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5

Managing perineal trauma after childbirth

Problems can extend into the long term, such as dyspareunia, urinary and faecal incontinence, pelvic organ prolapse, psychosocial problems, and postnatal depression  
bmj.com
over 4 years ago
Www.bmj
1
31

Lifestyle changes or metformin reduce type 2 diabetes risk in women with gestational diabetes, US study shows

Women with gestational diabetes have an increased risk of type 2 diabetes for years after giving birth, but intensive lifestyle changes or metformin therapy reduce this risk by more than a third, a US study has found.  
bmj.com
over 4 years ago
Www.bmj
1
23

Bias in observational study designs: case-control studies

Researchers investigated the association between sun exposure and risk of multiple sclerosis. A population based case-control study was performed. The participants were recruited from residents of Tasmania, Australia, who were aged under 60 years and had at least one grandparent born in Tasmania. Cases were people with multiple sclerosis who volunteered after information evenings at local multiple sclerosis societies, or after having been invited by a healthcare professional. In total, 136 people with a diagnosis of multiple sclerosis, as defined by clinical and magnetic resonance imaging criteria, were included as cases. For each case, two controls matched for sex and year of birth were randomly selected from the community. In total, 359 eligible controls were approached and the response rate was 76%.1  
bmj.com
over 4 years ago
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1
6

Authors’ reply to Selvapatt and colleagues, Matthews and colleagues, Badrinath, and Ward and Lee

Selvapatt and colleagues made several points: large numbers of people are infected; birth cohort screening is cost effective; previously treated patients without severe fibrosis are unlikely to progress; sustained virological response improves quality of life; treatment reduces mortality; and newer agents have fewer side effects (last two also alluded to by Matthews and colleagues).1 2 3 The number of patients is not the issue, which is whether …  
bmj.com
over 4 years ago
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2
16

Call the Midwife: I advise the BBC drama on midwifery

Terri Coates explains why it’s difficult to show the reality of birth of screen, and why she gets a hard time from admissions tutors on midwifery courses  
the Guardian
over 4 years ago
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Baby Circulation Right After Birth

Watch how the blood flows through the baby's circulation and compare it to what happens in the fetus. Rishi is a pediatric infectious disease physician and w...  
YouTube
over 4 years ago
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4
522

Development of the heart

Heart is the most important part in the human body Today, we explain how it is formed before birth For more information, please visit my blog http://adf.ly/f...  
YouTube
over 4 years ago
Foo20151013 2023 3p9kow?1444773972
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1697

A medical mystery for Mother's Day...

I'd like to tell you a curious story. Jane was a 52 year old woman in need of a kidney transplant. Thankfully she had three loving sons who were all very happy to give her one of theirs. So Jane's doctors performed tests to find out which of the three boys would be the best match, but the results surprised everyone. In the words of Jeremy Kyle, the DNA test showed that Jane was not the mother of two of the boys... Hang on, said Jane, child birth is not something you easily forget. They're definitely mine. And she was right. It turns out Jane was a chimera. Chimerism is the existence of two genetically different cell lines in one organism. This can arise for a number of reasons- it can be iatrogenic, like when someone has an organ transplant, or it can be naturally occurring. In Jane's case, it began in her mum's womb, with two eggs that had been fertilised by different sperm creating two embryos. Ordinarily, they would develop into two non-identical twins. However in Jane's case the two balls of cells fused early in development creating one person with both cell lines. Thus when doctors did the first tissue typing tests on Jane, just by chance they had only sampled the 'yellow' cell line which was responsible for one of her sons. When they went back again they found the 'pink' cell line which had given rise to the other two boys. This particular type of human chimerism is thought to be pretty rare- there are only 30 case reports in the literature. (Though remarkably both House and CSI's Gil Grissom have encountered cases.) What happens far more frequently is fetal microchimerism- which occurs in pregnant women when cells cross the placenta from baby to mum. This is awesome because we used to think the placenta was this barrier which prevented any cells crossing over. Now we've found both cells and free floating DNA cross the placenta, and that the cells can hang around for decades after the baby was born. Why? As is often the case in medicine we're not sure but one theory is that the fetal cells might have healing properties for mum. In pregnant mice who've had a heart attack, fetal cells can travel to the mum's heart where the develop into new heart muscle to repair the damage. Whilst we're still in the early stages of understanding why this happens, we already have a practical application. In the United States today, a pregnant woman can have a blood test which isn't looking for abnormalities in her DNA but in that of her fetus. The DNA test isn't conclusive enough to be used to diagnose genetic conditions, but it is a good screening test for certain trisomies including Down's syndrome. Now, we started with a curious tale, so lets close with a curious fact, and one that's appropriate for Mother's Day: This exchange of cells across the placenta is a two way process. So you may well have some of your mum's cells rushing through your veins right now. In my case they're probably the ones that tell me to put on sensible shoes and put that boy down... (FYI: This is a story I originally posted on my own blog)  
Dr Catherine Carver
over 6 years ago
Foo20151013 2023 vqxw?1444774199
5
283

