Pelvic Inflammatory Disease

 Pelvic Inflammatory disease is a condition in which there is an infection in the female reproductive organs. the include the fallopian tubes, the ovaries, uterus and the cervix. 

This is a common condition and may affect like every 5 in 100 woman, 

What actually happens is that first there is infection in the vagina which later on travels up and affects other organs. 

Clinical features

Sometimes the symptoms are very mild and the patient may not even know that they have an infection, while some may experience mild to moderate lower abdominal and pelvic area pain. Other symptoms include:

On and off Fever

Foul smelling vaginal discharge

pain during sex

pain during urination

infertility 

bleeding in between periods usually after intercourse.

tiredness and fatigue

Causes: 

Many different bacteria can cause pelvic inflammatory disease but Chlamydia and gonorrhea infections are the most common causes. 

How does the infection enter your body: 

The most common way is through sexual intercourse. Others include after a miscarriage or child birth when repeated pelvic examinations are done or when instruments are used for any diagnostic or treatment purposes. 

Risk Factors are any woman of reproductive age group who is sexually active, having multiple sexual partners, having sex without using protection (condoms), excessive use of different vaginal wash products as these may alter the normal vaginal pH causing the growth of bacteria. 

- Use of intrauterine contraceptive devise is also one risk factor. 

Treatment:

- Antibiotics are given to treat the infection. Usually a combination of 2-3 antibiotics are prescribed. - - - Pain killers and anti inflammatory medicines are given to control and manage pain. 

- It is always better to treat the partner at the same time even though males may not have any symptoms, because untreated partner usually leads to recurrence of infection and symptoms. 

Complications

- Spread to the blood can be serious and life threatening as it leads to sepsis.

- Infertility a very common complication, as long standing infections damages the pelvic organs and also leads to tube blockage.

- Ectopic pregnancy

- Chronic pelvic pain and scarring and adhesions of pelvic and abdominal organs.

Vaginal Yeast Infection

 

Yeast or Fungal infection in the vagina is a very common condition affecting almost every 3out of 5 woman, in most cases it is generally a mild infection and can be easily treated but sometimes it keeps on reoccurring. 

Presenting Features

- Itching and irritation in the vaginal and vulvar region.

-Burning and discomfort at the time of intercourse. 

- Thick, white, cottage cheese like vaginal discharge which is usually not foul smelling. 

If the infection occurs more than 4 times in a year it is considered to be a complicated case.

Why Does It Occur? 

Normally in the vagina there is normal flora (normal healthy bacteria) that help prevent many infections, sometimes due to certain conditions this normal flora is reduced and this can lead to growth of fungus. Candida albicans is the most common fungal infection affecting the vagina. The conditions commonly leading to fungal infection are.

-Pregnancy

-Any immunocompromised state like acute or chronic illness, generalized body weakness etc. 

-Use of antibiotics

-Diabetes

-Taking oral contraceptive pills or any hormonal medicines

-Use of silk panties.

- Using scented pads or tampons.

- Excessive sweating in warm conditions.

-Staying in a wet panty for a long time. 

- Stress

Yeast infection is not sexually transmitted and can even occur in unmarried girls or those who are not sexually active. 

How To Treat

Most cases are treated by using a local antifungal cream or pessary that can be used for 1 to 6 days. 

Sometimes oral antifungal treatment is also prescribed. 

Avoid taking unnecessary antibiotics like for common cold etc

Get tested for diabetes and treat and control blood sugar levels

Dietary Guidelines For Pregnant Ladies

Pregnancy is a normal physiological condition during which a baby is growing inside the mother's womb. There are different hormonal changes causing taste changes, food cravings and associated nausea, vomiting or gastrointestinal issues. During pregnancy the nutritional requirements are increased to meet the demands of the body for proper growth and development of the baby. 

Positive nutritional support during pregnancy leads to a good outcome for both mother and baby. 

Eating a balanced diet is very important and never think of starving yourself to avoid weight gain during pregnancy. 

A basic guideline is given is given below: 

- Consume a diet containing vegetables, fruits, and whole grains. 

- Take Vitamin supplements as prescribed by your doctor.

- Vitamin A containing supplement should be avoided especially during the first 3 months. 

- Drink 1-2 cups of fresh milk daily. If you like drinking flavored milk you can enjoy adding your preferred flavors.

- Avoid caffeine containing drinks. 

- Soak 7-9 almonds overnight and eat them with 3 dates in morning. 

- Take a cup of yogurt with bread or parahata (Asian bread ) 

- Eggs are safe and good source of protein. Take in any form you like boiled, omellete etc. 

- Oatmeal is healthy and helps with preventing constipation. 

