In prospective studies, the prevalence of undiagnosed subclinical hypothyroidism in pregnant women ranges from 3% to 15%. Subclinical hypothyroidism is associated with multiple adverse outcomes in the mother and fetus, including spontaneous abortion, pre-eclampsia, gestational hypertension, gestational diabetes, preterm delivery, and decreased IQ in the offspring. Only two prospective studies have evaluated the impact of levothyroxine therapy in pregnant women with subclinical hypothyroidism, and the results were mixed. Subclinical hypothyroidism is defined as raised thyrotropin combined with a normal serum free thyroxine level. The normal range of thyrotropin varies according to geographic region and ethnic background. In the absence of local normative data, the recommended upper limit of thyrotropin in the first trimester of pregnancy is 2.5 mIU/L, and 3.0 mIU/L in the second and third trimester. The thyroid gland needs to produce 50% more thyroid hormone during pregnancy to maintain a euthyroid state. Consequently, most women on levothyroxine therapy before pregnancy require an increase in dose when pregnant to maintain euthyroidism. Ongoing prospective trials that are evaluating the impact of levothyroxine therapy on adverse outcomes in the mother and fetus in women with subclinical hypothyroidism will provide crucial data on the role of thyroid hormone replacement in pregnancy.
over 7 years ago
A registrar who removed a healthy ovary from a pregnant woman with appendicitis instead of her appendix has been allowed to continue practising, after a Medical Practitioners Tribunal Service panel decided that he was “not a danger to the public.”
over 7 years ago
Vitamin D deficiency has been associated with an ever expanding list of diseases, and with this has come almost tonic-like claims for vitamin D supplementation. In observational studies, low vitamin D status has been associated with increased risk of multiple sclerosis, type 1 and type 2 diabetes, cardiovascular disease, colon cancer, breast cancer, autoimmunity, and allergy.1 The UK government has advised that all pregnant women, and children under 5 years, should take 400 IU vitamin D daily; a recent news story, however, reported a survey conducted by a charity which suggested that only 26% of pregnant women and 46% of healthcare professionals are aware of these guidelines.2 The most recent musculoskeletal trend seems to be the attribution of childhood problems such as Blount’s disease and slipped femoral epiphyses to vitamin D deficiency and the incorrect conflation of rickets with low serum calcidiol (25-hydroxyvitamin D3) concentrations.3 So are health professionals causing ill health through their lack of awareness and advocacy of vitamin D supplementation?
over 7 years ago
Much of the follow-up of pregnant women is carried out in the community, by midwifes at primary health care centres. The risk of death from pregnancy in the UK is roughly 1 in 20 000. Antenatal care is as much about educating women about pregnancy, childbirth and child care, as it is about providing for actual medical needs, particularly in the case of a first pregnancy. The exact measures will differ between NHS trusts, but below is a general outline of the type of care provided in pregnancy.
almostadoctor.com - free medical student revision notes
almost 8 years ago
Maybe it’s just me, but I cannot get my head around pharmacology and antibiotics are certainly doing their best to finish me off! My group at uni decided that this was one area that we needed to revise, and the task fell on my hands to provide the material for a revision session. So, the night before the session I began to panic about how to come up with any useful tips for my group, or indeed anyone at all, to try to remember anything useful about antibiotics at all. If only Paracetamoxyfrusebendroneomycin was a real drug, it would make our lives so much easier. Come on Adam Kay and Suman Biswas, get the trials started and create your wonderful super drug. For the mean time I guess I will just have to keep blissfully singing along to your song. However, that is not going to help me with my task in hand. After a lot of research that even took me beyond the realms of Wikipedia (something I do not often like to do), I found various sources suggesting remembering these Top 10 Rules (and their exceptions) All cell wall inhibitors are ?-lactams (except vancomycin) All penicillins are water soluble (nafcillin) All protein synthesis inhibitors are bacteriostatic (aminoglycosides) All cocci are Gram positive (Neisseria spp.) All bacilli are Gram negative (anthrax, tetanus, botulism, diptheria) All spirochetes are Gram negative Tetracyclines and macrolides are used for intracellular bacteria Pregnant women should not take tetracyclines, aminoglycosides, fluroquinolones, or sulfonamides Antibiotics beginning with a ‘C’ are particularly associated with pseudomembranous colitis While the penicillins are the most famous for causing allergies, people may also react to cephalosporins If those work for you, then I guess you can stop reading now… If they don’t, I can’t promise that I have anything better, but give these other tips that I found a whirl… Alternatively, I have created a Page on my own blog called Rang and Dale’s answer to Antibiotics, which summarises their information, so please take a look at that. Most people will suggest that you can categorise antibiotics in three ways, and it’s best to pick one and learn examples of them. Mode of action: bactericidal (kill) bacteriostatic (stop multiplying) 2 mnemonics to potentially help you remember examples: We’re ECSTaTiC about bacteriostatics? Erythromycin Clindamycin Sulphonamides Tetracyclines Trimethoprim Chloramphenicol Very Finely Proficient At Cell Murder (bactericidal) - Vancomycin Fluroquinolones Penicillins Aminoglycosides Cephalosporins Metranidazole Spectrum of activity: broad-spectrum (gram positive AND negative) narrow (gram positive OR negative) Mechanism of action Inhibit cell wall synthesis Inhibit nucleic acid synthesis Inhibit protein synthesis Inhibit cell membrane synthesis If you have any more weird and wonderful ways to remember antibiotics, let me know and I will add them! As always, thank you for reading.
