Does episiotomy at vacuum delivery increase maternal morbidity?

Episiotomy at the time of vacuum delivery does not appear to be of benefit, and it more likely than not increases maternal morbidity. This is especially true of median episiotomy (the type used most commonly in the United States), which increases the risk of OASIS at the time of vacuum delivery 5-fold in nulliparous and 89-fold in multiparous women.

Confidence in these conclusions is guarded. Based on the small number of reports, the lack of randomized trials, and the significant heterogeneity between the studies, the authors rated the overall quality of evidence as “low” to “very low” using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group criteria. Additional large prospective clinical trials are needed to definitively answer the question of whether episiotomy at vacuum delivery increases maternal morbidity.

Until such studies are available, however, it would be best if obstetric care providers avoid episiotomy at the time of vacuum delivery. On a personal note, I look forward to the day when a medical student turns to an attending and asks: “What is an episiotomy?” And the attending responds: “I don’t know. I’ve never seen one.” Only then will I be ready to retire. 

Sagi-Dain L, Sagi S. Morbidity associated with episi- otomy in vacuum delivery: a systematic review and meta- analysis. BJOG. 2015;122(8):1073-1081.

Do you have Diabetes? Protect Your Heart… YOU CAN DO IT !!

Ask your doctor about the ABCDEs to REDUCE your risk of heart attack and stroke:

A	A1C – Glucose control target is usually 7% or less
B	BP – Blood pressure control (less than 130/80 mmHg)
C	Cholesterol – LDL cholesterol in less than or equal to 2.0 mmol/L. Your doctor may choose to give you medication to keep your cholesterol at or less than 2.0 mmol/L
D	Drugs to protect your heart: Blood pressure pills (ACE inhibitors or ARBs), cholesterol lowering pills (statins), or ASA (Aspirin). These drugs will protect your heart even if your blood pressure or cholesterol is already at target.
E	Exercise / Eating – Regular physical activity which includes, healthy eating, achievement and maintenance of healthy body weight
s	Stop smoking and manage stress

To Tell or Not To Tell: Disclosing Your HIV Status

	You're HIV positive (HIV+). You've only just learned about your status. OR you've known about it for sometime. Whether it's still fresh news that you are beginning to absorb or it's something you have been living with for a while, there are bound to be many situations in your life in which you will be faced with the decision of whether or not to disclose your HIV status – to tell others that you are infected with HIV. In a number of circumstances you will find yourself trying to balance honesty with protecting your right to privacy.
	General disclosure tips You don't have to tell everyone. The choice is yours about whom to tell. Be selective. Be sure to consider the five "W's" when thinking about disclosure: who, what, when, where and why. Who do you need to tell? What do you want to tell them about your HIV infection, and what are you expecting from the person you are disclosing your HIV status to? When should you tell them? Where is the best place to have this conversation? Why are you telling them? Easy does it. In most situations, you can take your time to consider who to tell and how to tell them. Consider whether there is a real purpose for you to tell this person or if you are simply feeling anxious and want to "dump" your feelings. Telling people indiscriminately may affect your life in ways you haven't considered. Having feelings of uncertainty about disclosing is a very common reaction in this situation. You have a virus. That doesn't mean you've done anything wrong. You don't have anything to apologize for simply because you are HIV positive. Keep it simple. You don't have to tell the story of your life. Avoid isolating yourself about your status. If you are still not able to tell close friends, family members or other loved ones about your HIV status, allow yourself to draw upon the support and experience available to you, through organized groups in the HIV community. Consider taking help of ICTC personals and PLWHA  community forums. There's no perfect road-map for how to disclose. Trust your instinct, not your fears. Whatever the response you receive in a specific situation, and even if it doesn't go the way you'd hoped, you're going to survive it and your life will go on. Millions of others have dealt with this experience and have found their way through it. You will get through it too. Choosing whom to tell or not tell is your personal decision. It's your choice and your right.

ANAPHYLAXIS?: NOTHING TO FEAR, ADRENALINE CURES

Anaphylaxis is an emergency and may be life threatening if not attended to promptly. If a person is suspected to be having  anaphylaxis, he or she should be immediately attended.
One of the first and best treatments for anaphylaxis is Adrenaline injection. An adrenaline injection needs to be administered as soon as a serious reaction is suspected.
An oxygen mask helps the patient to breathe and fluids are given via intravenous injections.
Antihistamines and Corticosteroids are administered to relieve symptoms. Usually the patient is discharged in 1 to 3 days.
Antihistamines and corticosteroid tablets may be continued for a few days after discharge to prevent return of symptoms.
 This simplified chart would be of some help. PUT IT AT WORK STATIONS.

Government supports AYUSH practitioners as legal Medical Termination of Pregnancy ?

GOOD NEWS 

AYUSH doctors may soon have legal status as MTP Providers, if the government recommended an amendment to the 1971 MTP Act Bill is approved by the parliament. This news has definitely not gone well with the modern medicine practitioners, who believe that any traditional medicine practitioners should not be allowed to conduct any modern medicine procedures. In a recent turn of events, the health ministry has suggested an amendment in the Medical Termination of Pregnancy (MTP) Act, 1971 and recommended addition of medical practitioners with bachelor’s degree in Ayurveda, Unani, Siddha or Homeopathy that are working in the public sector with intention to increase the availability of safe and legal abortion services. The health ministry has proposed this amendment in an effort to increase the number of legal MTP providers and to ensure safe abortion services for women especially in rural areas where there is no modern medicine practitioner easily available. The exact conditions and criteria for place of delivery service, training, gestation limit, and technology used would be clarified and defined in the rules following the approval of the MTP amendment Bill by the Parliament. The national medical bodies like IMA and Federation of Obstetric and Gynaecological Societies of India (FOGSI) have shown their strong objection to this inclusion of traditional medicine practitioners to provide legal abortion services. These associations have opposed to allowing traditional medicine practitioners to prescribe and perform modern medicine procedures. Time will tell if there is any amendment in the MTP Act, and if AYUSH practitioners will be legal MTP providers. 

