27 December 2011

Springerlink free access to Journals in Pharmaceutical Science

Journals in Pharmaceutical Science Presently free access:


Free Access to Springer Journals till Dec 31

Food Science:


25 December 2011

Esophageal dysphagia ppt and recent publications

Esophageal dysphagia (the feeling of food getting stuck several seconds after swallowing)

Esophargeal  Dysphagia
by Jean  Paul Font, MD & Michael  Underbrink, MD, MBA

Esophagology  and Esophagoscopy
by Benjamin  Walton, MD

by Lianne  Beck, MD

GERD/Barrett's Esophagus,  Dysphagia, Hiatal Hernia, and Laparoscopic  Antireflux Procedure 
by Ben Degner & Dave Yonick

by Michael  Chao, MD

Management of  Oral and Esophageal Disorders

Stricturing of  the GI Tract

The  Basics of Feeding: A Workshop in Pediatric Dysphagia
Stacy  Antoniadis, Lisa  McCarty, Julie  McCollum Daly, Cindy  Straub\

Gastroesophageal  Reflux Disease (GERD)

Esophageal  Motility Abnormalities

Recent publications:


24 December 2011

Greetings to All of You


22 December 2011

Polycythemia vera ppts and latest articles

Myeloproliferative Disorders
Alice Ma, M.D.

Polycythemia Vera

Diagnostic  Approach to Myeloproliferative Neoplasms
Stephen  Oh, M.D, Ph.D.

Chronic  Myeloid Leukemia and  other Myeloproliferative  Neoplasms (MPNs)
by Dale Bixby,  M.D., Ph.D

Hypercoagulable  States: Polycythemia Vera
by Chris  Caulfield

Neoplastic  Disorders of The Bone  Marrow

Polycythemia Vera

Latest 20 articles


19 December 2011

Valvular Stenosis ppt and latest 20 publications

Valvular  Heart Disease
by Kenneth  S. Korr M.D.

Valvular  Heart Disease

Valvular  Heart Disease

Valvular  Heart Disease
by Steven R. Bruhl MD, MS

Valvular Disease,  Carditis & Cardiomyopathy

Valvular Heart Disease
by Laura Wexler, M.D.

The Essentials of Valvular Heart Disease

Valvular Stenosis
by Vikram  Chhokar MD

Cardiac  Cath Measurement of Stenotic Aortic Valve  Area
by Ryan  Tsuda, MD

Latest 20 publications


16 December 2011

Endometrial hyperplasia ppts and recent publications

Endometrial  Biopsy
by Oguchi Andrew  Nwosu, MD, FAAFP, Emory Family  Medicine

Endometrial  Cancer 
by Faina  Linkov, PhD, University  of Pittsburgh Cancer  Institute

Abnormal  Uterine Bleeding
by Todd  May, M.D.

Abnormal  Uterine Bleeding
by Peter J.  Chen, M.D., Hospital  of the University of Pennsylvania

Female  Reproductive System
External  Female Genitals
External  Reproductive Organs

Sexual  Function in the Geriatric Population
by Vinita  J. Speir, MD

Abnormal  Uterine Bleeding
by Karen  Carlson, M.D., University  of Nebraska Medical  Center

Diseases of  Vulva

Recent published articles


Obstetrics and gynaecology ppts from University of Kansas School of Medicine

Dysfunctional Uterine Bleeding
by-Darren Farley, M.D., UKSM-Wichita

Surgical  Complications of Pregnancy
by - Matthew  Voth M.D.

Mullerian  Anomalies
By Elizabeth Diaz

Asthma  in Pregnancy
by Timothy Hoskins,  M.D.

Pituitary  Disorders
by Jo  Choudhry, M.D.

