The increased cardiac output related to pregnancy can lead to heart failure, and the increased heart rate in the third trimester can lead to ischemic events. The potential obstetrical complications include preeclampsia or other hypertensive related disorders, premature birth, and small-for-gestational-age births.
For pregnant women diagnosed with uncomplicated malaria caused by chloroquine-resistant P. vivax infection, prompt treatment with artemether-lumfantrine (second and third trimesters) or mefloquine (all trimesters) is recommended. Doxycycline and tetracycline are generally not indicated for use in pregnant women
HOW TO DO A CESAREAN SECTION, EVIDENCE BASED by DR DELEKemi Dele-Ijagbulu
Introduction and Epidemiology, Indications and Classifications of Cesarean Section, Preoperative, Intra-operative and Postoperative Management, Complications, Concerns about Cesarean Sections, New Evidences on How To Perform a Caesarean Section, and Recommendations
nausea and vomiting in pregnancy is very common. it may be a manifestation of some medical - surgical - gynecological complications. hyperemesis gravidarum is a severe type of vomiting in pregnancy which has got deleterious effects on the health of the mother. it is a very important topic and it is also a topic in obstetrics. we should encourage and help young mothers to identify the symptoms. please read it and get knowledge about nausea and vomiting in pregnancy. stay tuned.
The increased cardiac output related to pregnancy can lead to heart failure, and the increased heart rate in the third trimester can lead to ischemic events. The potential obstetrical complications include preeclampsia or other hypertensive related disorders, premature birth, and small-for-gestational-age births.
For pregnant women diagnosed with uncomplicated malaria caused by chloroquine-resistant P. vivax infection, prompt treatment with artemether-lumfantrine (second and third trimesters) or mefloquine (all trimesters) is recommended. Doxycycline and tetracycline are generally not indicated for use in pregnant women
HOW TO DO A CESAREAN SECTION, EVIDENCE BASED by DR DELEKemi Dele-Ijagbulu
Introduction and Epidemiology, Indications and Classifications of Cesarean Section, Preoperative, Intra-operative and Postoperative Management, Complications, Concerns about Cesarean Sections, New Evidences on How To Perform a Caesarean Section, and Recommendations
nausea and vomiting in pregnancy is very common. it may be a manifestation of some medical - surgical - gynecological complications. hyperemesis gravidarum is a severe type of vomiting in pregnancy which has got deleterious effects on the health of the mother. it is a very important topic and it is also a topic in obstetrics. we should encourage and help young mothers to identify the symptoms. please read it and get knowledge about nausea and vomiting in pregnancy. stay tuned.
This presentation deals with information regarding a minor disorder of pregnancy i.e hyperemesis gravidarum, its manifestations, causes, diagnostic evaluation,complications, management, nursing interventions etc.Though its a minor disorder, delayed treatment can be fatal.
HYPEREMESIS GRAVIDARUM
Hyperemesis Gravidarum is excessive nausea and vomiting during pregnancy.
This pernicious vomiting is differentiated from the more common and more normal morning sickness by the fact that it is of greater intensity and extends beyond the first trimester.
Hyperemesis gravidarum may occur in any of the three trimesters. It is a condition affecting one in 1,000 pregnancies.
Hyperemesis gravidarum is a complication of pregnancy that is characterized by severe nausea and vomiting such that weight loss occur. The exact cause of hyperemesis gravidarum is not known. Risk factors include the first pregnancy, multiple pregnancy, obesity or family history of hyperemesis gravidarum.
DEFINITION
Hyperemesis Gravidarum is defined as extreme, excessive, and persistent vomiting in early pregnancy that may lead to dehydration and malnutrition.
INCIDENCE-
There has been marked fall in the incidence during the last 30years. It is now a rarity in hospital practice ( less than 1 in 1000 pregnancies). (a)Better application of family planning knowledge which reduces the number of unplanned pregnancies,(b) Early visit to the antenatal clinic and (c) Potent antihistaminic, antiemetic drugs.