Mrs Malaika Smith
about 8 years ago
Itraconazole is an antifungal drug used widely to treat fungal infections and is active against Aspergillus, Candida and Cryptococcus. It is effective and now much cheaper as it has passed out of the period of time granted to its inventor to exclusively sell it - there are now several competing manufacturers. It seems to be an increasingly useful and used drug now it has become more accessible which is a good thing in the main but this makes it increasingly important that this drug is properly understood and its very severe potential side effects appreciated and guarded against. These are the warnings published by the World Health Organisation Risk of congestive heart failure The agency says that while the available evidence suggests that the risk of heart failure with short courses of itraconazole is low in healthy, young patients, prescribers should exercise caution when prescribing the drug to at-risk patients. Amendments to the product information of all itraconazole formulations have been made to reflect this information. Risk to pregnant women By April 2000 the UMC had received 43 case reports from 5 countries regarding the use of itraconazole by pregnant women. 25 of these pregnancies ended in embryonic or foetal death. The remaining 19 reports described a variety of congenital malformation or neonatal disorders. In the 38 reports in which the route of administration was specified the drug was taken orally. The data suggested that: inspite of the approved recommendations and warnings itraconazole is being taken by pregnant women for minor indications, reported human experience seems to lend support to the experimental evidence that itraconazole is teratogenic, there is a predominance of abortion, and more firm warnings may be needed in the product information.Although not apparent from the UMC reports, a further question of interest was if itraconazole might decrease the reliability of oral contraceptives and so lead to unintended exposure in pregnancy. Care thus needs to be taken about which patients are prescribed itraconazole, adequate monitoring needs to be put in place if needed and sufficient advice given with the drug to ensure the patient is aware of the risks involved and the signs & symptoms to look out for.
almost 9 years ago
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
almost 9 years ago
Every facility providing maternity services and care for newborn infants should: Give newborn infants no food or drink other than breast milk unless medically indicated. For any breastfeeding babies being given food or drink other than breastmilk there should be acceptable medical reasons. No promotion for infant foods or drinks other than breastmilk should be displayed or distributed to mothers, staff, or the facility. The sixth step stresses that a newborn baby must not be given any food or drinks other than breast milk unless it is medically indicated. As the pregnant women are counseled in advance and the hospital staff is trained, we rarely have to give anything other than colostrums -- the first breast milk to the babies. More inf http://tensteps.org/step-6-successful-breastfeeding.shtml --.-- Ten Steps to Successful Breastfeeding - Video Series Babies who are breastfed are generally healthier and achieve optimal growth and development compared to those who are fed formula milk. If the vast majority of babies were exclusively fed breastmilk in their first six months of life -- meaning only breastmilk and no other liquids or solids, not even water -- it is estimated that the lives of at least 1.2 million children would be saved every year. If children continue to be breastfed up to two years and beyond, the health and development of millions of children would be greatly improved. This video series aims to raise awareness, encourage early adoption, promote training of health care staff, and build capacity for, and to stimulate dialogue about, breastfeeding and its impact on the public, in a range of community and public contexts in low- and middle-income countries. Our goal is to have these ten steps in every facility providing maternal services and care for newborn infants. Videos, presentations, research, evidence, papers, training and counselling materials, tools, and many other related and supporting resources are available. Visit us on-line a http://tensteps.org .
about 11 years ago
Every facility providing maternity services and care for newborn infants should: Inform all pregnant women about the benefits and management of breastfeeding. If the hospital has an affiliated antenatal clinic or antenatal ward...breastfeeding counseling [should be] given to most pregnant women using those services...The antenatal discussion should cover the importance of exclusive breastfeeding for the first 4-6 months, the benefits of breastfeeding, and basic breastfeeding management...Pregnant women of 32 weeks or more gestation...should confirm that the benefits of breastfeeding have been discussed with them...[including] at least two of the following benefits: Nutritional, protective, bonding, health benefits to the mother...and that they have received no group education on the use of infant formula. They should be able to describe at least two of the following breastfeeding management topics: importance of rooming-in, importance of feeding on demand, how to assure enough milk, and positioning and attachment. The third step is to have sessions with pregnant women to motivate them for breastfeeding and to remove all their doubts. More inf http://tensteps.org/step-3-successful-breastfeeding.shtml Benefits of Breastfeedin http://tensteps.org/benefits-of-breastfeeding.shtml Benefits for Infan http://tensteps.org/benefits-of-breastfeeding-for-the-infant.shtml Benefits for Mothe http://tensteps.org/benefits-of-breastfeeding-for-the-mother.shtml Benefits for the Famil http://tensteps.org/benefits-of-breastfeeding-for-the-family.shtml Benefits for the Hospita http://tensteps.org/benefits-of-breastfeeding-for-the-hospital.shtml Benefits for the Environment & Societ http://tensteps.org/benefits-of-breastfeeding-for-the-environment-society.shtml Other Benefit http://tensteps.org/benefits-of-breastfeeding-other.shtml --.-- Ten Steps to Successful Breastfeeding - Video Series Babies who are breastfed are generally healthier and achieve optimal growth and development compared to those who are fed formula milk. If the vast majority of babies were exclusively fed breastmilk in their first six months of life -- meaning only breastmilk and no other liquids or solids, not even water -- it is estimated that the lives of at least 1.2 million children would be saved every year. If children continue to be breastfed up to two years and beyond, the health and development of millions of children would be greatly improved. This video series aims to raise awareness, encourage early adoption, promote training of health care staff, and build capacity for, and to stimulate dialogue about, breastfeeding and its impact on the public, in a range of community and public contexts in low- and middle-income countries. Our goal is to have these ten steps in every facility providing maternal services and care for newborn infants. Videos, presentations, research, evidence, papers, training and counselling materials, tools, and many other related and supporting resources are available. Visit us on-line a http://tensteps.org .
about 11 years ago