Probiotics - There's a New Superhero in Town!

When you think of the term 'bacteria', it immediately conjures up an image of a faceless, ruthless enemy-one that requires your poor body to maintain constant vigilance, fighting the good fight forever and always. And should you happen to lose the battle, well, the after effects are always messy. But what some people might not know is that bacteria are our silent saviours as well. These 'good' bacteria are known as probiotics, where 'pro' means 'for' and 'bios' is 'life'. The WHO defines probiotics as "live micro-organisms which, when administered in adequate amounts, confer a health bene?t on the host". Discovered by the Russian scientist Metchnikoff in the 20th century; simply put, probiotics are micro-organisms such as bacteria or yeast, which improve the health of an individual. Our bodies contain more than 500 different species of bacteria which serve to maintain our health by keeping harmful pathogens in check, supporting the immune system and helping in digestion and absorption of nutrients. From the very first breath you take, you are exposed to probiotics. How so? As an infant passes through it's mother's birth canal, it receives a good dose of healthy bacteria, which in turn serve to populate it's own gastro-intestinal tract. However, unfortunately, as we go through life, our exposure to overly processed foods, anti-bacterial products, sterilized and pasteurized food etc, might mean that in our zeal to have everything sanitary and hygienic, we might be depriving ourselves of the beneficial effects of such microorganisms. For any health care provider, the focus should not only be on eradicating disease but improving overall health as well. Here, probiotic containing foods and supplements play an important role as they not only combat diseases but also confer better health in general. Self dosing yourself with bacteria might sound a little bizarre at first-after all, we take antibiotics to fight bacteria. But let's not forget that long before probiotics became a viable medical option, our grandparents (and their parents before them) advocated the intake of yoghurt drinks (lassi). The fermented milk acts as an instant probiotic delivery system to the body! Although they are still being studied, probiotics may help several specific illnesses, studies show. They have proven useful in treating childhood diarrheas as well as antibiotic associated diarrhea. Clinical trial results are mixed, but several small studies suggest that certain probiotics may help maintain remission of ulcerative colitis and prevent relapse of Crohn’s disease and the recurrence of pouchitis (a complication of surgery during treatment of ulcerative colitis). They may also help to maintain a healthy urogenital system, preventing problems such as vaginitis and UTIs. Like all things, probiotics may have their disadvantages too. They are considered dangerous for people with impaired immune systems and one must take care to ensure that the correct strain of bacteria related to their required health benefit is present in such supplements. But when all is said and done and all the pros and cons of probiotics are weighed; stand back ladies and gentlemen, there's a new superhero in town, and what's more-it's here to stay!  
Huda Qadir
over 5 years ago
Foo20151013 2023 dd0lu2?1444774205
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220

Male Postnatal Depression - a sign of equality or a load of nonsense?

