PPROM

PPROM is a common complication of pregnancy occurring in about 3% of all pregnancies. The obstetrician needs to be familiar with appropriate management of PPROM. High-risk consultation with a maternal-fetal medicine subspecialist should be considered in all cases to ensure appropriate current therapy is instituted.

In general, the following guidelines should be followed:

ROM diagnosis needs to be confirmed.

Digital vaginal examinations should be avoided.

Ultrasonography should be performed to confirm gestational age, estimated fetal weight, presentation, amniotic fluid index, and fetal anatomy if not already fully evaluated.

Antibiotics need to be given based on present evidence. See Medical Treatment.

Corticosteroids should be given to accelerate lung maturity between 24 and 34 weeks.

Informed consent should be obtained for expectant management versus delivery with careful documentation in the chart.

In PPROM, the rule should be hospitalization after viability in an institution where care for a premature neonate can be provided.

Maternal health is the primary indicator for the need to deliver. Any evidence of infection or maternal instability due to complications of PPROM, such as bleeding, requires careful evaluation and determination of the appropriateness of expectant management.

Fetal monitoring should be performed at least daily until delivery, and fetal well being and growth should be evaluated periodically with ultrasonography.

After 32 weeks and certainly after 34 weeks' gestation, the appropriateness of expectant management of PPROM should be reevaluated individually for each case.

PROM at term should be managed by delivery unless reasons exist to consider waiting for spontaneous labor. Large enough studies to document neonatal safety of expectant management of PROM at term do not exist.

Tocolytics

The most common cause of labor in the setting of PPROM is underlying chorioamnionitis. The use of tocolysis in that setting is not justified. No data indicate that administering tocolysis benefits the neonat

The use of corticosteroids to accelerate lung maturity should be considered in all patients with PPROM with a risk of infant prematurity from 24-34 weeks' gestation. The latency period has been suggested to be too short for the effects of corticosteroids to make a difference in neonatal morbidity; however, this clearly does not appear to be the case. Most patients with PPROM remain pregnant at 48 hours and thus will benefit from corticosteroid therapy

intravenous antibiotics were used for 48 hours—ampicillin 2 g q6h and erythromycin 250 mg q6h. The patients were then placed on oral amoxicillin 250 mg q8h and enteric-coated, erythromycin-base 333 mg q8h to complete a 7-day course of antibiotic therapy

cortocosteroid tx for PPROM

2dose of betamethazone 12mg IM 24 hourly

4doses of dexamethazone 6mg Im 12 houly

4 doses of hydrocotizone IV 12H

abotion summory in australia

Delirium, or acute confusional state, is an organically-caused decline from a previously attained baseline level of cognitive function. It is typified by fluctuating course, attentional deficits and generalized severe disorganization of behavior. It typically involves other cognitive deficits, changes in arousal (hyperactive, hypoactive, or mixed), perceptual deficits, altered sleep-wake cycle, and psychotic features such as hallucinations and delusions.

Delirium itself is not a disease, but rather a clinical syndrome (a set of symptoms).

most  common ct finding of catembolism syndrom is brain oedema.

small infarct also there,.diffuse infarction.

cerebral atropy later

diazepam is best used for acute anxiety state.

The overvalued idea, first described by Wernicke, refers to a solitary, abnormal belief that is neither delusional nor obsessional in nature, but which is preocceg upying to the extent of dominating the sufferer's life.eg....anorexia nervosa

Rumination refers to the tendency to repetitively think about the causes, situational factors, and consequences of one's negative emotional experience (Nolen-Hoeksema, 1991). Basically, rumination means that you continuously think about the various aspects of situations that are upsetting.

post tra,atic stress disorder

Psychotherapy is the "gold standard" of treatment for PTSD. Various psychotherapies are evidence-based for PTSD, including prolonged exposure, cognitive processing therapy, eye movement desensitization and reprocessing, cognitive restructuring therapy, trauma-focused cognitive behavioral therapy, brief eclectic psychotherapy, narrative therapy, and stress inoculation training.[

