Monday, January 20, 2020

Human Physiology: METHODS OF CONTRACEPTIONS

Human Physiology: METHODS OF CONTRACEPTIONS: CONTRACEPTIVE METHODS Contraceptive measures are methods used to prevent conception (pregnancy).They include all temporary and permanen...

METHODS OF CONTRACEPTIONS


CONTRACEPTIVE METHODS
Contraceptive measures are methods used to prevent conception (pregnancy).They include all temporary and permanent measures to prevent pregnancy   resulting from coitus (sexual intercourse).

             Methods of Contraception:-
1.     NATURAL  METHODS
2.     BARRIER  METHODS
3.     CHEMICAL  METHODS
4.     LONG-TERM / PERMANENT METHOD

1.NATURAL METHOD- It is also  known as fertility-based awareness methods. This  is the method that uses the body’s natural physiological changes and symptoms to identify the fertile and infertile phases of the menstrual cycle.

                                  
 TYPES:-
A.  BASAL BODY TEMPERATURE METHOD
B.  CALENDER METHOD OR  SAFE PERIOD METHOD
C.  LACTATIONAL  AMENORRHEA  METHOD
D.  WITHDRAWAL METHOD
                                           
A).BASAL BODY TEMPERATURE METHOD:- Ovulation raises body temperature by ½ - 1 degree F And temperature  will drop if fertilization does not occurs.


 B).CALENDER METHOD :-Couple avoid or abstain coitus from day 10 to 17  of menstrual cycle when ovulation could  be expected  and the chances of fertilisation are very high during the period , it is called fertility period.


C).LACTATIONAL AMENORRHEA:-Ovulation and menstrual cycle does not occur during intense lactation following parturition. Increased level of prolactin inhibit production and secretion of GnRH.  Thus decreases the level of oestrogen in body .Ovulation cannot occur without a surge in oestrogen level. These methods add   chemicals similar to  hormones to stop the  release of an egg and      weaken the sperm. The hormones change  your cervical mucus  and uterine lining, slow  sperm, and reduce  ability of fertilized egg to implant into  uterine wall

D).WITHDRAWAL METHOD:- The man takes his penis out of the vagina before  ejaculation.  Male needs to ejaculate away from  female; sperm on legs and labia can still  travel into vagina. Effectivity  of this method depends on a male’s self knowledge  and self control. Effectiveness: 78-96%.

2..BARRIER  METHODS:-Barrier  method  of contraceptive prevent the meeting   of ovum and sperms after coitus. These includes
                           I.        Mechanical Barrier
a.   Male condom
b.   Female condom
c.   Diaphragm
d.   Cervical cap

                         II.        Chemical Barrier
a.   Spermicides


                     III.        Combined

a).Male condom:-  A thin covering that you unroll over an erect  penis. Made of  latex, polyurethane, or animal membrane. Put on before any genital contact. At withdrawal, hold the rim in place at the base of  the penis so it doesn’t slip off. It may decrease the sensation for  men.
Lubrication makes condom less likely to break. Effectiveness: 82-98%. Have no side effect and protect against STD.

b).Female condom:- A soft, loose pouch that is inserted in the  vagina. Flexible rings at each end hold it in  place. Insert the small ring in vagina, large ring  stays outside partially covering labia. It can be put in up to 8 hours before sex. It can be used if you are allergic to latex  (made of nitrite).Men usually feel no reduction  in sensation. Effectiveness: 79-95%

c).Diaphragm &Cervical cap:- A diaphragm or Cervical  cap is a barrier method of contraception that  inside the  vagina and prevents sperm passing through the cervix (the entrance of  womb). A gel that kills sperm (spermicide)  need to use with it.


II).Chemical Barrier:-  (Spermicides)- A chemicals that go in the vagina before sex and they  immobilize or kills sperm. It is mostly  work for one hour . Put in vagina following   packaging directions.It need to be put in 10  minutes  before intercourse. Nanoxynol-9 and Octoxynol-3 are chemical used as spermicidal agent .Effectiveness: 72-91%.
It may be
·           Cream
·           Gel
·           Foam
·           Film
·           Suppository
·           Sponge


3.CHEMICAL  METHOD:-In this methods chemicals similar to  hormones added to stop the  release of an egg and     weaken the sperm. The hormones  change   cervical mucus  and uterine lining, slow  sperm, and reduce   ability of fertilized egg to implant into  uterine wall.


