गोष्टी सांगेन युक्तीच्या चार

गो�ष्टी� सां��गो�न यु�क्ती च्यु� चा�र...

डॉ�. शं�तन� अभ्यु�कर वा�ई

II मा�त� दे�वा� भवा II 15, 2023शंनिनवा�र अप्रॆ!ल 1.1

RATIONAL MEDICINE


II मा�त� दे�वा� भवा II

Tight rope walk

• Poor paramedical support Poor paramedical support

• No health insuranceNo health insurance

• Shoestring budgets and packagesShoestring budgets and packages

• Monsoon economyMonsoon economy

– Farmer suicidesFarmer suicides 15, 2023शंनिनवा�र अप्रॆ!ल 1.11

ANC CLASSES


HOW DOES ONE FACE THIS CHALLENGE?


LET PARAMEDICS SPEAK…


BENEFITS FOR THE DOCTOR


ONE WORD THAT COUNTS…RAPPORT


जे� जे� आपणा�सां� ठा�वा�...


BANGLE BREAKER

15, 2023शंनिनवा�र अप्रॆ!ल 1.24II मा�त� दे�वा� भवा II


MERE HATHON ME NAU NAU CHUDIYAN HAI

15, 2023शंनिनवा�र अप्रॆ!ल 1.25


IDEAL METHOD….

• BANGLES CAN BECOME A CAUSE OF DEATH

• BREAKING CAN BE UNSAFE AND TRAUMATIC FOR THE PATIENT AND THE HEALTH CARE PROVIDER.



ALL THAT IT NEEDS IS…RINGS USED FOR HAND

EMBROIDERY

THICK SEE THROUGH PLASTIC BAG

SIX INCH METAL SCALE

WOODEN ROD (ROLLING PIN!!)



DO IT YOURSELF…



THIS IS THE WAY TO USE IT


OBSTESTRICS IS BLOODY BUSINESS


THE NEW PETTICOAT…


THE NEW PETTICOAT



TUCK IN A SEE THROUGH PLASIC SHEET AND WORK

WITH YOUR HANDS UNDER IT


OBSTESTRICS IS BLOODY BUSINESS


पी�.पी�.एच. झा�ले मा�रा� बों�बों ; हा�य रिरास्कच� करा� नों�द.


देयु� हे�डॉ ल� , देयु� लिलथो� टॉ�मा�


क, थो�टॉर घा�ल� ब्ल,डॉरमाधी�


सां�ळा� न�बर इं�ट्रा�क, थो , दे�न्हे� हे�त��न� ल�वा� स्टॉ�टॉ


घ्यु� भरप�र ब्लडॉ सां,म्पल


मागोचा सां�रु कर� रिंर:गोरचा� नळा


मासां�जे कर� , क्ल�टॉ क�ढा�, टॉ�क� घा�ल� झटॉपटॉ


रक्ती सां�कळात�यु क� बघा� , न�हे�तर यु�ईल आफत.


चा�र ऍम्प्यु�ल प�टॉ�सां�न ब�टॉलAत टॉ�क�


इं�जे�क्शंन मा�थो�जेBन आयु.व्हे�. ठा�क�


देयु� प्रॆ�स्टॉ�डॉ�न मा��डॉ�माधी�


आणिणा चा�र सां�युटॉ�टॉ�क **माधी�


ऑक्सिक्सांजेनचा� चाढावा� मा�स्क


प�शं�टॉल� ठा� वा� गोरमा खा�सां


रक्ती चाढावा� , डॉ�क� लढावा� , रहे� सांदे� देक्ष...


आई वा�चा�ल ब�ळा जेगो�ल हे�चा आमाचा� लक्ष्यु


TUBECTOMY…


ESPECIALY AT THE PHC LEVEL…


COMPLICATIONS…

• ACCIDENTAL OPENING OF THE BLADDER

• AVULSION OF THE TUBE

• RARELY– INFECTION

– BOWEL INJURY


THE SOLUTION…


‘OPEN BAND APPLICATION INSTEAD OF MPM’


THE LARYNGOSCOPE PROVIDES RETRACTION, ILLUMINATION AND GOOD PNEUMOPERITONIUM.

TUBES NEED NOT BE HOOKED OUT OF THE ABDOMEN. NO FEAR OF AVULSION.

LESS PAINFUL. QUICK.

MORE REVERSIBLE.

BAND APPLICATION AT THE ISTHMUS IS EASIER THAN WITH MPM.