Posttraumatic stress disorder (PTSD)[note 1] is a mental illness that can develop after a person is exposed to one or more traumatic events, such as sexual assault, warfare, traffic collisions, terrorism or other threats on a person's life.[1] Symptoms include disturbing recurring flashbacks, avoidance or numbing of memories of the event, and hyperarousal, continue for more than a month after the occurrence of a traumatic event.[1]

Most people who have experienced a traumatizing event will not develop PTSD.[2] P

Agoraphobia is an anxiety disorder characterized by anxiety in situations where the sufferer perceives the environment to be dangerous, uncomfortable, or unsafe. These situations can include wide-open spaces, uncontrollable social situations, unfamiliar places, shopping malls, airports, and bridges. Agoraphobia is defined within the DSM-IV TR as a subset of panic disorder, involving the fear of incurring a panic attack in those environments.[1] In the DSM-5, however, agoraphobia is classified as being separate from panic disorder.[2] The sufferers may go to great lengths to avoid those situations, in severe cases becoming unable to leave their homes or safe havens.

depersonalisation may also accompany epilepsy.particulerly affecting the temporal lobe.

Hypochondriasis, or hypochondria, is an overwhelming fear that you have a serious disease, even though health care providers can find no evidence of illness. People with hypochondriasis misinterpret normal body sensations as signs of serious illness.

About Borderline Personality Disorder (BPD)

Brief Overview

Borderline personality disorder (BPD) is a serious mental illness that causes unstable moods, behavior, and relationships. It usually begins during adolescence or early adulthood.

Most people who have BPD suffer from:

Problems regulating their emotions and thoughts

Impulsive and sometimes reckless behavior

Unstable relationships

Impulsivity (or impulsiveness) is a multifactorial construct that involves a tendency to act on a whim, displaying behavior characterized by little or no forethought, reflection, or consideration of the consequences

Somatization disorder (also Briquet's syndrome) is a mental disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic symptoms

Munchausen syndrome is a psychiatric factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention, sympathy, or reassurance to themselves. It is also known[by whom?] as hospital addiction syndrome, thick chart syndrome, or hospital hopper syndrome.[citation needed] Munchausen syndrome fits within the subclass of factitious disorder with predominantly physical signs and symptoms, but they also have a history of recurrent hospitalization, travelling, and dramatic, extremely improbable tales of their past experiences.[

paranoid.### Someone who is paranoid has an irrational and obsessive distrust of others

Hypervigilance is an enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviors whose purpose is to detect threats. Hypervigilance is also accompanied by a state of increased anxiety which can cause exhaustion.

ulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to attempts to rid oneself of the food consumed. This may be done by vomiting or taking a laxative.[1]

usually depression patient awake 2or 3 hours early pts normal awaking time..

some major depression patients may slp more...

Social anxiety disorder, also called social phobia, is an anxiety disorder in which a person has an excessive and unreasonable fear of social situations. Anxiety (intense nervousness) and self-consciousness arise from a fear of being closely watched, judged, and criticized by others.

Postpartum psychosis (or puerperal psychosis) is a term that covers a group of mental illnesses with the sudden onset of psychotic symptoms following childbirth.

Postpartum psychosis (or puerperal psychosis) is a term that covers a group of mental illnesses with the sudden onset of psychotic symptoms following childbirth.

A typical example is for a woman to become irritable, have extreme mood swings and hallucinations, and possibly need psychiatric hospitalization.

factors that contribute to an increased risk of developing postpartum psychosis, such as an underlying bipolar disorder, or a previous postpartum psychosis, any pregnant woman is potentially at risk. T

post partum psycosis

Suicide is rare, and infanticide extremely rare, during these episodes. Infanticide after childbirth is usually due to profound postpartum depression (melancholic filicide) when it is often accompanied by suicide.[

post partum psycosis commonnin primies

post partuma psycosis

rarely in first 2PPD

usually within first 30 days

manic fx are more

sever insomniya

antipsycotic are given

ect for worst case but very effecyivenext child birth 20 % risk

methadone

methadone

noun

a powerful synthetic analgesic drug which is similar to morphine in its effects but less sedative and is used as a substitute drug in the treatment of morphine and heroin addiction.

catatonic stupor

Catatonic schizophrenia is a type (or subtype) of schizophrenia that includes extremes of behavior. At one end of the extreme the patient cannot speak, move or respond - there is a dramatic reduction in activity where virtually all movement stops, as in a catatonic stupor.

