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(Dub) 1 : Easy Does It

Even when pediatricians believe a child's murmur is innocent, however, they may still recommend a second opinion from a pediatric cardiologist to be certain. A referral to a pediatric cardiologist does not mean that the murmur is abnormal. Pediatricians are more likely to refer an infant with a heart murmur that occurs during the first six months of life.

(Dub) 1 : Easy does it

Patent ductus arteriosus. Premature infants may have this condition. It occurs when a blood vessel (ductus arteriosus) does not close. This causes blood to circulate abnormally between the two major arteries near the heart. It is often found shortly after birth and can be confirmed by echocardiography.

The broad spectrum of causes of abnormal uterine bleeding includes both genital and extra genital lesions. Diagnosis of DUB is given to the group of patients in whom there is no definitive underlying lesion. It can occur at any time between menarche and menopause, in ovulatory and anovulatory cycles. It has been known to be associated with almost any type of endometrium and ranging from normal endometrium to hyperplasia, irregular repining, chronic menstrual irregular shedding and atrophy (3, 4).The incidence of abnormal endometrium findings does not necessarily indicates the true incidence of abnormal endometrial bleeding because it greatly depends upon the time when the endometrial biopsy as performed in relation to cycle & bleeding.

The most probable etiology of abnormal uterine bleeding relates to the patient's reproductive age, as does the likelihood of serious endometrial pathology. The specific diagnostic approach depends on whether the patient is premenopausal, perimenopausal or postmenopausal. In premenopausal women with normal findings on physical examination, the most likely diagnosis is dysfunctional uterine bleeding (DUB) secondary to anovulation, and the diagnostic investigation is targeted at identifying the etiology of anovulation. In perimenopausal patients, endometrial biopsy and other methods of detecting endometrial hyperplasia or carcinoma must be considered early in the investigation. Uterine pathology, particularly endometrial carcinoma, is common in postmenopausal women with abnormal uterine bleeding. Thus, in this age group, endometrial biopsy or transvaginal ultrasonography is included in the initial investigation. Premenopausal women with DUB may respond to oral contraceptives, cyclic medroxyprogesterone therapy or cyclic clomiphene. Perimenopausal women may also be treated with low-dose oral contraceptives or medroxyprogesterone. Erratic bleeding during hormone replacement therapy in postmenopausal women with no demonstrable pathology may respond to manipulation of the hormone regimen.

An understanding of normal menstruation is essential to investigating the complaint of abnormal vaginal bleeding. The intervals of the menstrual cycle, the duration of flow and the volume of flow remain relatively constant during a woman's reproductive years. In the first part of the cycle, estrogen halts menstrual flow and promotes endometrial proliferation. After ovulation, progesterone stops endometrial growth, then promotes differentiation. If pregnancy does not occur, the corpus luteum regresses, progesterone production falls, the endometrium sheds its lining and menstrual bleeding follows.

If abnormal uterine bleeding is not severe and does not require emergent intervention, evaluation begins with a careful medical history, including the usual menstrual pattern, the extent of recent bleeding, sexual activity, trauma and symptoms of infection or systemic disease. A complete physical examination, supplemented by laboratory testing, should uncover any signs of systemic disease.

With continuous combined hormone replacement therapy, up to 40 percent of women have irregular bleeding in the first four to six months of therapy.19 Bleeding is more common when hormone therapy is started less than 12 months after menopause. Most sources recommend evaluation of abnormal bleeding if it lasts more than six to nine months after initiation of hormone replacement therapy. An approach less widely recommended is cessation of hormone therapy followed by a diagnostic evaluation if the bleeding does not stop within three weeks.19

The RT-1 makes press fit headset and bottom bracket bearing cup removal easy. The tool is pulled through the frame until the flared ends snap in behind the cup. The tool end is struck with a mallet and the flared ends evenly distribute force around the cup as the cup is driven out. Strong heat-treated alloy steel construction with nickel finish for a long service life.

But before you decide where you fall on this legendary debate, you will need to know the basics. Lesson one, what does dubbed mean in anime? Well, by the end of this article, you will know precisely what it means, and then you can join the ranks of subs or dubs. 041b061a72


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