This document discusses abnormal vaginal discharge, including its definition, prevalence, causes, examination, and treatment. Some key points:
1. Abnormal vaginal discharge is defined as excessive discharge not associated with menstruation, offensive or malodorous discharge, or yellowish/mucopurulent discharge.
2. Approximately 1/3 of females may complain of abnormal vaginal discharge, which can occur at any age. Many clinics report 70% of pregnant women experience it due to infection.
3. Causes include physiological changes, infections like bacterial vaginosis, candidiasis, and trichomoniasis, chemical irritation, and foreign bodies. Examination involves history, appearance, pH
Leucorrhoea
Dr. Yashika
Abnormal Vaginal Discharge
Frequent complaint.
Discharge may vary from excess to normal.
Discharge may be blood-stained / contaminated with urine or stool.
Characteristics of normal vaginal fluid
Nature - watery
Colour - white
Odour - Odourless
pH - 4.0
Microscopically - Squamous epithelial cells,
Leucorrhoea
Leucorrhoea is defined as excessive normal vaginal discharge.
Features of vaginal discharge in leucorrhoea :
Excess secretion.
Non purulent
Non offensive
Non irritant
Never causes pruritis.
Etiology :
Physiological excess
Cervical causes
Vaginal causes
Physiologic excess
Puberty
Menstrual Cycle
Pregnancy
Sexual excitement
Cervical causes:
Cervicitis
Cervical ectopy
Cervical polyp
Treatment
General health improvement
Surgical treatment of cervical factors
Pill users are asked to stop pill immediately
Local hygiene
Secretions produced by the glands of vaginal wall and cervix that drain from the vaginal opening.
Vaginal discharge is a common presentation of women to the STI clinic
Can be physiological or pathological
Related with some common STIs
Leucorrhoea
Dr. Yashika
Abnormal Vaginal Discharge
Frequent complaint.
Discharge may vary from excess to normal.
Discharge may be blood-stained / contaminated with urine or stool.
Characteristics of normal vaginal fluid
Nature - watery
Colour - white
Odour - Odourless
pH - 4.0
Microscopically - Squamous epithelial cells,
Leucorrhoea
Leucorrhoea is defined as excessive normal vaginal discharge.
Features of vaginal discharge in leucorrhoea :
Excess secretion.
Non purulent
Non offensive
Non irritant
Never causes pruritis.
Etiology :
Physiological excess
Cervical causes
Vaginal causes
Physiologic excess
Puberty
Menstrual Cycle
Pregnancy
Sexual excitement
Cervical causes:
Cervicitis
Cervical ectopy
Cervical polyp
Treatment
General health improvement
Surgical treatment of cervical factors
Pill users are asked to stop pill immediately
Local hygiene
Secretions produced by the glands of vaginal wall and cervix that drain from the vaginal opening.
Vaginal discharge is a common presentation of women to the STI clinic
Can be physiological or pathological
Related with some common STIs
Polycystic Ovarian Syndrome is heterogeneous, multisystem endocrinopathy in women of reproductive age characterized by chronic anovulation resulting in infertility, irregular bleeding, obesity and hirsutism. Most common, although the least understood, cause of androgen excess. Initially it was described in 1935.Also known as Stein-Leventhal syndrome
The slide includes:
Introduction
Incidence
Pathophysiology
Pathology
Clinical features
Investigation
Treatment
what is endometriosis? Theories in endometriosis, sites of endometriosis. types and clinical presentation. signs and symptoms.
Investigations :TVS, CA125
laparoscopic findings
chocolate cyst and extrapelvic endometriosis.
Classification of endometiosis
Diffential diagnosis
Management :of asymptomatic and symptomatic cases
drugs and minimally invasive surgery
surgey and preventive measures in endometiosis.
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
Polycystic Ovarian Syndrome is heterogeneous, multisystem endocrinopathy in women of reproductive age characterized by chronic anovulation resulting in infertility, irregular bleeding, obesity and hirsutism. Most common, although the least understood, cause of androgen excess. Initially it was described in 1935.Also known as Stein-Leventhal syndrome
The slide includes:
Introduction
Incidence
Pathophysiology
Pathology
Clinical features
Investigation
Treatment
what is endometriosis? Theories in endometriosis, sites of endometriosis. types and clinical presentation. signs and symptoms.
Investigations :TVS, CA125
laparoscopic findings
chocolate cyst and extrapelvic endometriosis.
Classification of endometiosis
Diffential diagnosis
Management :of asymptomatic and symptomatic cases
drugs and minimally invasive surgery
surgey and preventive measures in endometiosis.
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
Yeast infections are generally caused by an organism called Candida albicans. Natural cures are simple, less expensive, and by far the most important point, they actually work. Get few tips for avoiding this disease with ease.
http://www.yeastinfectionheal.com/
Bacterial vaginosis by dr alka mukherjee DR APURVA MUKHERJEE nagpur m.s.alka mukherjee
Bacterial vaginosis is a type of vaginal inflammation caused by the overgrowth of bacteria naturally found in the vagina, which upsets the natural balance. Women in their reproductive years are most likely to get bacterial vaginosis, but it can affect women of any age. Bacterial overgrowth in the vagina.
Bacterial vaginosis tends to affect women of childbearing age. Activities such as unprotected sexual intercourse or frequent douching can increase a person's risk.
In some cases, there are no symptoms. In other cases, there may be abnormal vaginal discharge, itching or odour. BV can clear up on its own.
Treatment can include prescription cream, gel or medication. Recurrence within three to 12 months is common, requiring additional treatment.