Source: The Economic Times

AYUSH doctors may soon have legal status as MTP Providers, if the government recommended an amendment to the 1971 MTP Act Bill is approved by the parliament. This news has definitely not gone well with the modern medicine practitioners, who believe that any traditional medicine practitioners should not be allowed to conduct any modern medicine procedures. In a recent turn of events, the health ministry has suggested an amendment in the Medical Termination of Pregnancy (MTP) Act, 1971 and recommended addition of medical practitioners with bachelor’s degree in Ayurveda, Unani, Siddha or Homeopathy that are working in the public sector with intention to increase the availability of safe and legal abortion services. The health ministry has proposed this amendment in an effort to increase the number of legal MTP providers and to ensure safe abortion services for women especially in rural areas where there is no modern medicine practitioner easily available. The exact conditions and criteria for place of delivery service, training, gestation limit, and technology used would be clarified and defined in the rules following the approval of the MTP amendment Bill by the Parliament. The national medical bodies like IMA and Federation of Obstetric and Gynaecological Societies of India (FOGSI) have shown their strong objection to this inclusion of traditional medicine practitioners to provide legal abortion services. These associations have opposed to allowing traditional medicine practitioners to prescribe and perform modern medicine procedures. Time will tell if there is any amendment in the MTP Act, and if AYUSH practitioners will be legal MTP providers. Source: The Economic Times

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Metformin appears to be the aspirin of the 21st century and has the potential to prevent and treat preeclampsia.

New study indicates that metformin has the potential to prevent and treat preeclampsia

Drug shows promise for treating this complication of pregnancy that can threaten the life of both the mother and baby

  

Philadelphia, PA, December 22, 2015 - An article published today in the American Journal of Obstetrics and Gynecology reports that a commonly-used drug for the treatment of diabetes, metformin, may have the potential to prevent and treat preeclampsia. Metformin has long been used to treat diabetes in both non-pregnant and pregnant patients, and is considered safe during pregnancy.
Preeclampsia affects 5-8% of all pregnant women and is diagnosed by the new onset of high blood pressure and the presence of protein in the urine after 20 weeks of gestation. This condition is a leading cause of maternal death; approximately 100 maternal deaths and 400 perinatal deaths worldwide occur per day. Thus far, the only treatment for preeclampsia is delivery.
Preeclampsia is a disorder unique to pregnancy and is related to problems with the placenta. Inadequate blood supply to the placenta causes damage to this organ, which leads to the release of toxins into the maternal blood, causing high blood pressure and possible damage to multiple organs, such as the liver, brain, and kidneys.
Over the last decades, scientists have identified that preeclampsia is an endothelial cell disorder (endothelial cells are the inner coat of all blood vessels in the body). At least two toxins produced by the placenta (soluble vascular endothelial growth factor receptor 1 and soluble endoglin) are elevated in preeclampsia, and they can damage endothelial cells, causing the dysfunction responsible for the disease. However, agents or drugs to decrease the production of these toxins are not currently available for clinical use in pregnancy.
A group of physician-scientists from Melbourne, Australia (Mercy Hospital for Women and the University of Melbourne) report that the drug metformin decreases the production of the two toxins elevated in preeclampsia and also helps heal injured blood vessels. The lead author of the study, Dr. Fiona Brownfoot, believes that in light of the laboratory findings, clinical trials should now be conducted to see whether metformin could be used to treat women with preeclampsia. Professor Stephen Tong, senior author and head of the Translational Obstetrics Group at Mercy Hospital for Women, emphasized that metformin is safe during pregnancy.
The Editor-in-Chief for Obstetrics of the American Journal of Obstetrics and Gynecology, Roberto Romero, MD, DMedSci., characterized the in vitro findings as exciting and promising. Dr. Romero indicated that an anti-angiogenic state (a condition that does not favor the formation of blood vessels) is present not only in preeclampsia, but also in other pregnancy complications such as fetal death, fetal growth restriction, and premature labor. "Metformin appears to be the aspirin of the 21st century, because the drug has been discovered to have unexpected health benefits not only in diabetes, but also in polycystic ovarian disease and recent work has highlighted its anti-cancer properties," Dr. Romero said. He believes that systematic reviews of previous randomized clinical trials in which pregnant women had been given metformin, as well as new randomized clinical trials, are urgently needed to determine if this simple intervention can be effective in preventing preeclampsia and other pregnancy complications.

Research Offers Recommendations for Use of Aspirin to Prevent Pre-Eclampsia

December 16, 2015

PROVIDENCE, RI -- December 16, 2015 -- To prevent pre-eclampsia, new research suggests that low-dose aspirin should be given prophylactically to all women at high risk (those with diabetes or chronic hypertension) and any woman with 2 or more moderate risk factors (including obesity, multiple gestation, and advanced maternal age).
The findings are published in the December issue of the journal Obstetrics & Gynecology.
Erika Werner, MD, Division of Maternal-Fetal Medicine at Women & Infants Hospital of Rhode Island, and Brown University, Providence, Rhode Island, and colleagues developed a decision model to evaluate the risks, benefits, and costs of 4 different approaches to aspirin prophylaxis: no prophylaxis, prophylaxis per recommendations of the American College of Obstetricians and Gynecologists (ACOG), prophylaxis per the US Preventive Task Force (USPTF) recommendations, and universal prophylaxis for all women.
The estimated rate of pre-eclampsia would be 4.18% without prophylaxis compared with 4.17% with the College approach in which 0.35% (n = 14,000) of women receive aspirin, 3.83% with the USPTF approach in which 23.5% (n = 940,800) receive aspirin, and 3.81% with universal prophylaxis.
Compared with no prophylaxis, the USPTF approach is the most cost-beneficial in 79% of probabilistic simulations.
“Both the US Preventive Task Force approach and universal prophylaxis would reduce morbidity, save lives, and lower healthcare costs in the United States to a much greater degree than the approach currently recommended by ACOG,” the authors wrote.
                                                               SOURCE: Care New England

Tips to Keep Joints Healthy

1- Stay in Motion:-

 It's the golden rule of joint health: The more you move, the less stiffness you'll have. Whether you're reading, working, or watching TV, change positions often. Take breaks from your desk or your chair and get active.