THEORY
• Endocrine theory :high levels of hCG & estrogen during pregnancy
• Metabolic theory :vitamin B6 deficiency
• Psychological theory : Psychological stress increase the symptoms
CLINICAL MANIFESTATION-
From the management and prognostic point of view the clinical manifestation divided in to two types-
• EARLY
• LATE (moderate to severe)
1)Early- Vomiting occurs throughout the day. Normal day to day activities are curtailed. There is no evidence of dehydration or starvation.
2)late-(Evidence of dehydration and starvation are present).
o Tachycardia.
o Hypotension.
o Rise in temperature.
o Poor appetite.
o Poor nutritional intake.
o Loss of more than 25% of body weight.
o Dehydration and electrolyte imbalance.
o Rapid pulse and low blood pressure.
o Occasionally, jaundice develops in severe cases.
DIAGNOSTIC EVALUATION-
• Opthalmoscopic examination: Required if the patient is seriously ill. Retinal hemorrhage and detachment of the retina are the most unfavorable signs.
• ECG: When there is abnormal serum potassium level.
COMPLICATION
Weight loss
Dehydration
Metabolic acidosis from starvation
Hypokalemia (electrolyte imbalance)
MANAGEMENT-
Women with hyperemesis gravidarum are admitted to the hospital. Initially nothing is given by mouth. Hypovolemia and electrolyte imbalance are corrected by intravenous infusion. Vitamin supplements are given parenterally. Fluids and diet are gradually introduced as the woman’s condition improves.
principles of management :
• To control vomiting.
• To correct the fluids and electrolytes imbalance.
• To correct metabolic disturbances(acidosis or alkalosis).
• To prevent the serious complications of severe vomiting.
Hospitalization-
HYPEREMESIS GRAVIDARUM
Hyperemesis Gravidarum is excessive nausea and vomiting during pregnancy.
This pernicious vomiting is differentiated from the more common and more normal morning sickness by the fact that it is of greater intensity and extends beyond the first trimester.
Hyperemesis gravidarum may occur in any of the three trimesters. It is a condition affecting one in 1,000 pregnancies.
Hyperemesis gravidarum is a complication of pregnancy that is characterized by severe nausea and vomiting such that weight loss occur. The exact cause of hyperemesis gravidarum is not known. Risk factors include the first pregnancy, multiple pregnancy, obesity or family history of hyperemesis gravidarum.
DEFINITION
Hyperemesis Gravidarum is defined as extreme, excessive, and persistent vomiting in early pregnancy that may lead to dehydration and malnutrition.
INCIDENCE-
There has been marked fall in the incidence during the last 30years. It is now a rarity in hospital practice ( less than 1 in 1000 pregnancies). (a)Better application of family planning knowledge which reduces the number of unplanned pregnancies,(b) Early visit to the antenatal clinic and (c) Potent antihistaminic, antiemetic drugs.
THEORY
• Endocrine theory :high levels of hCG & estrogen during pregnancy
• Metabolic theory :vitamin B6 deficiency
• Psychological theory : Psychological stress increase the symptoms
CLINICAL MANIFESTATION-
From the management and prognostic point of view the clinical manifestation divided in to two types-
• EARLY
• LATE (moderate to severe)
1)Early- Vomiting occurs throughout the day. Normal day to day activities are curtailed. There is no evidence of dehydration or starvation.
2)late-(Evidence of dehydration and starvation are present).
o Tachycardia.
o Hypotension.
o Rise in temperature.
o Poor appetite.
o Poor nutritional intake.
o Loss of more than 25% of body weight.
o Dehydration and electrolyte imbalance.
o Rapid pulse and low blood pressure.
o Occasionally, jaundice develops in severe cases.
DIAGNOSTIC EVALUATION-
• Opthalmoscopic examination: Required if the patient is seriously ill. Retinal hemorrhage and detachment of the retina are the most unfavorable signs.
• ECG: When there is abnormal serum potassium level.