Recent published articles on Dysfunctional Uterine Bleeding


15 December 2011

Hypercalcemia, Hypercalcemia and Renal Sarcoid,Hypercalcemia and Multiple Myeloma, Milk-Alkali Syndrome and Evaluation of Hypercalcemia, Approach to Hypercalcemia, Disorders of Calcium and Phosphate Metabolism, Calcium homeostasis, Case Studies in Calcium Metabolism, Endocrine Emergencies ppt

By: Ayesha Shaikh
Emory Family  Medicine Residency Program

Hypercalcemia  secondary to Primary Hyperparathyroidism
by - Emily  Kingsley, MD

Hypercalcemia  and Renal Sarcoid
by Jason  McClune

Hypercalcemia  and Multiple Myeloma

Milk-Alkali  Syndrome and Evaluation of Hypercalcemia
by: TJ O’Neill

Approach to  Hypercalcemia
by Elizabeth  George M.D.
University  of Wisconsin-Madison


Disorders  of Calcium and Phosphate Metabolism

Calcium  homeostasis

Case Studies in Calcium Metabolism

Endocrine Emergencies
William E. Clutter, M.D


Peripheral Vascular System and Lymphatic System, Anesthetic Management of Vascular Surgery, Blood Flow through Vascular System, Macro and Microlevel of Noninvasive Examination of the Vascular System ppt

Peripheral  Vascular System

Assessment  of the Peripheral Vascular and Lymphatic  System

Peripheral  Vascular System and Lymphatic System

Introduction  to Clinical Practice II
Peripheral  Vascular Disease
by:Joseph  S. Giglia, MD

Anesthetic Management of Vascular Surgery
by: Dennis  Stevens CRNA, MSN, ARNP

Blood Flow through Vascular System

Vascular and  Lymphatic System Pathology

Assessment of Peripheral Vascular and Lymphatic System

Advanced Assessment of the Cardiovascular System
By: Mary Beerman, RN, MN, CCRN

Regulation of Blood Flow and Pressure

Macro and Microlevel of Noninvasive Examination of the Vascular System 
By:  Ulyana B. Lushchyk,  MD, V.V. Novytskyy, I.P.Babiy, N.G. Lushchyk


14 December 2011

University of Texas, Department of Otolaryngology, Grand Rounds ppts

Branchial  Anomalies
by: David  Gleinser, MD, Harold  Pine, MD
University  of Texas Medical Branch (UTMB)
Department of Otolaryngology, Grand Rounds Presentation

Surgical  Management of Advanced  and Recurrent Subglottic  Stenosis
by: Andrew Coughlin,  MD, PGY-4, Michael Underbrink,  MD
The University  of Texas Medical Branch (UTMB)
Department of  Otolaryngology , Grand Rounds Presentation

Frontal  Sinus Fractures
by: Leo  Martinez, MD, Patricia  Maeso, MD
The  University of Texas Medical Branch
Department  of Otolaryngology, Grand  Rounds Presentation

Blunt Neck  Trauma and Laryngotracheal Injury
by: Susan Edionwe,  MD, Farrah Siddiqui,
University  of Texas Medical Branch,
Department  of Otolaryngology, Grand Rounds  Presentation

Esophagology  and Esophagoscopy
By: Benjamin  Walton, MD, Michael Underbrink,  MD
University  of Texas Medical Branch (UTMB Health)
Department  of Otolaryngology, Grand Rounds Presentation

EGFR  Targets in Head and Neck Cancer
By: Francisco G.  Pernas, M.D., Vicente A. Resto, M.D., Ph.D.
The University  of Texas Medical Branch
Department of  Otolaryngology, Grand Rounds  Presentation

Current controversies in the Management of Malignant Parotid Tumors
Francisco  G. Pernas, MD, Susan  D. McCammon, MD
The  University of Texas Medical Branch,
Department  of Otolaryngology, Grand  Rounds Presentation

Unilateral  Vocal Fold Paralysis
By: Naren  Venkatesan, MD, Michael  P. Underbrink, MD
The  University of Texas  Medical Branch
Department  of Otolaryngology, Grand  Rounds Presentation


Corneal ulcer, Eye Emergencies, Red Eye and Ocular Trauma ppt and publications

Corneal Melt
by Jeremy B. Wingard, MD

Red  Eye and Ocular Trauma
Harold  E Cross MD PhD

Conditions Causing Low Vision

by Katherine Leon & Dr. Edwin Ginés-Candelaria

Eye  Emergencies
by Nikki  Waller

Ocular  Urgencies and Emergencies

The  Red Eye
By Charlise A. Gunderson, M.D

Primary  Care for the Red Eye
by Alice  L. Bashinsky, M.D., Phillip  C. Hoopes, Jr, M.D

