Wednesday, April 18, 2018

A birth control vaccine is on the horizon for family planning.

 
Vaccines for control of fertility are likely to have an important impact on family planning methods. They are designed to act by mobilization of an internal physiological process and do not require external medication on a continuous basis. A number of birth control vaccines are at different stages of development, the most advanced being a vaccine inducing antibodies against human chorionic gonadotrophin (hCG). This vaccine consists of a heterospecies dimer (HSD, beta hCG associated with alpha-subunit of ovine luteinizing hormone, beta hCG:alpha oLH) linked to tetanus toxoid (TT) or diphtheria toxoid (DT) as carriers. The vaccine has recently passed an important milestone; it has completed the first leg of phase II efficacy trials. Women of proven fertility leading active sexual life were protected from becoming pregnant at antibody titres > or = 50 ng of hCG bioneutralization capacity per ml. This vaccine has previously been demonstrated to be reversible in its effect. It is free from any notable side-effects on endocrine, cardiovascular and other body functions. Ovulation was not disturbed and menstrual regularity was maintained. A logistic disadvantage of the present vaccine is the requirement for multiple injections. This is expected to be overcome by encapsulation of the requisite doses of the vaccine in biodegradable microspheres, which could be given at a single contact point for sustained antibody titres lasting over a year. A live recombinant vaccine has also been made that elicits high anti-hCG titres in monkeys for nearly 2 years following primary immunization and a booster at 8-9 months.

Saturday, April 14, 2018

WHO and UNICEF issue new guidance to promote breastfeeding in health facilities globally. WHO news

WHO and UNICEF on April 14 launched a Ten Steps to Successful Breastfeeding Guide to encourage new mothers to breastfeed and help health facilities to support breastfeeding in the best way possible.
 WHO and UNICEF today issued new 10-step guidance to increase support for breastfeeding in health facilities that provide maternity and newborn services. Breastfeeding all babies for the first 2 years would save the lives of more than 820,000 children under age 5 annually.
The Ten Steps to Successful Breastfeeding underpin the Baby-friendly Hospital Initiative, which both organizations launched in 1991. The practical guidance encourages new mothers to breastfeed and informs health workers how best to support breastfeeding.
Breastfeeding is vital to a child’s lifelong health, and reduces costs for health facilities, families, and governments. Breastfeeding within the first hour of birth protects newborn babies from infections and saves lives. Infants are at greater risk of death due to diarrhea and other infections when they are only partially breastfed or not breastfed at all. Breastfeeding also improves IQ, school readiness, and attendance, and is associated with higher income in adult life. It also reduces the risk of breast cancer in the mother.
"Breastfeeding saves lives. Its benefits help keep babies healthy in their first days and last well into adulthood," says UNICEF Executive Director Henrietta H. Fore. "But breastfeeding requires support, encouragement, and guidance. With these basic steps, implemented properly, we can significantly improve breastfeeding rates around the world and give children the best possible start in life."
WHO Director-General Dr. Tedros Adhanom Ghebreyesus says that in many hospitals and communities around the world, whether a child can be breastfed or not can make the difference between life and death, and whether a child will develop to reach his or her full potential.
"Hospitals are not there just to cure the ill. They are there to promote life and ensure people can thrive and live their lives to their full potential," says Dr. Tedros. "As part of every country’s drive to achieve universal health coverage, there is no better or more crucial place to start than by ensuring the Ten Steps to Successful Breastfeeding are the standard for care of mothers and their babies."
The new guidance describes practical steps countries should take to protect, promote, and support breastfeeding in facilities providing maternity and newborn services. They provide the immediate health system a platform to help mothers initiate breastfeeding within the first hour and breastfeed exclusively for 6 months.
It describes how hospitals should have a written breastfeeding policy in place, staff competencies, and antenatal and post-birth care, including breastfeeding support for mothers. It also recommends limited use of breastmilk substitutes, rooming-in, responsive feeding, educating parents on the use of bottles and pacifiers, and support when mothers and babies are discharged from hospital.

Dilution Of PC PNDT Act By Health Ministry


Union Health Ministry has agreed to make certain changes in the draconian PC-PNDT Act. This decision has angered many doctors and women’s rights activists who fear that the proposed amendments will weaken this act and further aggravate the imbalanced sex ratio in the country.
The PC-PNDT Act 1994, which was enacted with the aim to curb female feticide, has failed to improve the sex ratio in the country despite being in existence for over 20 years. Even a smallest error in compliance of the Act, either in sex determination or non-maintenance of records, brings heavy penalty on the errant. Thus, implementation of this draconian Act has major negative consequences.
Therefore, IMA has been demanding major revisions in the PC-PNDT Act since 2015, stating that “In its current form, the implementation of the Pre-Conception, Pre-Natal Diagnostic Technique (PCPNDT) Act has deprived the community of life-saving and essential ultrasonography which has now become an extension of clinical practice for all specialties globally, being a well-known non-invasive, cost-effective and accurate diagnostic tool.” (The Hindu, October 25 2015)
In this regard, IMA had 2 key demands:
  • There will be “graded punishments” in case of violations of the act
  • Non-obstetric ultrasound centers will not be required to be registered anywhere.
The health ministry has agreed to these changes and the changes are likely to come within next 45 days.
A women’s right activist who was instrumental in the framing of the PC-PNDT act said that “Specifically, the strong deterrent sections will be amended by bringing in graded punishments which will lead to conversion of criminal offenses into technical deficiencies (clerical errors).” (New Indian Express 10 April 2018)
Source: New Indian Express

