Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity .
Can prevent two generations from developing diabetes in the future.
Pre-gestational hypertension, pregnancy induced hypertension and pre-eclampsia
Go over the different forms of hypertension in pregnancy, pathophysiology and treatment
diabetes is very common disorder in all age group i.e from infancy to secondary childhood age so intake of good healthy diet is very important for the production of insulin which is needed for body for regular activities
An alternative way at looking at pregnancy complicated by diabetes. A guide for the student in understanding this problem and the important points to be included in a clinical assessment.
Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity .
Can prevent two generations from developing diabetes in the future.
Pre-gestational hypertension, pregnancy induced hypertension and pre-eclampsia
Go over the different forms of hypertension in pregnancy, pathophysiology and treatment
diabetes is very common disorder in all age group i.e from infancy to secondary childhood age so intake of good healthy diet is very important for the production of insulin which is needed for body for regular activities
An alternative way at looking at pregnancy complicated by diabetes. A guide for the student in understanding this problem and the important points to be included in a clinical assessment.
Diabetes during Pregnancy - Risk Factors, Detection, & TreatmentAshutosh Pandit
Diabetes during pregnancy can severely affect the health of both - mother & baby. Find out the symptoms and complications of Gestational Diabetes and learn how it can be detected & treated.
Philippine CPG on Diagnosis & Screening for Gestational DiabetesIris Thiele Isip-Tan
Philippine CPG on diagnosis and screening of gestational diabetes presented for comments at the 3rd Unite for Diabetes Annual Convention this September.
Gestational diabetes mellitus (GDM) is a condition that develops during pregnancy when the body is not able to make enough insulin. GDM affects 2-10% of women during pregnancy.It is important to recognize and treat gestational diabetes as soon as possible to minimize the risk of complications to mother and baby.
This talk was delivered for postgraduates and faculty of Dr. TMA Pai Hospital, Udupi on 07 March, 2017. This talk covered pathophysiology, screening, diagnosis, complications and management of diabetes mellitus in pregnancy.
Diabetes and pregnancy - Endocrine society guidelines 2013Jagjit Khosla
This presentation talks about diabetes mellitus in relation to pregnancy. It classifies diabetes in pregnant pts as overt and gestational diabetes. Then it discusses the various guidelines given by Endocrine Society in 2013 for management of diabetic patients during pregnancy
Analyze how's Apple perceived.
If Apple became a person, what kind of person would be?
This is just an opinion from me.
Thank you for these following informations
- http://thefinancialbrand.com/14053/bank-credit-union-branding-personality-attributes/
- http://www.marketingminds.com.au/branding/apple_branding_strategy.html
A comprehensive guide to the management of hyperglycaemia in pregnancy aimed at the primary care physician and based on latest evidenced based criteria. Includes information from latest studies such as HAPO study and ACHOIS, and involves guidelines from the IADPSG, ADA, WHO and Malaysia.
Gestational diabetes is carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy (WHO). There are an estimated 4.5 million people living with diabetes in the UK (2). The estimated diabetes prevalence for adults between the ages of 20 and 70 worldwide was 415 million in 2015 and it is expected to affect 642 million people globally, by 2040 (1 in 10 people).
Our aim is to reduce morbidity and mortality related to Non communicable diseases such as hypertension, diabetes, cardiovascular disease, stroke, Obesity, Cancer and lifestyle diseases among those least able to withstand the burden of the disease.
