DO YOU EAT MORE IN BAD TIMES????

 

When people predict of bad times, they start consuming more calories... some researches show that, news about bad economical state may add up some more pounds to their weight.
                   According to researches, people were given more calorie food to the persons who received some bad news and they consumed 40% more than their diet. In contrast of this, when given less calorie food, they consumed 25% less than their routine diet. AMAZING RIGHT???
 

A NEW HERBAL CURE OF BLOOD PRESSURE

 Consuming a glass of beet root juice can keep your blood pressure under control.
 According to researches, people were given around 250 ml of beet root juice ( made of approx. 227 grams of beet root) and kept under observation for 24 hours. Which showed that the effect starts from 3 to 6 hours lasting till 24  hours.

PRETERM LABOR : Incidences & Causes

 

Preterm labor refers to the onset of uterine contractions of sufficient strength and frequency to effect progressive dilatation and effacement of cervix between 20 and 37 weeks of gestation.

Incidences:

           Overall incidence of preterm labor is reported to be 6-15% and 4-50% of these occur spontaneously, whereas 25% occur following preterm pre-labor rupture of membranes (PPROM).

           Iatrogenic (resulting from the activity of physician) preterm labor due to obstetric intervention to avoid maternal or fetal compromise, accounts for about 25%.

 Causes :

Maternal causes:

n  Racial – its seen more in black because of the reason of low socio economic condition.

n  Maternal age – both the extremes of  reproductive age that is below 18 and above 40 yrs are at greater risk.

n  Maternal weight –

n  Maternal weight less than 45 kgs this indirectly points towards the maternal nutritional level.

n  Socioeconomic status – associated with inadequate antenatal care, poor nutrition. 

n  Substance abuse –

n   Smoking  (nicotin –  vasoconstirction –  uteroplacental insufficiency )

n  Alcohol

n  Tobacco

n  Trauma –

n     Coitus  - prostaglandins released during coitus and those present in the seminal fluid can lead to preterm uterine contractions.              

n  Strenuous work

n  Psychological - personal  stress

n  Chronic ill health

Iatrogenic (resulting from the activity of physicians)

 

  n  Elective induction – with consideration to maternal illness, wrong calculation of GA (gestational age)

n  Previous induced abortion

n  Past history of preterm labour

n  Short interval between pregnancies

n  PROM (premature rupture of membrane)

n   Chorioamnionitis (inflammation of the fetal membranes)

 

Medical and obstetrical conditions

n  Anaemia 

n  Diabetes mellitus

n  Asthama

n  Pre eclampsia, eclampsia (complication of pregnancy)

n  Chronic HTN (hypertension)

n  Antepartum hemorrhage (bleeding during pregnancy)

n  Infection – pneumonia, UTI, asmptomatic bacteriosis, pylonephritis, reproductive tract infection like bacterial vaginosis, appendicitis, dental infections. 

 

Uterine and cervical factors:

n  Congenital abnormalities – septate, unicornuate, bicornuate uterus (congenital malformations of uterus)

n  Uterine over distention – hydramnios, multiple pregnancy, fibroids.

n  Incompetent cervix – following conization, spontaneous or induced miscarriage. 

n  Placental factors:

                abnormalities in placenta (placenta previa, abruptio placenta)

 

Fetal factors :

Ø   Congenital malformations – fetal hydrops, polyhydramnios (excess of amniotic fluid )

Ø  IUD (intrauterine devices)

Ø  Genetic

ABNORMAL VAGINAL DISCHARGES – A COMMON HEALTH PROBLEM IN WOMEN

Abnormal Vaginal discharge is quite frequent complaint of a woman met in day to day. The discharge may range from what is called excess of normal to one, which is a part of wide spectrum of ailments.

            Vaginal discharge may be blood stained or contaminated with urine or stool, but here we are only concerned with a white , cream, yellow or greenish discharge which is often loosely and wrongly called LEUCORRHOEA-a term which should be reserved for only one type.