2- Safety First:-

Padding is your pal. So suit up when you do things like in-line skating or play contact sports. If your joints already ache, it might help to wear braces when you do activities like tennis or golf.

3- Lean In to Your Weight:-  

Your size affects some of the strain on your hips, knees, and back. Even a little weight loss can help. Every pound you lose takes 4 pounds of pressure off the knees. Ask your doctor what's the best way for you to get started.

4- Don't Stretch Before Exercise

Flexibility helps you move better. Try to stretch daily or at least three times a week. But don't do it when your muscles are cold. Do a light warm-up first, like walking for 10 minutes, to loosen up the joints, ligaments, and tendons around them.

5- Go Low-Impact

What exercise is good? The best choices are activities that don't pound your joints, like walking, bicycling, swimming, and strength training.

6- Flex Some Muscle

Get stronger to give your joints better support. Even a little more strength makes a difference. A physical therapist or certified trainer can show you what moves to do and how to do them. If you have joint problems, avoid quick, repetitive movements.

7- Work on Your Range

Are your joints too stiff and inflexible? You'll want to get back as much as you can of your "range of motion." That's the normal amount joints can move in certain directions. Your doctor or physical therapist can recommend exercises to improve this.

8- Power Up Your Core

Stronger abs and back muscles help your balance, so you're less likely to fall or get injured. Add core (abdominal, back, and hip) strengthening exercises to your routine. Pilates and yoga are great workouts to try.

9- Know Your Limits

It's normal to have some aching muscles after you exercise. But if you hurt for more than 48 hours, you may have overstressed your joints. Don't push so hard next time. Working through the pain may lead to an injury or damage.

10- Eat Fish to Reduce Inflammation

If you have joint pain from rheumatoid arthritis, eat more fish. Fatty cold-water types like salmon and mackerel are good sources of omega-3 fatty acids. Omega-3s may help keep joints healthy, as well as lower inflammation, a cause of joint pain and tenderness in people with RA. Don't like fish? Try fish oil capsules instead.

11- Keep Your Bones Strong

Calcium and vitamin D can help you do that. Dairy products are the best sources of calcium, but other options are green, leafy vegetables like broccoli and kale. If you don't get enough calcium from food, ask your doctor about supplements.

12- Target Your Posture

Stand and sit up straight to protect joints all the way from the neck down to your knees. To improve your posture, take a walk. The faster you do it, the harder your muscles work to keep you upright. Swimming can also help.

13- Ease Your Load

Consider your joints when lifting and carrying. Carry bags on your arms instead of with your hands to let your bigger muscles and joints support the weight.

14- Chill Out Pain

Ice is a natural -- and free -- pain reliever. It numbs the hurt and eases swelling. If you have a sore joint, apply a cold pack or ice wrapped in a towel. Leave it on for up to 20 minutes at a time. You can also try a bag of frozen vegetables wrapped in a towel. Never apply ice directly to your skin.

15- Supplements? Ask First

Stores are filled with ones that promise to relieve joint pain. Glucosamine and SAMe have the best research behind them. Talk to your doctor if you want to give supplements a try, so you know about what's safe and what might affect your medicines or health conditions.

16- Treat Joint Injuries

They can add to the breakdown of cartilage in your joints. If you get hurt, see your doctor right away for treatment. Then take steps to avoid more damage. You may need to avoid activities that put too much stress on your joint or use a brace to stabilize it.
                                              Source:   http://www.webmd.com/

Is the End of AIDS in Sight? 10 Facts About HIV/AIDS Ahead of World AIDS Day

Here are some facts about AIDS in 2015 with data from the World Health Organisation, the United Nations children's agency UNICEF, and UNAIDS:

1. Globally about 36.9 million people are living with HIV including 2.6 million children.
2. An estimated 2 million were infected in 2014.
3. An estimated 34 million people have died from HIV or AIDS, including 1.2 million in 2014.
4. The number of adolescent deaths from AIDS has tripled over the last 15 years.
5. AIDS is the number one cause of death among adolescents in Africa and the second among adolescents globally.
6. In sub-Saharan Africa, the region with the highest prevalence, girls account for 7 in 10 new infections among those aged 15-19.
7. At start of 2015, 15 million people were receiving antiretroviral therapy compared to 1 million in 2001.
8. Despite widespread availability of HIV testing, only an estimated 51% of people with HIV know their status.
9. The global response to HIV has averted 30 million new HIV infections and nearly 8 million deaths since 2000.
10. In 2015, Cuba was the first country declared to have eliminated mother-to-child transmission of HIV.
                                   
Reuters Health Information,    
December 02, 2015

Breastfeeding 'Protects Against Diabetes'

New evidence has emerged on  the   role that breastfeeding could have in preventing diabetes.Early results from a Canadian study suggest that breastfeeding reduces the risk of mothers and their offspring developing the condition.

Growing Rates of Diabetes

A person with type 2 diabetes has high blood sugar due to inability of their pancreas to produce enough insulin. The condition usually follows a period of insulin resistance, meaning the body does not react properly to insulin.

Type 2 diabetes is the most common type of diabetes, with around 3 million people in the UK diagnosed with the condition. Rates of diabetes are increasing worldwide.

The study by a team from the University of Manitoba explored the link between breastfeeding and type 2 diabetes rates in the Canadian province.

In total they studied 334,553 deliveries during a 24-year period in Manitoba. Of these, 60,088 births were to mothers from indigenous communities where rates of diabetes in pregnancy (gestational diabetes) are 2 to 3 times higher than among non-indigenous mothers. Gestational diabetes is known to be associated with a higher risk of later development of type 2 diabetes among both mothers and their offspring.