Screening for gestational diabetes an update by dr alka mukherjee nagpur ms i...alka mukherjee
Gestational Diabetes Mellitus (GDM) is defined as any glucose intolerance with the onset or first recognition during pregnancy. This definition helps for diagnosis of unrecognized pre-existing Diabetes also. Hyperglycemia in pregnancy is associated with adverse maternal and prenatal outcome. It is important to screen, diagnose and treat Hyperglycemia in pregnancy to prevent an adverse outcome. There is no international consensus regarding timing of screening method and the optimal cut-off points for diagnosis and intervention of GDM. DIPSI recommends non-fasting Oral Glucose Tolerance Test (OGTT) with 75g of glucose with a cut-off of ≥ 140 mg/dl after 2-hours, whereas WHO (1999) recommends a fasting OGTT after 75g glucose with a cut-off plasma glucose of ≥ 140 mg/dl after 2-hour. The recommendations by ADA/IADPSG for screening women at risk of diabetes is as follows, for first and subsequent trimester at 24-28 weeks a criteria of diagnosis of GDM is made by 75 g OGTT and fasting 5.1mmol/l, 1 hour 10.0mmol/l, 2 hour 8.5mmol/l by universal glucose tolerance testing. Critics of these criteria state that it causes over diagnosis of GDM and unnecessary interventions, the controversy however continues. The ACOG still prefer a 2 step procedure, GCT with 50g glucose non-fasting if value > 7.8mmol/l followed by 3-hour OGTT for confirmation of diagnosis. In conclusion based on Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study as mild degree of dysglycemia are associated with adverse outcome and high prevalence of Type II DM to have international consensus It recommends IADPSG criteria, though controversy exists. The IADPSG criteria is the only outcome based criteria, it has the ability to diagnose and treat GDM earlier, thereby reducing the fetal and maternal complications associated with GDM. This one step method has an advantage of simplicity in execution, more patient friendly, accurate in diagnosis and close to international consensus. Keeping in the mind the diversity and variability of Indian population, judging international criteria may not be conclusive, thus further comparative studies are required on different diagnostic criteria in relation to adverse pregnancy outcomes
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.
- 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
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.
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!
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
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.
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
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. DEFINITION
Gestational diabetes mellitus (GDM) is
carbohydrate intolerance with recognition or
onset first time during pregnancy,
irrespective of the treatment with diet or
insulin.
4. One of major causes of complications during
pregnancy
Good glycemic control-improves perinatal
outcome
5. IMPORTANCE OF GDM
2 GENERATIONS AT RISK
TYPE 2 DM
CHILDHOOD
OBESITY
TYPE 2 DM
6. In the Indian context, there is 11 fold increased risk of
developing glucose intolerance during pregnancy
compared to Caucasian women.
16.55% prevalence of GDM
Urban 17.8%
Rural 9.91%.
7. EFFECT ON PREGNANCY
Insulin resistance :
Production of placental HPL.
Increased production of cortisol, estriol, progesterone.
Increased insulin destruction by kidney and placenta.
Increased lipolysis: For her caloric needs and saves
glucose for fetal needs.
Changes in gluconeogenesis: Fetus uses preferentially
alanine and other amino acids and deprives the mother
of a major gluconeogenic source.
8. Hormonal events during early Pregnancy
Early pregnancy Estrogen
Progesterone
Pancreatic B-cell
hyperplasia
Insulin secretion
Peripheral utilization of
glucose
Maternal FBS
Hepatic glucose
production
Glycogen storage
9. Hormonal events during mid pregnancy
Mid-trimester pregnancy
HPL
Cortisol
Prolactin
Progesterone
Estrogen
Insulin resistance in peripheral tissues
13. AIMS & OBJECTIVES
The objective is to estimate
PGBS in antenatal women
and follow up them till
delivery for fetomaternal
outcomes.
1. To screen for GDM & GGI as
early as possible.
2. Determine fetomaternal
outcome.
14. MATERIAL & METHODS
STUDY DESIGN: Prospective Longitudinal Observational Time bound
hospital based study.
DURATION: 07 months.
SETTINGS: Dept. of ObGy, NKP Salve Institute Of Medical Sciences
Nagpur
STUDY POPULATION: Women attending antenatal OPD.
SAMPLE SIZE : 400
SELECTION: Consecutive
Institutional Ethical committee permission
15. INCLUSION CRITERIA:
Singleton pregnancies.