               TYPES OF CHEMICAL  METHODS

                       A).STEROIDAL DRUGS

                        1).The Oral Contraceptive Pills.
                                  1.COMBINED PILLS
                                  2.SEQUENTIAL PILLS
                                  3.MINI PILL OR MICRO PILL
                                  4.PROGESTERONE ANTAGONIST
                         2).Depot Preparation.
1.      The Patch
2.      Vaginal Ring
3.      The Shot
4.      Sub-dermal Implants.

                      B).NON STEROIDAL DRUGS
                                           
                               1).Centchroman
                     C).INTRAUTERINE CONTRACEPTIVE DEVICES

                        D).EMERGENCY CONTRACEPTIVE


A).ORAL CONTRACEPTIVE PILLS :- The Contraceptive pills  (also called  birth control pill or "the Pill") is a  daily pill  that contains hormones, who  prevent the pregnancy by changing  the  the body function . Hormones are chemical substances that control the functioning of the body's organs. In this case, the hormones in the Pill control the ovaries and the uterus.
TYPES:-
1.COMBINED PILLS
2.SEQUENTIAL PILLS
3.MINI PILL OR MICRO PILL
PROGESTERONE ANTAGONIST

1.COMBINED PILLS: - It contains orally active progesterone (nor-ethioesterone , norethynodrel, chromodinone) combined with small amount of oestrogen (ethinyl oestradiol).eg-MALA-D ,MALA-N

 2. SEQUENTIAL PILL:-High dose of estrogen for 15 days followed by 5     days of oestrogen + progesterone . This inhibits ovulation by suppressing the release of both FSH and LH.

3. MINI PILL OR MICRO PILL:-Low dose of progesterone.
   eg- POP (PROGESTIN ONLY PILLS)

4. PROGESTRONE ANTAGONIST:-Producing abortion following the conception  Inhibiting the progestational effect on uterus.
 eg – MIFEPRISTONE

  Mode of action of pills:-Pills makes cervical mucus thick and renders the cervical mucus hostile  (unfriendly ) to sperm penetration.  It induces endometrial changes which prevent implantation of blastocyst. By an action or hypothalamus which inhibits secretion of LH.

DEPOT PREPARATION:-  Depot  preparations are long acting drugs and highly effective. These are available in four  forms:
1.  The Patch
2.  Vaginal Ring
3.  The Shot or Injectable preparation.
4.     Subdermal Implants

1.The Patch:- A bandage-like patch that sticks to  skin and it changed weekly. no patch required on 4th week of menstrual cycle. Hormones are absorbed through the skin .It is less effective body  weight over 198  pounds.It may causes skin irritation. Prescription needed for its application.Effectiveness: 91-99.7%
2.Vaginal Ring:-  Vaginal rings containing norgestrel are implanted intravaginally .The body absorbs hormones from the  ring through vaginal wall.The ring is  inserted and left in the vagina for 3 weeks. Effectiveness: 91-99.7%

3.The Shot: - A long acting hormone injected intramuscularly. Female is given a shot one time every 3 months. It is non reversible- and once the injection  given , the hormones are in the woman for at  least 3 months. It may take a long time to get  pregnant after the shot. More chance of weight gain than any  other method. Effectiveness: 94-99.8%.It may be two types
i).Oily progestrin preparation
ii).Combined injectable preparation
4.Subdermal Implant:- A soft rod 1 ½ inches long placed  under the skin in your upper arm which  are slowly releases hormones into your  body These are two types

I).Norplant-six flexible silastic tube ,each containing 35mg progesterone (Levonorgestrel).

ii).Norplant(R)2-two rod of (Levonorgestrel).Implant  prevents pregnancy for 3 years, but  can be taken out at any time.Effectiveness: 99.95%

B).NON STEROIDAL DRUGS
    1).Centchroman:- The new oral contraceptive for the females contain a non-steroidal  preparation developed by CDRI    Lucknow marketed under the trade name SAHELI.  It is once a week pill” with very few side effects  and  high contraceptive value.
C).INTRAUTERINE CONTRACEPTIVE DEVICES:- Implantation of foreign body into uterine cavity for contraceptive purposes.