Breastfeeding was recorded in 56% of indigenous mothers and 83% of non-indigenous mothers.

Reduced Diabetes Risk

The researchers found that breastfeeding was associated with:

· A 14% reduced risk of type 2 diabetes among indigenous mothers

· A 23% reduced risk among non-indigenous mothers

· An 18% lower risk among all children regardless of ethnicity.

They say that these results were independent of other factors, including gestational diabetes, gestational high blood pressure, family income, location of residence, age of mothers at birth and the birth weight of offspring.

Details of the study have been presented at the World Diabetes Congress in Vancouver. The results should be treated with caution as they have yet to be published in a peer-reviewed journal.

SOURCES:

'Breastfeeding initiation reduces incidence of diabetes in mothers and offspring: A population-based study in Manitoba', Shen et al, World Diabetes Congress.
Diabetes UK

Obesity in Youth May Harm the Heart Long-Term, Even After Weight Loss?

WEDNESDAY, Nov. 25, 2015 (HealthDay News) -- A new study finds that even if overweight or obese young women slim down later on, obesity-linked damage to the heart may linger for decades.
The research shows that even formerly overweight women remain at heightened risk for sudden cardiac death later in life.
So, "it is important to maintain a healthy weight throughout adulthood as a way to minimize the risk of sudden cardiac death," lead author Stephanie Chiuve, assistant professor of medicine at Harvard Medical School, said in a news release from JACC: Clinical Electrophysiology. The study was published in the journal Nov. 25.
In their research, Chiuve's team tracked outcomes for more than 72,000 healthy American women followed from 1980 to 2012. The women provided information about their weight and height when they were age 18. Their body mass index (BMI - an estimate of body fat based on weight and height) was then checked every two years during the study period.
Over those 32 years, there were 445 sudden cardiac deaths, almost 1,300 deaths from heart disease, and nearly 2,300 nonfatal heart attacks, the researchers said.
Compared to women with a healthy weight during adulthood, the risk of sudden cardiac death over the next two years was 1.5 times higher among those who were overweight and 2 times higher among those who were obese.
And women who were overweight or obese at age 18 or at the start of the study had an increased risk of sudden cardiac death throughout all 32 years of the study, regardless of whether they lost the weight or not.
Women who put on large amounts of weight a few years later -- in early-to-mid adulthood -- were also at higher risk of sudden cardiac death, regardless of their BMI at age 18, Chiuve's team found. In fact, women who gained 44 pounds or more during early-to-mid-adulthood had a nearly twofold increased risk of sudden cardiac death, compared to women who'd stayed slim.
The researchers also found that overweight and obese women were at heightened risk for death from heart disease and for nonfatal heart attacks, but the link between weight and these risks was weaker than it was for sudden cardiac death.
The fact that a prior history of obesity confers cardiac risk to women who are normal weight today is interesting, Chiuve said.
She pointed out that,"nearly three-quarters of all sudden cardiac deaths occur in patients not considered to be high-risk based on current guidelines."
Two experts said that more Americans need to pay heed to warnings linking obesity to heart trouble.
"The effects of obesity on the heart include its influence on promoting diabetes, hypertension, coronary artery disease and arrhythmias, as well as obstructive sleep apnea," said Dr. Kevin Marzo, chief of cardiology at Winthrop-University Hospital in Mineola, N.Y.
"Weight loss remains at the cornerstone of risk reduction," he said.
Dr. Mitchell Rosln is chief of obesity surgery at Lenox Hill Hospital in New York City. He agreed that obesity's impact "is multi-dimensional and impacts the entire body."
"These study results are alarming and really mean that weight loss and physical fitness need to emphasized," he said.
SOURCES: Mitchell Roslin, M.D., chief, obesity surgery, Lenox Hill Hospital, New York City; . Kevin Marzo, M.D., chief, division of cardiology, Winthrop-University Hospital, Mineola NY; JACC: Clinical Electrophysiology, news release, Nov. 25, 2015

PrEP: Simple and Effective Yet Underused in HIV prevention.

Pre-Exposure Prophylaxis (PrEP), an important way for clinicians to protect their patients from becoming infected with HIV.
PrEP involves an HIV-negative person taking a pill containing tenofovir and emtricitabine. PrEP is taken daily and reduces sexual acquisition of HIV by more than 90% when taken correctly. Clinicians are key to increasing awareness of PrEP, and you can discuss HIV risk with all patients to better identify those who would benefit.
Every year, about 45,000 people in the United States are diagnosed with HIV. PrEP complements other tools to prevent HIV, such as condom use, HIV testing, and early diagnosis and treatment of HIV infection.
Any prescribing healthcare provider can deliver PrEP care. You have the power to protect your patients from HIV by assessing their risk from sex and drug use behaviors and offering PrEP to patients with the recommended indications.
CDC estimates that 1.2 million people in the United States may have indications for PrEP use, and these people fall into three groups^[1]:

• About 1 in 4 HIV-negative sexually active gay and bisexual adult men. This includes men who have multiple sex partners and report any anal sex without a condom or who had a recent sexually transmitted infection, as well as men who have an ongoing sexual relationship with an HIV-positive partner.
• About 1 in 5 HIV-negative adults who inject drugs. This includes people who share needles or equipment to inject drugs or have recently been in a drug treatment program.
• About 1 in 200 sexually active, HIV-negative heterosexual adults. This includes adults in an ongoing sexual relationship with HIV-positive partners. It also includes people who have multiple sex partners and who infrequently use condoms during sex with partners known to be at substantial risk for HIV infection. Partners at substantial risk include people who inject drugs and, for women, bisexual men.

