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By: Pierre Kory, MPA, MD

  • Associate Professor of Medicine, Fellowship Program Director, Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Beth Israel Medical Center Icahn School of Medicine at Mount Sinai, New York, New York

https://www.medicine.wisc.edu/people-search/people/staff/5057/Kory_Pierre

Disadvantage the suturing is difficult Shearing of the tissue occurs the repaired wound tends to arthritis neck brace buy generic plaquenil 200 mg on line be pucked rheumatoid arthritis gout buy plaquenil 200mg without prescription. Disadvantages Bartholins duct may be served the levatorani muscle is weakened Bleeding is more profuse Suturing is more difficult the woman experiences subsequent discomfort Local analgesia for Episotomy Lignocaine /lidocaine/ 0 arthritis diet and gout generic 200mg plaquenil with mastercard. The head should be well down on the perineum, low enough to keep it stretched and thinned 2. The two extent of the laceration is determined Controlling methods of bleeding after episiotomy 1. The first stitch inserted at the apex of the incision the most commonly used suturing material is 2/0 chromic catgut. Defintion Puerperium is period from the expulsion of the placenta to the time the reproductive organs returns to pregravid state lasts 6 weeks. Other physiological changes occurred during pregnancy are reversed (Involution) 3. The care which required during the puerperium should be based up on 3 main principles 1. Encouraging sound methods of infant feeding and promoting the developmenof good maternal and child relationship. Physiology of Puerperium Involution of the uterus Definition: the uterus returns to its normal site, tone & position of non pregnant state Mechanism: 1. Ischemia: After the birth of the baby & placenta, the uterine muscle & blood vessels contracts so the blood circulation decreases. Lining of the uterus is cast off and is replaced first by granular tissue and then by endometrium. Progress of change in the uterus after delivery Weight of uterus Diameter of placental site Cervix End of labour 900Gms 12. Circulatory system: blood volume decreases to pregravid level & blood regains its normal viscosity. Muscle tone of 123 blood vessel improves cardiac out put returns to normal and blood pressure returns to its usual level. Respiratory system full ventilation because lungs are no longer compressed by the enlarged uterus. It continuous to act upon uterine muscle fibers that maintaining their contractions reducing the placental site & presenting hemorrhage. In women who choose to breast feed their babies, the sucking of the infant stimulates further secretion of oxytocin and this aids the continuing involution of the uterus and expulsion of milk. The abdominal and pelvic floor muscles gradually regain their tone with the assistance of postnatal exercise. Advice the mother to care for her self and for her baby covering a wide range of subjects like hygiene nutrition, immunization, family planning, etc. Admission to post natal ward the mother and baby are usually transferred to the post natal word with in an hour or 2 after delivery. Excess fruit should be avoided as substances from this will pass to the baby in the milk & may cause diarrhea. Restores her body figure the role of the nurse: during this period now a days is largely for advice and educate the mother in the care of her baby and herself, to listen patiently to her fears and expression, to 126 answer her questions and through out to given her encouragement and reassurance. Record vital sign st & nd a) 4 times daily for the 1 2 day b) then twice daily c) if elevated as doctor ordered 6.

