Malignant mediastinal germ cell tumors (seminomas) were first described as a clinical entity approximately 50 years ago. Mediastinal and other extragonadal germ cell tumors were initially thought to represent isolated metastases from an inapparent gonadal primary site

World Malaria Day 2012

The theme for World Malaria Day 2012 - "Sustain Gains, Save Lives: Invest in Malaria" - marks a decisive juncture in the history of malaria control. Whether the malaria map will keep shrinking, as it has in the past decade, or be reclaimed by the malaria parasites, depends, to a great extent, on the resources that will be invested in control efforts over the next years.
Investments in malaria control have created unprecedented momentum and yielded remarkable returns in the past years. In Africa, malaria deaths have been cut by one third within the last decade; outside of Africa, 35 out of the 53 countries, affected by malaria, have reduced cases by 50% in the same time period. In countries where access to malaria control interventions has improved most significantly, overall child mortality rates have fallen by approximately 20%.
However, these gains are fragile and will be reversed unless malaria continues to be a priority for global, regional and national decision-makers and donors. Despite the current economic climate, development aid needs to continue flowing to national malaria control programs to ensure widespread population access to life-saving and cost-effective interventions. Long-term success will also depend on investments in on-going research and development to combat emerging threats such as parasite resistance.
Sustaining malaria control efforts is an investment in development. Continued investment in malaria control now will propel malaria-endemic countries toward near-zero deaths by 2015 and achieving the Millennium Development Goals, especially those relating to improving child survival and maternal health, eradicating extreme poverty and expanding access to education.
In 2010, about 3.3 billion people - almost half of the world's population - were at risk of malaria. Every year, this leads to about 216 million malaria cases and an estimated 655 000 deaths. People living in the poorest countries are the most vulnerable.
World Malaria Day - which was instituted by the World Health Assembly at its 60th session in May 2007 - is a day for recognizing the global effort to provide effective control of malaria. It is an opportunity:

• for countries in the affected regions to learn from each other's experiences and support each other's efforts;
• for new donors to join a global partnership against malaria;
• for research and academic institutions to flag their scientific advances to both experts and general public; and
• for international partners, companies and foundations to showcase their efforts and reflect on how to scale up what has worked.

Earth Day is on Sunday, 22 April 2012.

Earth Day is a name used for 2 similar global observances. While some people celebrate Earth Day around the time of the March Equinox, We and others observe the occasion on April 22 each year.

       Earth Day aims to inspire awareness of and appreciation for earth's environment.

             It's not to be confused with Earth Hour

The April 22 Earth Day, founded by Senator Gaylord Nelson, was first organized in 1970 to promote ecology and respect for life on the planet as well as to encourage awareness of the growing problems of air, water and soil pollution.

The Centre proposes to merge the National Rural Health Mission (NRHM) and the yet-to-be-launched National Urban Health Mission (NUHM)

The Centre proposes to merge the National Rural Health Mission (NRHM) and the yet-to-be-launched National Urban Health Mission (NUHM) in the 13th Five-Year-Plan period. The two ambitious Missions will be separate entities in the upcoming 12th Five-Year-Plan period, after the launch of the urban health mission, but subsequently merged.

In its proposals to the Planning Commission, the Ministry of Health and Family Welfare has said that the National Urban Health Mission would be taken up as a thrust area for the 12th Plan and launched as a separate mission for urban areas with focus on slums and urban poor. It will cover all cities and towns with a population of more than 50,000, broadly covering 779 cities and towns including seven mega cities including Mumbai, New Delhi, Kolkata, Chennai, Bengaluru, Hyderabad and Ahmedabad.

The budget allocation for the mission is envisaged to be Rs. 30,000 crore and the programme will be implemented by investing in health professionals, creating new and upgradation of existing infrastructure, and strengthening the existing health care service delivery system.