LEUCORRHOEA

It is strictly defined as an excessive normal vaginal discharge.

CAUSES

              1.Physiological

              2.Pathological.

PHYSIOLOGICAL

         Normal secretions from the vulva, vagina and cervix show an increase under following conditions -

     1.Seen in newborn baby for a week due to maternal oestrogen.

     2.Seen in girls during puberty due to hormonal changes.

     3.At the time of ovulation and in early pregnancy.

     4. During sexual excitement.

PATHOLOGICAL

        In pathological Leucorrhoea the causes are:

     1.General health causes

       A. Ill health and under nutrition

       B. Psychological

     2. Dysfunctional state in genital tract

           The important cause of leucorrhoea are-

·         Vaginitis

·         Cervical erosion

·         Genital prolapse

·         Cervical carcinoma

 

VAGINITIS

          Between puberty & the menopause , presence of lactobacilli maintains a vaginal pH between 3.8 – 4.2 . This protects against infection. Before puberty & after menopause, the higher pH increases the risk of infection.

         The vagina may be infected pathologically by various microbes such as – Trichomonas vaginalis, candida albicans, & other nonspecific organisms.

TRICHOMONIASIS

Vaginal trichomoniasis is the common and important cause of vaginitis in the child bearing period

CAUSITIVE ORGANISM:

       It is caused by trichomonas vaginalis, a pear shaped parasite .

 MODE OF TRANSMISSION

         The organism is predominatly  transmitted by sexual contact .The transmission may also be possible by the toilet articles from one women to other or through examining gloves . The incubation period is 3-28 days.

 PATHOLOGY

In about 25% of women in the reproductive period , the parasites harbor in the vagina in asymptomatic state. When the local defense is impaired during and after menstruation, after sexual stimulation and following illness, the ph of the vagina is raised to 5.5-6.5. At this level of ph , the tricomonads thrive . The organism usually lie in between the rugae and produce surface inflammatory reaction when the defence is lost. In about 75% cases, the organism can be isolated from the urethra , skene’s tubules or even from the bartholian glands.

CLINICAL FEATURES:

Symptoms:

                  1. Copious vaginal discharge.

                  2. Itching of vulva

                 3.   Dyspareunia

                  4.   Frequency of urination & dysuria

SIGNS :

                  1.  Vaginal wall when exposed by a speculum is found swollen, red, tender, with red papilae which bleeds on touch.

                  2. Discharge is copious, frothy, greenish yellow & offensive.

                  3. Cervix appears like strawberry.

CANDIDA VAGINITIS (MONILIASIS)

                Caused by over growth of monilia albicans- a fungus of yeast group.

Its growth is faoured with vaginal pH below 4.5 & rich supply of carbohydrate.

Incidence is increased during pregnancy which can be as higher as 40%

CLINICAL FEATURES:

Symptoms :

1. Profuse vaginal discharge. Thick curdy white.

 2.  Intense vulval itching.

Signs :

            1. Redness of the entire vaginal & vulval mucus wall.

            2.  Adherent curdy flakes on vaginal wall which shows petechial haemorrhage on removal.

NON SPECIFIC VAGINITIS:

During the reproductive period, when the vaginal defence is lost , the local pathogens like staphylococcus, streptococcus(haemolytic and anaerobic), E.coli etc.. Gain footing and produce acute symptoms. Foreign bodies like pessary, tampon, IUCD or child birth trauma or vaginal operations predispose to such infection.

CLINICAL FEATURES:

 There is varying amount of vaginal discharge

 sometimes offensive with irritation of the vulva.

ON EXAMINATION:

1. The colour, consistency and the amount of discharge varies.
2. Vulva may be congested and swollen with evidence of pruritus
3. Vaginal mucosa is red , tender and swollen

       Hence,  the vaginal ecosystem is a complex system of micro-organism interacting with host factors to maintain its equilibrium .