Integrating the delivery of PrEP care into your practice involves five key steps:

• Test all adolescent and adult patients for HIV as recommended by the US Preventive Services Task Force and CDC as a routine part of medical care. Patients who test positive for HIV should be prescribed HIV treatment right away.
• Discuss HIV risks and prevention methods with all patients. If an HIV-negative patient has indications for PrEP and is interested in taking it, then move on to the next step.
• Perform the recommended laboratory tests, including tests to exclude acute HIV infection if the symptom history suggests this, and tests for renal function and hepatitis B virus. If the tests show that the patient is still a candidate for PrEP, then move on to the next step.
• Prescribe PrEP to your patient and counsel them about steps that they can take to make sure that PrEP is taken every day. If payment is an issue, provide assistance as to how they may apply for insurance or other programs.
• The last step is to schedule appointments every 3 months for follow-up including HIV testing and prescription refills.

Incorporating PrEP into your practice is simple, and it works. Since CDC published the Public Health Service Clinical Practice Guidelines for PrEP in 2014, open-label studies and demonstration projects conducted with gay and bisexual men in the United States achieved high adherence with PrEP.^[2-6] And a recent study conducted in New York State suggests that the use of PrEP as a prevention tool can be increased substantially for persons who are Medicaid-insured—if education efforts about PrEP for both clinicians and patients are implemented successfully.^[7]In closing, increasing the use of PrEP by patients could be a major tool in reducing the number of new HIV infections in the United States. But many clinicians who can prescribe PrEP, and many people who can benefit from it, aren't aware of it. Together we can scale up the use of this important HIV prevention tool.

Head Lice infestation Could Contribute to Iron Deficiency Anemia

 

         Head lice infestation could cause iron deficiency anemia in the absence of any other cause, according to a case report published online in BMJ Case Reports.
Noting that the concurrent presence of lice infestation and iron deficiency anemia has been reported in children and adults, Sarah Ali Althomali, from the King Abdulaziz Specialist Hospital in Taif, Saudi Arabia, and colleagues document a case of a young woman with severe iron deficiency anemia with no known cause.
The 23-year-old patient presented to the emergency department with chest discomfort on exertion, palpitation, light-headedness, and generalized fatigability. She had a medical history of depression, which began four years earlier with loss of her mother. For the previous six months she had had secondary amenorrhea. The patient appeared depressed, fatigued, and uninterested in conversation. Her head was covered in lice and lice nits, and scratch marks were seen on her scalp.
The researchers reported that the patient was treated for head lice and given intravenous iron therapy for the anemia. Improvement was seen in her symptoms after ensuring good body hygiene and psychological therapy. The patient was lost to follow-up.
"We conclude that chronic and heavy lice infestation could be the cause of iron deficiency anemia in the absence of an obvious cause of iron deficiency anemia such as menstrual loss or chronic gastrointestinal bleeding," the authors write.

Reference

1. Althomali SA, Alzubaidi LM, Alkhaldi DM, et al. Severe iron deficiency anaemia associated with heavy lice infestation in a young woman. BMJ Case Reports. 2015;doi:10.1136/bcr-2015-212207.

This 8-Year-Old Girl Is the Youngest Person Ever to Be Diagnosed with Breast Cancer

A cancer diagnosis is always devastating, but the story of Chrissy Turner is especially distressing: The 8-year-old was diagnosed with secretory breast carcinoma earlier this month after discovering a lump in her breast.
“She came to us on a Sunday afternoon. She said, ‘Mommy I have been scared and I have this lump,'" Chrissy’s mom, Annette Turner, tells ABC News. “It had been there for a while.”

Annette says she “was in shock" when she got her daughter’s diagnosis, adding, “no child should ever have to go through cancer.”

Secretory breast carcinoma is extremely rare (it affects just one in one million people), although it has occurred in children in the past, according to research published in the Archives of Pathology & Laboratory Medicine journal. It also typically has a “favorable prognosis.”
Chrissy is the youngest known patient with this type of breast cancer, says Annette.
Chrissy’s doctors are confident that they can remove the tumor via a mastectomy. However, Chrissy will lose all of her breast tissue to prevent the cancer from coming back. It's unclear whether Chrissy will be able to develop breasts after her surgery, but according to the research published in the Archives of Pathology & Laboratory Medicine, "preservation of prepubertal breast tissue is important to ensure proper breast development; however, that is not always possible because of the location of the tumor."
Unfortunately, health battles aren’t new for the Turner family: Annette is a cervical cancer survivor, and her husband has non-Hodgkin's lymphoma.
"We're just going to keep fighting," Annette tells ABC4 Utah News. "Doing everything we can to smile every day and laugh every day and carry our head high and do our best to overcome this."

http://www.womenshealthmag.com/health/secretory-breast-carcinoma

Progesterone Does Not Improve Outcomes for Women With History of Recurrent Miscarriages

BIRMINGHAM, United Kingdom -- November 25, 2015 -- New research published in the New England Journal of Medicine shows that progesterone supplements in the first trimester of pregnancy do not improve outcomes in women with a history of unexplained recurrent miscarriages.
The findings mark the end of a 5-year trial and provide a definitive answer to 60 years of uncertainty on the use of progesterone treatment for women with unexplained recurrent losses.
The study of 826 women with previously unexplained recurrent miscarriage showed that those who received progesterone treatment in early pregnancy were no less likely to miscarry than those who received a placebo. This was true whatever their age, ethnicity, medical history, and pregnancy history.
Nearly two thirds of the women in the trial had their baby, whether they had progesterone or the placebo. The live birth rate was 65.8% in the treatment group, and 63.3% in the placebo group.
Though the results of the Progesterone in Miscarriage Treatment (PROMISE) trial will be disappointing to many, it will allow researchers to direct their efforts towards exploring other treatments that can reduce the risk.
“We had hoped, like many people, that this research would confirm progesterone as an effective treatment,” said Arri Coomarasamy, MD, University of Birmingham, Birmingham, United Kingdom. “Though disappointing, it does address a question that has remained unanswered since progesterone was first proposed as a treatment back in 1953. Fortunately, there are a number of other positives that we can take from the trial as a whole.”
The trial results also showed that there were no significant negative effects of progesterone treatment for women or for their babies. This is important information for women taking progesterone for other reasons, such as fertility treatment, or for those taking part in other trials.
“It may well be that progesterone supplements have other uses, such as preventing miscarriage in women with early pregnancy bleeding, so it’s not the end of the road,” said Dr. Coomarasamy. “Furthermore, the PROMISE trial created a solid network of doctors, nurses and midwives across the UK and beyond, all committed to miscarriage research. That wealth of expertise and information will be invaluable as we continue to explore and test other treatments that really can reduce the risk of miscarriage.”
SOURCE: University of Birmingham

Teasing Girls About Weight May Cause Lasting Harm

FRIDAY, Nov. 20, 2015 (Health Day News) -- Teasing overweight girls about their weight can cause lasting harm to their self-image and might increase their risk of eating disorders, a new study suggests.