Puerperal Depression (PD) is a severe from of depression or elation occurring in the first few weeks after the baby is born. The term `puerperal' refers to the six week period immediately following childbirth

Deinstitutionalisation (or deinstitutionalization) is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability.

Chlorpromazine (CPZ), marketed as the trade name Thorazine and Largactil among others, is an antipsychotic medication. It is primarily used to treat psychotic disorders such as schizophrenia. Other uses include the treatment of bipolar disorder, attention deficit hyperactivity disorder, nausea and vomiting, anxiety before surgery, and hiccups that do not improve following other measures. It can be given by mouth, by injection into a muscle, or into a vein.[2]

vaginismus  usually associate with phobic anxiety

post partum psycoss

common in primi

usually within 30 days of ppp

rarely in 1st 2days

mix picture of organic,affective and schizophrenic

but more manic disorder

onset usually abrupt with sever insomnia followed by confusion

anti depressent and lithium can be use

ECT is very effective specially patient with  schzophrinic fx

next pregnancy 20 % risk

lithium carbonate is definitly teratogenic in 1st trimester

benzodiazepine,fluphenazine,TCA relatively contraindicated in pregnancy..with METHIDONE mothers are encourage to remain on it during 1st trimester

Antipsychotics (also known as neuroleptics or major tranquilizers) are a class of psychiatric medication primarily used to manage psychosis (including delusions, hallucinations, or disordered thought), in particular in schizophrenia and bipolar disorder, and are increasingly being used in the management of non-

acute dystonia occur with neuroleptic drugs/antipycjotic and treat with haloperidol and fluphenazine

treat IV/IM with anticholinergics such as benztropine 2mg 

can repeat in 30 mins

Dystonic reactions most often occur shortly after initiation of drug treatment; 50% occur within 48 hours and 90% occur within 5 days of initiation of treatment.

Drug-induced acute dystonic reactions are a common presentation to the emergency department. They occur in 0.5% to 1% of patients given metoclopramide or prochlorperazine.1 Up to 33% of acutely psychotic patients will have some sort of drug-induced movement disorder within the first few days of treatment with a typical antipsychotic drug

What are Anticholinergics?

Anticholinergics are a class of drugs that block the action of the neurotransmitter acetylcholine in the brain. They are used to treat diseases like asthma, incontinence, gastrointestinal cramps, and muscular spasms. They are also prescribed for depression and sleep disorders. The drugs help to block involuntary movements of the muscles associated with these diseases. They also balance the production of dopamine and acetylcholine in the body. Anticholinergics can also be used to treat certain types of toxic poisoning, and are sometimes used as an aid to anesthesia.

Anticholinergics are only available with a doctor’s prescription. Some examples include:

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Trihexyphenidyl (Artane)

Benztropine mesylate (Cogentin)

Biperiden

Procyclidine

2,5 antihistamines (orphenadrine)

Atropine

Flavoxate (Urispas)

Oxybutynin (Ditropan, Oxytrol)

Scopolamine

Hyoscyamine (Levsinex)

Tolterodine (Detrol)

Belladonna alkaloids

Fesoterodine (Toviaz)

Solifenacin (VESIcare)

Darifenacin (Enablex)

Propantheline (Pro-Banthine) (UCSF)

There are many other types available. A doctor will select the best medication for your condition.

michanisam of action of atrophine

n general, atropine counters the "rest and digest" activity of glands regulated by the parasympathetic nervous system. This occurs because atropine is a competitive, reversible antagonist of the muscarinic acetylcholine receptors (acetylcholine being the main neurotransmitter used by the parasympathetic nervous system).

Atropine is a competitive inverse agonist for the muscarinic acetylcholine receptor types M1, M2, M3, M4 and M5.[24] It is classified as an anticholinergic drug (parasympatholytic).