1.NON-MEDICATED IUCDs- eg-Lippes loop
2.MEDICATED IUCDs-These are two types

a).Second generation IUCDs-
 eg-Copper T, Coper T200,NOVA-7,NOVA-T,
                multi-loaded devices.
b).Third generation IUCDs-Harmone releasing IUCDs
    eg- PROGESTASERT, LNG 20

D).EMERGENCY CONTRACEPTIVE :- It is also known as Post coital pill or Morning after pills.A pill or combination of pills which are recommended within 72 hours of unprotected intercourse. It contains a higher dosage (DOUBLE DOSE of combined pills )of the same  hormones found in regular birth control. It won’t stop an existing pregnancy .Available at pharmacy for girls  17+, prescription is needed if less than 17 .Effectiveness is  Approx 95% if taken within first  24 hours of unprotected sex, rape or contraceptive failure.


4).LONG-TERM / PERMANENT METHOD:-  These procedures are permanent, and  are usually done by people 35+ years, Both procedures are done in a doctor’s  office.
1. Female- Tubal  ligation
2. Male- Vasectomy

Female- Tubal  ligation :-A small incision is made in the abdomen to  access the fallopian tubes. Fallopian tubes are  blocked, burned, or clipped shut to prevent the  egg from traveling through the tubes  . Recovery usually takes 4-6 days.

Male- Vasectomy:-A small incision is made to access the vas  deferens, (the tube through which sperm travels from the  testicle to the penis) and is sealed, tied, or  cut.After a vasectomy, a male will still  ejaculate, but there won’t be any sperm present.

Sunday, January 19, 2020

Friday, January 17, 2020

ABNORMALITIES ASSOCIATED WITH SEX CHROMOSOME




Sex chromosome abnormalities are gender specific. Female abnormalities are due to variation in number of X chromosome .Male abnormalities are due to either the X or the Y chromosome or both.

Sex Chromosomal abnormalities
  1. Turner’s syndrome
  2. Klinefelter’s  syndrome
  3. Triple X syndrome
  4. Testicular feminizing syndrome
  5. True hermaphrodites
  6. Developmental abnormalities

1.TURNER’S  SYNDROME:- Turner ,s syndrome is also known as gonadal or ovarian dysgenesis. This is a condition that affects only females, results when one of the X chromosomes (sex chromosomes) is missing or partially missing. Turner syndrome can cause a variety of medical and developmental problems. In This case Karyotype is 45 XO (44 autosome + 1 sex chromosome).This is results from nondisjunction of one X chromosome.
Characteristics feature-
  • Diminish sexual development.
  • Webbing of neck.
  • Gonadal tissue absent or rudimentary.
  • Primary amenorrhea.
  • No sexual maturation at puberty.

2.Klinefelter’s syndrome:- This is also known  as  SEMINIFEROUS TUBULE DYSGENESIS. This  syndrome is a genetic condition that results when a boy is born with an extra copy of the X chromosome. It is a condition affecting males, and it often isn't diagnosed until adulthood This is Most common sex  chromosomal abnormality .  Karyotype is 47 XXY (44 autosome + XX sex chromosome +one extra Y chromosome)

Characteristics feature-
  • Feminine feature in an apparent male with small testis.
  • Patient is genetically female but develop male genitalia.
  • Male characteristics develop due  to adequate testosterone
  • Mental retardation
  • Primary hypogonadism and infertility
  • Seminiferous tubules are not properly develop

3.Triple  x syndrome:-This is a common aberration of sexual differentiation in which the karyotype is XXX .Usually, it is not associated with any characteristic abnormalities  and therefore remains undetected.In this case Females are known as super females.