- Morning sickness is common during the first 3 months, to prevent vomiting don't stay with an empty stomach, take some crackers or wheat biscuits' when you wake up in the morning. 

- Avoid taking too much liquid during mealtimes.

- Avoid foods with strong odors. 

- Drink coconut water or lemon drink whenever easily available.

- Eat proper meals containing meat, vegetables or lentils . Take small frequent meals if you face any digestive issues. 

- Totally avoid soft drinks. 

- No alcohol and No smoking. 

- Drink 8-10 glasses of water daily. 

- Avoid spicy and oily foods.

- Diet needs to be modified if you suffer from any other medical condition or gestational diabetes.

Have a safe and heathy pregnancy. 

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Postpartum Depression And How To Manage It

 

It is quiet common for the new mother to feel sad, worried, tired or fatigued. As many as 80 out of 100 mothers go through such feelings for a week or two after the birth of the baby. It is completely normal and they start to feel better and normal after a few weeks..

Postpartum depression is diagnosed when these symptoms are much severe and lasts longer. It can cause severe mood swings, and a mix of physical, emotional and behavioral changes.

The symptoms usually begins within the first few weeks after giving birth but sometimes may even begin earlier while being pregnant or later up to a year after birth. 

Suffering from postpartum depression does not mean that a mother does not love her baby or that she is a bad mother. It is just that she is suffering from a medical condition and needs counselling therapy and treatment. 

Symptoms may vary among different woman but a list of common symptoms include:

- Feeling low

-Lack of interest in daily activities

- Body aches and headache

-Lack of appetite

- Anxiety and irritability

- Not able to think or make proper decisions. 

- Feeling difficult to bond with the baby.

- No interest in friends and family,

What causes Postpartum Depression: Female body produces a lot of hormones during pregnancy but soon after delivery there is a sudden decrease of these hormones which causes changes in the chemical system of the brain leading to depression. 

How To Manage:

Depending on the severity and the type it can be treated with psychotherapy or antidepressant medications. 

It is important to seek medical help if symptoms of depression lasts longer than 2 weeks within 1 year of giving birth. 

-Get Support from friends and family. 

-Be open about your feelings and discuss it with your partner and your family. 

- Join support groups.

-Antidepressants may be prescribed to you by your doctor but they usually take 6-8 weeks to show improvement in symptoms. 

- Psychotherapy helps with more positive thinking approach. 

Tab Duphaston - Uses, Dosing and Other Information

 

Introduction: Tab Duphaston contains dydrogesterone 10mg which is a synthetic orally active progestogen. 

Indications: 

- Treatment of painful menstrual periods that are not managed by over the counter pain killers.
- Treatment of endometriosis.
- Treatment of missed periods.
- Treatment of irregular cycles.
- Treatment of abnormal uterine bleeding.
- Treatment of pre-menstrual syndrome.
- Treatment of threatened abortion, associated with proven progesterone deficiency.
- Treatment of habitual abortion, with history of repeated miscarriages  associated with proven progesterone deficiency.
- Treatment of infertility due to luteal insufficiency.
- Luteal support as part of an Assisted Reproductive Technology (ART) treatment.
- Hormone replacement therapy.

Duphaston should only be taken upon prescription from your doctor. Different indications need different dosing and duration of treatment. 

Dosing: 

For hormone replacement therapy(Usually Given in post menopausal woman): In combination with continuous oestrogen therapy, take one tablet daily for 14 consecutive days of a 28 day cycle.

 Dysmenorrhoea (painful menstruation): Take one tablet twice daily from day 5 to day 25 of the cycle.

Endometriosis (abnormal growth of uterine tissues outside the uterus): Take one tablet two or three times daily from day 5 to day 25 of the cycle or continuously (as prescribed by the doctor).

Dysfunctional bleeding (to stop bleeding): Take one tablet twice daily for five to seven days.

Dysfunctional bleeding (to prevent bleeding): Take one tablet twice daily from day 11 to day 25 of the cycle.

Amenorrhoea (missed periods with a negative pregnancy test): The doctor should prescribe an oestrogen along with Duphaston. Then take the oestrogen once daily from day 1 to day 25 of the cycle, together with one tablet of dydrogesterone twice daily from day 11 to day 25 of the cycle.

Premenstrual syndrome: Take one tablet twice daily from day 11 to day 25 of the cycle.

Irregular cycles: Take one tablet twice daily from day 11 to day 25 of the cycle.

Threatened abortion(history of bleeding or spotting in early pregnancy): Take four tablets at once, then one tablet every eight hours until symptoms subside.

Habitual abortion(history of repeated miscarriages): Take one tablet twice daily until the twentieth week of pregnancy.