Recent publications:


Carpal Tunnel Syndrome (CTS)ppts and publications

Carpal Tunnel  Syndrome (CTS)ppts and publications

Nerve Compression  Syndromes

Diagnosis  of Carpal Tunnel

Carpal Tunnel  Syndrome

Carpal Tunnel  Syndrome
By: Tino Cantu And Maggie Sanchez

Carpal Tunnel Syndrome
By NathaëlF Hyppolite  RIII MF

Carpal Tunnel  Syndrome (CTS)
Rachel M  Schutz

Carpal  Tunnel Syndrome (CTS)

Avoiding Carpal Tunnel Syndrome
By Kathy Ames

Latest 20 Publications


11 December 2011

Mucormycosis ppts and recent publications

Mucormycosis is a fungal infection of the sinuses, brain, or lungs

Fungal  Urinary Tract Infections Diagnosis and Management
by Tristan T. Berry, M4, Medical College of Virginia

Fungal Rhinosinusitis
by Hausin Wong

Meningitis and Enchephalitis
by:  Donnette O'Neill, Suzanne Brydges, Mónica Richardson

Deep Neck Space Abscesses and Life-Threatening Infections of the Head and Neck
by Carl Schreiner, MD, F. B. Quinn, MD

Mucous Membrane and Deep Organ Fungal Infections
by: Dr. John R. Warren

Latest research articles:

  1. A Case of Intestinal Mucormycosis in a Common Marmoset (Callithrix jacchus).
  2. Burn Wound Mucormycosis-A Case Report.
  3. Coexisting pulmonary tuberculosis and mucormycosis in a patient with aplastic anemia post allogenic stem cell transplantation.
  4. Cutaneous and mucous mucormycosis mimicking pancreatic panniculitis and gouty panniculitis.
  5. Disseminated mucormycosis infection after the first course of dose-modified R-EPOCH for advanced-stage lymphoma.
  6. Gastric mucormycosis: A rare cause of gastrointestinal bleeding in cirrhosis.
  7. Homozygous carrier of the NOD2 1007fs frame-shift mutation presenting with refractory community-acquired spontaneous bacterial peritonitis and developing fatal pulmonary mucormycosis: A case report.
  8. Invasive mucormycosis and aspergillosis in a healthy 22-year-old battle casualty: case report.
  9. Massive lower gastrointestinal bleeding secondary to colonic mucormycosis.
  10. Mucormycosis causing giant gastric ulcers.
  11. Mucormycosis in Mato Grosso, Brazil: A Case Reports, Caused by Rhizopus microsporus var. oligosporus and Rhizopus microsporus var. rhizopodiformis.
  12. Mucormycosis of the head and neck: Report of five cases with different presentations.
  13. Pulmonary, rhino-orbital and cutaneous mucormycosis caused by Rhizomucor pusillus in an immunocompromised patient.
  14. Renal mucormycosis in aplastic anemia: a novel presentation.
  15. Rhinocerebral mucormycosis: five cases and a literature review.
  16. Rhinocerebral mucormycosis-a case report.
  17. Rhinomaxillary mucormycosis: A palatal ulcer.
  18. Successful Knee Extensor Mechanism Reconstruction in a Warfare-Related Open Lower Extremity Injury Complicated by Mucormycosis Infection: A Case Report.
  19. The Deferasirox-AmBisome Therapy for Mucormycosis (DEFEAT Mucor) study: a randomized, double-blinded, placebo-controlled trial.
  20. Two decades of experience in Mucormycosis after kidney transplantation.