Principally, the NUHM will cover the entire urban areas irrespective of the dwelling status (including general population, listed and unlisted slums) but outreach services will be targeted for slum/slum like areas and other homeless people, street vendors, railway and bus station coolies, homeless people and street children, construction site workers who may be in slums or on sites. Inter-sectoral convergence will be planned between the Jawaharlal Nehru National Urban Renewal Mission, Rajiv Awas Yojana and the NUHM.

Realising that the health care needs of the urban poor and vulnerable populations, the urban health mission will ensure adequate resources for addressing the health problems in urban areas and address the need-based city specific urban health care system to meet the diverse health needs of the urban population with focus on the urban poor and other vulnerable sections. The institutional mechanism and management systems will be in place to meet the health-related challenges of a rapidly growing urban population and join hands with community for a more proactive involvement in planning, implementation and monitoring of health activities.

At the primary care level, one Urban Primary Health Centre will be established for every 50-60,000. At the community level, outreach services will be provided to the urban poor slums with the help of Urban Social Health Activist (USHA) (200-500 households) and Mahila Aarogya Samiti (50-100 households). No sub-centres are proposed but communisation will be made possible through Mahila Aarogya Samiti and Rogi Kalyan Samiti while secondary and tertiary level services will be provided through public or empanelled private providers.

The National Rural Health Mission was launched in 2005 and is proposed to be extended by five years.

ADDING LIFE TO YEARS!

WHO DAY 2012

Emergency contraception (EC)

Despite many highly effective methods of contraception are available nowadays, many pregnancies are unintended. Emergency contraception (EC) is the use of drug or device after unprotected intercourse to prevent an unwanted pregnancy. It is a woman's last chance to prevent unintended pregnancy. Nevertheless the confusion about mechanisms of action, side effects, clinical efficacy and contraindications makes the intervention underused in every setting investigated.
So far levonorgestrel (LNG) has been considered the gold standard for oral EC. Today, a new type of second generation progesterone receptor modulator, ulipristal acetate (UPA) has been proposed as a more effective drug than LNG in prevention of unwanted pregnancies by delaying or inhibiting ovulation;
Visitdrsujnanendra's--emergency-contraception-powerpoint

The 4 Principles of Hand Awareness

Possible New Route To Fight Dengue Virus

Researchers have identified enzymes and biochemical compounds called lipids that are targeted and modified by the dengue virus during infection, suggesting a potential new approach to control the aggressive mosquito-borne pathogen.

Findings also suggest that medications used to treat high cholesterol and other lipid-related conditions might also inhibit dengue's replication and could represent a potential new therapy. The researchers have identified how infected mosquito cells undergo changes to certain lipids in membranes and in biochemical sensors that alert cells of invading viruses.

"The virus reorganizes the internal architecture of the cell to support its own needs," said Purdue University research scientist Rushika Perera. "Many details are unknown. This is our first attempt to understand how the virus alters lipids as part of the infection process. Part of what we looked at in this work was how the virus changes the cell, and the next step will be to figure out why."

The researchers uncovered new details of how the virus alters lipids in membranes surrounding structures inside cells called organelles, including the mitochondria, which provide energy critical for a cell to function, and the endoplasmic reticulum, where proteins and lipids are synthesized.

"Findings also show that important host enzymes are used by the virus and may be targets for future antiviral drugs," said Richard J. Kuhn, a professor and head of Purdue's Department of Biological Sciences and director of the Bindley Bioscience Center. "It turns out, the pills you take to control your cholesterol might have some capability to control dengue."

The work was led by Perera in collaboration with researchers at Purdue's Bindley Bioscience Center and the Pacific Northwest National Laboratory. Findings are detailed in a research paper in the journal PLoS Pathogens

Eye can see a nest of worms!

In October, 2010, a 38-year-old woman presented with creeping sensation in her right eye, but without any systemic or visual symptoms. Her medical history was notable only for an unknown insect flying into her right eye during farm work about 3 months earlier. On examination, a live worm was seen moving out from the nasal upper eyelid of the right eye above the conjunctiva (figure A). This was further viewed with anterior segment optical coherence tomography (figure B). When proxymetacaine eye-drops were administered, preparing the eye for surgical exploration, more than two worms were seen moving (figure C, D).