In cardiac uses, it works as a nonselective muscarinic acetylcholinergic antagonist, increasing firing of the sinoatrial node (SA) and conduction through the atrioventricular node (AV) of the heart, opposes the actions of the vagus nerve, blocks acetylcholine receptor sites, and decreases bronchial secretions.[medical citation needed]

In the eye, atropine induces mydriasis by blocking contraction of the circular pupillary sphincter muscle, which is normally stimulated by acetylcholine release, thereby allowing the radial pupillary dilator muscle to contract and dilate the pupil. Atropine induces cycloplegia by paralyzing the ciliary muscles, whose action inhibits accommodation to allow accurate refraction in children, helps to relieve pain associated with iridocyclitis, and treats ciliary block (malignant) glaucoma.[medical citation neede

fx of dellirium

gitation

confution

motor restlessness

dysathria

myoclonus

hallucination

convulsion

An acetylcholinesterase inhibitor (often abbreviated AChEI) or anti-cholinesterase is a chemical or a drug that inhibits the acetylcholinesterase enzyme from breaking down acetylcholine, thereby increasing both the level and duration of action of the neurotransmitter acetylcholine.

Lithium

indications

1.propilactic for bi poler

2.acute tx for mania

3.resistant depression

4.tx fir aggression in the develomentally disabled handicap

Li toxicity

early signs if Li

lithium toxicity

early signs of lithium toxicity can be seen in patient who lave normal laboratoty ranges,especially in elderly patients.

how to measured Li level in bld

1.stady Li dose for 4 to 5 days

2. 12 hours after nihht dose Li lebel in bld measuer in morning time

mesuering plasma level not carried out with andi depressant,..

only Nortripptyline has well define theraputic range

smilerly  plsma level mesuring of antipsycjotic agents , MAO inhibiters been of only limited usefulness...except clozapine

acute increse of plsma Li level can be drop withing few hours due to tissue distribution.. 3mmol /L can drop yo 1mmol/L in few hours

Fx of Li toxicity

1. lethagy

2.apathy

3.tremour

4.slurred speach

5.ataxia

6.muscle fasciculayion

7.choreoathetosis

8.convulsion

9.coma

10.death

there may be residual neurological seque

se

treatment for Li toxivity more than 4mmol per /L is haemodyalisis

clozapine use to treat gor treatment refacyory schizophrenia

clozapne may assoviate with fatal agranulocytosis. and leupenia

clozapine is atypival anticychotic

it has law potential for extrapyramidal side effect

commonly cause

1.drowsinesz

2.hypersalivation

3.tachycardia

4.dizziness

5.vertigo

6.headavhe

7.git effects

8tocic delirium

clozapine should gradually reduce over 2 weeks to minimise rebound exacerbation of psychosis

clozapine conytaindiacated for

1.myaloproliferative disorder

2.sever CNS depression

3.prebious hx of leucopenia

4.agranulocytosis

cannibies

ocational use of canibies /marijuana/Ganja  does not cause withdrowal symtoms.

highdoes uses produce withdrowal fx

1.anorexia

2.irritability

3.insomnia

4,restlessness

5.hot flashes

6.swetting

7.hicops

8. ost often compared with a boat of influenza

LSD  withdrowal Fx

Lysergic acid diethilmide does not produce withdrowal symptoms

but repeated use may produce "bad trip"

1. cause visual hallucination

2.perceptual distortions

3.intense emotions of frightening

heroin withdrowal Fx

1.Yawaning

2.Nausia

3.runny eyes and nose

4.colicky abdominal pain and twitch

cocaine and ampatamine

cocaine or ampatamine may precipitate "stimulant psychosis"

which is indisyinguishble from acute paranoid schizophrenia

and it is characterised by paranoia and persecurity delusions in clear consciousness, togeter with ideas of referwnce, auditory and visual halucinations.

these symptoms remits wiyh rest,sedation,and absence of futher use

most common symptoms of withdrowal of opiate is Rhinorrhea

gooseflesh

ˈɡuːsflɛʃ/

noun

a pimply state of the skin with the hairs erect, produced by cold or fright.