COMPLICATION
Weight loss
Dehydration
Metabolic acidosis from starvation
Hypokalemia (electrolyte imbalance)
MANAGEMENT-
Women with hyperemesis gravidarum are admitted to the hospital. Initially nothing is given by mouth. Hypovolemia and electrolyte imbalance are corrected by intravenous infusion. Vitamin supplements are given parenterally. Fluids and diet are gradually introduced as the woman’s condition improves.
principles of management :
• To control vomiting.
• To correct the fluids and electrolytes imbalance.
• To correct metabolic disturbances(acidosis or alkalosis).
• To prevent the serious complications of severe vomiting.
Hospitalization-
Please find the power point on Hyperemesis gravidarum and its managemen. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal Lifecare Centre
Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal
Intrahepatic cholestasis of pregnancy (ICP) is characterized by Pruritus and an elevation in serum bile acid concentrations, typically developing in the late second and/or third trimester and rapidly resolving after delivery.
Dr Anil Arora address the liver diseases that are specific during pregnancy. The presentation contains case discussions on diagnosis, treatments & take home messages
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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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
- 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
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.
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.
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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Couples presenting to the infertility clinic- Do they really have infertility...
Vomiting-in-Pregnancy.pptx
1. Vomiting in Pregnancy
Vomiting is a symptom which may be
related to pregnancy or may be a
manifestation of some medicalsurgical-
gynecological complications, which can occur at
any time during pregnancy.
The former is by far the most common one and
is called vomiting of pregnancy.
2. The causes of vomiting in pregnancy can be
classified as follows
1. Early Pregnancy
Related to pregnancy (vomiting of
pregnancy)
•Simple vomiting (morning sickness, emesis
gravidarum)
•Hyperemesis gravidarum (pernicious
vomiting)
3. Associated with pregnancy
Medical
•Intestinal infestation
•Urinary tract infection
•Hepatitis
•Ketoacidosis of diabetes
•Pyelonephritis, uremia
Surgical
•Appendicitis
•Peptic ulcer
•Intestinal obstruction
•Cholecystitis
•Pancreatitis
Gynecological
•Twisted ovarian tumor
• Red degeneration of fibroid
4. 2.Late Pregnancy
Related to pregnancy
•Continuation or reappearance of simple
vomiting of pregnancy
•Acute fulminating preeclampsia
Associated with pregnancy
•Medical-surgical-gynecological causes in early
pregnancy
•Hiatus hernia
5. VOMITING IN PREGNANCY
The vomiting is related to the pregnant state and
depending upon the severity, it is classified as
Simple vomiting of pregnancy-milder type
Hyperemesis gravidarum-severe type
SIMPLE VOMITING (Syn: morning sickness, emesis
gravidarum)
The patient complains of nausea and occasional
sickness on rising in the morning. Slight vomiting
is so common in early pregnancy (about 50%)
that it is considered as a symptom of pregnancy.
It may, however, occur at other times of the day.
6. The vomitus is small and clear or bile
stained. It does not produce any
impairment of health or restrict the
normal activities of the women. The
feature disappears with or without
treatment by 12–14th week of pregnancy.
High level of serum human chorionic
gonadotropin, estrogen and altered
immunological states are considered
responsible for initiation of the
manifestation, which is probably
aggravated by the neurogenic factor.
7. Management
Assurance is important. Taking of dry toast
or biscuit and avoidance of fatty and spicy
foods are enough to relieve the symptoms
in majority.
Supplementation with vitamin B1 100 mg
daily is helpful.
If the simple measures fail, antiemetic
drugs — trifluoperazine (Espazine) 1 mg
twice daily is quite effective.
Promethazine and ondansetron can be
used. Patient is advised to take plenty of
fluids (2.5 L in 24 hours) and fruit juice.
8. HYPEREMESIS GRAVIDARUM
DEFINITION
t is a severe type of vomiting of pregnancy which
has got deleterious effect on the health of
mother and/or incapacitates her in day-to-day
activities.