 Weight status may be a more sensitive issue for children who are overweight or obese, and being teased about it may elicit a stronger response from them as opposed to children who are not overweight or obese," Norma Olvera, a professor and health educator at the University of Houston, said in a university news release.
The research included 135 black and Hispanic girls about age 11 who were overweight or obese. Eighty-one percent of the girls were obese. All of them said they were unhappy about their body weight and wished they were thinner, the researchers said.
"The study focused on black and Hispanic girls because they are at a higher risk of obesity, which may increase their desire to be thinner and lead them to engage in unhealthy eating behaviors," Olvera said. "Secondly, there is not a lot of research that explores these issues in minority girls."
Fifty-two percent of the girls said they had been teased about their weight by other girls. Sixty percent said they had been teased by boys, and some said they had been teased by siblings, the research revealed.
The teasing seemed to trigger unhealthy eating behaviors in the girls, the researchers found. But, it's important to note that this type of study isn't designed to prove a cause-and-effect relationship; it can only show an association between teasing and the girls' eating behaviors.
Seventy percent of those who were teased started to cut back on or skip meals, diet or starve themselves to lose weight, the study showed. The researchers also found that 12 percent engaged in binge eating followed by forcing themselves to throw up, and 33 percent reported eating because they were upset or bored (emotional eating).
"Results from this study may guide health educators and practitioners to design interventions to teach coping strategies to these children to help them deal with peer-weight teasing," Olvera said. "The findings also support social policies of no tolerance of weight-related teasing, particularly in school settings"
The study was published recently in the Journal of Early Adolescence.
SOURCE: University of Houston, news release, Nov. 10, 2015

DISPLACED IUCD

Laparoscopic Removal of displaced IUD

World Toilet Day is November 19th

Poorly built toilets and sewage systems are a major cause of illness and groundwater contamination. As clean water becomes more scarce, disposing of human waste in ways that do not cause more water contamination becomes increasingly important.

Human waste (feces and urine) can pollute water, food, and soil with germs and worms, leading to serious health problems. The safe disposal of human waste (sanitation) by building and maintaining toilets and washing hands prevents the spread of germs and is necessary for good health.
Whether your community uses pit toilets, toilets that turn human waste into fertilizer (ecological sanitation), toilets that flush human wastes and water (sewage), or another type of toilet, the main goal is to prevent human waste from contaminating drinking water, food, and our hands. Just as important as a safe and comfortable toilet is a way to wash hands after using it. Safe toilets and hand washing together can prevent most of the illnesses that come from germs in human waste.
Over 2.4 billion people around the world lack toilets, which means they lack access to good sanitation which helps them avoid disease in their homes, their communities and their water systems. 

It means that they struggle to avoid illness when they go out to relieve themselves, and if they're sick they struggle even harder to get well. It means that women risk violence every time they look for a quiet, private place to go.

Maybe if we forced our government leaders to dig their own latrines - and use and clean them - they'd develop the political will to solve the essentially simple problem of lack of access to sanitation. Until that happens, we can provide people with the knowledge to build and maintain healthy sanitation systems.   

  

 

 

Breastfeeding and Eyesight

Breastfeeding may help protect premature infants from a common eye disease that can lead to blindness.
A new study looks at how nursing affects the incidence of retinopathy of prematurity… a condition where abnormal blood vessels grow in the retina, increasing risk of detachment.
Researchers analyzed medical records of more than 2,200 preterm infants comparing breastfeeding to formula feeding.
While any amount of breastfeeding played a protective role in preventing retinopathy of prematurity, exclusive or mainly breastfeeding was associated with significant benefits in preventing severe disease.
The authors say these findings may be related to the antioxidant and immune protective properties of breast milk, which contains vitamin C, vitamin E and beta-carotene.
 Dr. Cindy Haines of HealthDay TV

Sweetened Drinks and Heart Failure

What you drink may be as important as what you eat when it comes to heart health.
A new study finds men who drink two or more servings of sweetened beverages per day are at increased risk of heart failure. Researchers tracked the health of around 42,000 men for more than a decade. Participants were asked to fill out food frequency questionnaires that looked at their average consumption of 96 food and drink items. During the monitoring period, about 3,600 new cases of heart failure were diagnosed and another 509 people died of the condition. Men who consumed two or more daily servings of sweetened drinks had a 23 percent higher risk of developing heart failure compared to those who did not. According to the study, tens of millions of people worldwide are affected by heart failure. The authors say these findings may aid in heart failure prevention strategies, such as improving diet recommendations.
Source:-  https://www.nlm.nih.gov/medlineplus/videos/news

Bioethical issues in medical practice Rights and duties of a parent

A girl suffering from intellectual disability, serious enough so that she could not take care of herself became pregnant at the care home. By the time the pregnancy was discovered she was pregnant for over four months. The girl was admitted to a government hospital and assessed for MTP. The girl insisted- from the point of view of her limited understanding of the matter- that she wanted to keep the child and bring it up herself. Doctors at the hospital where she was admitted after the pregnancy was discovered were of the opinion that she was intellectually unfit to look after herself, what to say of a child. What should the doctors do?

a) Carry out MTP regardless of the girl’s wishes

b) Allow the pregnancy to continue possibly to the future detriment of the unborn baby.

c) Any other recourse such as going to court – but what if the court orders continuance of the pregnancy? Who will look after the baby?




