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.