The document discusses various ultrasound features that can help diagnose different types of ectopic pregnancies, including tubal, cervical, interstitial, abdominal, and caesarean scar pregnancies. Key diagnostic criteria include gestational sac location, presence of healthy myometrium tissue, and Doppler flow characteristics. The document provides diagrams and descriptions to illustrate differences between pseudosacs, normal intrauterine pregnancies, and ectopic pregnancies located in fallopian tubes, ovaries, and other abnormal locations. Careful ultrasound examination is important for accurately identifying ectopic pregnancies.
Incidence of ectopic pregnancy is rising while maternal mortality from it is falling.
ALWAYS suspect ectopic pregnancy in a woman of a child-bearing age c/o pain and/or p.v. bleeding
Incidence of ectopic pregnancy is rising while maternal mortality from it is falling.
ALWAYS suspect ectopic pregnancy in a woman of a child-bearing age c/o pain and/or p.v. bleeding
In this presentation we will discuss
First trimester US especially TVS is an integral part for confirmation of intrauterine pregnancy and to rule out ectopic pregnancy.
First trimester US helps us in suggesting conceptus viability.
First trimester US especially TVS is very efficient in approaching and evaluating the cause of vaginal bleeding.
A case report of cervical ectopic pregnancy misdiagnosed as cervical miscarriageApollo Hospitals
Cervical pregnancy is a rare variety of ectopic gestation. The aetiology is obscure. Diagnosis may be difficult unless the clinician/the radiologist is conscious of the entity. The evaluation of first trimester vaginal bleeding or pelvic pain is an important task for the emergency physician. The early identification of an ectopic pregnancy can help prevent significant morbidity and mortality for patients seeking emergency care. We present the case of a patient found to have a cervical ectopic pregnancy.
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
Concurrent imperforate hymen and transverse vaginal septum: A rare presentati...Apollo Hospitals
A 13 year old girl not attained menarche presented as a case of acute abdomen; she had a mass per abdomen, on ultrasound diagnosed as haematometra and hematocolpus; clinically had an imperforate hymen; further evaluation by MRI revealed a high vaginal cause of obstruction which cannot be differentiated as vaginal atresia or a combination of transverse vaginal septum and imperforate hymen; operative findings showed a imperforate hymen with a patent lower vagina and a transverse vaginal septum separating upper and lower vagina; surgical correction done and drained 1000 ml of blood and post operatively patient is followed up for a month and bleeding through vagina during the next cycle is noted showing the patent vagina. This is a first case of concurrent transverse vaginal septum and imperforate hymen without any other genitourinary anomalies in literature.
A Case of Abdominal Pregnancy, Primary vs Secondary – Radiological Workupiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Ruptured ectopic pregnancy in non-communicating right rudimentary horn: A cas...Apollo Hospitals
Rudimentary horn is a developmental anomaly of the uterus, and pregnancy in a non-communicating rudimentary horn is very difficult to diagnose before it ruptures. As the fetus enlarges in the rudimentary horn, the chances of rupture in the first or second trimester are increased. Catastrophic hemorrhage results in increased maternal and
perinatal mortality and morbidity. To date, management of such cases remains a challenge due to diagnostic dilemma. Expertise in ultrasonography and early resort to surgical management are lifesaving in such cases. A case of undiagnosed rudimentary horn pregnancy presented to our department in shock with features of acute abdomen, and the diagnosis was confirmed at laparotomy that revealed ruptured rudimentary horn pregnancy. And excision of the accessory horn was done.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
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
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
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.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
- 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
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
3. USS Features of Normal Uterus
• Convex appearance of the uterine fundus
• No significant fundal indentation of the
uterine cavity
• Presence of two interstitial portions of the
Fallopian tubes.
– This helps in
• excluding the diagnosis of unicornuate uterus
• making the diagnosis of interstitial pregnancy
4. Gestational sac vs Pseudosac
Gestational sac Pseudosac
Eccentric Central
Surrounded by echogenic ring of Surrounded by single layer of tissue
trophoblast-Double Decidual Sac sign
(link)
Endometrial midline echo is seen midline echo can’t be seen
separately
More :
The Intradecidual Sign: Is It Reliable for Diagnosis of Early Intrauterine Pregnancy?