Storylines on popular TV dramas are a great way of raising the public's awareness of a disease. They're almost as effective as a celebrity contracting an illness. For example, when Wiggles member Greg Page quit the group because of postural orthostatic tachycardia syndrome, I had a spate of patients, mostly young and female, coming in with self-diagnosed "Wiggles Disease". A 30% increase in the number of mammograms in the under-40s was attributed to Kylie Minogue's breast cancer diagnosis. The list goes on. Thanks to a storyline on the TV drama Desperate Housewives, I received questions about male postnatal depression from local housewives desperate for information: "Does it really exist?" "I thought postnatal depression was to do with hormones, so how can males get it?" "First it's male menopause, now it's male postnatal depression. Why can't they keep their grubby mitts off our conditions?" "It's like that politically correct crap about a 'couple' being pregnant. 'We' weren't pregnant, 'I' was. His contribution was five seconds of ecstasy and I was landed with nine months of morning sickness, tiredness, stretch marks and sore boobs!" One of my patients, a retired hospital matron now in her 90s, had quite a few words to say on the subject. "Male postnatal depression -- what rot! The women's liberation movement started insisting on equality and now the men are getting their revenge. You know, dear, it all began going downhill for women when they started letting fathers into the labour wards. How can a man look at his wife in the same way if he has seen a blood-and-muck-covered baby come out of her … you know? Men don't really want to be there. They just think they should -- it's a modern expectation. Poor things have no real choice." Before I had the chance to express my paucity of empathy she continued to pontificate. "Modern women just don't understand men. They are going about it the wrong way. Take young couples who live with each other out of wedlock and share all kind of intimacies. I'm not talking about sex; no, things more intimate than that, like bathroom activities, make-up removal, shaving, and so on." Her voice dropped to a horrified whisper. "And I'm told that some young women don't even shut the door when they're toileting. No wonder they can't get their de facto boyfriends to marry them. Foolish girls. Men need some mystery. Even when you're married, toileting should definitely be kept private." I have mixed feelings about male postnatal depression. I have no doubt that males can develop depression after the arrival of a newborn into the household; however, labelling it "postnatal depression" doesn't sit all that comfortably with me. I'm all for equality, but the simple fact of the matter is that males and females are biologically different, especially in the reproductive arena, and no amount of political correctness or male sharing-and-caring can alter that. Depressed fathers need to be identified, supported and treated, that goes without saying, but how about we leave the "postnatal" tag to the ladies? As one of my female patients said: "We are the ones who go through the 'natal'. When the boys start giving birth, then they can be prenatal, postnatal or any kind of natal they want!" (This blog post has been adapted from a column first published in Australian Doctor http://bit.ly/1aKdvMM)  
Dr Genevieve Yates
over 5 years ago
Foo20151013 2023 zwf33b?1444774244
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92

"So are you enjoying it?"

"When did the pain start Mr Smith?" "Ah so do you enjoy it?" 'It' of course refers to your five year medical degree. Patients can be nice can't they. Often it seems that all patients want to talk about is you. I thought the public didn't like students, aren't students lazy drunks who wake up at midday, squander their government hand-outs on designer clothes, and whose prevailing role in society was to keep the nation's budget baked bean industry in the black? Apparently the same isn't thought of medical students, well maybe it is, but god patients are polite. The thing is I have found these questions difficult; it is surprising how they can catch you off guard. Asking if I am enjoying 'it' after I have woken up at dawn, sat on a bus for 40 minutes, and hunted down a clinician who had no idea I was meant to be there, could lead on to a very awkward consultation. But of course it doesn't "yes it is really good thank you". "Do you take any medications, either from your GP or over the counter?" "Are you training to be a GP then?" Medicine is a fascinating topic and indeed career, which surely human nature makes us all interested in. As individuals lucky enough to be studying it, maybe we forget how intriguing the medical profession is? This paired with patients sat in a small formal environment with someone they don’t know could bring out the polite ‘Michael Parkinson’ in anybody. Isn't this just good manners, taking an interest. Well yes. Just because I can be faintly aloof doesn't mean the rest of the world has to me. But perhaps there is a little more to it, we ask difficult personal questions, sometimes without even knowing it, we all know when taking a sexual history to expect the consultation to be awkward or embarrassing, but people can be apprehensive talking about anything, be it their cardiovascular disease, medications, even their date of birth. We often then go on to an examination: inspecting from the end of the bed, exposing a patient, palpating. Given a bit context you can see why a patient may want to shift the attention back to someone like us for a bit, and come on, the medical student is fair game, the best target, asking the consultant whether they enjoys their job, rather you than me. If we can oblige, and make a patient feel a bit more at ease we should, and it certainly won't be doing our student patient relationship any harm. Hopefully next time my answers will be a bit more forthcoming. "Any change in your bowels, blood in any motions?" "How many years do you have left?" It is a good thing we are all polite.  
Joe de Silva
over 5 years ago
Foo20151013 2023 e2a8vo?1444774258
7
294

