doctors at dilemma

The care

Raised nitric oxide levels may cause atonic postpartum hemorrhage in women with anemia during pregnancy

Soltan MH et al. – Even moderate anemia can raise levels of NO and enhance its biologic effects, which in turn can result in uterine muscle relaxation and atonic postpartum hemorrhage (PPH). Preventing or treating anemia during pregnancy could avoid these complications.
Methods

• Of 319 women admitted to the Department of Obstetrics and Gynecology, Dayrout General Hospital, Assiut, Egypt, for delivery in July 2010, 200, who were not considered to be at risk of atonic PPH, were eligible for inclusion.
• Plasma levels of Hb and nitrite were measured on admission.
• The third stage of labor was actively managed.

Results

• A total of 22 participants had significantly raised PN levels (P<0.001), 12 of whom developed PPH—with Hb levels of 9g/dL or less and nitric oxide (NO) levels of 180μM/L or greater.
• The other 10 women underwent over 6hours of stressful labor prior to hospital admission.

International Journal of Gynecology & Obstetrics, 11/28/2011

Aspirin for primary prevention of vascular events in women: individualized prediction of treatment effects European Heart Journal, 11/17/2011 Clinical Article

Dorresteijn JAN et al. – Aspirin was ineffective or even harmful in the majority of patients. Age was positively related to treatment effect, whereas current smoking and baseline risk for cardiovascular events were not. When the NWT is 50 or lower, the aspirin treatment strategy that is associated with optimal net benefit in primary prevention of vascular events in women is to treat none.
Methods

• Randomized controlled trial data from the Women's Health Study were used to predict treatment effects for individual women in terms of absolute risk reduction for major cardiovascular events (i.e. myocardial infarction, stroke, or cardiovascular death).
• Predictions were based on existing risk scores, i.e. Framingham (FRS), and Reynolds (RRS), and on a newly developed prediction model.
• The net benefit of different aspirin treatment–strategies was compared:
• Treat no one,
• Treat everyone,
• Treatment according to the current guidelines (i.e. selective treatment of women >65 years of age or having >10% FRS),
• And prediction–based treatment (i.e. selective treatment of patients whose predicted treatment effect exceeds a given decision threshold).

Results

• The predicted reduction in 10–year absolute risk for major cardiovascular events was <1% in 97.8% of 27 939 study subjects when based on the refitted FRS, in 97.0% when based on the refitted RRS, and in 90.0% when based on the newly developed model.
• Of the treatment strategies considered, only prediction–based treatment using the newly developed model and selective treatment of women >65 years of age yielded more net benefit than treating no one, provided that the 10–year number–willing–to–treat (NWT) to prevent one cardiovascular event was above 50.                                                                                                                      http://www.mdlinx.com/read-article.cfm/3835678

Tot left brain damaged after doctors fight in delivery room

Tuesday, 31 August 2010

A baby was born with suspected brain damage and his mother needed emergency surgery after two doctors began fighting during the delivery in Italy.

The country's health minister went to Sicily today to deliver a personal apology to the mother.

Laura Salpietro (30) also had to have her uterus removed and her son, Antonio, suffered heart problems and possible brain damage following his birth last Thursday in Messina's public hospital.

Health officials and Ms Salpietro's husband, Matteo Molonia, said the two doctors disagreed about whether to perform a Caesarean section and then began punching each other while Ms Salpietro was in labour.

Mr Molonia said that the brawl delayed the C-section by over an hour, leading to complications for both mother and son.

The fistfight occurred at a state hospital between a doctor who works there and a private physician who Ms Salpietro paid as her gynaecologist. Prosecutors have placed five doctors under investigation, and Health Minister Ferruccio Fazio visited Ms Salpietro in the hospital to apologise.

“I tried to give her words of hope, and above all I tried to tell her that the government was with her and her family at this time,” Mr Fazio said. The incident was the latest evidence of medical mistakes frequently reported in southern Italian hospitals and it underscored Italians' increasing use of private doctors.