Thursday, April 12, 2018

Remedies for Restless Legs Syndrome

Sleep Late

Restless legs syndrome, also called RLS, makes it hard to sleep. Your legs may ache, burn, tingle, twitch, or jerk. To get the deep sleep you need, try going to bed a little later and sleeping later in the morning. Those morning hours ay be some of your best rest.

Keep a Regular Bedtime

Going to sleep and waking up at the about the same time every day helps just about everyone sleep better. When you have RLS, it may stop a bad cycle where fatigue makes your symptoms worse, and then the twitching and tingling ruins your sleep for another night. Pay attention to how much sleep you need to feel your best. Most adults need seven to nine hours each night.

Stretch Before You Sleep

Gentle stretching before bed might help. For a calf stretch, step forward and bend your front leg while keeping your back leg straight, in a small lunge. You can put your hand on a wall for support. Repeat on the other side. Stretching also helps if you've been sitting for a long time.

Cut the Caffeine

Coffee, tea, chocolate, and cola can all give you a little burst of energy, thanks to the caffeine, but they can also make your RLS symptoms worse, even hours later. Cut out this stimulant and you may find it easier to fall asleep and stay asleep.  If you cut down, keep in mind that caffeine can affect some people for as long as 12 hours.

Soak in a Warm Bath

A warm bath before bedtime relaxes you and makes it easier to fall asleep. So it's probably not surprising that this classic way to wind down also reduces the symptoms of RLS.

Chill or Warm Your Legs

Heating pad or ice pack? Go with whatever feels good. Either change in temperature can be soothing. Some people say a cold shower works best.

Make Exercise a Habit

Moderate exercise during the day pays off with better sleep at night. Walk, jog, lift weights, or find any exercise you enjoy. One study found that exercise led to less leg movement and longer and deeper sleep for people with RLS. Be careful not to overdo it. Intense exercise or working out just before bedtime could make your symptoms worse.

Exercise Your Brain

Sitting still can trigger RLS symptoms, such as when you sit down in the evening to watch TV or you're stuck on a crowded bus. Activities that distract your mind can sometimes ease your symptoms.  Work a crossword puzzle, read a great book, or play a video game.

Move Your Legs

When your legs ache or twitch, moving them may ease those uncomfortable feelings. Sometimes just shaking or moving your legs can help. Choose an aisle seat in a movie theater or airplane so you can get up easily.

Breathe Deeply

Stress makes RLS symptoms worse. Release the tension by taking slow, deep breaths. It also helps to dim the lights and listen to soothing music before you go to bed.
 

Massage Your Legs

A calf massage before bed might calm your RLS symptoms and help you get to sleep. You can do it yourself or trade mini-massages with a family member.  Give your partner a 10-minute shoulder rub, then stretch out for a leg massage and relax deeply.

Ease Into a Yoga Pose

Yoga combines three remedies that can reduce mild RLS symptoms: stretching, deep breathing, and relaxation. Try a class or video to learn the right posture and pace for each move.  Once you know the poses, you can do them on your own. A podcast can lead you through the moves and include an eyes-closed, guided relaxation at the end.

Turn Off the TV Before Bed

Watching television or using the computer just before bed can make it harder to fall asleep. Sleep experts say you should make the bedroom a TV- and computer-free zone.

Avoid Alcohol and Cigarettes

Alcohol and cigarettes can bring on the symptoms of RLS and harm your sleep in other ways, too. A drink may make you drowsy at first, but you're more likely to wake up during the night or have poor sleep that doesn’t leave you feeling rested. The nicotine in cigarettes is what triggers RLS symptoms, so avoid cigars, "chew," and any other tobacco products.

Ask About Iron Supplements

People with RLS often have low levels of iron in their blood. Your body needs iron to make dopamine, a brain chemical that helps control movement. Ask your doctor whether an iron supplement might help you. If so, take it with a glass of orange juice or another source of vitamin C  to help your body absorb the iron.
 

Review Your Medicines

Some cold and allergy drugs can trigger RLS symptoms, especially some antihistamines. Some antidepressants and drugs to treat nausea can also cause the same problem. Tell your doctor about all medicines and supplements you take. There may be another drug you can take that won’t trigger your RLS symptoms.