Monkey See, Monkey Do.

So you're sitting in a bus when you see a baby smile sunnily and gurgle at his mother. Your automatic response? You smile too. You're jogging in the park, when you see a guy trip over his shoelaces and fall while running. Your knee jerk reaction? You wince. Even though you're completely fine and unscathed yourself. Or, to give a more dramatic example; you're watching Titanic for the umpteenth time and as you witness Jack and Rose's final moments together, you automatically reach for a tissue and wipe your tears in whole hearted sympathy ( and maybe blow your nose loudly, if you're an unattractive crier like yours truly). And here the question arises- why? Why do we experience the above mentioned responses to situations that have nothing to do with us directly? As mere passive observers, what makes us respond at gut level to someone else's happiness or pain, delight or excitement, disgust or fear? In other words, where is this instinctive response to other people's feelings and actions that we call empathy coming from? Science believes it may have discovered the answer- mirror neurons. In the early 1990s, a group of scientists (I won't bore you with the details of who, when and where) were performing experiments on a bunch of macaque monkeys, using electrodes attached to their brains. Quite by accident, it was discovered that when the monkey saw a scientist holding up a peanut, it fired off the same motor neurons in its brain that would fire when the monkey held up a peanut itself. And that wasn't all. Interestingly, they also found that these motor neurons were very specific in their actions. A mirror neuron that fired when the monkey grasped a peanut would also fire only when the experimenter grasped a peanut, while a neuron that fired when the monkey put a peanut in its mouth would also fire only when the experimenter put a peanut in his own mouth. These motor neurons came to be dubbed as 'mirror neurons'. It was a small leap from monkeys to humans. And with the discovery of a similar, if not identical mirror neuron system in humans, the studies, hypotheses and theories continue to build. The strange thing is that mirror neurons seem specially designed to respond to actions with clear goals- whether these actions reach us through sight, sound, smell etc, it doesn't matter. A quick example- the same mirror neurons will fire when we hop on one leg, see someone hopping, hear someone hopping or hear or read the word 'hop'. But they will NOT respond to meaningless gestures, random or pointless sounds etc. Instead they may well be understanding the intentions behind the related action. This has led to a very important hypothesis- the 'action understanding' ability of mirror neurons. Before the discovery of mirror neurons, scientists believed our ability to understand each other, to interpret and respond to another's feeling or actions was the result of a logical thought process and deduction. However, if this 'action understanding' hypothesis is proved right, then it would mean that we respond to each other by feeling, instead of thinking. For instance, if someone smiles at you, it automatically fires up your mirror neurons for smiling. They 'understand the action' and induce the same sensation within you that is associated with smiling. You don't have to think about what the other person intends by this gesture. Your smile flows thoughtlessly and effortlessly in return. Which brings us to yet another important curve- if mirror neurons are helping us to decode facial expressions and actions, then it stands to reason that those gifted people who are better at such complex social interpretations must be having a more active mirror neuron system.(Imagine your mom's strained smile coupled with the glint in her eye after you've just thrown a temper tantrum in front of a roomful of people...it promises dire retribution my friends. Trust me.) Then does this mean that people suffering from disorders such as autism (where social interactions are difficult) have a dysfunctional or less than perfect mirror neuron system in some way? Some scientists believe it to be so. They call it the 'broken mirror hypothesis', where they claim that malfunctioning mirror neurons may be responsible for an autistic individual's inability to understand the intention behind other people's gestures or expressions. Such people may be able to correctly identify an emotion on someone's face, but they wouldn't understand it's significance. From observing other people, they don't know what it feels like to be sad, angry, surprised or scared. However, the jury is still out on this one folks. The broken mirror hypothesis has been questioned by others who are still skeptical about the very existence of these wonder neurons, or just how it is that these neurons alone suffered such a developmental hit when the rest of the autistic brain is working just dandy? Other scientists argue that while mirror neurons may help your brain to understand a concept, they may not necessarily ENCODE that concept. For instance, babies understand the meaning behind many actions without having the motor ability to perform them. If this is true, then an autistic person's mirror neurons are perfectly fine...they were just never responsible for his lack of empathy in the first place. Slightly confused? Curious to find out more about these wunderkinds of the human brain? Join the club. Whether you're an passionate believer in these little fellas with their seemingly magical properties or still skeptical, let me add to your growing interest with one parting shot- since imitation appears to be the primary function of mirror neurons, they might well be partly responsible for our cultural evolution! How, you ask? Well, since culture is passed down from one generation to another through sharing, observation followed by imitation, these neurons are at the forefront of our lifelong learning from those around us. Research has found that mirror neurons kick in at birth, with infants just a few minutes old sticking their tongues out at adults doing the same thing. So do these mirror neurons embody our humanity? Are they responsible for our ability to put ourselves in another person's shoes, to empathize and communicate our fellow human beings? That has yet to be determined. But after decades of research, one thing is for sure-these strange cells haven't yet ceased to amaze and we definitely haven't seen the last of them. To quote Alice in Wonderland, the tale keeps getting "curiouser and curiouser"!  
Huda Qadir
over 5 years ago
Foo20151013 2023 xzilvf?1444774307
1
312