classic symptoms of withrowal fx of opiate/herroin

 ###detoxification by oral METHADONE and oral CLODINE 

overdose ekakadi denne naloxone

clodine valin sleep disterbance,dizziness and postural hypotention enava

abdominal crams

nausia

diarrhea

swetting

insomnia

rhinorrhea

exvessive lachrymation

goose flesh,,,,,,body hair erect venava

withdrowal fx peak in 36 to 48 hours

ECT not effective for chronic schizophrenia, but help in acute shizophrenia

also depression secondory to schizophrenia is not respond to ECT

good tx to catatonic stupor

Condyloma (plural: "Condylomata", from Greek "knuckle") refers to an infection of the genitals. The two subtypes are: Condyloma acuminata, or genital warts, caused by human papilloma virus subtypes 6, 11, and others

knee dislocation - Google Search

anterior dislocation ekedi yata kotasa anterior peththata yaava.

posterior dislocation ekedi yata kotasa posterior peththata enava

Molluscum contagiosum virus transmission through direct skin contact between children sharing a bath and between athletes sharing gymnasium equipment and benches has been reported. An association between school swimming pool use and molluscum contagiosum infection has also been reported.

Seborrheic dermatitis is a papulosquamous disorder patterned on the sebum-rich areas of the scalp, face, and trunk (see the image below). In addition to sebum, this dermatitis is linked to Malassezia,[1] immunologic abnormalities, and activation of complement. Its severity ranges from mild dandruff to exfoliative erythroderma.

seborretic dermayitis

Intermittent, active phases manifesting with burning, scaling, and itching, alternating with inactive periods; activity is increased in winter and early spring, with remissions commonly occurring in summer

auditory cortex - Google Search

feature of cerebellar disease - Google Search

feature of cerebellar disease - Google Search

The pyramidal tracts include both the corticospinal and corticobulbar tracts. These are aggregations of upper motor neuron nerve fibres that travel from the cerebral cortex and terminate either in the brainstem (corticobulbar) or spinal cord (corticospinal) and are involved in control of motor functions of the body.

pyridostigmine

ˌpɪrɪdə(ʊ)ˈstɪɡmiːn/

nounMEDICINE

a synthetic compound related to neostigmine, with similar but weaker and longer-acting effects.

use to treat myasthrnis gravis

Polymyositis is an idiopathic inflammatory myopathy that causes symmetrical, proximal muscle weakness; elevated skeletal muscle enzyme levels; and characteristic electromyography (EMG) and muscle biopsy findings (see the images below). Clinically similar to polymyositis, dermatomyositis is an idiopathic, inflammatory myopathy associated with characteristic dermatologic manifestations.[1] Inclusion body myositis is a slowly progressive, idiopathic, inflammatory myopathy with characteristic pathologic findings that is generally found in older males.

Dermatomyositis is an idiopathic inflammatory myopathy with characteristic cutaneous findings that occur in children and adults (see the image below). This systemic disorder most frequently affects the skin and muscles but may also affect the joints; the esophagus; the lungs; and, less commonly, the heart.[1, 2] Dystrophic calcinosis may complicate dermatomyositis and is most often observed in children and adolescents.

Carbidopa (Lodosyn) is a drug given to people with Parkinson's disease in order to inhibit peripheral metabolism of levodopa. This property is significant in that it allows a greater proportion of peripheral levodopa to cross the blood–brain barrier for central nervous system effect.

Miller Fisher syndrome is a rare, acquired nerve disease that is considered to be a variant of Guillain-Barré syndrome. It is characterized by abnormal muscle coordination, paralysis of the eye muscles, and absence of the tendon reflexes. Like Guillain-Barré syndrome, symptoms may be preceded by a viral illness.

Rapid urease test, also known as the CLO test (Campylobacter-like organism test), is a rapid diagnostic test for diagnosis of Helicobacter pylori. The basis of the test is the ability of H. pylori to secrete the urease enzyme, which catalyzes the conversion of urea to ammonia and carbon dioxide.

The test is performed at the time of gastroscopy. A biopsy of mucosa is taken from the antrum of the stomach, and is placed into a medium containing urea and an indicator such as phenol red. The urease produced by H. pylori hydrolyzes urea to ammonia, which raises the pH of the medium, and changes the color of the specimen from yellow (NEGATIVE) to red (POSITIVE).