Very common
More than 10 million cases per year (India)
Treatable by a medical professional
Short-term: resolves within days to weeks
Requires a medical diagnosis
Lab tests or imaging often require
Yeast infections are generally caused by an organism called Candida albicans. Natural cures are simple, less expensive, and by far the most important point, they actually work. Get few tips for avoiding this disease with ease.
http://www.yeastinfectionheal.com/
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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.
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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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. • Vaginal discharge is the most common
presenting complaint of females attending obs
department.
• Excessive vaginal discharge may be
physiological or Pathological.
3. DEFINITION
Abnormal vaginal discharge (AVD) is defined as any one
of the three presentations,
• 1. Excessive vaginal discharge not associated with
menstruation; pre, mid and post period.
• 2. Offensive or malodorous discharge
• 3. Yellowish or mucopurulent discharge
4. PREVALANCE
It has been estimated that approximately
1/3 rd of female patients may complain of
abnormal vaginal discharge.
It can occur in females of all ages,from neonatal to the
post menopausal period and it is quite common during
pregnancy.
Many clinics have reported that 70% of pregnant women
manifest Abnormal vaginal discharge due to lower genital
tract infection.
5. NORMAL DISCHARGE
• Floccular in consistency
• Whitish and non malodourous
• Normal pH is acidic ranging from 3.5 to 4.5 due to
Lactobacilli which convert glycogen to lactic acid
• Secondary fermentation of endocervical mucus by
vaginal flora also contribute to low pH.
6. Normal Flora :
i. Lactobacilli : • Found in 96% of women
ii. Concentrations 105 to 108 / ml.
iii. Protective effect by interfering with adherence to epithilial cells
iv. Facultative organisms : • Diphtheroids – streptococci – E.coli –
ureapalasma urealyticum – mycoplasma hominis i. Anaerobic
organisms : • Peptostreptococci – bacteroid - fusobacterium
7. CAUSES FOR VAGINAL DISCHARGE
• PHYSIOLOGICAL :
AGE-DEPENDENT :
1.NEONATE AND INFANT
2.PRE-PUBERTY
3.CHILD BEARING
4.POST MENOPAUSAL
8. • EXCESSIVE SECRETION :
1.PREGNANCY
2.SEXUAL AROUSAL
PATHOLOGICAL :
A) NON-INFECTIVE CHEMICAL IRRITATION –Antiseptics,bath additives
deodorants,detergent spermicides,douches, perfumed soaps.
B) FOREIGN BODIES IUCD,RETAINED MATERIALS,RETAINED TAMPONS
RETAINED SHEATHS GYNAECOLOGICAL CONDITIONS ENDOCERVICAL
C) INFECTIVE CAUSES CERVICITIS
1.HERPES GENITALIS
2.MUCOPURULENT CERVICITIS— a) Gonococcal b) Non gonococcal- Chlamydia
positive and Chlamydia negative VAGINITIS 1.BACTERIAL VAGINOSIS 2.VAGINAL
CANDIDIASIS 3.VAGINAL TRICHOMONIASIS
9. • CHILD BEARING AGE :
Causes for increased vaginal secretion during child bearing age is as
follows:
1.Mid cycle stimulation of endo cervical glands by oestrogen
2. EXOGENOUS-Semen of recent ejaculation
3. Mid cycle discharge is sufficient to keep the vagina moist and
usually does not stain the under garments.It may be associated with
Mittelshmerz or mid cycle unilateral pelvic discomfort.
10. • POST MENOPAUSAL PERIOD
There is atropy of vaginal epithelium due to diminished
estrogen secretion
Thin,serous discharge,occasionally blood stained and
associated with itching and burning.
Small areas of granulation and ulceration
along with slight vaginal bleeding may develop
.Most common cause of Abnormal
Vaginal discharge is Atropic vulvovaginitis.
12. HISTORY:
Source of discharge must be determined.
Perineal discharge could originate from vagina, cervix, urinary tract and rectum
Ascertain the following attributes of the discharge: quantity, duration, colour,
consistency and odour. Symptoms include : itching or burning . External
Dysuria, Dyspareunia
Obtain history of the following: • Prior similar episodes • Sexually transmitted
infection • Sexual activities • Birth control method • Last menstrual period •
Douching practice • Antibiotic use • General medical history •
Systemic symptoms such as lower abdominal pain, fever, chills, nausea, and
vomiting
13. PHYSICAL EXAMINATION
Appearance of discharge.
Erythema and edema of vaginal mucosa
pH levels
Diagnostic Tools:
pH : Nitrazine paper ,Wet prep: microscopic examination of
discharge ( clue cells of BV)
KOH prep: dissolves cellular debris leaving pseudohyphae of
candida.
Whiff test: Fishy odor of BV Culture
14. Bacterial Vaginosis Medication:
Oral: metronidazole 500mg bid for
7 days, or clindamycine 300mg bid for 7 days.
2. Vaginal: metronidazole gel 0.75% bid for 5 days, or
clindamycine cream 2% for 7 days.
NO TREATMENT OF SEXUAL PARTNER IS NEEDED
15. • Candida medication
Clotrimazole 1% cream 5g intravaginally for 7-14 days OR 2% for 3 days
OR
Miconazole 2% for 7 days OR 4% for 3 days
OR
Tioconazole 6.5% single application
OR
Butoconazole 2% single application
OR
Terconazole 0.4% for 7 days OR 0.8% for 3 days
ORAL AGENT:
Fluconazole 150mg orally single dose
16. • Trichomonas Vaginitis Medication
Metronidazole 2g orally single dose
OR
Tinidazole 2g orally single dose
Alternative regimen
Metronidazole 500mg orally twice a day for 7 days