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Hormones: A natural substance that is produced in the body and that influences the way the body grows or develops rheumatoid arthritis yeast infections buy plaquenil 200 mg cheap. A chemical substance produced by your body that influences its growth arthritis medication once a week purchase plaquenil 200 mg online, development how to cure arthritis in feet naturally best 200mg plaquenil, and condition. Inflammation: A condition in which a part of your body becomes red, swollen, painful and feels hot. Insulin: A hormone released by the pancreas whose job is to help use or store glucose as glycogen. Metabolic Syndrome: A medical condition characterized by obesity, insulin resistance, hypertension and dyslipidemia. Pancreas: A large gland of the body that is near the stomach and that produces insulin and other substances that help the body digest food. Steatohepatitis: A form of inflammation in the liver in which there is a buildup of fat in the liver. Symptoms: A change in the body or mind which could show that a disease is present. Triglycerides: One of the main fatty substances in the blood that can clog arteries. Ultrasound (U/S): A type of test that uses sound waves to take pictures of parts of the body. Unsaturated Fats: A type of fat found in food such as nuts, seeds, avocados, and fish. Methodology We searched PubMed using the following terms, Polycystic Ovary Syndrome, polycystic ovarian morphology, miscarriage, early preg nancy loss, recurrent pregnancy loss, 1st trimester loss. Polycystic Ovary Syndrome and Early Pregnancy Loss: A Review Article 36 controls the reported rates were 14. Miscarriage rates after fertility treatment, mirror those found in other infertile populations [14] (Table 2). Obesity has also been associated with increased risk of early pregnancy loss in patients undergoing fertility treatment [19]. On the other hand treatment of obesity based on a 6 month lifestyle intervention program has shown that a mean weight loss of 10 kg resulted in significant reduction of early pregnancy losses [21]. Hyperinsulinemia is also associated with obesity and high circulating levels of plasminogen activator inhibitor-1 [28]. Both these factors are implicated in the aetiology of early pregnancy loss [19,28]. Metformin administration and correction of insulin resistance resulted in improvement of endometrial blood flow parameters [44]. Polycystic Ovary Syndrome and Recurrent Pregnancy Loss Recurrent miscarriage is defined as loss of 3 or more consecutive pregnancies and it affects approximately 1% of couples trying to conceive [45]. It has been suggested that many risk factors are implicated in the pathogenesis of recurrent miscarriages such as advanced maternal age [46], previous miscarriages [47], antiphospholipid syndrome [48], chromosomal abnormalities [49,50], congenital uterine malformations [51], inherited thrombophilic defects [52], immunological factors [53] and finally endocrine factors [54] (Table 3). Recently it has been suggested that this link is mainly due to hyperandrogenaemia and insulin resistance. The prevalence of polycystic ovarian morphology amongst patients with recurrent miscarriages varies according to different authors. A strong causative relationship though still remains largely unconfirmed from the current evidence. Intended user of this directive are all Coast Guard Units that maintain Medical Manuals. Area and district commanders, commanders of maintenance and logistics commands, commanding officers of Headquarters units, Assistant Commandants for directorates, Chief Counsel and special staff offices at Headquarters shall ensure compliance with the provisions of this Notice. Meticulous attention to all details and aspects of preventing disease must be a continuing program. It is imperative that shipboard and station sanitation and preventive health practices be reviewed constantly in order that any disease promoting situation may be discovered immediately and promptly eradicated.