Haotian Lin, Xiaoling Liang

Diclofenac-tramadol vs. diclofenac-acetaminophen combinations for pain relief after caesarean

Mitra S, Khandelwal P, Sehgal A;

compared the analgesic efficacy of diclofenac-acetaminophen combination with diclofenac-tramadol combination to optimize multimodal post-operative analgesia in women undergoing caesarean section. METHODS: In this randomized, double-blind, parallel-group controlled trial, 204 women undergoing caesarean section under spinal anaesthesia with bupivacaine received rectal suppository diclofenac 100 mg (8 hourly till 24 h) plus either intravenous acetaminophen (1 g 6 hourly) or tramadol (75 mg 6 hourly) post-operatively. The primary outcome measure was the summed pain intensities during the entire observation period, calculated as the sum of time-weighted pain intensity scores as an area under the curve (AUC). Secondary outcome was the use of rescue analgesic, administered if the patient's numeric rating scale (NRS) scores ≥ 4. RESULTS: The overall pain score for the entire observation period measured as AUC was significantly lower in the diclofenac-tramadol group. However, diclofenac-tramadol combination produced Bonferroni-corrected statistically significant lower NRS pain scores only on movement at 24 h. Rescue analgesic consumption was comparable between the groups (13% vs. 12%, P = 0.872). Overall, the pain scores were low in both of the groups across various time intervals (median NRS scores 0-2 for pain both at rest and on movement), indicating satisfactory pain control in both groups. Side effects were few and comparable, except nausea (significantly more in tramadol group than acetaminophen group, 15% vs. 2%, P = 0.001). CONCLUSION: Both diclofenac-tramadol and diclofenac-acetaminophen combinations can achieve satisfactory post-operative pain control in women undergoing caesarean section. The diclofenac-tramadol combination was overall more efficacious but associated with higher incidence of post-operative nausea.

When Unneeded, Induced Labor May Increase Complications Mother, child fare best with spontaneous labor at 38 to 39 weeks' gestation, study finds

FRIDAY, March 9 (HealthDay News) -- Inducing labor when it's not necessary increases the risk of cesarean section delivery and other childbirth complications, a new study says.
The Australian researchers noted that induced labor is common and increasing in many countries. In many cases, labor is induced for "social" and other "non-recognized" reasons, they added.
For the study, the investigators analyzed data from more than 28,000 women with spontaneous onset of labor, induction of labor for known medical reasons, and induction of labor for non-recognized reasons.
Compared with spontaneous labor, inducing labor for non-recognized reasons was associated with a 67 percent increased risk of cesarean section delivery, a 64 percent increased risk that an infant would require care in the neonatal intensive care unit (NICU), and a 44 percent increased risk that an infant would require treatment in the NICU.
The researchers also found that mothers who gave birth at or after 41 weeks' gestation had the lowest likelihood of requiring epidural or spinal analgesia for pain relief. Those who gave birth after 37 weeks had the lowest risk of severely tearing the perineum during childbirth, they said, and those who gave birth after 38 weeks had the lowest risk of labor complications.
Overall, the lowest risk of mother and infant complications occurred with birth between 38 and 39 weeks and with the spontaneous onset of labor.
The study was published in the February issue of the journal Acta Obstetricia et Gynecologica Scandinavica.
"Our research relates to the optimal timing and management of labor and birth at term for women with an uncomplicated pregnancy," study leader Rosalie Grivell, of the University of Adelaide's Robinson Institute, said in a journal news release. "We hope our findings will increase awareness of potential complications related to the common use of induction of labor in situations where there is no serious maternal or fetal problem."