Infertility due to luteal (yellow body) insufficiency (Deficiency of natural production of progesterone hormone): Take one tablet daily from day 14 to 25 of the cycle. Continue the treatment for at least six consecutive cycles. In addition, it is advisable to continue treatment for the first few months of pregnancy as described under "Habitual abortion". If the patient is uncertain about how long to continue the treatment, talk to the doctor.

Luteal support as part of an Assisted Reproductive Technology (ART) treatment: Take one tablet three times daily (30mg daily) starting at the day of oocyte retrieval and continuing for 10 weeks if pregnancy is confirmed.

Side Effects: Duphaston is considered one of the safe drugs with minimal side effects. Some adverse effects observed are 

- Headache

- Nausea/Vomiting

- Abdominal Pain

- Breast tenderness.

Contraindicated to be used when any history of allergy to the medicine and should be avoided when breastfeeding. 

Management Of Minor Burns

 

Minor burns can occur anytime while working in the kitchen or accidents can happen with young kids. Immediate first aid management of burns is important to know . 

First degree minor burns are usually not life threatening but are very painful and may even leave a scar if not properly treated.  

The skin is red and painful and there may be some swelling. 

1. First of all remove the victim and move to a safe place to avoid further burning. 

2. Cool the hot burned skin under cool running water or immerse in cool water for sometime , this helps to relieve the pain. 

3. Apply a moisturizing lotion like the one with aleo vera.

4. You can apply petroleum jelly 2-3 times a day. Avoid putting butter, too much of oil or lotions with fragrances which may cause an infection. 

5. Cover the burned skin with a sterile non sticking bandage .

6. If blisters form never pop them up. 

7. Take an over the counter pain killer like paracetamol or ibuprofen.

8. Protect the burned area from sun exposure.

9 If any signs of infection antibiotics may be needed

Positioning A Baby While Breast Feeding

 

Breastfeeding your baby is always encouraged but at times new mothers find it difficult and face a lot of problems which in the end results in giving up and switching to formula.

Proper positioning the baby is very important for breastfeeding and to prevent problems later on.

How to position a baby while breast feeding  depends on the choice and comfort of both mother and baby. No matter which position is used it is important to make sure that

-         The baby’s whole body is supported

-         Baby’s body is facing and is close to the breast

-         Baby’s neck is straight. (not turned or twisted)

-         Baby approaches the breast and nose is in line with the nipple.

While Breast feeding it is very important that

-Mother is comfortable and relaxed.

She should know and learn how to support the breast while feeding. Baby’s lips should be first touched with the nipple and then wait for the baby to widely open the mouth so that nipple along with areola goes in and baby starts sucking.

Five Possible Positions

1.   Cradle Position: The mother cradles the baby in her arm. The baby should be held close to the mother’s body, with the forearm supporting the baby’ head. For mother’s comfort she may want to support the cradling arm with a pillow or her other arm.

2.   Cross Cradle: The mother cradles the baby in her arm. Her hand is supporting the baby’s head and neck.

3.   Football Hold: The mother is sitting or leaning back and the baby is under her arm with feet pointing back. The mother support the baby’s head and neck with her hand and a pillow may be used to support the baby in this position.

4.   Side lying position: Mother is lying on her side and baby lies on its side facing the mother. Mother supports the baby’s head and neck with her hand or a pillow.

5.   Supine Position: The mother is lying on her back with the baby lying face down on the mother’s chest. Mother’s hand supports the baby’s head on her breast. This position is useful immediately after a c section.

Nausea And Vomiting

 

Nausea

Can be simply described as an uncomfortable feeling or a sensation of sickness which may or may not be followed by vomiting.

Vomiting

Is an effortless regurgitation of  stomach contents.

Nausea and vomiting is caused by a wide variety of conditions which stimulate the vomiting receptors in the brain.

Vomiting may lead to dehydration, electrolyte imbalances, aspiration pneumonia.

How to Manage

A detailed history helps to identify the underlying cause.

-         Sudden onset of vomiting without any associated pain may suggest food poisoning, infectious gastroenteritis or use of any dugs

-         Vomiting along with abdominal pain may be caused by acute abdominal conditions like appendicitis, acute gastritis or intestinal obstruction.

-         Early weeks of pregnancy causes nausea, morning sickness and vomiting due to hormonal changes.

-         Migraine headaches are commonly associated with nausea and sometimes vomiting too.

Laboratory tests that should be done include

-         Serum Electrolytes

-         Blood glucose

-         Urea and Creatinine

-         Serum Amylase

-         Liver function tests

-         TSH

-         Pregnancy test

Imaging Studies that can help find out the cause include

-         Flat and upright abdominal X ray

-         Ultrasound of abdomen

-         CT scan abdomen

-         Barium studies

Medications that help includes different antiemetic medicines which are given to control vomiting.