Patients willing to
comply.
Patients willing to deliver
at LMH
EXCLUSION CRITERIA:
Multiple pregnancies.
History of previous GDM.
Patients not willing for any
intervention.
Patients not willing to
deliver at LMH
16. Demographic data, Medical, Obstetric &
Surgical history, antepartum, intra partum &
postpartum data was collected.
Analysis was done regarding number of
patients with GDM & GGI, distribution
according to age, parity & their fetomaternal
outcomes . Statistical evaluation was done.
18. METHODOLOGY
Detailed history, consent, examination done
DIPSI TEST was done
75gm of glucose dissolved in 200ml of water, consumed
over period of 15min (regardless of day or time of last
meal)
Venous blood samples taken at 2hrs.
21. TOTAL PATIENTS SCREENED & DISTRIBUTION
ACCORDING TO INTOLERANCE
GGI GDM OVERT
54(13.5%) 37(9.25%) 6(1.5%)
TOTAL
SCREENED
TOTAL
NORMAL
DERANGED PGBS
400 303 97(24.25%)
13.5% patients had normal PGBS in early trimester but later diagnosed
with GDM by repeat screening.
22. AGE DISTRIBUTION TABLE
AGE GGI GDM OVERT
<19 8% 8.3% 0%
20-25 13.52% 8.6% 0%
26-30 12% 10.93% 2.3%
>31 31% 12.5% 6.25%
Advancing age was associated with increasing trend of
GGI & GDM
24. Gestational Age
GGI GDM OVERT
<24wk 6.1% 2.06% 0
24-32 11.34% 8.24% 1.03%
>32 41.23% 27.80% 5.10%
Increased incidence was noted in third trimester
because maximum patients presented in third trimester
27. Fetal Complications
NORMAL GDM+GGI
RESP DISTRESS 7.9% 9.2%
PRETERM 2.3% 3%
IUGR 5.9% 6.1%
NICU 4.9% 6%
PERINATAL
MORTALITY 1.05% 1.09%
CONG ANOMALY 0.3% 1.03%
MOST COMMAN COMPLICATION FOUND TO BE RESPIRATORY
DISTRESS
28. HbA1c
HbA1c% GDM & GGI
<5.7 4.10%
5.7-6.1 1%
>6.1 8.20%
MAXIMUM PATIENTS WITH GDM HAD HbA1c MORE THAN 6.1%
29. MODE OF DELIVERY
NORMAL GDM+GGI
NVD 21.10% 19.5%
LSCS 32% 44.5%
INSTRUMENTAL 1.9% 1.3%
S&E 0.6% 1.03%
INCIDENCE OF CESAREAN SECTION WAS MAXIMUM
AMONG GDM PATIENTS
32. SUMMARY
Out of 400 antenatal women,
54 had GGI (13.5%)
37 had GDM (9.25 %) according to screening by DIPSI
Prevalence rate of GDM was 9.25% which was significant
Advancing age was associated with increasing trend of GGI &
GDM
33. o Pregnancy complications noted in the present study in patients
with GDM were -- PIH in 18.55%,Poly in 3%, PROM in 5%, CPD
in 2.06%
o Operative deliveries were found more in GDM patients 44.5%
o Fetal complications noted were 9.2% of neonates had
respiratory distress, 6% had NICU admissions
o Perinatal mortality rate 1.09% were high in GDM patients
o 8.3% patients managed by insulin & diet
34. ROLE OF OBSTETRICIAN
PRIMARY PREVENTION:
Obesity, PCOS- lifestyle
modification
SECONDARY PREVENTION:
GDM screening & care
TERTIARY PREVENTION:
Future long term complication
36. TAKE HOME MESSAGE
GDM continues to be an important obstetrical condition
with significant feto maternal morbidity.
This study thus recommends screening of all antenatal
women for GGI & GDM as early as possible & proper
management to ameliorate morbidity & mortality
associated with it.