Italy has universal healthcare, but some Italians use private doctors to avoid long waits for procedures. 
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Effect of oral phytoestrogen on androgenicity and insulin sensitivity in postmenopausal women;

A study was conducted by Lee CC, Bloem CJ, Kasa-Vubu JZ, Liang LJ; published in  Diabetes, Obesity & Metabolism (Nov 2011) to determine and compare the effect of treatment with transdermal estrogen and phytoestrogen on insulin sensitivity and SHBG levels in healthy postmenopausal women.
Materials and Methods: Forty-three healthy postmenopausal women age 68 ± 7 (mean ± SD) years who were not receiving hormonal replacement therapy completed a three month randomized drug therapy study. The participants were randomized to one of four groups: 0.05 mg or 0.1 mg transdermal estrogen/day, or 40 or 80 mg oral phytoestrogen (Promensil)/day Insulin sensitivity was indirectly measured using the Quantitative insulin sensitivity check index (QUICKI). Sex hormone-binding globulin (SHBG), total testosterone, estradiol, and fasting glucose and insulin levels for calculation of insulin sensitivity were obtained at baseline and at monthly intervals during 3 months of therapy.
Results: In healthy nondiabetic postmenopausal women, the rate of change in QUICKI was significantly different between the red clover based phytoestrogen and transdermal estrogen groups, so that after three months of therapy, QUICKI with red clover based phytoestrogen therapy was lower than that in the transdermal estrogen group, p = 0.01. Red clover based phytoestrogen therapy was not associated with any changes in SHBG levels whereas transdermal estrogen therapy significantly increased SHBG levels, p = 0.05.
Conclusions: In contrast to transdermal estrogen therapy, oral phytoestrogen therapy does not decrease androgenicity and is associated with a decrease in insulin sensitivity. These effects are similar to those of raloxifene and consistent with phytoestrogen's selective estrogen receptor modulator (SERM) properties.

Easy-to-Treat Condition Can Disrupt Breast-Feeding . Up to 10 percent of newborns have ankyloglossia or 'tongue-tie'

A "tongue-tie" condition in infants that hinders breast-feeding can be quickly diagnosed and treated in many cases, an expert says. The condition, also known as ankyloglossia, occurs in 4 percent to 10 percent of newborns. The most common type is easy to identify and occurs when a tight band of tissue causes a heart-shaped tongue indentation at the front of the mouth.
Another form of the condition is harder to detect, according to Dr. Dale Tylor, an assistant professor of pediatric otolaryngology at Vanderbilt University Medical Center in Nashville, Tenn.

"For an infant to properly breast-feed, the baby needs to move his or her tongue to their lips to allow sucking to occur," Tylor said in a Vanderbilt news release. "If there's a tethering, the baby has a hard time latching on and uses his or her gums or lips. It becomes painful for the mom, and can even cause bleeding."

Other indications of tongue-tie include a baby who breast-feeds for up to an hour at a time, is frustrated during feeding, or falls asleep before becoming full.

These problems can cause mothers to supplement breast-feeding with formula or give up breastfeeding altogether.
But Tylor said more than two-thirds of mothers of babies with tongue-tie can successfully breast-feed their babies after a simple, outpatient tongue-tie-clipping procedure called a frenotomy.
Tylor also said her research shows that early treatment of tongue-tie reduces the risk of speech problems. Left untreated, tongue-tie can cause other problems.
"They may have problems taking a spoon," Tylor said. "Or they may not be able to lick an ice-cream cone or stick out their tongues with their brother, sister or peers. They could even have problems into adulthood with common social activities like brushing their teeth or even kissing."
SOURCE: Vanderbilt University Medical Center, news release, Nov. 10, 2011

HealthDay

When does pregnancy begin? Doctors disagree

(Reuters Health) - Though most doctors will give you a definition of when pregnancy begins, it's not always the same one, according to a new survey.

Most of the polled obstetrician-gynecologists believe pregnancy begins when the sperm fertilizes the egg. But a minority say it doesn't begin until a week later when the fertilized egg implants in the uterus -- the definition given by the American College of Obstetrics and Gynecology (ACOG).

