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Next ObG Watch 2004
K A G U Y A
Has 2 Ammas but
No Appa!
Born in Jan 2004 & weighing just 10 oz (284 gms), Zoe Koz fitted into his father’s palm. He went home on 4th June
after eye surgery & is still on Oxygen.
Cochrane Review2004
Massage to Promote Growth, Decrease Stress
& increaseTactile stimulation
inPreterm & LBW
Conclusion:
‘Evidence is weak’
•Incidence of 7.1% of PTL & FGR in Group never consuming Fish to 1.9% in Group eating Fishas hotmeal atleast once a week
•In a study of 8729 women
Maternal Nutrition GroupDanish Epidemiology Science Center, Copenhagen
BMJ Feb 2002
DHA
PG Synthesis
UterineContractions
PretermLabour
GestationalDuration
N-3 Fatty Acids: Docosahexaenoic Acid ( DHA )And Prevention of Preterm labour
Biol Med vol226(6)2001Am J ObG Apr 1997BMJ Feb 2002
DHA & Brain Development
‘Intake of DHA-PUFA duringPregnancy&Lactation (Cod liverOil) may improve child’s IQ’-Helland et al Paed Jan2003
Prenatal exposure to higher concentrationOf DHA results in Mature pattern of SleepSuggesting better CNS integrity - Am J Clin Nutr 2002
Maternal Nutrition during last 3 months of PregnancyAnd Child’s Nutrition during first 3 years are crucial
Brain reaches 70% of Adult size at Birth, 15% by 1 year and 10% in Pre school age
Two thirds of Brain weight is Phospholipids & Longchain FA
DHA & AA ( Fish oil & Sea food) are Brain friendly
Breast-fed Babies have (>8 point) higher IQ (Lancet 1994)
Singh M Ind Paed March 2003
•Fetal Neural Activity Begins at 10 weeks•Neurons spin out Axons•Electrical activity fine -tunes Brain circuitry•Learning begins at Birth with sensory experiences
WHAT GOES ON?
•Babies can see at Birth
•Knack of Focussing
comes later
What Parents can do?
•Regular eye exam
From 2 weeks onwards
What goes on?•Emotion
circuits areConstructed
early•Distress &
ContentmentFollowed by
Joy, Sadness,envy,
Empathy, Pride, Shame
What parents can
do?•Loving care
provides Emotional
Stimulation•Neglect & Abuse lead
to Anxiety & abnormal
stress response
What goes on?•Tunes to
Mother’s voiceEven before
Birth•Deciphers & reproduces
Lyrics in 6 years•Can recognize
vowels (Building Blocks of Speech) at 6
months
What parents can do?
•Talking a lot speeds up Learning process
•High pitched sing song style help connect
objects with words
What goes on?
•Movements jerky at Birth
•Refined circuits for ReachingGrabbing,
Sitting, Crawling.Walking &
Running in 4 years
What parents can
do?•Give
Freedom to explore safely
•Engage in Activities for
Hand-eye coordination
Women with Low Waist to Hip RatioAnd Large Breasts have
30% more Estradiol as well as Progesterone
They have the Highest Reproductive Potential!
- Jasienka G University of Krakow,
Poland
“Coffee gives me warmth,Waking and anUnusual force”
NO EFFECT ON:CV Problems
MI, Arrhythmias,AtherosclerosisHypertensionCholesterol
Acid Peptic DiseaseOsteoporosis
Ca Breast / BladderQuality of Sleep
Fertility Male/FemaleFetus/Neonate Teratogenesis
AbortionUterine Contractions
BENEFITS:Increased Alertness
( Less RTA)Better WorkPerformance
Elevates Mood( More after Meal )
Anti oxydantsLess: Suicides colorectal CaGall stones CirrhosisAsthma
Parkinson’sType II DM
Adverse Effects:
Less Sleep
Anxiety
Crosses Placenta
Secreted in Milk
A 17-cm Scissors left inside abdomen at Surgery for Ca Colon18 months ago at St George Hospital Sydney in 2001 -Sky TV
American Men shave 48 sq inches
24 times/monthWomen, 412 sq inches
11 times/month-Gillette
-Westinghouse 1941
HRT-The Evidence
• 6 large RCTs in progress (HERS-EVTET-EST-WHI-ESPIRIT UK-WISDOM)
• Of them, 3 involving CE + MPA were stopped prematurely, because
• Incidence of Breast Ca > specified limits
• Conclusion: Risk > Benefit Source: Chatterjee A JOGI Feb 2004
Million women study-Lancet 2003
• HRT increases risk of Breast Ca
• CE + MPA carries higher risk than E alone
• Advice to GPs: 1. Advocate short HRT
(3-6 mths) for relief of symptoms
2. Discourage long term HRT
3. If on HRT discontinue
Increased Risk:• Breast Ca• Stroke• Pulmonary
Embolism
Decreased Risk:• Colorectal Ca• # Femur
No Difference:•CHD (Coronary)•Endometrial Ca•Alzeimer•Cognition
Summary of 4 Publications
(>20,000 Women)
1. Eminence-Based Medicine
‘The more senior the physician, the less important the evidence!’
“Clinical Experience” is defined as ‘Making the same mistakes With increasing confidence
over an impressive number of years’
2. Vehemence-Based Medicine
‘Substitution of volumeFor Evidence!’
3. Eloquence-Based Medicine
‘Smooth tongue, Sartorial elegance And Verbal eloquence are
Powerful Substitutes’
4. Providence-Based Medicine
‘Decision may best be leftIn the hands of Almighty!’
5. Diffidence-Based Medicine
‘A sense of DespairMakes the physician feel helpless
And do nothing!’
6. Nervousness-Based Medicine
‘Fear of Litigation Leads to over investigate
And over treat!’
7. Confidence-Based Medicine
(Restricted to Surgeons)
‘He will let his scalpel speak! ’
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