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Leopold's Maneuvers are difficult to perform on obese women and women who have hydramnios. The palpation can sometimes be uncomfortable for the woman if care is not taken to ensure she is relaxed and adequately positioned. To aid in this, the health care provider should first ensure that the woman has recently emptied her bladder. If she has not, she may need to have a straight urinary catheter inserted to empy it if she is unable to micturate herself. The woman should lie on her back with her shoulders raised slightly on a pillow and her knees drawn up a little. Her abdomen should be uncovered, and most women appreciate it if the individual performing the maneuver warms their hands prior to palpation. First maneuver: Fundal Grip While facing the woman, palpate the woman's upper abdomen with both hands. A professional can often determine the size, consistency, shape, and mobility of the form that is felt. The fetal head is hard, firm, round, and moves independently of the trunk while the buttocks feel softer, are symmetric, and the shoulders and limbs have small bony processes; unlike the head, they move with the trunk. Second maneuver After the upper abdomen has been palpated and the form that is found is identified, the individual performing the maneuver attempts to determine the location of the fetal back. Still facing the woman, the health care provider palpates the abdomen with gentle but also deep pressure using the palm of the hands. First the right hand remains steady on one side of the abdomen while the left hand explores the right side of the woman's uterus. This is then repeated using the opposite side and hands. The fetal back will feel firm and smooth while fetal extremities (arms, legs, etc.) should feel like small irregularities and protrusions. The fetal back, once determined, should connect with the form found in the upper abdomen and also a mass in the maternal inlet, lower abdomen. Third maneuver: Pawlick's Grip In the third maneuver the health care provider attempts to determine what fetal part is lying above the inlet, or lower abdomen.[2] The individual performing the maneuver first grasps the lower portion of the abdomen just above the symphysis pubis with the thumb and fingers of the right hand. This maneuver should yield the opposite information and validate the findings of the first maneuver. If the woman enters labor, this is the part which will most likely come first in a vaginal birth. If it is the head and is not actively engaged in the birthing process, it may be gently pushed back and forth. The Pawlick's Grip, although still used by some obstetricians, is not recommended as it is more uncomfortable for the woman. Instead, a two-handed approach is favored by placing the fingers of both hands laterally on either side of the presenting part. Fourth maneuver The last maneuver requires that the health care provider face the woman's feet, as he or she will attempt to locate the fetus' brow. The fingers of both hands are moved gently down the sides of the uterus toward the pubis. The side where there is resistance to the descent of the fingers toward the pubis is greatest is where the brow is located. If the head of the fetus is well-flexed, it should be on the opposite side from the fetal back. If the fetal head is extended though, the occiput is instead felt and is located on the same side as the back. Cautions Leopold's maneuvers are intended to be performed by health care professionals, as they have received the training and instruction in how to perform them. That said, as long as care taken not to roughly or excessively disturb the fetus, there is no real reason it cannot be performed at home as an informational exercise. It is important to note that all findings are not truly diagnostic, and as such ultrasound is required to conclusively determine the fetal position.

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Male 19 y. age victim of penetrating brain injury. All the criteria for the encephalic death diagnosis were present. The presence of this complex spinal reflex doesn't exclude the brain death diagnosis and must be known and understood by the professionals involved in this very important diagnosis

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---Como Quitar Acne Cara. Existe una CAUSA PRINCIPAL DEL ACNÉ. Y no siempre un producto para el acné ataca esta causa. Esto significa que, si bien podrías obtener un beneficio de lociones, u otros productos o terapias, nunca curarás tu acné con ellos.
Es un poco como tener un techo con goteras y "solucionarlo" poniendo recipientes para recoger el agua de lluvia que cae del techo. Para solucionar adecuadamente el techo con goteras, se debe corregir la causa de raíz, que es el agujero en el techo.
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La causa del acné es un DESEQUILIBRIO HORMONAL. Esto es algo que las empresas del acné nunca te dirán...
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Chronic myelogenous leukemia (CML), also known as chronic myeloid leukemia, is a myeloproliferative disorder characterized by increased proliferation of the granulocytic cell line without the loss of their capacity to differentiate. Consequently, the peripheral blood cell profile shows an increased number of granulocytes and their immature precursors, including occasional blast cells.

CML is one of the few cancers known to be caused by a single, specific genetic mutation. More than 90% of cases result from a cytogenetic aberration known as the Philadelphia chromosome (see Pathophysiology).

CML progresses through 3 phases: chronic, accelerated, and blast. In the chronic phase of disease, mature cells proliferate; in the accelerated phase, additional cytogenetic abnormalities occur; in the blast phase, immature cells rapidly proliferate.[1] Approximately 85% of patients are diagnosed in the chronic phase and then progress to the accelerated and blast phases after 3-5 years. The diagnosis of CML is based on the histopathologic findings in the peripheral blood and the Philadelphia chromosome in bone marrow cells (see Workup).

CML accounts for 20% of all leukemias affecting adults. It typically affects middle-aged individuals. Uncommonly, the disease occurs in younger individuals. Younger patients may present with a more aggressive form of CML, such as in accelerated phase or blast crisis. Uncommonly, CML may appear as a disease of new onset in elderly individuals.

The goals of treatment are to achieve hematologic, cytogenetic, and molecular remission. Although a variety of medications have been used in CML, including myelosuppressive agents and interferon alfa, the tyrosine kinase inhibitor imatinib mesylate is currently the agent of choice, and other drugs in this category are playing increasingly important roles. However, allogeneic bone marrow transplantation is currently the only proven cure for CML.

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A diabetes tipo II se tornou uma das doenças mais comuns nos tempos modernos. A boa notícia é que em pouco menos de um mês, seguindo um plano de alimentação e vida saudável, é possível equilibrar seu nível de açúcar no sangue e prevenir as terríveis consequências que esta doença tem.

A seguir, você encontrará este plano para nivelar o açúcar no sangue e dizer adeus para a diabetes.

Restrinja o consumo de todo o tipo de bebidas.

Realize atividade física de baixo impacto todo o dia, por um mínimo de meia hora.

Elimine por completo de suas refeições, todos os alimentos que contenham farinha branca.

Inclua em sua alimentação habitual, ácidos gordos essenciais (especialmente ácidos ômega 3), inclua também o consumo de frutas secas.

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