Why doesn’t the NHS make money?

The NHS provides care free at the point of us to British citizens and anyone who needs emergency care while in the UK. It tries to provide every kind of service and treatment that it can but obviously there are limits. The NHS gets its money mainly from governments taxes, charities, research grants, some payment for services and from renting out retail space etc. Healthcare is a financial blackhole, any money put in the budget will get spent, efficiently and effectively or not. The NHS is constantly being expected to provide a better, more efficient service and new treatments, without a comparable increase in government funding. So, why doesn’t the NHS set up services that could make it money? Some money making suggestions Gift shops and NHS clothing brand – The American hospital I went to for elective had quite a large shop near the entrance that sold hospital branded goods. People love the NHS and it could make itself a brand, “I love the NHS” t-shirts, “I was born here” ties, “I gave birth at Blah hospital” car stickers, hats, jackets, tracksuits, teddy bears in white coats and so many more things could be sold in this shops to raise money for the NHS. Patients in a hospital are a captive market and their visitors are semi-captive. The captives get very bored! Why not provide opportunities for these people to spend their money and relieve the boredom while they are in hospital with some retail therapy? For instance, new hospitals should be built with a shopping mall in them and a cinema. A couple of clothes shops would give people something to do and raise money from rent. While we are on the subject of new hospitals, they should be designed with the input of the clinical staff who know how to maximise the flow of patients through the "patient pathway". Hospitals should be built like industrial conveyor belts: patients enter through ED, get stabilised, get fixed in theatre, stabilised again in ITU, recover on the wards and out the exit to social services and the outpatient clinics. New hospitals should be designed to sit on top of HUGE underground multi-story car parks. If shopping centres can do this then so can hospitals. Almost all hospitals are short of parking spaces and most car parks are eye sores. So, try to plan from the beginning to get as many car parking spaces as possible. Estimate how many are needed for staff and visitors - then double it! Also, design a park and ride system so additional parking is available off site. If costa can make money from a coffee shop in an NHS hospital, why isn’t the NHS setting up its own brand of high quality coffee shops in the hospitals and cutting out Costa the middle man? “NHS healthy eating” – NHS branded diet plans or ready meals could be produced in partnership with a supermarket brand. Mixing public heath, profit and the NHS brand. “Good for you and good for the NHS” The NHS could set up hospitals abroad that are for profit institutions that use the NHS structures, or market our services to foreigners that they then pay for. Health tourism is a thing, why not make the most of it? “NHS plus” – the NHS should be a two tier system. Hours of 8am til 6pm should be for elective procedures free at the point of use and free emergency care. Between 6pm and 11pm the hospitals currently only do emergency care, so there is loads of rooms and kit lying about unused. Why not allow hospitals to set up systems where patients can pay for an evening slot in the MRI scanner and cut the queue? Allow surgeons to pay to use the facilities for private procedures in the evenings. Allow physicians to pay to use the outpatients clinics for private work after hours. An “NHS Journal” could publish research and audits conducted within and relevant to the NHS. “NHS pharma” – the NHS buys a huge amount of off patent drugs, why not produce them itself? Set up a drug company that produces off patent medication, these can be given to the NHS at cost price and sold to other healthcare providers for profit. NHS pharma could also work with British universities and researchers to produce new drugs for the British market that would be cheaper than new Drug company drugs because they wouldn’t need huge advertising budgets. There are so many ways the NHS could make more money for itself that could then be used to deliver newer and better treatments. Yes, it is a shift in ideology and culture, but I am sure it would have positive outcomes for the NHS and patients. If you have any ideas on how the NHS could produce more money then please do leave a comment.  
jacob matthews
about 5 years ago
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1602