IT KEEPS THE LARYNGOSCOPE IN GOOD WORKING CONDITION. II मा�त� दे�वा� भवा II 15, 2023शंनिनवा�र अप्रॆ!ल 1.64


India is a land of festivals…

• Menarch

• Engagement

• Marriage

• Honeymoon

• Pregnancy

• Childbirth

• Naming ceremony



But…..

• Termination of fertility…..


USE OF VAGINAL BALL BEARING:

AN EFFECTIVE AND COST-EFFECTIVE METHOD TO TREAT POST PARTUM SUI AND

EVEN THAT EMBARRASING PASSAGE OF GAS PER VAGINUM.


SUI, A COMMON CLINICAL PROBLEM.

AN EPIDEMIC WAITING TO HAPPEN.

DOCTORS ARE RELLUCTANT TO OFFER TREATMENT

PATIENTS HARDLY SEEK TREATMENT..


GRANDGRAND


Plevnik’s vaginal cones

20, 32.5, 45, 60 and 75gm.


NECESSITY IS THE MOTHER OF INVENTION

SO BALL BEARINGS

THOSE USED FOR TRUCKS AND TRACTORS.

CHEAP

20 gm TO 100 gm WEIGHT.

READILY STERILISED.

THEY DISCOURAGE ‘VALSALVA’ & ENCOURAGE ‘KEGEL’

BUT

TOO SMALL AND TOO LARGE


HOW TO GO ABOUT IT…

CONFIRM SUI, ETC:BE SURE THAT VAGINAL WEIGHTS WILL HELP.GIVE DETAILED EXPLANATION.START WITH THE ‘PASSIVE WEIGHT’. ENDOWS CONFIDENCE.


20 gm INCREMENT / DAY.

15 TO 20 min OF WALKING WITH WEIGHTS IN SITU. NO SQUATTING OR SITTING TO BEGIN WITH.

LATER PERMIT SITTING AND EVEN SQUATTING.

THERAPY AT HOME GOOD ENOUGH.


आमाच्यु�हे� आर.सां�.ओ.जे�. गो�ईडॉल�ईन्सां


RCOG GUIDELINESNT, sos biochemical markers

Consider maternal age (30%)

Do an NT scan at 11 to 13+6 weeks ( 75%)

If >3 offer invasive testing.

If grey zone consider Nasal bone (90%)

Biochemical markers if grey zone results

(95%)

15, 2023शंनिनवा�र अप्रॆ!ल II मा�त� दे�वा� भवा II 1.76


Fundal pressure

• Ventouse and Forceps… only after you have tried Biceps and Triceps

• WHO says…– Level C recommendation– Proper pressure, direction and timing



THINK OF AUTOLOUGUS DONATION / TRANSFUSION

• ANY WOMEN WITH NO ANY WOMEN WITH NO OTHER CONTRAINDICATION OTHER CONTRAINDICATION FOR DONATION & Hb OF 10+ FOR DONATION & Hb OF 10+ & PCV 35%+ MAY DONATE & PCV 35%+ MAY DONATE BLOODBLOOD


RCOG GUIDELINES

• USE STARCH SOLUTIONS TO PRE-LOAD THE PATIENT PRIOR TO SPINAL ANAESTHESIA.


• ADMINISTER O2 ON MASK THROUGHOUT THE SURGERY, SINCE THE SpO2 INVARIABLY DROPS WITH SEDATION (PENTAZOCINE).



INSIST ON A BT, CT, PC, AND PT(IF POSSIBLE EVEN APTT).

OBSERVE THE CLOT VERY KEENLY AND FREQUENTLY.

IF IT FORMS AND DISSOLVES, WARN OF MORTALITY,

EVACUATE FIRST THE UTERUS AND

THEN THE PATIENT.

RCOG GUIDELINES

IN HIGH RISK PATIENTS…


INTRACATH CAN READILY BE PLACED IN

THE FEMORAL VEIN, SUTURE IT THERE.


JUGULAR ACCESS IS EASY; NEVER HESITATE


HAVE ANATOMY CHARTS, PROTOCOLS, NO16 INTRACATH AND CENTRAL CATHETERISATION KIT

TAPED ON THE WALL


A place for everything and everything in its place

AORTIC PRESSURE…


जेरूर कर�वा� असां� क�हे�...


GIVE AN ANTENATAL DOSE…

300 mcg @ 28 weeks

Or

100 mcg @ 28 & then again @ 34 weeks


TESTS FOR QUANTIFYING FMH

• ERYTHROCYTE ROSETTE TEST– HIGHLY SENSITIVE (100%).– POOR SPECIFICITY.– THUS RESULTS NEED CONFIRMATION BY ONE

OF THE TESTS BELOW.

