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Chromosomes replicate themselves during the cell cycle which consists of a short M phase during which mitosis occurs antifungal over the counter pill buy terbinafine 250 mg, and a longer interphase fungi quiz questions discount terbinafine online american express. The stages of mitosis ­ prophase antifungal uses cheap terbinafine 250 mg overnight delivery, prometaphase, metaphase, anaphase and telophase ­ are followed by cytokinesis when the cytoplasm divides to give two daughter cells. The first division involves the pairing and separation of maternal and paternal chromosome homologs during which exchange of chromosomal material takes place. This process of recombination separates groups of genes that were originally located on the same chromosome and gives rise to individual genetic variation. The second cell division is the same as in mitosis, but there are only 23 chromosomes at the start of division. During spermatogenesis, each spermatocyte produces four spermatozoa, but during oogenesis there is unequal division of the cytoplasm, giving rise to the first and second polar bodies with the production of only one large mature egg cell. Other samples analysed on a routine basis include cultures of fibroblasts from skin biopsy samples, chorionic villi and amniocytes for prenatal diagnosis, and actively dividing bone marrow cells. The cell cultures are treated to arrest growth during metaphase or prometaphase when the chromosomes are visible. Until the 1970s, chromosomes could only be analysed on the basis of size and number. A variety of banding techniques are now possible and allow more precise identification of chromosomal rearrangements. The most commonly used is G-banding, in which the chromosomes are subjected to controlled trypsin digestion and stained with Giemsa to produce a specific pattern of light and dark bands for each chromosome. The Paris convention in 1971 defined the terminology used in reporting karyotypes. The centromere is designated "cen" and the telomere (terminal structure of the chromosome) as "ter". The short arm of each chromosome is designated "p" (petit) and the long arm "q" (queue). Each arm is subdivided into a number of bands and sub-bands depending on the resolution of the banding pattern achieved. High resolution cytogenetic techniques have permitted identification of small interstitial chromosome deletions in recognised disorders of previously unknown origin, such as Prader­Willi and Angelman syndromes. Deletions too small to be detected by microscopy may be amenable to diagnosis by molecular in situ hybridisation techniques. Karyotypes are reported in a standard format giving the total number of chromosomes first, followed by the sex chromosome constitution. All cell lines are described in mosaic abnormalities, indicating the frequency of each. Additional or missing chromosomes are indicated by or for whole chromosomes, with an indication of the type of abnormality if there is a ring or marker chromosome. Structural rearrangements are described by in dicating the p or q arm and the band position of the break points. Unbalanced translocations cause spontaneous abortions or syndromes of multiple 14 physical and mental handicaps 13 Figure 4. This can be used to identify the chromosomal origin of structural rearrangements that cannot be defined by conventional cytogenetic techniques. Hybridisation reveals fluorescent spots on each chromatid of the relative chromosome. Another application of this technique is in the study of interphase nuclei, which permits the study of non-dividing cells. Thus, rapid results can be obtained for the diagnosis or exclusion of Down syndrome in uncultured amniotic fluid samples using chromosome 21 specific probes. Incidence of chromosomal abnormalities Chromosomal abnormalities are particularly common in spontaneous abortions. At least 20% of all conceptions are estimated to be lost spontaneously, and about half of these are associated with a chromosomal abnormality, mainly autosomal trisomy. Cytogenetic studies of gametes have shown that 10% of spermatozoa and 25% of mature oocytes are chromosomally abnormal. The extra haploid set is usually due to fertilisation of a single egg by two separate sperm. Very few triploid pregnancies continue to term and postnatal survival is not possible unless there is mosaicism with a normal cell line present as well. All autosomal monosomies and most autosomal trisomies are also lethal in early embryonic life.