The adverse effects of severe vomiting are
Dehydration
metabolic acidosis (from starvation)
alkalosis (from loss of hydrochloric acid)
electrolyte imbalance (hypokalemia)
weight loss
9. ETIOLOGY: The etiology is obscure but the
following are the known facts
It is mostly limited to the first trimester
It is more common in first pregnancy
Younger age
Low body mass
History of motion sickness or migraine
It has got a familial history
It is more prevalent in hydatidiform
mole and multiple pregnancy
11. CLINICAL COURSE
From the management and prognostic point of
view, the cases are grouped into
Early „
Late
EARLY
Vomiting occurs throughout the day. Normal day-
to-day activities are curtailed. There is no
evidence of dehydration or starvation
LATE
Evidences of dehydration and starvation are
present
12. Symptoms
Vomiting is increased in
frequency with retching. Urine
quantity is diminished even to
the stage of oliguria.
Epigastric pain, constipation
may occur.
Signs
Features of and ketoacidosis:
Dry coated tongue,
sdehydration unken eyes,
acetone smell in breath,
tachycardia, hypotension, rise
in temperature may be noted,
jaundice is a late feature.
13. Investigations
Urinalysis
•Quantity—small
•Dark color
•High specifc gravity with acid reaction
•Presence of acetone, occasional presence of
protein and rarely bile pigments and
•Diminished or even absence of chloride
Biochemical
•Serum electrolytes-sodium, potassium and
chloride
•Serum TSH, T3 and Free T4
•ECG when there is abnormal serum potassium
level.
14. DIAGNOSIS
The pregnancy is to be confirmed first.
Ultrasonography is useful not only to
confirm the pregnancy but also to exclude
other, obstetric (hydatidiform mole,
multiple pregnancy), gynecological,
surgical or medical causes of vomiting.
15. COMPLICATIONS
Maternal
The majority of the clinical manifestations are
due to the effects of dehydration and starvation
with resultant ketoacidosis. Leaving aside those
symptomatology, the following complications may
occur which are fortunately rare nowadays
1. Neurologic complications
Wernicke’s encephalopathy, beriberi due to
thiamine deficiency
Pontine myelinolysis
Peripheral neuritis
Korsakoff’s psychosis
16. 2.Stress ulcer in stomach
3.Esophageal tear (MalloryWeiss syndrome)
4.Jaundice, hepatic failure
5.Convulsions and coma
6.Hypoprothrombinemia due to vitamin K
deficiency
7.Renal failure
Effects on the fetus
Fetus usually remains unaffected once the
problem is resolved. Fetal risks may be due to
low birth weight.
PREVENTION: The only prevention is to impart
effective management to correct simple vomiting
of pregnancy
17. MANAGEMENT
The principles in the management are: ‹
Maintenance of hydration ‹
To control vomiting ‹
To correct the fuids and electrolytes
imbalance ‹
To correct metabolic disturbances
(acidosis or alkalosis) ‹
To prevent the serious complications of
severe vomiting ‹
Care of pregnancy.
18. Hospitalization
Whenever a patient is diagnosed as a case of
hyperemesis gravidarum, she is admitted.
Fluids
Oral feeding is withheld for at least 24 hours
after the cessation of vomiting. During this
period, fluid is given through intravenous drip
method. The amount of fluid to be infused in 24
hours is calculated as follows: The total amount
of fluid approximates 3 liters, of which half is 5%
dextrose and half is Ringer’s solution
19. Drugs
Antiemetic drugs promethazine (Phenergan) 25
mg or prochlorperazine (Stemetil) 5 mg or
triflupromazine (Siquil) 10 mg may be
administered twice or thrice daily
intramuscularly.
Trifluoperazine (Espazine) 1 mg twice daily
intramuscularly is a potent antiemetic therapy.
Vitamin B6 and doxylamine are also safe and
effective.
Metoclopramide stimulates gastric and intestinal
motility without stimulating the secretions. It is
found useful. (b)
20. Hydrocortisone 100 mg IV in the drip is
given in a case with hypotension or in
intractable vomiting. Oral method
prednisolone is also used in severe cases.
Nutritional supplementation— with
vitamin B1 (100 mg daily), vitamin B6 ,
vitamin C and vitamin B12 are given