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For reasons of data sufficiency arthritis in dogs natural medicine discount plaquenil 200mg online, breast cancer As noted earlier in this chapter arthritis medication in kenya buy generic plaquenil 200mg on line, knowledge of heritable risk in typical Western populations was considered and il factors in tumorigenesis stems largely from studies on lustrated arthritis joint pain medication order 200 mg plaquenil with mastercard. This approach, which is based on established Men strongly predisposing autosomal dominant familial traits and delian principles, employed best estimates of the prevalence autosomal recessive disorders having unambiguous pheno of known, high-penetrance breast cancer-predisposing genes types. However, not unexpectedly, an un risk imposed by the given gene mutations; the risk of radio derstanding of this issue is proving difficult to obtain. To a genic breast cancer in normal individuals was based on data large measure this is due to the likelihood that, individually, from Japanese atomic bomb survivors. These will tend to escape detection by conventional kenazi Jews) and the influence of reduced penetrance on medical genetic and epidemiologic studies. The following points summarize the out of such genes and their interaction with environmental risk come of these modeling exercises. In brief, in studies on controversial, Dunning and colleagues (1999) and Na cultured blood lymphocytes, up to around 40% of un thanson and Weber (2001) note the potential involvement selected breast cancer cases were shown to exhibit an ab of polymorphic genes that encode steroid hormone recep normal excess of chromatid aberrations following X-irradia tors and paracrine growth factors. By contrast, this with genes involved in the metabolism of chemical species chromosomal trait was seen in only around 5% of age. Although the position re There is evidence that the genetic component of colonic mains somewhat uncertain, it seems reasonable to conclude cancer also includes a significant contribution from genes of that while increased breast cancer risk may be associated low penetrance. Specific data relating 2000; Chenevix-Trench and others 2002), and for these, the to gene polymorphisms and radiation risk are lacking al relative risk may be substantially higher. In their review of gene-environ these studies considered 141 patients with second cancers; ment interactions, Shields and Harris (2000) focus on lung the studies of Shafman and colleagues (2000) and Broeks cancer risk, and in this area, Bennett and colleagues (1999) Copyright National Academy of Sciences. The most germline deficiencies in these genes can lead to heritable important messages to emerge from these studies are that predisposition to cancer. Accordingly, considerable effort is multiple common loci can exert complex patterns of control being expended in the search for common functional poly over tumor susceptibility and resistance (synergistic and an morphisms that might act as low-penetrance cancer suscep tagonistic interaction), that the loci tend to be relatively tis tibility genes. The associations between interaction of a proportion of these loci was also demon these polymorphisms and radiosensitivity and/or tumor risk strated. Much of this seek evidence of natural polymorphic loci that modify the work has centered on genes involved in base or nucleotide tumorigenic expression of a major cancer-predisposing excision repair (Miller and others 2001). Multiple loci have been shown to influence susceptibility to radiation-induced lymphoma and leukemia (Balmain and Genetic Studies with Animals Nagase 1998; Szymanska and others 1999; Saito and others the recognized difficulties of resolving the modifying 2001; Santos and others 2001). This approach has been applied principally in mice for Genetic loci influencing the susceptibility of mice to the study of naturally arising polymorphic variation that in particle (227Th)-induced osteosarcoma have also been fluences spontaneous cancer risk and the risk after exposure mapped (Rosemann and others 2002), but again, no candi to chemical carcinogens and, in a few instances, ionizing date genes were specifically identified. Thus, although specific duced breast cancer (Okayasu and others 2000; Yu and oth Copyright National Academy of Sciences. This same Prkdc polymorphism has also been founded, but rather the extent to which genetic distortion of implicated in radiation-induced lymphomagenesis, as a the distribution of this risk might lead to underprotection of modifier of induced intestinal neoplasia in Apcminmice (Degg an appreciable fraction of the population. In this respect, and others 2003), and as a candidate gene for the Rapop1 some initial guidance for thought is already available from apoptosis-controlling locus (Mori and others 2001). Equally, however, the balance of additional S and R locus combina tions might provide a degree of resistance to the induction Conclusions and development of cancer in other organs. Thus, with this Although much remains to be learned about genetic sus first genetic scenario, major distortions of the distribution of ceptibility to the tumorigenic effects of radiation, it is pos overall cancer risk after radiation might not apply simply sible to frame some interim conclusions of the role it may because different genetic susceptibilities would tend to av play in determining radiation cancer risk at the individual erage out across organs. The phisms for genes involved in initial tissue-wide cellular re data available, although far from complete, tend to support sponse to radiation damage). The key issues and arguments are determined distortion of the distribution of overall cancer given here in brief summary. At present, the data available are For rare major gene deficiencies in humans and mice, insufficient to distinguish the likely contributions from these there can be strong effects on radiation cancer risk, and for two genetic scenarios. Although the data are sparse, such high-dose leagues (2000) and Hoover (2000) make some important radiation exposure in childhood may carry the greatest risk.

