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! ’