Source
Smita N Deshpande
Head, Dept. of Psychiatry, De-addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
Park Street, New Delhi

Breastfeeding and Allergy Protection

Breastfeeding provides many emotional and physical benefits to babies, but allergy protection may not be one of them.
A new study finds no significant difference in allergies between children who were breastfed and those who were formula fed. Researchers analyzed the medical records of 194 children… 4 to 18 years old… who were diagnosed with allergic rhinitis or hay fever. They were divided into two groups based on their infant feeding history. 134 were breastfed and 60 were formula fed. The number of patients with a positive skin prick test for hay fever was the same in both groups.
They also had similar numbers of patients with asthma, eczema and food allergies.
One study author stresses breastfeeding is good for babies, and new mothers should continue to breastfeed. He says, “Larger studies need to be done to determine how these results might apply to the larger population."
       Source:-  Dr. Cindy Haines of HealthDay TV

WHO Recommendations for Prevention and Treatment of Maternal Peripartum Infections. September 2015

Key Messages

1. • Bacterial infections around the time of childbirth account for about one-tenth of maternal deaths    and contribute to severe morbidity and long-term disability for many affected women.
2. • Standard infection prevention and control measures are a cornerstone of peripartum infection prevention(e.g.,hand hygiene and use of clean equipment).
3. • WHO recommendations for prevention and treatment of maternal peripartum infections include both recommended and non-recommended interventions during labour, childbirth, and the postpartum period.
4. • Clinical monitoring, early detection, and prompt treatment of peripartum infection with an appropriate antibiotic regimen are essential for reducing death and morbidity in affected women.
5. • Recommendations for antibiotic prophylaxis/treatment for specific indications balance health benefits for the mother and newborn with safety concerns (e.g., adverse effects) and the public health imperative to control antibiotic resistance.

Good Clinical Practice:  
Observe Standard Infection Prevention and Control Measures and Judicious Use of Antibiotics to Control Antimicrobial Resistance 

1. • Identify and correct predisposing factors to infection (e.g., by providing nutritional advice and addressing nutritional deficiencies, anaemia, and other maternal medical conditions [e.g., diabetes]) during antenatal care. 
2. • Promote hand hygiene, use of clean products (e.g., blood products), use of clean equipment, and aseptic surgical practices (e.g., standard skin preparation techniques and proper use of antiseptic agents for surgical site preparation). 
3. • Maintain clean hospital environment (e.g., clean water, appropriate waste disposal, and sanitation).
4. • Develop and implement local protocols on infection prevention and control practices in accordance with existing WHO guidance.
5. • Promote judicious use of antibiotics (administer only for recommended indications; use narrowest antibacterial spectrum and simplest effective dose; verify woman’s history of drug intolerance; monitor local bacteria and antibiotic susceptibility and resistance patterns). 

Cardiac Arrest in Pregnancy AHA scientific statement on maternal resuscitation

October 19, 2015

The American Heart Association’s (AHA) scientific statement on maternal resuscitation includes up-to-date and comprehensive information, guidelines, and recommendations for all aspects of maternal resuscitation. The statement is intended to help health care providers be prepared and provide the best possible care for a maternal cardiac arrest. Among the recommendations are:

• The newly developed in-hospital and out-of-hospital basic life support and advanced cardiovascular life support algorithms should be the backbone of the response plan to a maternal cardiac arrest.

• Special attention should be paid to manual left uterine displacement (LUD), the difficult airway, and appropriate use of perimortem cesarean delivery (PMCD).

• A maternal cardiac arrest committee must be formed at every institution.

• Emergency response plans specific to each institution must be developed and implemented.

Citation: Jeejeebhoy FM, Zelop CM, Lipman S, et al. Cardiac arrest in pregnancy: A scientific statement from the American Heart Association. [Published online ahead of print October 6, 2015]. Circulation. doi: 10.1161/CIR.0000000000000300. 

Prepare for emergent c-section as soon as cardiac arrest identified in the pregnant woman 

Quickly determine gestational age during initial resuscitation of mother 

Once procedure begins, ideally two teams now working independently 

 CPR is continued on mother Factors that increase the infant’s chance of survival 

 Short interval between arrest and delivery 

 No sustained prearrest hypoxia of mother 

 Minimal or no signs of fetal distress before arrest 

 Aggressive/effective resuscitation of mother 

 Procedure performed in center with neonatal ICU 

 Emergency C-section within rescuer’s procedural range of experience/skills

Katz and colleagues recommended 

 “initiation of C-section within 4 minutes of maternal arrest and fetal delivery within 5 minutes.” These recs have been supported by other studies and consensus panels 

Forms the basis of the “4 minute” rule 

Case reports of prolonged time (>20) do not make this “4 minute rule “ absolute

Vitamin D status is inversely associated with anemia and serum erythropoietin during pregnancy

Findings the STUDY by Thomas C, Guillet R, Queenan R, Cooper E, Kent T, Pressman E, Vermeylen F, Roberson M, O'Brien K; American Journal of Clinical Nutrition (Oct 2015) 

DESIGN The trial was a prospective longitudinal study of 158 pregnant adolescents (aged ≤18 y). Maternal circulating biomarkers of vitamin D and iron were determined at midgestation (∼25 wk) and delivery (∼40 wk). Linear regression was used to assess associations between vitamin D and iron status indicators. Bivariate and multivariate logistic regressions were used to generate the OR of anemia as a function of vitamin D status. A mediation analysis was performed to examine direct and indirect relations between vitamin D status, hemoglobin, and erythropoietin in maternal serum.