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Chromosomal changes in prostate cancer: a fluorescence in situ hybridization study psoriatic arthritis diet research purchase plaquenil 200 mg on-line. Perioperative lower urinary tract infections and deep sepsis in patients undergoing total joint arthroplasty arthritis medication new cheap plaquenil 200 mg on line. Benign prostatic hyperplasia is a reawakened process of persistent Mullerian duct mesenchyme arthritis hand surgery purchase plaquenil 200mg otc. Inferior vena cava compression due to massive hydronephrosis from bladder outlet obstruction. Effects of dopamine and epinephrine infusions on renal hemodynamics in severe malaria and severe sepsis. Test characteristics of the urine Gram stain in infants <or= 60 days of age with fever. Long-term outcome of the retained ureteral stump after lower pole heminephrectomy in duplex kidneys. Percutaneous tibial nerve neuromodulation is well tolerated in children and effective for treating refractory vesical dysfunction. Lower urinary tract dysfunction in children with generalized hypermobility of joints. Transurethral resection vs microwave thermotherapy of the prostate: a cost-consequences analysis. Clinical efficacy of a new 30-min algorithm for transurethral microwave thermotherapy: initial results. Long-term risk of re-treatment of patients using alpha-blockers for lower urinary tract symptoms. Transurethral microwave thermotherapy: the gold standard for minimally invasive therapies for patients with benign prostatic hyperplasia. Efficacy and safety of the new high-energy 30-minute transurethral microwave thermotherapy: results of 1-year follow-up in a multicenter study. Alpha1-blocker therapy for lower urinary tract symptoms suggestive of benign prostatic obstruction: what are the relevant differences in randomised controlled trials. Immunoexpression of tumour necrosis factor-alpha and its receptors 1 and 2 correlates with proliferation/apoptosis equilibrium in normal, hyperplasic and carcinomatous human prostate. Immunohistochemical comparative analysis of transforming growth factor alpha, epidermal growth factor, and epidermal growth factor receptor in normal, hyperplastic and neoplastic human prostates. The evolution of detrusor overactivity after watchful waiting, medical therapy and surgery in patients with bladder outlet obstruction. The role of pelvic-floor therapy in the treatment of lower urinary tract dysfunctions in children. Comparative efficacy of two alpha-adrenoreceptor antagonists, doxazosin and alfuzosin, in patients with lower urinary tract symptoms from benign prostatic enlargement. Observational multicentric trial performed with doxazosin: evaluation of sexual effects on patients with diagnosed benign prostatic hyperplasia. Development of renal function after neonatal urinary ascites due to obstructive uropathy. Quest for standardisation of electrical sensory testing in the lower urinary tract: the influence of technique related factors on bladder electrical thresholds. Inverse association between prostate cancer and the use of calcium channel blockers. Efficacy and safety of long term treatment with the dual 5 alpha-reductase inhibitor dutasteride in men with symptomatic benign prostatic hyperplasia. Comparison of a phytotherapeutic agent (Permixon) with an alpha blocker (Tamsulosin) in the treatment of benign prostatic hyperplasia: a 1-year randomized international study. Impact of phytotherapy on utility scores for 5 benign prostatic hyperplasia/lower urinary tract symptoms health states. Lower urinary tract reconstruction is safe and effective in children with end stage renal disease. Reductase activity of 17beta-hydroxysteroid oxidoreductase in prostatic tumors of different histological structure. Outcome of colposuspension in patients with stress urinary incontinence and abnormal cystometry.