7. Questions to answer..
• (i) Is this gestational sac?
• (ii)Where is the gestational sac located?
– Examine the longitudinal section of uterus to
establish the connection between cervical canal &
gesational sac.
8. Normal gestational sac should be located above
the level of internal os otherwise consider
miscarriage
cervical ectopic
caesarean section scar pregnancy
Internal os is indentified by the insertion of
uterine arteries
12. Interstitial pregnancy
Interstitial pregnancy Intrauterine pregnancy located in the
upper lateral part of uterine
cavity(angular pregnancy)
Gestational sac is surrounded by thin Endometrial myometrial junction extend
myometrial mantle around the sac.
Narrow communication between the Communication between the gestational
gestational sac and endometrial cavity sac and uterine cavity is wide.
At laparoscopy the pregnancy is located
medial to the round ligament
13. Interstitial pregnancy
• Criteria by Timor-Tritsch
1) an empty uterine cavity
2) a gestational sac >1 cm from the most lateral point of the
endometrial cavity*
3) a gestational sac surrounded by a thin myometrial layer
Most useful diagnostic feature is Interstitial line sign –see the
next lide
* a strict application of a 1-cm cut-off may lead to an interstitial pregnancy being misdiagnosed as intrauterine pregnancy -Hafner T, Aslam
N, Ross JA, Zosmer N, Jurkovic D. The effectiveness of non-surgical management of early interstitial pregnancy: a report of ten cases
and review of the literature. Ultrasound Obstet Gynecol 1999; 13: 131–136.
16. Cornual ectopic pregnancy
• Pregnancy in the rudimentary cornu
• Failure to diagnose a cornual pregnancy can lead to
serious complications
• Criteria can be used to diagnose cornual pregnancy on
ultrasound examination:
1) a single interstitial portion of Fallopian tube in the
main uterine body
2) a gestational sac, mobile and separate from the uterus,
surrounded by myometrium;
3) a vascular pedicle adjoining the gestational sac to the
unicornuate uterus
17. Cervical ectopic pregnancy
1) No evidence of intrauterine pregnancy
2) Hourglass uterine shape with ballooned
cervical canal
3) Presence of a gestational sac or placental
tissue within the cervical canal
4) Closed internal os
18. Criteria for Cervical and Caesarean
Ectopic pregnancy
• Gestational sac located below the level of the
internal os or within a visible myometrial
defect at the site of the previous lower
segment Cesarean section scar
• Evidence of functional trophoblastic/placental
circulation on color Doppler examination,
characterized by high-velocity (peak velocity
>20 cm/s) and low impedance (pulsatility
index <1) blood flow
19. Criteria for Cervical Ectopic
Pregnancy....
• Negative sliding organs sign- Inability to move
the gestational sac from its position at the
level of the internal os using gentle pressure
applied by the transvaginal probe.
20. Caesaren section scar Pregnancy
• Combined approach
– TVS : Fine details of the sac and its relation to the
scar
– Transabdominal scan with the full bladder:
• To get the panoramic view of the uterus
• To get the accurate measurement of the distance
between the sac & the bladder.
• Maymon R, Halperin R, Mendlovic S, Schneider D, Vaknin Z, Herman A,et al. Ectopic pregnancies in Caesarean scars: the 8
year experienceof one medical centre. Hum Reprod 2004;19:278–84.
21. Caesaren section scar Pregnancy
• Other Diagnostic tools
– 3D ultrasound scan
– Magnetic resonance imaging
Differentiation from cervical pregnancy
In cervical pregnancy healthy myometrium visible
between the bladder and gestational sac.