BACKGROUND Vitamin D and iron deficiencies frequently co-exist. It is now appreciated that mechanistic interactions between iron and vitamin D metabolism may underlie these associations.
OBJECTIVE We examined interrelations between iron and vitamin D status and their regulatory hormones in pregnant adolescents, who are a group at risk of both suboptimal vitamin D and suboptimal iron status.
RESULTS Maternal 25-hydroxyvitamin D [25(OH)D] was positively associated with maternal hemoglobin at both midgestation and at delivery (P<0 .01="" 25="" 8="" a="" adjustment="" adolescents="" after="" age="" an="" and="" anemia="" associated="" at="" be="" between="" both="" by="" concentrations="" could="" delivery="" direct="" enrollment="" erythropoietin.="" erythropoietin="" explained="" for="" greater="" hemoglobin="" in="" indirect="" inversely="" maternal="" mediated="" midgestation="" nmol="" observed="" odds="" of="" p="" race="" relation="" significant="" than="" that="" the="" those="" times="" was="" with=""> CONCLUSIONS In this group of pregnant adolescents, suboptimal vitamin D status was associated with increased risk of iron insufficiency and vice versa. These findings emphasize the need for screening for multiple nutrient deficiencies during pregnancy and greater attention to overlapping metabolic pathways when selecting prenatal supplementation regimens.

Source: Am J Clin Nutr 

Polio death in Lao renews int'l effort to eradicate polio around world

VIENTIANE, Oct. 17 (Xinhua) -- The recent death of a polio-stricken 8-year-old Lao boy had refocused local and world attention to polio, an ailment which is now almost extinct in other parts of the world.
The death has drawn the attention of policymakers from the 10-member Association of South-East Asian Nations (ASEAN) as they gather in the nation's capital Vientiane for a five-day Ministerial Meeting on Rural Development and Poverty Eradication.
A personal tragedy for the boy's family and a deep concern for local and national Lao health authorities, the death also marks a setback in the global fight against the disease and the attainment of a "polio-free world."
The incident has also drawn attention to the plight of children in the developing country of some seven million, whose population is mostly young people and is set to surpass 10 million by the end of the decade.
One particularly passionate advocate of children in Laos and beyond is United Nations Children's Fund (UNICEF) Country Representative for Laos, China's Ms Hongwei Gao.
Speaking to Xinhua's Vientiane Bureau, Ms. Gao said the death was a reminder that every child must be immunized to prevent polio and other potentially fatal or debilitating illnesses.
"The polio virus can cause lifelong paralysis. There is no cure but it can be prevented by vaccine. We are now close to a polio-free world, but there is only one way to reach it: take action and immunize all children," she said.
Meanwhile, the launch of a national polio vaccination campaign by the country's Prime Minister Thongsing Thammavong Thursday was a demonstration of high level commitment to the cause.
"In the past two or three years the government of Laos has sharply increased this budget allocation to support national immunization program to buy good quality vaccines...this is evidence of action to concretely support child development," Ms. Gao said.
She said Laos had made great strides to achieve the Millennium Development Goals set for 2015, particularly in reducing extreme poverty and hunger, decreasing child and maternal mortality rates, and ensuring that more children are enrolled in schools.
However, Ms. Gao said the country's high rate of malnutrition or under nutrition among some 44 percent of Lao children remained an area requiring continued improvement, particularly in affected rural and remote areas.
"Nutrition is the one indicator where Lao is really lagging behind other countries and this is a huge challenge to national development. If not addressed properly, this would result in huge loss in human capital," she said.
Improved sanitation and food preparation practices and exclusive breastfeeding for the first six months of the child's life are among the remedies, she said.
"What does it take to ensure that a child has good nutritional status?"
It takes, of course, good and sufficient food, and good and efficient feeding practices by parents," Ms. Gao said.
According to Ms. Gao, a well coordinated effort to boost children's safety and their active participation in socio-economic development could particularly benefit countries with young populations such as Laos.        More

Positive Living With Sickle Cell Disease

If you or your child has sickle cell disease (SCD), you should learn as much as you can about the disease. Your health care providers are there to help you, and you should feel comfortable asking questions.

Adopt Healthy Lifestyle

Like all people, you or your child should strive to maintain a healthy lifestyle that includes:

• A nourishing diet
• Enough sleep
• Regular physical activity

People with SCD often tire easily, so be careful to pace yourself and to avoid very strenuous activities.
Don’t smoke and try to avoid second-hand smoke. If you drink alcohol, try to quit and drink extra water to avoid dehydration.

Prevent and Control Complications

Avoid situations that may set off a crisis. Extreme heat or cold, as well as abrupt changes in temperature, are often triggers. When swimming, ease into the pool rather than jumping right in.
Avoid overexertion and dehydration. Take time out to rest and drink plenty of fluids.
Do not travel in an aircraft cabin that is unpressurized.
Take your medicines as your doctor prescribes. Get any medical and lab tests or immunizations that your doctor orders.
See a doctor right away if you have any of the following danger signs:

• Fever
• Stroke symptoms
• Problems breathing
• Symptoms of splenic enlargement
• Sudden loss of vision
• Symptoms of severe anemia

If your child attends daycare, preschool, or school, speak to his or her teacher about the disease. Teachers need to know what to watch for and how to accommodate your child.

Get Ongoing Care

Make and keep regular appointments with your SCD doctor or medical team. These visits will help to reduce the number of acute problems that need immediate care. Avoid seeing your doctor only when you or your child has an urgent problem that needs care right away.
Your SCD medical team can help prevent complications and improve your quality of life.

Coping With Pain

Every person experiences pain differently. Work with your doctor to develop a pain management plan that works for you. This often includes over-the-counter medicines, as well as stronger medicines that you get with a prescription.
You may find other methods that help your pain, such as:

• A heating pad
• A warm bath
• A massage
• Physical therapy
• Acupuncture
• Distracting and relaxing activities, such as listening to music, talking on the phone, or watching TV

Mental Health

Living with SCD can be very stressful. At times, you may feel sad or depressed. Talk to your doctor or SCD medical team if you or your child is having any emotional problems. Tell your doctor right away if you or your child is feeling very depressed. Some people find counseling or antidepressant medicines helpful.
You may find that speaking to a counselor or psychiatrist, or participating in a support group is helpful. When families and friends provide love and support to people with SCD, they can help to relieve stress and sadness. Let your loved ones know how you feel and what you need.