Characteristics feature-
  • Taller than the average height.
  • Ovary abnormalities lead to premature ovarian failure.
  • Learning difficulties in speech and language.
  • In the range of low or normal intelligence.


4.TESTICULAR FEMINIZATION SYNDROME:- The patient appear normal females externally. The chromosome are 46  in number with  XY KARYOTYPE. This is a X-Linked recessive   disorder.  These are the Androgen receptor resistance-high testosterone blood level.

Characteristics feature:-
  • Patient is genetically  male but appears like normal female.
  • Primary amenorrhea.
  • no development of uterus.
  • Gonads are testis with immature seminiferous tubule.
  • Testis are present but spermatogenesis does not occur.


5.TRUE  HERMAPHRODITISM:-This is a rare condition in which both testis and ovaries are present.In this case  karyotype is 46 (XX-XY).Sometimes , ovary is present on one side and testis is present on the opposite side. Both male and female sex differentiations occur with development of combined female & male external and internal genitalia.

6.PSEUDOHERMAPHRODITISM:-A pseudo hermaphrodite is an individual with genetic constitution and gonad of one sex , but the external genitalia of other sex .Patients have normal gonadal development according to their chromosome. Both male and female pseudo hermaphrodite are present.
1.Female pseudo hermaphroditism-
  • Male external genital develop in genetic female.
  • Individual posses ovary and oviduct with varying degree of masculine differentiation.
  • Source of androgen is congenital virilising adrenal hyperplasia.
  • Chromosomal sex is female.

2.Male pseudo hermaphroditism-
Development of female external genitalia in genetic male.
Due to defective testicular development.
Also due to androgen resistance or due to defect in androgen receptor.

Diagnosis of Sex Chromosomal abnormalities-Chromosomal abnormality can be diagnosed before birth by-
  1. Amniocentesis
  2. Chorionic villi sampling
  3. Triple marker screening test   

1.Amniocentesis- It is a procedure in which amniotic fluid is removed from the uterus for testing or treatment. Amniotic fluid is the fluid that surrounds and protects a baby during pregnancy. This fluid contains fetal cells and various proteins.
2.Chorionic villus sampling (CVS)- It is a prenatal test in which a sample of chorionic villi is removed from the placenta for testing. The sample can be taken through the cervix (trans cervical) or the abdominal wall (transabdominal).
1.    3.Triple marker screening test-  This is also knows as  triple test or  triple screen, the Kettering test or the Bart's test.  This  is an investigation performed during second trimester of  pregnancy  to classify a patient as either high-risk or low-risk for chromosomal abnormalities (and neural tube defects). Triple marker screening test is used to measure the 3 substance
  • Alpha- fetoprotein
  • Human chorionic gonadotrophin
  • Estradiol.

Sex chromosomal abnormalities are rare seen in human population.Chromosomal error prevent a foetus from developing normally and because of this abnormality miscarraige occur in 1st trimester of pregnancy.

Wednesday, January 15, 2020

Gout


क्या है गठिया?

गठिया को हम आम भाषा मेंजोड़ो का दर्दकहते है। दरअसल मेडिकल भाषा में जब हड्डियों के जोडो़ में यूरिक एसिड इकठ्ठा होने लगता है तब वह गठिया कहलाता है। इसके साथ ही जोड़ों में दर्द, अकड़न, सूजन, गांठ और शूल चुभने जैसी पीड़ा उत्पन होने लगती है।