SOURCES:

Text books :

1.       Jaffecoate’s principle of gynaecology – international edition

2.       Howkin’s & bourne , shaw’s textbook of gynaecology – 12^th Edition

3.       D.C. DUTTA, Textbook of gynaecology – 4^th Edition

4.       Current obstetric & gynecologic diagnosis & treatment by Ralph C. Benson

PUERPERIUM - The Changes After Delivery

Pregnancy and delivery brings a myriad of physiological and psychological changes in the women during the post natal period. During this time the baby tries to adjust itself to the new environment ex-utero & is dependent on its sole nurturer - the mother, who has to adjust herself not only to the infants needs but also to her own physiological and psychological variations. This period of her after delivery is termed as puerperium.

The word Puerperium is derived from the Latin word ‘puer’ means ‘a child’ and the word ‘pario’ means ‘to bring forth’

Definition –

            It is a time following delivery during which the body tissues, specially the pelvic organs revert back approximately to the pre pregnant state both anatomically and physiologically.

Duration –

            It begins as soon as the placenta is expelled and lasts for approximately 6 weeks. This period is divided into

• Immediate – with in 24 hrs
• Early – 7 days
• Remote – up to 6 weeks.

 

Physiological aspects –

            The main physiological event that occurs during the puerperium is the involution and the lactation.

     Involution doesn’t only mean the involution of the uterus; in a broader sense it also includes the reverting back of the other pelvic organs like the vagina, cervix, etc, to the pre pregnant state.

 Involution of the uterus –

                        Just after delivery the uterus is hard, retracted and weighing about 1000 grams. It is about 6 inches long, 4 ½ inch broad and 3 ½ inch thick. After 1 week it reduces to 500 grams and after 2 weeks to 300 grams, and at the end of 6 weeks to 50 grams, and 3x2x1 inch size. It never returns to the pre pregnant state. The rate of involution varies in different individual. In some cases it is pushed to one side or the other.

Lochia –

            It is the vaginal discharge after delivery. It has a peculiar offensive fishy odour and alkaline in reaction.

Table : Lochia

Lochia	Days	Colour	Composition
Rubra	1-4	Red	Blood, shreds of fetal membrane & decidua, vernix caseosa, lanugo and meconium.
Serosa	5-9	Yellowish, pink or pale brownish	Less RBC, more leucocytes, wound exudates, mucus from cervix and microorganism.
Alba	10-15	Pale white	Plenty of decidual cells, leucocytes, mucus, cholestrin crystals, fatty & granular epithelial cells & micro-organisms.

 

The average amount of discharge for the 1^st 5-6 days is 200ml.

 

General condition during puerperium:

Cardiovascular system –

There is 3-4 kg weight loss due to increase fluid & electrolyte loss in diuretics. Hematocrit values increases by 5% & cardiac output increases by 50%.

 

Urinary system - There is increased diuresis for 2-3 days. Mild trauma to bladder occurs in all cases of vaginal delivery. There is edema & hyperemia of the bladder mucosa. Chances of UTI are increased during this period.

Gastrointestinal system – constipation is commonly seen due to intestinal atony. Hemorrhoids may be a complication of the delivery process itself. Fluid loss induces increased thirst. Adequate diet is needed.

Lactation – colostrum is secreted from the breast following delivery for the 1^st two days. It contains proteins, vitamin A, sodium, chloride, low levels of carbohydrate, fat, potassium, etc. the important feature is presence of IgA.

In puerperium, even mild health problem proves to be troublesome due to her weak body & reduced strength which is the result of the strenuous delivery process. So, the new mother should be taken special care during this period.

