific findings:
Hydrops,
Ventriculomegaly (mild symmetrical to severe hydrocephalus),
Intracranial calcifications (periventricular)
Non specific findings:
ascites,
hepatomegaly,
liver calcification,
pericardial /pleural effusion,
oligohydramnios, IUGR, placental thickness
Aboubakr Elnashar
25. 2. Amniocentesis or cordocentesis
. IgM
. High eosinophil count, LFT & low platelet count
. PCR: sensitive & specific
. Inoculation to mice or tissue culture
Aboubakr Elnashar
27. •Depends upon:
prevalence rate & economic issues.
Cost benefit ratio
•Obligatory in: France, Austria, Belgium.
•Not done in UK, Egypt.
In USA (precomceptional)
In France (prenuptial)
NICE (2003):
Routine antenatal serological screening for
toxoplasmosis should not be offered because the
harms of screening may outweigh the potential
benefits. [B]
Aboubakr Elnashar
28. •ACOG (2000): SCREENING in:
-High-risk persons
Who eat undercooked meat (pork, lamb)
Who clean litter boxes.
Who garden without glove.
Who have had a recent mononucleosis-type like illness
-U/S findings suggestive of toxoplasmosis:
hydrocephalus
intracranial calcifications
Microcephaly
fetal growth retardation
Ascites
Hepatosplenomegaly [C]
Aboubakr Elnashar
29. •Indications of screening during pregnancy
(Bader et al,1997)
1. Symptoms suggestive of acute infection
2. Exposure to the organism during pregnancy
3. Residence or migration to high prevalence
areas e.g. France
4. Infection with HIV
Aboubakr Elnashar
30. Preconceptional:
IgG +ve No further tests
-ve IgG/ 4-8 W during pregnancy
First antenatal visit:
IgG -ve IgG/4-8 w +ve Acute infection
+ve IgM titer high Acute infection
-ve or low Past infection
Aboubakr Elnashar
32. Indications:
•Pregnancy
•Immunocompromised or immunodeficient
•Severe persistent symptoms
•Serious damage of vital organs
•Infection acquired via blood transfusion
Mode of action:
Non of the drugs is effective against the encysted
form
slowing down multiplication of tachozites
Aboubakr Elnashar
33. Aim during pregnancy:
1. Prevention of localization in the placenta
2. Prevention or modification of neonatal infection
By 60% (Holfeld et al, 1994)
No effect on intracranial or occular lesions (Gras
et al, 2001)
Effectiveness is less
if infection acquired in late pregnancy or
tt is delayed.
Aboubakr Elnashar
34. Pyrimethamine & S. diazine combination
Pyrimethamine
• Mode of action:
inhibit production of dihydrofolate reductase &
synthesis of DNA,RNA & proteins
•Side effects:
teratogenic in first trimester
bone marrow depression
•How to avoid side effects:
not used in 1st trimester
CBC/4d
folonic ac (yeast tab 8 tab/4d)Aboubakr Elnashar
35. S. diazine
•Other types of sulpha:
S. pyrimidine, S. pyrazine, S. methazine.
• Side effects:
crystalluria
haematuria
rash
neonatal hyper bilirubinemia at term
• How to avoid side effects:
Maintain high urinary flow
not used at term.
Aboubakr Elnashar
36. •Dose & duration
Non pregnant
Pyrim: loading dose: 2 mg/ k/d x 2 d
Maintenance dose: 1 mg/ k/d x 4 - 6 w
S. diazine: Loading dose: 50 mg /k
then 100 mg / k /d 4 divided doses
Pregnant
1 st trimester: S. diazine (50 - 100 mg /k /d)
2nd & 3rd trimester: S. diazine + Pyrim.(0.5 -1 mg /k /d)X4 w
At term: Pyrim.
Aboubakr Elnashar
37. Spiramycin
• Mode of action:
macrolide cross placental barrier poorly.
intracellular toxoplasmicidal
•Side effects:
n. & vomiting, diarrhea, allergic skin reaction
•Dose: (T= 1.5 million iu= 0.5 gm)
# 3 gm in 4 divided doses X 3 w on & 2 w off till
term
# If f. infection is confirmed:
Pyrim. & S. diazine X 3 w then spiramycin x 3 w
& so on till delivery
Aboubakr Elnashar
38. •Therapeutic abortion is not recommended
1. Risk of transmission to the f. is low
2. Treatment can prevent f. infection as the
parasite takes 4-8 w to cross placenta
Aboubakr Elnashar
40. Prevention of maternal infection (primary prevention)
•Kill tissue cysts in the meat :
heat 60c
freeze at -20 or -6 for 24 h
•Avoidance of oocytes from cats :
Hand wash,
Wear gloves,
Wash fruits & vegetables
Dry heat or boiling water
Avoid contamination with cats
Prevent infection of cats
• Avoid blood or blood products with toxoplasmosis
Aboubakr Elnashar
41. Prevention of congenital infection (secondary
prevention)
•Preconceptional screening
•Diagnosis & treatment of acute infection during
pregnancy
•Avoid infection during pregnancy
Tertiary Prevention:
Early detection and treatment of neonatal
disease
Aboubakr Elnashar
43. •Toxoplasmosis is not a cause of habitual
abortion.
•Routine screening should consider the cost
benefit ratio.
•If IgG is +ve before pregnancy: No need for
retesting or treatment. No fear of congenital
infection.
•Only primary acute infection can lead to fetal
infection which occurs in 33%.
•Acute infection is diagnosed if IgM is high or IgG
avidity is low.
•+ve IgG or +ve IgM is not diagnostic of acute
infection.
Aboubakr Elnashar