"People say that the medical profession has settled on this," said Dr. Farr Curlin, the senior author of the study and a professor at the University of Chicago. "And what our data show rather clearly is that it is not at all settled among the medical profession."

The definition of pregnancy can have a major impact on law and policy.

For example, embryonic stem cells are often derived from surplus embryos that aren't implanted into a woman after in vitro fertilization.

And some contraceptives, such as intrauterine devices, prevent implantation. So if pregnancy is considered to begin at fertilization, "then you see why any technology that prevents implantation would be problematic," Curlin said.

Federal policies have used implantation as the beginning of pregnancy.

For the survey, published in the American Journal of Obstetrics and Gynecology, Curlin and his colleagues sent questionnaires to more than 1,000 ob-gyns. The questions asked whether pregnancy begins at conception, at implantation, or if the doctor was unsure.

Most of the doctors, 57 out of every 100, said that pregnancy begins at conception, while 28 out of every 100 said it begins at implantation. The rest were unsure.

Implantation happens about a week after fertilization. That's when the blastocyst, a tiny group of cells that will later become the foetus, embeds itself into the wall of the uterus.

Physicians who responded that they were religious or opposed to abortion or contraceptives that prevent implantation were more likely to believe that conception is the start of pregnancy.

Curlin said he was surprised that most of the doctors in his study disagree with ACOG, which is the leading organisation for this field of medicine.

ACOG did not respond to requests for comment.

"In this case, the science shows exactly what happens, but what you define as pregnancy is not what science can settle," Curlin told Reuters Health.

One of the weaknesses in the survey is the use of the word "conception" rather than fertilization in the questionnaire. While conception is usually defined as fertilization, others interchange it with implantation, Curlin said.

The length of pregnancy -- typically 40 weeks -- remains the same regardless of how doctors define the beginning of pregnancy, because the 40 weeks are not counted from the time of fertilization or implantation, but from the time of the mother's last menstrual period.

SOURCE: bit.ly/uyX2P4 American Journal of Obstetrics and Gynecology, online November 9, 2011.

Doctor Is Guilty in Michael Jackson’s Death

 

Dr. Conrad Murray during the final stage of his trial on Thursday.

LOS ANGELES — Michael Jackson, among the most famous performers in pop music history, spent his final days in a sleep-deprived haze of medication and misery until finally succumbing to a fatal dose of potent drugs provided by the private physician he had hired to act as his personal pharmaceutical dispensary, a jury decided on Monday.
The physician, Dr. Conrad Murray, was found guilty of involuntary manslaughter nearly two and a half years after Jackson’s shocking death at age 50. The verdict came after nearly 50 witnesses, 22 days of testimony and less than two days of deliberation by a jury of seven men and five women. The trial had focused primarily on whether Dr. Murray was guilty of abdicating his duty or of acting with reckless criminal negligence, directly causing his patient’s death.
Dr. Murray, 58, faces up to four years in prison and the loss of his medical license. He sat stoically as the verdict was read and did not react as he was led out of the courtroom in handcuffs. Judge Michael Pastor ruled that he should be held without bail until his sentencing, set for Nov. 29.
Jackson, who had become a star as a child in Gary, Ind., singing with his siblings in the Jackson 5, grew into one of the best-known performers in the world. Though increasingly eccentric in his later years, often living on a secluded California estate he called Neverland, Jackson always had a fervent core of fans and, despite scandals, his lavish lifestyle and persistent money woes, always seemed just a comeback away from a return to the top.
Hundreds of fans showed their devotion by gathering outside the downtown courthouse throughout the trial — many of them sporting Jackson’s signature single white glove. On Monday, they chanted “Justice, justice” and spent hours after the verdict dancing to his hits, from “Beat It” to “I Want You Back.” Huge crowds had also gathered outside the California court where Jackson was tried, and acquitted, on child molesting charges in 2005.
The singer’s parents, Joe and Katherine Jackson, and siblings La Toya, Jermaine and Randy were in the courtroom for the verdict. The family left the courthouse without speaking to the hordes of reporters gathered outside, simply saying they were “very happy” with the verdict and flashing a thumb.
Dr. Murray, a Houston cardiologist, was paid $150,000 a month to work as Jackson’s personal physician as he rehearsed in Los Angeles for “This Is It,” a series of 50 sold-out concerts in London that he needed to pay off hundreds of millions of dollars in mounting debts.
Testimony showed that Dr. Murray had stayed with Jackson at least six nights a week and was regularly asked — and sometimes begged — by the insomniac singer to give him drugs powerful enough to put him to sleep. Jackson, Dr. Murray told the authorities, was especially eager to be administered propofol, a surgical anesthetic that put him to sleep when other powerful sedatives could not. Testimony indicated that propofol, in conjunction with other drugs in the singer’s system, had played the key role in his death on June 25, 2009.
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BIRTH CONTROL SOLUTION