 

SOURCES:

1. Stedman’s Medical dictionary, New Delhi, S. Chand & Company Ltd; 23^rd edition
2. D. C. Dutta, Text book of Obstetrics, Calcutta, New Central Book Agency (P) Ltd; 4^th edition, 1998
3. Dr. R. K. Sachdeva, A guide to Obstetrics & Gynecology, New Delhi, Jay Pee Brothers Medical publishers, 5^th edition, 1996
4. Mudaliar & Menon, Clinical Obstetrics, Madras, Orient Longman, 9^th edition, 1990
5. D. C. Dutta, Text book of Obstetrics, Calcutta, New Central Book Agency; 6^th edition, 1998

PAIN - An Unpleasant Sensation

Have you ever thought what PAIN is???

 Usually we never bother to think about the general physical problems. We just feel it and go for its treatment. But have you ever sincerely thought what mechanism would be underlying this uncomfortable physical response called PAIN?

 So grossly if we see, pain is a sensation that hurts, and it has both physical and emotional aspects to consider.

It is a combination of what your body feels and how your mind processes those sensations.

The International Association for the Study of Pain says  that it is "an unpleasant sensory and emotional experience in association with actual or potential tissue damage, or described in terms of such damage."

                   Pain serves a biological function. It signals the presence of damage or disease within the body.

 How is pain produced????

·         Pain is produced when a  nociceptive (a receptor preferentially sensitive to a noxious stimulus)  stimulus  is received.

·         it is stimulated by any of the agents like,cut,blow,acid,burn or disease.and subsequently transmit signals through sensory neurons in the spinal cord.

·         which releases glutamate, a major exicitory neurotransmitter that relays signals from one neuron to another and ultimately to the thalamus, in which pain perception occurs.

·         From the thalamus, the signal travels to the cerebrum, at which point the individual becomes fully aware of the pain.

Interestingly, the brain itself is devoid of nociceptive tissue, and hence cannot experience pain (thus a headache is not pain in the brain itself).

Do you know, pain also has classification??

  1) Fast pain &
  2) Slow pain

Fast pain is felt within about 0.1sec after pain stimulus is applied,

whereas slow pain begins only after 1 sec or more and then increases slowly over many seconds and even some minutes.
 

importantly, it can also be classified as:

 

Pain

                          Nociceptive                               Non-nociceptive

                                                                                          

        Somatic            Visceral                            Neuropathic      Sympathetic

 

Nociceptive  pain  arises from the stimulation of specific pain receptors. These receptors can respond to heat, cold, vibration,stretch and chemical stimuli released from damaged cells.

Non Nociceptive pain  arises from within the peripheral and central nervous system. Specific receptors do not exist here.

 Somatic Pain :  occurs in skin, muscle, joints, bones, and ligaments etc.

It is often sharp and well localized, and can often be reproduced by touching or moving the area or tissue involved.

 Visceral Pain: occurs in  internal organs of the main body cavities. Like, liver, kidneys, spleen, bowels, bladder, womb etc.

 Often poorly localized, and  may feel like a vague deep ache, sometimes being cramping or colicky in nature. It frequently produces referred pain.

 Nerve Pain (neuropathic):  within the nervous system itself.

signs of nerve malfunction such as hypersensitivity (touch, vibration, hot and cold), tingling, numbness, and weakness. There is often referred pain to an area where that nerve would normally supply e.g. sciatica from a slip disc. Nerve pain is often described as lancinating, shooting, burning, and hypersensitive.

 Sympathetic pain: due to over-activity of sympathetic and central / peripheral nervous system mechanisms.

occurs more commonly after fractures and soft tissue injuries of the arms and legs which presents as extreme hypersensitivity in the skin around the injury and also peripherally in the limb, and is associated with abnormalities of sweating and temperature control in the area. The limb is usually so painful, that the sufferer refuses to use it, causing secondary problems after a period of time with muscle wasting, joint contractures, and osteoporosis of the bones.

 

              So, to sum up, Pain is a perception and not an objective bodily state.

           Despite its unpleasantness, pain is a critical component of the body's defense system. It is a part of a rapid warning and defense relay instructing the motor neurons of the central nervous system to minimize detected physical harm.

It is important to understand that pain medicines do not remove all pain; instead, they lessen what the body feels and help the mind accept those feelings.