अर्थराइटिस के प्रकार

·         रूमेटॉयड अर्थराइटिस: यह बहुत अधिक पाया जाने वाला गठिया का गंभीर रूप है जो शरीर की प्रतिरक्षा प्रणाली उपास्थि (ऊतक जोड़ों को एक साथ जोड़ती है) पर हमला करती है।
·         सोराइटिक अर्थराइटिस: अर्थराइटिस के दर्द का यह रूप प्रायः सोरायसिस नामक त्वचा संक्रमण के कारण होता है जो  समय पर इलाज न होने पर काफी घातक और लाइलाज हो जाती है।
·         ओस्टियोसोराइसिस: यह बीमारी आनुवांशिक हो सकता है जो नसों और अस्थिरज्जु, उपास्थि और जोड़ो की अंतर्निहित हड्डियों पर बुरा प्रभाव डालता है। । यह उम्र बीतने के साथ प्रकट होता है। यह बीमारी अक्सर  शरीर का भार सहन करने वाले अंगों जैसे पीठ, कमर, घुटना, रीढ़, अंगूठे का जोड़ और पैर की अंगुलियों को प्रभावित करता है।
·         पोलिमायलगिया रूमेटिका: यह गठिया का प्रकार अक्सर 50 साल की आयु पार कर चुके लोगों में होता है। इसमें गर्दन, कंधा और कमर में असहनीय पीड़ा होने के साथ साथ इन अंगों को घुमाने में कठिनाई होती है।
·         एनकायलाजिंग स्पोंडिलाइटिस: यह सामान्यत: पीठ और शरीर के निचले हिस्से के जोड़ों को प्रभावित करती है। इसमें दर्द हल्‍का होता है लेकिन लगातार बना रहता है।
·         गाउट या गांठ: जब जोड़ों में मोनोसोडियम युरेट क्रिस्टल समाप्‍त हो जाता है तब वह गांठ वाली गठिया का रूप ले लेता है। इस बीमारी में भोजन में बदलाव जरुरी होता है और कुछ दवाओं की सहायता से कुछ दिन में आराम हो जाता है ।
·         सिडडोगाउट: यह रूमेटायड और गाउट से मिलता जुलता गठिया का प्रकार है जिसमे जोडों में कैल्शियम पाइरोफासफेट या हाइड्रोपेटाइट क्रिस्टल जमा हो जाते है।
·         सिस्टेमिक लयूपस अर्थिमेटोसस: यह एक ऑटो इम्यून बीमारी है जो जोड़ों के साथ साथ त्वचा और अन्य अंगों को प्रभावित करती है। यह बच्चे पैदा करने वाली उम्र में महिलाओं को होती है।


गठिया के लक्षण-
·         जोड़ों में दर्द या अकड़न
·         जोड़ों में सूजन या फुलाव
·         चलने-फिरने या हिलने-डुलने में परेशानी
·         प्राय शुरुआत में ये लक्षण घुटनों, नितंबों, उंगलियों तथा मेरू की हड्डियों दिखते है
·         समय से इलाज होने पर कलाइयों, कोहनियों, कंधों तथा टखनों के जोड़ों में भी ये लक्षण दिखाई पड़ने लगते है

गठिया के कारक-
·         महिलाओं में एस्ट्रोजन की कमी
·         शरीर में आयरन की अधिकता
·         शरीर में कैल्सियम की अधिकता
·         पोषण की कमी
·         मोटापा
·         संक्रमण
·         ज्‍यादा शराब पीना
·         हाई ब्‍लड प्रेशर
·         किडनियों को ठीक प्रकार से काम ना करना
·         वंशानुगत

गठिया का उपचार कैसे करे?
·         गठिया के उचित उपचार के लिए चिकित्सक से जरुर परामर्श ले। चिकित्सक आपका रक्त परीक्षण और एक्स-रे करा सकते है। चिकित्सक द्वारा निर्देशित दवाइयां का नियमित रूप से सेवन करे।
  • शारीरिक वजन पर नियंत्रण रखें।
·         पौष्टिक आहार का सेवन करें।
·         चिकित्सक द्वारा निर्देशित व्यायाम या योग नियमित रूप से करें।
·         समुचित विश्राम करें।
·         आप हलकी मालिश भी कर सकते है।
·        आप हीटिंग पैड और आईस पैक का भी प्रयोग कर जोड़ों और मांसपेशियों के दर्द से बच सकते हैं।
  • आप एक्यूपंक्चर का भी सहारा ले सकते है। इस चिकित्सा में त्वचा के प्रभावित बिंदुओं पर शुद्ध सुइयों को चुभो कर गठिया के दर्द को ठीक करा जाता है।