Was this baby born Monday in INDIA the seven billionth human? Statistically possible, say United Nations demographers. India has over one billion of the world's roughly seven billion people. 
A United Nations report released on Tuesday projects that world population, instead of stabilizing at above 9 billion by 2050, will keep growing and may hit 10.1 billion by 2100.
The population of Africa, for instance, could more than triple, rising to 3.6 billion by century's end. Nigeria, the continent's most populous nation, could see its population increase from 162 million today to 730 million by 2100. Accelerating rates of growth are already evident: world population is expected to pass 7 billion in October, only a dozen years after reaching 6 billion.

How will the world accommodate this growth? What have we learned from history about how countries adapt to feed and house ever more people?
Partly for that reason, the world’s population just raced past the seven billion mark this week, at least according to the fuzzy calculations of United Nations demographers. It took humans hundreds of thousands of years, until the year 1804, to reach the first billion. It took another 123 years to reach two billion, in 1927. Since then, we’ve been passing these milestones like billboards along a highway. The latest billion took just a dozen years.
In 1999, the United Nations’ best projection was that the world wouldn’t pass seven billion until 2013, but we reached it two years early. Likewise, in 1999, the U.N. estimated that the world population in 2050 would be 8.9 billion, but now it projects 9.3 billion.
What’s the impact of overpopulation? One is that youth bulges in rapidly growing countries like Afghanistan and Yemen makes them more prone to conflict and terrorism. Booming populations also contribute to global poverty and make it impossible to protect virgin forests or fend off climate change. Some studies have suggested that a simple way to reduce carbon emissions in the year 2100 is to curb population growth today.
Moreover, we’ve seen that family planning works. Women in India average 2.6 children, down from 6 in 1950. As recently as 1965, Mexican women averaged more than seven children, but that has now dropped to 2.2.
But some countries have escaped this demographic revolution. Women in Afghanistan, Chad, Congo, Somalia, East Timor and Uganda all have six or more children each, the U.N. says. In rural Africa, I’ve come across women who have never heard of birth control. According to estimates from the Guttmacher Institute, a respected research group, 215 million women want to avoid getting pregnant but have no access to contraception.
What’s needed isn’t just birth-control pills or IUDs. It’s also girls’ education and women’s rights — starting with an end to child marriages — for educated women mostly have fewer children.
“In times past, the biggest barrier to reducing birth rates has been a lack of access to contraceptives,” the Population Institute notes in a new report. “Today, the biggest barrier is gender inequality.”
The seven billion population milestone is also a reminder that we need more research for better contraceptives.
One breakthrough is an inexpensive vaginal ring that releases hormones, lasts a year and should not require a doctor. Developed by the Population Council, it has completed Phase 3 trials and seems highly effective. It could even contain medication to reduce the risk of an infection with the AIDS virus.
  When contraception is unavailable, the likely consequence is not less sex, but more pregnancy.
Contraception already prevents 112 million abortions a year, by U.N. estimates. The United Nations Population Funds promotes contraception means that it may have reduced abortions more than any organization in the world.
Contraceptives no more cause sex than umbrellas cause rain. So as we greet the seven-billionth human, let’s try to delay the arrival of the eight billionth. We should all be able to agree on voluntary family planning as a cost-effective strategy to reduce poverty, conflict and environmental damage..

Correct Postures

Here are some correct postures which should be used while using a computer to reduce stress and other ill effects.