Obstetrics in Flow Charts: Revision Summary for Finals

This slide show should be an easy way to cover almost all of the obstetric information you will need for your final exams. It covers pregnancy, emergencies, infections, miscarriages & still births, TOP, induction, c-sections, normal labour, antenatal care and post natal care.  
speakerdeck.com
over 4 years ago
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0
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Pregnant at 65: Miracle of medicine - BBC News

Annegret Raunigk, 65, is reportedly due to give birth to quadruplets. How is that medically possible?  
bbc.co.uk
over 4 years ago
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2
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Parturition - Pregnancy, Hormones, Giving Birth

https://www.facebook.com/ArmandoHasudungan Support me: http://www.patreon.com/armando Instagram: http://instagram.com/armandohasudungan Twitter: https://twit...  
youtube.com
over 4 years ago
Www.bmj
0
11

Mother is awarded £13m compensation after mistakes at births of two children

Two siblings have won £13m (€18m; $19.2m) in compensation for mistakes made at their births in the same UK hospital 17 months apart that left them both needing lifelong care.  
feeds.bmj.com
over 4 years ago
Www.bmj
0
15

Lifestyle changes or metformin reduce type 2 diabetes risk in women with gestational diabetes, US study shows

Women with gestational diabetes have an increased risk of type 2 diabetes for years after giving birth, but intensive lifestyle changes or metformin therapy reduce this risk by more than a third, a US study has found.  
feeds.bmj.com
over 4 years ago
Www.bmj
0
10

Bias in observational study designs: case-control studies

Researchers investigated the association between sun exposure and risk of multiple sclerosis. A population based case-control study was performed. The participants were recruited from residents of Tasmania, Australia, who were aged under 60 years and had at least one grandparent born in Tasmania. Cases were people with multiple sclerosis who volunteered after information evenings at local multiple sclerosis societies, or after having been invited by a healthcare professional. In total, 136 people with a diagnosis of multiple sclerosis, as defined by clinical and magnetic resonance imaging criteria, were included as cases. For each case, two controls matched for sex and year of birth were randomly selected from the community. In total, 359 eligible controls were approached and the response rate was 76%.1  
feeds.bmj.com
over 4 years ago
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0
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Free birth control reduces teen pregnancies and abortions

Teens who received free contraception and were educated about the pros and cons of various birth control methods were dramatically less likely to get pregnant, give birth or get an abortion...  
medicalnewstoday.com
over 4 years ago