Embrace Providing Hope – Manjula’s Story

Manjula’s story has touched Embrace team tremendously. Having lost her first two babies, her pain is evident, but she is hopeful that with the help of the Embrace Infant Warmer, her third baby will survive.
When Manjula’s third baby was born, she weighed just under two pounds.  Manjula’s husband quietly told us, “My wife gave birth to our first baby at home with the help of village elders; the baby survived only for a couple of hours…we are not sure why she passed away. Our second baby died at birth in the hospital – his kidneys had not developed.”
Five days after being placed in the Embrace Infant Warmer, her baby’s weight had increased to over two and half pounds, a positive indication she was becoming healthy.  Her husband later reported to us, “Our baby has now survived past twenty days, a very good sign.”


Manjula’s story is tragically familiar. Sadly, she was blamed by her community and extended family for the loss of her first two babies, and has been labeled “worthless” as a result.  This is a persistent pattern in many such areas of the world, due to lack of education.  Manjula is silent, and a little apprehensive, but the hope in her eyes is evident as she looks after her little girl.
We are thankful that Embrace was able to help her baby girl survive, and perhaps set Manjula on the path to recover her self confidence.

Thalassaemia in pregnancy Best Practice & Research Clinical Obstetrics & Gynaecology, 02/03/2012

Leung TY et al. – After birth, resumption of iron chelation and bisphosphonates treatment is needed, and counselling on breast feeding and contraception should be given.

• Thalassaemia is the most common monogenetic disease worldwide.
• Antenatal screening is effective and simple, and accurate genetic prenatal diagnosis can be achieved in early gestation.
• Less invasive methods are feasible with ultrasound fetal assessment for alpha–thalassaemia, analysis of circulating fetal nucleic acid in maternal plasma, and pre–implantation genetic diagnosis.
• Women with thalassaemia major and intermedia are at risk of various maternal complications, such as cardiac failure, alloimmunisation, viral infection, thrombosis, endocrine and bone disturbances.
• Therefore, it is prudent to adhere to a standard management plan in this group of pregnant women.
• Close monitoring of the maternal and fetal condition during pregnancy is essential, and various treatments, such as blood transfusion or postpartum prophylaxis for thromboembolism, may be indicated.
• After birth, resumption of iron chelation and bisphosphonates treatment is needed, and counselling on breast feeding and contraception should be given.

Intrauterine exposure to mild analgesics during pregnancy and the occurrence of cryptorchidism and hypospadia in the offspring

Snijder CA et al. – The results suggest that intrauterine exposure to mild analgesics, primarily paracetamol, during the period in pregnancy when male sexual differentiation takes place, increases the risk of cryptorchidism.
Methods

• Associations between maternal exposure to mild analgesics during pregnancy and cryptorchidism or hypospadia in the offspring were studied in 3184 women participating in a large population–based prospective birth cohort study from early pregnancy onwards in the Netherlands (2002–2006), the Generation R Study.
• Cryptorchidism and hypospadia were identified during routine screening assessments performed in child health care centres by trained physicians.
• The use of mild analgesics was assessed in three prenatal questionnaires in pregnancy, resulting in four periods of use, namely, periconception period, first 14 weeks of gestation, 14–22 weeks of gestation and 20–32 weeks of gestation.
• Logistic regression analyses were used to study the associations between maternal exposure to mild analgesics and cryptorchidism and hypospadia.

Results

• The cumulative prevalence over 30 months of follow up was 2.1% for cryptorchidism and 0.7% for hypospadia.
• Use of mild analgesics in the second period of pregnancy (14–22 weeks) increased the risk of congenital cryptorchidism [adjusted odds ratio (OR) 2.12; 95% confidence interval (CI) 1.17–3.83], primarily due to the use of acetaminophen (paracetamol) (adjusted OR 1.89; 95% CI 1.01–3.51).
• Among mothers of cryptorchid sons, 33.8% reported (23 of 68) the use of mild analgesics during pregnancy, compared with 31.8% (7 of 22) of mothers with a boy with hypospadia and 29.9% (926 of 3094) of mothers with healthy boys.