This document discusses twinning and multiple pregnancies. It begins by defining multiple pregnancy as when more than one fetus develops in the uterus simultaneously. It then discusses the types of twins, mechanisms of twinning, epidemiology, and complications of multiple pregnancies. Dizygotic twins result from two eggs and make up two-thirds of twin pregnancies while monozygotic twins result from one egg splitting and make up one-third. Complications discussed include fetal complications like twin-to-twin transfusion syndrome and acardiac twins, as well as increased risks for the mother such as preeclampsia, preterm labor, and postpartum hemorrhage.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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 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
1. TWINNING AND MULTIPLE PREGNANCY
FACILITATOR- PROF. NGASSAPA
PRESENTERS
MUHUMUZA NEVILLE
TUSAL MAVJI PATEL
EVANS .A. MLAY
PATRICE KUETE MEKONTCHOU
YONAZ MBONEA REUBEN
ALEX ELIUS
2. OBJECTIVES
Upon completion of this session, students are
expected to be able to:
• Define twinning and multiple pregnancy
• Describe the epidemiology of twin pregnancy
• Describe the types of twin pregnancy
• Explain the mechanism of twinning
• Identify complications of multiple pregnancy
4. DEFINITION
Multiple pregnancy - A pregnancy in which more than one
fetus develops in the uterus simultaneously.
• Two fetuses (twins)
• Three fetuses (triplets)
• Four fetuses (quadruplets)
• Five fetuses (quintuplets)
• Six fetuses (sextuplets)
5. EPIDEMIOLOGY.
• The incidence of multiple births increased significantly in late
20th century.
• The increasing is due to the use of ART (Assisted Reproductive
Therapy) and advanced maternal age at time of conception.
Types of twins Global prevalence Tz Prevalence
Monozygotic twins 2-4:1000 births
Dizygotic ~7-10:1000 births
Triplets 1:7000-10000 births
Quadruplets 1:600,000 births
7. TYPES OF TWINS
Dizygotic twins
• Are also called Fraternal, two-egg or binovular twins
• Make up 2
3 of all twin pregnancies
Monozygotic twins
• Syn. identical or uniovular twins
• Make up 1
3 of all twin pregnancies.
9. • Make up two-thirds of all twin pregnancies.
• result from fertilization of two ova, usually of the same or one
from each ovary, by two different sperms during a single
ovarian cycle.
• The resultant two zygotes form two blastocysts—each of which
implants separately into the uterine endometrium.
MECHANISM OF TWINNING
Dizygotic twins (fraternal):
10. • These twins are not genetically alike. Hence have no
more resemblance than any other two brothers and
sisters.
• They may or may not be of different sex.
• They are di-amniotic and di-chorionic
12. Monozygotic twins (identical):
• One third of all twins
• Result from cleavage of a single fertilized ova
• The timing of cleavage determines placentation.
– Always of same sex
– Identical including the HLA genes(isografting)
– However fingerprints may differ.
13.
14. Dichorionic/diamniotic monozygotic twins:
• Cleavage within 0-4 days after
fertilization
• Division prior to morula stage (2 cell
stage)
• Each fetus will be surrounded by
amnion & chorion like dizygotic
twins
• Has the lowest mortality rate of
monozygotic twins.
15. Monochorionic/diamniotic
• Cleavage between day 4 and 8 after fertilization
• Splitting of the zygote usually occurs at the early
blastocyst stage.
• The inner cell mass splits into two separate groups
of cells within the same blastocyst cavity
• Division after differentiation of the trophoblast but
before the amnion formation.
• Share single placenta but separate amniotic sac
(monochorionic diamniotic)
• The mortality rate is 25%
16. Monochorionic/monoamniotic
• < 1% of cases
• Cleavage after the 8th day (day 9-12)
• Division after amnion differentiation
• Share single placenta & single sac
• High risk of twin to twin transfusion
• Mortality is 50-60%, usually before 32
weeks
20. Superfecundation:
• Is an extremely rare
phenomenon that occurs
when a second ova released
during the same menstrual
cycle is additionally fertilized
by the sperm cells of a
different man in separate
sexual intercourse.
21. Superfetation:
• Superfetation can be
defined as the ovulation,
fertilisation and
implantation of a second
or additional embryo(s)
during pregnancy.
22. Heterotopic pregnancy
• presence of multiple
gestations, with one being
present in the uterine cavity
and the other outside the
uterus, commonly in the
fallopian tube and
uncommonly in the cervix or
ovary.
25. FETAL COMPLICATIONS
(Congenital malformation)
Congenital malformations occur as twice in twins
compared to singleton pregnancy. One percent of
monozygotic twins have malformations
These may include;-
a) Conjoined twins
b) Parasitic twins
c) Acardiac twins
26. a) Conjoined (Siamese) twins
Originate from incomplete division of the unizygote.
If the division occurred after embryonic disc
formation, incomplete or conjoined twins will occur.
Separation take place after 13th day.
27. They are classified according to the nature and
degree of union.(pagos, fasterned)
– Omphalopagus
– Thoracopagus-joined at the thorax
– Craniopagus(twins joins at the head)
– Pyopagus(twins joins at sacral region)
28. • The type of twins formed depend upon
when and to what extent abnormalities of
the node and streak occured.
• Some conjoined twins are separable
surgically, if no common internal organs
which may lead to death.
31. Twin to twin transfusion
• Vascular communication between two fetuses, mainly in
mono chorionic placenta
• Account 10% of monozygotic twins
• Twins are often of different sizes
• One is a donor and another is recipient
• Donor twin is small,dehydrated, oligohydraminous and
anemic , usually dies due to anemic heart failure
• Recipent twin = edematos ascites enlarged liver
polyhydramnious from congestive heart failure
32.