Wednesday, April 11, 2018

Practical tips to help physicians improve communication with patients



  • Introduce yourself and your role
  • Address the patient by name and use common courtesy
  • Make nursing your partner
  • Ensure that the patient knows and understands the plan of care
  • Explain what the patient can expect (tests, procedures, consultations)
  • Address questions
  • Understand that house staff, care partners, and consultants impact your communication scores
  • Respect the patient's privacy
  • Be aware of what you do and say in front of patients
  • Include the patient's family when appropriate
  • Ask patients and visitors how they are being treated and if they need anything
  • Discuss pain management and set expectations
  • When necessary, apologize--try to right a wrong
  • Role model good behavior and address bad behavior

Sunday, April 8, 2018

Menstruation Matters

MENSTRUAL HYGIENE MANAGEMENT HAS A STAGGERING IMPACT ON GIRLS, THEIR COMMUNITIES & THE  ENVIRONMENT
Menstrual Hygiene Management (MHM) describes access to adequate materials, information, and support with which to manage menstruation in a healthy, safe, and dignified manner.




Menstruation-related school absenteeism increases a girl’s risk of:
  • Reduced educational attainment and school dropout
  • Lost economic opportunities
  • Poor reproductive health
  • Economic dependency
  • Early marriage
Menstruation causes girls throughout the world to miss crucial days of education or even dropout of school altogether. When girls lack menstrual products and information about their periods, they are less likely to engage fully in school and may have trouble participating or concentrating in class, which can negatively impact their impact and learning compared to their male peers.
As part of its initiatives to empower women, the Odisha government today launched a scheme to provide free sanitary napkins to school girls across the state.

The scheme will be implemented by the health and family welfare department of the state at a cost of 70 crore per year, a senior government official said.

"In continuation with our pro-women initiatives, Government of Odisha announced the scheme 'KHUSHI'. Under the scheme, the state will provide free sanitary napkins to 17 lakh girls studying in Classes 6 to 12 in government and government-aided schools,"

Friday, April 6, 2018

Doctors in India at breaking point, courtesy continuing attacks: Lancet report

Nearly 75% doctors in India have faced either verbal or physical violence during their lifetime, says a report of ‘The Lancet’—one of the oldest medical journals in the world—quoting the Indian Medical Association (IMA).
The medical journal has pointed out that most of the cases of violence are due to patients’ death, inflated bills and sometimes behaviour of the doctors. The solution is that the government should regulate private health sector strictly and upgrade facilities in government hospitals.
“According to the report, the health workers (doctors) in India have reached a breaking point in the wake of continuous physical attacks on them,” says Dr PK Gupta, spokesperson for the IMA, Lucknow Chapter.
“It’s not a matter of pride for India that Lancet picked up such a scene of India’s health sector. Perhaps that is the reason why most of the young doctors are not interested in serving government hospitals. Junior doctors are more exposed to violence for they are the first responders. May be they are inexperienced in handling the patients’ relatives,” adds Dr Gupta.
“The Lancet report highlights the fact that funding of public health care has declined and passive privatisation has been encouraged this has caused stress on pockets of common man leading to brawls,” says senior IMA member Dr Aleem Sid

Tuesday, April 3, 2018

HIV Preexposure Prophylaxis: A Review;

Importance About 40 000 Americans and 2 million people worldwide are newly infected with HIV each year. The combination antiretroviral regimen, tenofovir disoproxil fumarate (TDF)/emtricitabine, taken as a single pill once daily, has been shown to prevent HIV transmission but is used by fewer than 20% of people who could benefit in the United States.
Observations PubMed was searched on February 15, 2018, using the search terms pre-exposure, prophylaxis, HIV, and PrEP to identify English-language articles published between 2010 and 2018. Four placebo-controlled randomized clinical trials have demonstrated that preexposure prophylaxis (PrEP) with daily dosing of TDF / emtricitabine significantly reduces HIV acquisition in men who have sex with men, high-risk heterosexuals, and injection drug users who share injection equipment. The efficacy of daily TDF/emtricitabine exceeds 90% but is highly correlated with degree of adherence. TDF / emtricitabine is safe and well-tolerated. Only 2% of people discontinue PrEP because of adverse effects. Sexually transmitted infections are common among those using PrEP. Resistance to TDF/emtricitabine when used for PrEP is rare
 Conclusions and Relevance :- TDF/emtricitabine is an effective and safe therapy for preventing HIV transmission. Increasing prescription of TDF/emtricitabine for patients at risk of acquiring HIV has the potential to reduce new HIV infections.

Riddell J, Amico K, Mayer K; Journal of the American Medical Association (JAMA) 319 (12), 1261-1268 (Mar 2018)


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