For mild, self limited acute vomiting no treatment is needed , just give clear fluids and soft easily digestible small quantities of food.

In cases of severe vomiting IV fluids are needed to correct and prevent dehydration.

Ectopic Pregnancy - Pregnancy Which Occurs Outside The Uterus

 

Ectopic pregnancy

Ectopic pregnancy is defined as a pregnancy which occurs outside the uterine

cavity, the commonest site being the fallopian

tube. It may also occur, although  rare, in:

• ovary;

• cervix;

• abdominal cavity

Why Does Ectopic Pregnancy Occur

The ovum is fertilized in the fallopian tube and reaches the uterus in about five days. Anything that delays the passage of the fertilized ovum to the uterus can result in tubal pregnancy, such as

-intrauterine device (IUD) and progesterone-only pill (POP)

 Risk factors for ectopic pregnancy

Pelvic inflammatory disease (PID)

Previous pelvic surgery

Previous ectopic pregnancy

Intrauterine device (IUD)

Progesterone only pill (POP)

Depoprovera

Emergency contraception

Sterilization

Clinical features

The picture of ectopic pregnancy is:

Missed periods and a positive pregnncy test

Pain—typically constant and often unilateral due to spasm of the tubal muscle

Vaginal bleeding The bleeding is usually scanty, less than a normal period and dark brown in colour.

 Faintness or even shock with an acute rupture.

 How to Diagnose

Ultrasound is helpful. While it may not always show the embryo or its sac in the tube, findings may include:

• an empty uterus with thickened decidua;

• fluid (blood) in the pouch of Douglas;

• a multi-echo mass in the region of the tube.

Progesterone levels are commonly low because the pregnancy is failing.

Serum bhCG is usually lower than expected for gestation and on serial measurements increases by less than 60% over 48 hours.

 Laparoscopy is the ultimate investigation to make the diagnosis with direct vision

 

Differential diagnosis

The diagnosis is from any other acute abdominal conditions such as rupture of a viscus or acute peritonitis. The clinical picture is so typical that in most cases diagnosis presents no difficulty. Other diagnoses which may confuse are:

• inevitable miscarriage;

• bleeding with an ovarian cyst;

• pelvic appendicitis;

• acute salpingitis.

Treatment

The treatment of tubal pregnancy is removal of the pregnancy and sometimes the affected tube by laparoscopy or laparotomy. If the tube is patent and not seriously damaged, it may be possible to conserve it and thus leave the woman with a chance of conception later in life.

Laparoscopy techniques exist to:

• kill the embryo with a direct injection of methotrexate or mifepristone allowing absorption so requiring no surgery on the tube;

• incise the swollen tube over the ectopic pregnancy, aspirate the embryo, and achieve haemostasis (salpingostomy).

In a case of severe haemorrhage, the patient must be taken immediately to the operating theatre.

Little time should be wasted in attempting resuscitation which can prove useless and may only increase bleeding. 

An intravenous drip should be set up and a blood transfusion given as soon as possible.

In most cases the affected tube should be removed;

an exception may be made if the woman

desires children and the other tube is already missing

or seriously diseased. The disadvantage of conservation

is the increased risk of recurrence of

ectopic pregnancy.

 

• Medical treatment with methotrexate can be used if the hCG level is less than 5000 iu/l and the ectopic mass is less than 4 cm in diameter on ultrasound scan. There should be no symptoms or signs of rupture.

Gastritis - Inflammation Of The Stomach Lining

Gastritis

Simply defined as inflammation of the gastric mucosa.

It may occur as an Acute gastritis when symptoms appear within a few days or it may be chronic when it is present for a long time.

Clinical Features include

-         -vague symptoms like nausea, sometimes vomiting , loss of appetite, upper abdominal pain or discomfort.

-        - Upper gastrointestinal bleeding

-         -Mild epigastric tenderness on palpation which may or may not be present.

Underlying Causes include

-         -Stress

-         -Use of NSAIDs

-        - Alcohol

-         -H.pylori Gastritis

-         -Radiation therapy

-         -Any acute disease or surgery

-        - Cancer of the stomach or pancreas

Differential Diagnosis

-Peptic Ulcer disease.

- Functional or non ulcer dyspepsia

- GERD

- Viral gastroenteritis

- indigestion from iver eating, high fat food.

- Biliary Disease

- Pancreatitis

- Cholecystitis

- Angina (Ischemic heart disease )

 

How to Manage

Avoid the precipitating factors like NSAIDs, alcohol, caffeine, cigratte smoking and high fat diet.

Workup to look for the presence of H pylori, and treat if present.

Medicines like proton pump inhibitors (omeprazole) and H2 receptor blockers (Ranitidine) are helpful.