33. PARASITIC TWIN
• One member of the pair may be rudimentary due to
diminished blood supply and grow like a parasite on the
body of a well develop twin.
• May be full or partial complement of organs.
• The condition is known as fetus in fetu.
34.
35. TRAP
• This refers to Twin Reversed Arterial Perfusion Syndrome
Or Acardiac Twin.
• Absent heart in one fetus with arterial arterial
communication in placenta, donor twin also dies.
• Twin has no head, upper limbs and upper trunk. while the
lower part of the trunk and lower limbs are well formed
• Such a twin is known as acardiac acephalic twin
• Amorphous twin-shapeless mass of bones, skin etc
36. • The normal fetus – “Pump Twin”
• Rabnormal fetus – TRAP twin
37. Blighted Twin/ Vanishing Twin Syndrome
• Is a condition in which one of a set of twins or multiple
embryos dies in utero, disappear, or gets resorbed
partially or entirely, with an outcome of a spontaneous
reduction of a multi-fetus pregnancy to a singleton
pregnancy, portraying the image of a vanishing twin.
• This phenomenon can range from the disappearance of
an early empty gestational sac to a sac that had
developed a fetal pole to a fetus with documented heart
activity.
38.
39. Maternal Complications
• Increased pregnancy risks such as;-
• Anaemia(15%); due to iron deficiency or folic acid deficiency
• Pre eclampsia
• Threatened or actual abortion
• Polyhydramnios- more common in monozygotic
• Ante Partum Hemorrhage(APH)
• Psychological problems
• Mechanical risks; supine hypotension syndrome, Increased
varicosities, pressure on the ureter with increased urinary tract
infections
40. Increased labour risks
• Pre term labour (50%) twins -37 weeks,
triplets-34 weeks, quadruplets -30 weeks.
• Abnormal fetal presentations
• Locked twins or entanglement
• Cord prolapse
• Post Partum Haemorrhage
• Puerperal sepsis
41. References
• Williams Obstetrics 24th Edition by Cunningham, Leveno
et al
• Essential of human embryology by Kaduri and
Ngassapa.
• Textbook of Clinical Embryology by Vishram Singh
• https://www.bbc.com/news/uk-england-birmingham-
54841555
• UpToDate
42. MAY ONE OF YOU BE BLESSED WITH SUCH A
BEAUTIFUL BUNDLE
Editor's Notes
Each fetus will be surronded by amnion & chorion( each fetus has its own placenta)
Product of Fertilization of 2 ova by 2 sperms
It is inherited as recessive autosomal trait via female descendants,
Martenal height and weight
Increased martenal age,35-45years
White mothers of blood group A and O
Race has special importance:
Blacks(Nigeria 49/1000>whites(U.S.A 12/1000)>asians(Japan1.3/1000)
Identical including the HLA genes(isografting) mirror images of one another), however fingerprints differ. Not genetically determined, Constant rate in all races 2.3-4/1000 pregnancies.
Mechanism of monozygotic twinning.
Black boxing and blue arrows in columns A, B, and C indicate timing of division.A. At 0 to 4 days postfertilization, an early conceptus may divide into two. Division at this early stage creates two chorions and two amnions (dichorionic, diamnionic). Placentas may be separate or fused.
B. Division between 4 and 8 days leads to formation of a blastocyst with two separate embryoblasts (inner cell masses). Each embryoblast will form its own amnion within a shared chorion (monochorionic, diamnionic).
C. Between 8 and 12 days, the amnion and amnionic cavity form above the germinal disc. Embryonic division leads to two embryos with a shared amnion and shared chorion (monochorionic, monoamnionic).
D. Differing theories explain conjoined twin development. One describes an incomplete splitting of one embryo into two. The other describes fusion of a portion ofone embryo from a monozygotic pair onto the other.
In December 2001, a perilous operation took place in Birmingham to separate three-month-old conjoined twins, Sanchia and Eman Mowatt. They started life in the full focus of the world's media, such was the rarity of their predicament. What are the 19-year-old sisters who defied the medical odds doing today?
https://www.bbc.com/news/uk-england-birmingham-54841555
Twin reversed arterial perfusion (TRAP) sequence or acardiac twinning is a very rare problem, occurring in approximately 1% of monochorionic twins (MC, twins sharing one placenta). One twin is usually structurally completely normal. The other is an abnormal mass of tissue, consisting usually of legs and a lower body, but no upper body, head or heart. Because of the absent heart, the term “acardiac twin” has been used to describe this mass. The normal fetus is referred to as the “pump twin” because its heart is used to pump blood to the abnormal mass. The “acardiac twin” has no chance of survival.
Due to the absence of a beating heart, the acardiac does not send blood to any portion of the placenta, and all of its blood supply comes from and goes back to the circulation of the pump twin through unique vascular connections on the surface of the shared placenta. Arteries usually carry blood away from the fetus and toward the placenta to receive oxygen from the mother’s circulation. When there is an “acardiac twin”, the unique vascular connections allow blood in the artery to flow in the reversed direction (toward the acardiac fetus rather than away from it). Thus, the phrase “twin reversed arterial perfusion” (TRAP) sequence has been used to describe this condition.
The normal “pump” twin faces the excess burden of having to send and receive blood to the acardiac mass as well as to its own growing tissues. As such, the normal twin’s heart has to work extra hard and is under a lot of stress. This can result in heart failure for the normal twin. Left untreated, up to 50% of these otherwise normal twins may die in utero (stillbirth) or die shortly after birth.