Uveitis Powerpoint Presentations and Publications

Vogt-Koyanagi-Harada Syndrome
by Laura S. Gilmore, MD, Department of Ophthalmology

Primary Intraocular Lymphoma – Uveitis Masquerade Syndrome

Unexplained Visual Loss
by Laura S. Gilmore, MD, Grand Rounds

Latest 20 publication on Uveitis

1: Babu K, Kini R, Mehta R, Philips M, Subbakrishna DK, Murthy KR.
Predictors For Tubercular Uveitis: A Comparison Between Biopsy-Proven Cases of Tubercular and Sarcoid Uveitis. Retina. 2011 Dec 5. [Epub ahead of print] PubMed PMID: 22146129.

2: Peralta-Calvo J.
Vitrectomy as anti-inflammatory treatment in intermediate uveitis.
Arch Soc Esp Oftalmol. 2011 Dec;86(12):421. Epub 2011 Sep 9. English,
Spanish. PubMed PMID: 22117744.

3: Fonollosa A, Adán A.
Uveitis: a multidisciplinary approach.
Arch Soc Esp Oftalmol. 2011 Dec;86(12):393-394. English, Spanish. PubMed PMID: 22117737.

4: Oltra EZ, Morris C, Birnbaum AD, Tessler HH, Goldstein DA.
Chronic anterior uveitis in common variable immunodeficiency.
Ocul Immunol Inflamm. 2011 Dec;19(6):448-9. PubMed PMID: 22106916.

5: Erckens RJ, Mostard RL, Wijnen PA, Schouten JS, Drent M.
Adalimumab successful in sarcoidosis patients with refractory chronic non-infectious uveitis. Graefes
Arch Clin Exp Ophthalmol. 2011 Nov 27. [Epub ahead of print] PubMed PMID: 22119879.

6: Rosenzweig HL, Woods A, Clowers JS, Planck SR, Rosenbaum JT.
The NLRP3 inflammasome is active but not essential in endotoxin-induced uveitis.
Inflamm Res. 2011 Nov 26. [Epub ahead of print] PubMed PMID: 22119862.

7: Cohen AE, Assang C, Patane MA, From S, Korenfeld M; Avion Study Investigators.
Evaluation of Dexamethasone Phosphate Delivered by Ocular Iontophoresis for Treating Noninfectious Anterior Uveitis.
Ophthalmology. 2011 Nov 22. [Epub ahead of print] PubMed PMID: 22115712.

8: Willermain F, Rosenbaum JT, Bodaghi B, Rosenzweig HL, Childers S, Behrend T, Wildner G, Dick AD. Interplay between innate and adaptive immunity in the development of non-infectious uveitis. Prog Retin Eye Res. 2011 Nov 22. [Epub ahead of print] PubMed PMID: 22120610.

9: Işık M, Kılıç L, Doğan I.
Recurrent uveitis due to sildenafil usage in a patient with Behçet's disease. Rheumatol Int. 2011 Nov 18. [Epub ahead of print] PubMed PMID: 22095394.

10: Kim TW, Kang JS, Kong JM, Bae S, Yu Y, Chung H, Yu HG.
 Maturation profiles of peripheral blood dendritic cells in patients with endogenous uveitis.
Immunol Lett. 2011 Nov 15. [Epub ahead of print] PubMed PMID: 22108236.

11: Heiligenhaus A, Michels H, Schumacher C, Kopp I, Neudorf U,…
Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis.
Rheumatol Int. 2011 Nov 15. [Epub ahead of print] PubMed PMID:

12: Gül A, Tugal-Tutkun I, Dinarello CA, Reznikov L, Esen BA, Mirza A, Scannon P, Solinger A.
Interleukin-1β-regulating antibody XOMA 052 (gevokizumab) in the treatment of acute exacerbations of resistant uveitis of Behcet's disease: an open-label pilot study.
Ann Rheum Dis. 2011 Nov 14. [Epub ahead of print] PubMed  PMID: 22084392.

13: Cantarini L, Simonini G, Frediani B, Pagnini I, Galeazzi M, Cimaz R. Treatment strategies for childhood noninfectious chronic uveitis: an update.
Expert Opin Investig Drugs. 2011 Nov 11. [Epub ahead of print] PubMed PMID: 22074394.

14: Esterberg E, Acharya NR. Corticosteroid-sparing therapy: practice patterns among uveitis specialists. J Ophthalmic Inflamm Infect. 2011 Nov 6. [Epub ahead of print] PubMed PMID: 22057810.