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Occurrence: Yarrow is native to arthritis medication and warfarin generic 200 mg plaquenil fast delivery the Northern Hemisphere and Eurasia but is widely naturalized in United States arthritis pain vs bone cancer pain buy discount plaquenil 200mg online. Now it is widely distribute in Asia arthritis diet therapy order 200mg plaquenil free shipping, in which it is distributed in Iran, Afghanistan, Turkey, and also in Indian Subcontinent (India Pakistan). Uses Reported in Literature: It is reported to be associated with the treatment of amenorrhea, contraceptive (unproven), diabetes treatment, digestion (stimulates) gastro-intestinal disorders, dyspepsia, gastritis, inflammation, emmenagogue, menses (suppressed), menorrhagia, menstruation (regulates, 1 relieves pain). Kingdom: Plantae Order: Acorales Family: Acoraceae Genus: Acorus Local Name: Gur Bach Sindhi Name: Kini kathi English Name: Sweet flag, calamus Part used: Whole plant Fruits and leaves of Acorus calamus L. Description: A rhizomatous, perennial semi aquatic plant grows up to 40 cm in height. Leaves are simple, bright green, distichous, thickened in the middle, ensiform; flowers seen in densely packed spadix inflorescence, fruits is oblong berries are suspended from the apex of cells. Occurrence: Indigenous to India, Acorus calamus is now found across Europe, in southern Russia, northern Asia Minor, southern Siberia, China, Indonesia, Japan, Burma, Sri Lanka, and Australia. Kingdom: Plantae Order: Asparagales Family: Alliaceae Genus: Allium Local Name: Piaz Sindhi Name: Basar English Name: Onion Parts Used: Underground corn Bulb sand leaves of Allium cepa L. Description: Bulb is clustered, cylindrical to ovoid or almost rounded coats papery, white to brownish or reddish. Occurrence: Native to Central Asia, probably described from Iran, it is cultivated almost everywhere in Pakistan too. Uses Reported in Literature: 2 It is used for the prevention of lactation of women in lactation period. Kingdom: Plantae Order: Asparagales Family: Alliaceae Genus: Allium Local Name: Lehsan Sindhi Name: Thooma English Name: Garlic Parts Used: Bulb Bulbs and leaves of Allium sativum L. Occurrence: Native to Southwestern Asia, Britain, North America, cultivated in Pakistan. Ethnobotanic Data: It is used for menstrual problems like leucorrhea, dysmenorrhea and menorrhea. Kingdom: Plantae Order: Asparagales Family: Xanthorrhoeaceae Genus: Aloe Local Name: Aloe Sindhi Name: Alva English Name: Aloe vera Parts Used: Leaves and roots Leaves of Aloe vera (L. The leaves are thick and fleshy, green to grey-green, with some varieties showing white flecks on the upper and lower stem surfaces. Aloe vera grows in arid climates and is widely distributed in Africa, India, Nepal and other arid areas like Uses Reported in Literature: the plant is said to be used in menstrual diseases and the pulp is used in menstrual 2 suppression. Kingdom: Plantae Order: Zingiberales Family: Zingeberaceae Genus: Amomum Local Name: Bari illaichi Sindhi Name: Wada phota English Name: Black cardamom Parts Used: Whole plants Leaves of Ammomum subulatum Roxb. Individual flowers stay open for three days and more and new ones open successively. Occurrence: It is native to Nepal, Bangladesh, China, Bhutan, India, Assam, Sikkim, West Bengal, and Myanmar. Uses Reported in Literature: 2, 6 2, 6 2 It is stimulant, carminative, and blood thinner. Ethnobotanic Data: It is used for pelvic swelling and treats pelvic inflammatory disease in combination with holy basil leaves and rock salt. Kindom: Plantae Order: Apiales Family: Apiaceae / Umbellifarae Genus: Anethum Local Name: Soya Sindhi Name: Sowa English Dill Part used: Seeds, leaves Flowers of Anethum sowa Roxb. Description: An aromatic annual herb grows up to 1 m in height with hollow grooved stem. Leaves are compound, 2-3 pinnate, bluish-green, segments are filiform, leaf sheath surrounds the stem; flowers are 1 yellow, in flat compound umbels; fruits are narrowly winged, vittae large and conspicuous. Wild and weedy types of dill are widespread in the Mediterranean basin, in West Asia and in Pakistan. Uses Reported in Literature: 2 It increases lactation and prevent early pregnancy after birth. Ethnobotanic Data: Its suppositories are made in combination with different herbs and used for used treating uterus fibroid.

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References:

  • https://www.aafp.org/afp/2010/1015/afp20101015p942.pdf
  • https://www.cdss.ca.gov/ord/entres/getinfo/pdf/fccman.pdf
  • https://academic.oup.com/eurheartj/article-pdf/35/41/2873/17898679/ehu281.pdf
  • https://www.chlpi.org/wp-content/uploads/2013/12/Appendix.pdf

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