• FLOW CYTOMETRY– HIGHLY SENSITIVE (100%), COSTLY,

TECHNICALLY DIFFICULT.

• KLEIHAUER-BETKE TEST– LAB & TECH ERRORS


D immunoglobulin cross matching

• D immunoglobulin cross-matched with maternal blood

• + ve if 20 ml or more feto-maternal bleed

• K-B still the test of choice to assess exact volume.



• स्वायु�चालिलत रक्ती चा�चाणा� अहेवा�ल क�ळाजे�प�वाLकवा�चा�वा�.


RCOG guidelines for Thal screening

• High RBC count– RBC > 4.5

• Low indices• MCV < 72

• MCH < 22

MCV2 * RDW

Hb*100

<65 ….THALASSEMIA


THE PREVELENCE OF BETA THAL IN

INDIA IS 3.3%

6.5% in Punjab 8.4% in Tamilnadu 4.3% in south India 3.5% in Bengal MY CLINIC 2.8%

High prevalence in some communities Sindhi, Luvana, Tribes, and Rajputs (10% to 15% in these communities)


Hb ELECTROPHORESIS


SICKLE CELL ANEMIA


MgSO4 FOR IMMINANT PT BIRTH

Recommendations

For women with imminent preterm birth (≤ 31+6 weeks), antenatal magnesium sulphate administration should be considered for fetal neuroprotection. (I-A)


जेरूर कर�वा� असां� आणाखा� क�हे�...


navajaat baalakaMcyaa

navyaa navyaa tpasaNyaa


मा�क� कर�नित वा�चा�लमाM


गो�ष्टी तशं� सां�धी�चा पणा...


CONGENITAL HYPOTHYROIDISM


CRETINISM


• Congenital hypothyroidism incidence of 2.1 per 1000

• Incidence of 1 in 4000 reported in Western literature and

• 1 in 1700 from other regions of India

• Urvi Sanghvi and KK Diwakar,Department of Neonatology,Malankara Orthodox Syrian ChurchMedical College,

Kolenchery PO, Kochi 682311, Kerala,


THAT’S FINE BUT…

• WILL THEY DO ALL THIS????

• WILL THEY AFFORD ALL THIS????


निवात्त नव्हे� वा�त्त�..... हे� प्रॆश्न आहे�...

NO

MONEY IS NOT THE PROBLEM 15, 2023शंनिनवा�र अप्रॆ!ल 1.129II मा�त� दे�वा� भवा II

अशं�स्त्री�यु/अधीLशं�स्त्री�यु/ छदेMम्माशं�स्त्री�यु / शं�स्त्री निवासां�गोत

• प्रॆलिथोन��च्यु� भ�कट्या� / निबस्किस्कटॉ�• दे�णा�ऱ्यु�न� दे�त जे�वा� घा�णा�ऱ्यु�न� घा�त जे�वा�• माहे�गोडॉ� फ�लिलक आम्ल / क, लशं�युमा• आयुसां�सां�प्रॆ�न• मा�नवा� जेर�यु�त्पन्न जेननग्रं�थो�प�षक सां�प्रॆ�रक• वा�र�वा�र हे�णा�ऱ्यु� गोभLप�त�सां�ठाZ टॉ�चाL• गोभLसां�स्क�र



• PROTEIN POWDERS AND TONICS



• AMINO ACID DRIP / MEDICATION FOR BLANKET TREATMENT OF IUGR



• COSTLY FOLIC ACID / CALCIUM



• ISOXSUPRINE FROM DAY 1



• HUMAN CHORIONIC GONADOTROPINS TO SUPPORT PREGNANCY



• TORCH TEST FOR BOH



• COSTLY IRON


0.20 * 365 = 73 FERROUS SULPHATE

10 * 365 = 3650 COSTLY IRON

3650-73 = 3577 SAVINGS


असां�...II मा�त� दे�वा� भवा II 15, 2023शंनिनवा�र अप्रॆ!ल 1.141

मान[प�वाLक धीन्युवा�दे

• DR.VIDYADHAR GHOTAWDEKAR• DR. MANISH MACHAWE• DR. ANURADHA RIDHORKAR• DR. MILIND SHAH• DR VILAS PARAMANE

• AND MANY MORE WHO HAVE DARED TO SERVE THE RURAL MASSES RISKING SO MUCH FOR SO LITTLE…


गोष्टी सांगेन युक्तीच्या चार

Health & Medicine