15: Gallagher A.
Leptospirosis in a dog with uveitis and presumed cholecystitis.
J Am Anim Hosp Assoc. 2011 Nov;47(6):e162-7. PubMed PMID: 22058365.

16: Batmanabane V, Chidambaranathan GP, Rathinam S.
Spectrum of Leptospira species identified in patients with leptospiral uveitis in an ophthalmological institute in South India.
Indian J Med Microbiol. 2011 Oct;29(4):444-5. PubMed PMID: 22120817.

17: Santos FF, Commodaro AG, Souza AV, Pinho JR, Sitnik R, Garcia C, Ribeiro AL, …
Real-time PCR in infectious uveitis as an alternative diagnosis.
Arq Bras Oftalmol. 2011 Aug;74(4):258-61. PubMed PMID: 22068852.

18: Hunter RS, Lobo AM.
Dexamethasone intravitreal implant for the treatment of noninfectious uveitis.
Clin Ophthalmol. 2011;5:1613-21. Epub 2011 Nov 11. PubMed PMID: 22140307; PubMed Central PMCID: PMC3225458.

19: Pratap DS, Lim LL, Wang JJ, Mackey DA, Kearns LS, Stawell RJ; …
The role of toll-like receptor variants in acute anterior uveitis.
Mol Vis. 2011;17:2970-7. Epub 2011 Nov 16. PubMed PMID: 22128242; PubMed Central PMCID:

20: Yang MM, Lai TY, Tam PO, Chiang SW, Chan CK, Luk FO, Ng TK, Pang CP.
CFH 184G as a genetic risk marker for anterior uveitis in Chinese females.
Mol Vis. 2011;17:2655-64. Epub 2011 Oct 13. PubMed PMID: 22065918; PubMed Central PMCID:


19 November 2011

Acute Respiratory Failure, Respiratory Failure Vent Support, Respiratory Failure and ARDS ppts

Acute respiratory failure - A physiologic approach
By: Robert Paine, M.D

Acute Respiratory Failure
By: Cindy Kin

Critical Care Board Review
By: Sachin B. Patel, M.D.

Respiratory Failure Vent Support

Respiratory Failure and ARDS
By: Nancy Jenkins


18 November 2011

Thyroid, Parathyroid, Adrenal, Endocrine and Hepatic Disorders, Hormonal Regulation, Renal Failure ppts

Thyroid Disorders - Hyperthyroidism

Thyroid, Parathyroid, and Adrenal

Nutrition and Metabolism Dysfunction: Thyroid and Adrenal Disorders

Renal Failure and Treatment

Endocrine Disorders

Endocrine and Hepatic Disorders
by: Kimberley McComb-Meisinger RN-BC MSN

Alterations of Hormonal Regulation

Introduction to the Endocrine System

Endocrine and Nervous Systems

Renal Failure and  Treatment


17 October 2011

Occiput Posterior - Abnormal Labor Presentation

What is Occiput Posterior?

The most common position for a baby during labor is head down with the back of the head (occiput) facing the front of the mother (anterior). When the back of the head is facing the back of the mother (posterior) the baby's position is called Occiput Posterior.

Mechanisms of Birth - Complications of Labor

Abnormal Labor
by Barbara M. O’Brien, M.D.Women and Infants Hospital, Brown University

Pregnancy, Labor and Delivery
by Calla Holmgren, MD, University of Washington

Assessment of Complications During The Labor Process
by Prof. Unn Hidle

Pregnancy Childbirth and Postpartum at Risk

Electronic Fetal Monitors


Breast feeding presentations

Breast feeding techniques

Breast feeding 
by: Mahdia  Alkony, RN, BSN, MSN

Breastfeeding Formulas and other juicy stuff

Infants: The Feeding Relationship

Breast feeding
by Dr.Nagayeva S

Managing the Breastfeeding Woman
by SARAH BARTS, RD, LDN, OB/GYN Registered Dietitian
Hospital of the University of Pennsylvania

Newborn behaviors and early interactions 
by Daniel Messinger


18 September 2011

Institutional Animal Care and Use Committee Guidebook

Institutional Animal Care and Use Committee Guidebook
230 Pages.