22. Abdominal ectopic pregnancy
• Criteria*
absence of an intrauterine gestational sac
no evidence of tubal dilatation or a complex
adnexal mass
a gestational sac surrounded by loops of
bowel and separated from the uterus
free mobility of the gestational sac
*Gerli S, Rossetti D, Baiocchi G, Clerici G, Unfer V, Di Renzo GC. Early ultrasonographic diagnosis and laparoscopic treatment of abdominal pregnancy.
Eur J Obstet Gynecol Reprod Biol 2004; 113: 103–105.
24. Tubal Ectopic pregnancy
• If the uterus is empty at the time of the initial
scanning, we should look for the corpus
luteum.
• Ectopic pregnancy has been shown to be on
the ipsilateral side of corpus luteum in 70 to
85% of cases
25. Tubal ectopic pregnancy Vs Corpus
luteum
(I) Gentle pressure with the ultrasound probe
combined with abdominal palpation may
demonstrate free movement between the
adnexal mass(tubal ectopic pregnancy) and
the ovary (sliding organs sign)
26. Tubal Ectopic pregnancy....
(II) The tubal ring of an ectopic pregnancy is
usually more echogenic than ovarian
parenchyma, and the corpus luteum is usually
equal to or less echogenic than the ovary.
Echogenicity of an adnexal mass may help
distinguish the tubal ring of an ectopic
pregnancy from a corpus luteum.(Source)
27. Resources
(i)
Catch me if you scan: ultrasound diagnosis of ecto
D. JURKOVIC and D. MAVRELOS
(ii)
Imaging of Pelvic Pain in the First Trimester of Preg
Figure 1. Diagram of the various locations of an ectopic pregnancy.
Figure 7a. Diagrams show a pseudo–gestational sac in an ectopic pregnancy (a) and a double decidual sac sign in a normal intrauterine pregnancy (b).
Figure 7b. Diagrams show a pseudo–gestational sac in an ectopic pregnancy (a) and a double decidual sac sign in a normal intrauterine pregnancy (b).
Figure 10. Abortion in progress in a patient with a history of vaginal bleeding. Transvaginal US image of the uterus demonstrates a low-lying gestational sac (arrow) with mixed hyper- and hypoechoic contents in the endometrial cavity of the fundus (arrowheads), which represent decidual reaction and hemorrhage. The patient experienced a complete spontaneous abortion a few hours after the US examination. (Reprinted, with permission, from reference 16.)
Figure 9. Cervical pregnancy. Transvaginal US image of the uterus obtained along the longitudinal axis reveals a gestational sac that contains the fetal pole (arrow) within the cervix. Fu = uterine fundus. (Reprinted, with permission, from reference 25.)
Figure 11. Scar pregnancy in a patient with a history of cesarean section. Transvaginal gray-scale US image of the uterus, obtained with M-mode scanning along the longitudinal axis, reveals a gestational sac with a fetal pole (arrowhead) in the anterior wall of the uterus. There was no fetal cardiac activity, a finding suggestive of fetal demise.
Figure 8b. Interstitial pregnancy. (a) Transvaginal US image obtained along an oblique axis shows the yolk sac (arrowhead) within a gestational sac, which is located in the interstitial portion of the fallopian tube. The interstitial line sign (arrow) is also seen. (b) Diagram of the interstitial pregnancy and the interstitial line sign. (c) Transverse gray-scale US image of the uterus in another patient shows a gestational sac (arrow), which contains an embryo (arrowhead), in the cornua/interstitial portion of the fallopian tube. (Fig 8a reprinted, with permission, from reference 25.)
Figure 8a. Interstitial pregnancy. (a) Transvaginal US image obtained along an oblique axis shows the yolk sac (arrowhead) within a gestational sac, which is located in the interstitial portion of the fallopian tube. The interstitial line sign (arrow) is also seen. (b) Diagram of the interstitial pregnancy and the interstitial line sign. (c) Transverse gray-scale US image of the uterus in another patient shows a gestational sac (arrow), which contains an embryo (arrowhead), in the cornua/interstitial portion of the fallopian tube. (Fig 8a reprinted, with permission, from reference 25.)