14 March 2010

Infertility: the role of the family doctor

Infertility: the role of the family doctor
By: Carroll Haymon, M.D.

Definitions 
    * Infertility = Inability of a couple practicing frequent intercourse and not using contraception to fail to conceive a child within one year.
    * Infertility affects 15-20% of couples, or 11 million reproductive age people in the U.S.

Causes of infertility 
    * Tubal pathology  35%
    * Male factor   35%
    * Ovulatory dysfunction 15%
    * Unexplained   10%
    * Cervical/other   5%

Counsel patience!
    * In normal young couples:
          o 25% conceive after one month
          o 70% conceive after six months
          o 90% conceive by one year
    * Only an additional 5% will conceive in an additional 6-12 months

Genetically (devoid of RNA) Virus Particles as Drug Delivery Agent

Genetically (devoid of RNA) Virus Particles as Drug Delivery Agent




Scientists at John Innes Centre in Norwich, UK managed to create Cowpea mosaic virus particles that are missing their genetic material (devoid of RNA), turning them into drug ferrying containers that may prove useful against cancer and other localized diseases.

Hematologic Complications of Pregnancy

Hematologic Complications of Pregnancy
By:Joseph Breuner, MD

outline
* Anemia
* Thrombophilias
* Thrombocytopenia

Case #1
* Anemia, pro’s and cons of treating
Which patients will benefit from iron treatment?
What hematocrit at 28 wks should generate attention?
* Dilutional or physiologic
* Iron Deficiency Anemia
* Thalassemias

Physiologic Anemia of Pregnancy
* Pregnancy-induced hypervolemia has several important functions:
1. To meet the demands of the enlarged uterus with its greatly hypertrophied vascular system.
2. To protect the mother, and in turn the fetus, against the deleterious effects of impaired venous return in the supine and erect positions.
3. To safeguard the mother against the adverse effects of blood loss associated with parturition.

Psychiatric Complications of Pregnancy and the Postpartum

Psychiatric Complications of Pregnancy and the Postpartum
By:Joseph Breuner, MD
Swedish Family Medicine Residency

Objectives
    * Appreciate the postpartum period as a time of increased vulnerability to psychiatric illness
    * Recognize and diagnose psychiatric illness during pregnancy and the postpartum
    * Understand risks to the fetus of psychiatric medications
    * Prevent and treat psychiatric illness in pregnancy and the postpartum

Outline 1
    * Review DSM-IV diagnoses
    * Psychiatric illness during pregnancy
    * Psychiatric illness in the postpartum

But first, a review
DSM-IV Definition of...

    *   For at least one week (or less, if hospitalized) the patient's mood is
    *   abnormally and persistently high, irritable or expansive.
    *   To a material degree during this time, the patient has persistently had 3 or
    *   more of these symptoms (4 if the only abnormality of mood is irritability):
    *   -Grandiosity or exaggerated self-esteem
    *   -Reduced need for sleep