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Evidence of obstructed labour includes arrested dilatation or descent with: Large caput and excessive moulding Presenting part poorly applied to antifungal roof shingles purchase terbinafine now cervix or cervix is oedematous Ballooning of the lower uterine segment and formation of a retraction band Maternal and fetal distress Prolonged labour without delivery antifungal dog food cheap terbinafine 250mg otc. Check pulse anti fungal remedies buy terbinafine 250 mg with mastercard, blood pressure and hydration (tongue, urine output), temperature Does she have any medical problems? If the woman has at least 2 uterine contractions lasting more than 20 seconds over 10 minutes, do a vaginal examination to assess cervical effacement and dilatation. If the cervix is not dilated on first examination, it may not be possible to make a diagnosis of labour. At this stage, if there is effacement and dilatation, the woman is in labour; if there is no change, make a diagnosis of false labour. An incorrect diagnosis of labour in this situation can lead to unnecessary anxiety and interventions. Active phase Cervix between 4 cm and 10 cm dilated Rate of cervical dilatation at least 1 cm/hour Effacement is usually complete Fetal descent through birth canal begins. Second stage Early phase (non-expulsive) Cervix fully dilated (10 cm) Fetal descent continues No urge to push. Late phase (expulsive) Fetal presenting part reaches the pelvic floor and the woman has the urge to push Typically lasts < 1 hour in primigravidae and < 30 minutes in multigravidae. Carry out vaginal examinations at least once every 4 hours in the first stage of labour and plot the findings on the partograph. The partograph is very helpful in monitoring the progress of labour and in the early detection of abnormal labour patterns. Record the actual time on the X axis, corresponding to this point on the Alert line. At each vaginal examination, record the following: Effacement and dilatation Presenting part and station Colour and odour of liquor. Assess progress in labour by: Measuring changes in cervical effacement and dilatation in the latent phase Measuring the rate of cervical dilatation in the active phase Assessing fetal descent in the second stage. Assess fetal condition by: Checking the fetal heart rate during or immediately after a contraction Listening in to the fetal heart for one full minute: ­ Every half hour in the active phase ­ After every 5 minutes in the second stage. Listening more frequently if an abnormality is detected: while the normal fetal heart rate is between 120 and 180 beats/minute, rates of <100 or >180 are suggestive of fetal intolerance of labour or distress. Listening for the fetal heart rate recovery after contractions: repetitive slow recovery indicates fetal distress. Greenish-yellow fluid, blood stained fluid or no fluid are suggestive of placental insufficiency and possibly fetal compromise. Findings suggestive of satisfactory progress in labour Regular contractions of progressively increasing frequency and duration Rate of cervical dilatation at least 1 cm/hour in the active phase of labour Satisfactory descent with pushing in the expulsive phase Cervix closely applied to fetal head. Findings suggestive of unsatisfactory progress in labour Irregular, infrequent and weak contractions Cervical dilatation rate slower than 1 cm/hour in the active phase No descent with pushing in the expulsive phase Presenting part applied loosely to the cervix. Findings suggestive of risks to the fetus Bloodstained amniotic fluid Greenish-yellow coloured amniotic fluid Fetal heart rate abnormalities, such as decelerations, tachycardias or delayed recovery of fetal heart rate after contraction. Mistaking false labour for the latent phase leads to unnecessary induction and unnecessary caesarean section. The latent phase is prolonged when the cervical dilatation remains less than 4 cm after 8 hours. If a woman has been in the latent phase for more than 8 hours, reassess the situation: If there has been no change in cervical effacement or dilatation and there is no fetal distress, review the diagnosis of labour; the woman may not be in labour If there has been a change in cervical effacement and dilatation, augment contractions with oxytocin. Artificial rupture of membranes is recommended along with or before augmentation of labour with oxytocin. Reassess every 4 hours: If the woman has not entered the active phase within 8 hours, consider delivery by caesarean section, but be sure the patient is not in false labour If membranes are already spontaneously ruptured, induce or augment labour without delay In areas of high Group B streptococcal prevalence, give antibiotic prophylaxis starting at 12 hours after rupture of the membranes to help reduce Group B streptococcus infection in the neonate If there is any evidence of amnionitis, augment labour immediately and treat with antibiotics. Slow progress of labour in the active phase of labour may be due to one or more of the following causes: Inefficient uterine contractions Malpresentations and malpositions. When the rate of dilatation in the active phase is slower than 1 cm per hour, reassess the mother for poor contractions or malpresentation: If there is evidence of obstruction, perform a caesarean section If there is no evidence of obstruction, augment labour with amniotomy and oxytocin. Reassess progress by vaginal examination after 2 hours of good contractions: If there is no progress between examinations, deliver by caesarean section If there is progress, continue oxytocin and re-examine after 2 hours. Inefficient, poor uterine contractions are less common in a multigravida, so make every effort to rule out disproportion before augmenting with oxytocin.

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