If you are conducting experiments on animals, you might have faced problems with some Institutional Ethical Committee members.  In one meeting some one says something in the other meeting other member says conflicting things.

For existing and future ethical committee members reference, I am posting link to a guide book


11 September 2011

Free Access to some Wiley Journals

Free Access to some Wiley Journals
Several Wiley-Blackwell journals offer free access to their backfiles on Wiley Online Library. All content prior to a given date is made free online to all.

Academic Emergency Medicine: Content older than 12 months back to Jan 1st 1997
Acta Crystallographica Section E (Electronic): Full Open Access
Acta Ophthalmologica: Content older than 2 years back to Jan 1st 1997
Aging Cell: Content older than 2 years
Alimentary Pharmacology & Therapeutics: Content older than 18 months back to Jan 1st 1997
Allergy: Content older than 2 years back to Jan 1st 1997
American Anthropologist: Content older than 35 years
American Journal of Hematology: Content older than 1 year back to 1996
American Journal of Transplantation: Content older than 1 year
Annals of Human Genetics: Content older than 2 years back to Jan 1st 1997
Anthropology News: Content older than 35 years
Archives of Drug Information: Full Open Access
Australian Journal of Entomology: Content older than 1998
Biochemistry and Molecular Biology Education: Content older than 2 years back to 2002
BJU International: Content older than 1 year back to Jan 1st 1997
British Journal of Clinical Pharmacology: Content older than 1 year
Cancer: Content older than 1 year back to Vol 1, 1948 (Vol 81, 1997 for Cancer Cyotpathology)
Cancer Cytopathology: Content older than 12 months
Cancer Science: Content older than 2 years
Cardiovascular Therapeutics: Open Access after 1 year
Cellular Microbiology: Content older than 2 years
Clinical & Experimental Immunology: Content older than 1 year
Clinical and Experimental Optometry: Content older than 2 years back to Jan 1st 1997
Clinical Microbiology and Infection: Content older than 2 years back to Jan 1st 1997
Cytometry Part B: Clinical Cytometry: Content older than 1 year back to Vol 18, 1994 (started as section in 1994)
Development Growth & Differentiation: Content older than 2000
Developmental Dynamics: Content older than 1 year back to 1992
Developmental Medicine and Child Neurology: Content older than 1 year back to Jan 1st 1997
ENT Today: Open Access Journal
Epilepsia: Content older than 1 year back to Jan 1st 1997
Ethos: Content older than 35 years
Experimental Physiology: Content older than 1 year
FEBS Journal: Content older than 1 year
Fems Yeast Research: Content older than 2 years
Functional Ecology: Content older than 2 years
Genes To Cells: Content older than 6 months
Genes, Brain and Behavior: Content older than 2 years
Geographical Analysis: All Content prior to 2001
Health Information & Libraries Journal: Content older than 3 years
Hepatology: Content older than 1 year back to 1996
Hereditas (Electronic): Full Open Access
HIV Medicine: Content older than 2 years
Immunology: Content older than 1 year
Inflammatory Bowel Diseases: Content older than 1 year back to 1995
IUBMB Life: Content older than 12 months
Journal of Anatomy: Content older than 2 years
Journal of Animal Ecology: Content older than 2 years
Journal of Applied Ecology: Content older than 2 years
Journal of Applied Microbiology: Content older than 3 years back to Jan 1st 1997
Journal of Ecology: Content older than 2 years
Journal of Evolutionary Biology: Content older than 2 years
Journal of Family Therapy: Content older than 2000 back to 1979
Journal of General Internal Medicine: Content older than 12 months
Journal of Internal Medicine: Content older than 2 years back to Jan 1st 1997
Journal of Neurochemistry: Content older than 1 year back to Jan 1st 1997
Journal of Sleep Research: Content older than 1 year back to Jan 1st 1997
Journal of Thrombosis and Haemostasis: Content older than 1 year
Journal of Travel Medicine: Content older than 1 year
Letters In Applied Microbiology: Content older than 3 years back to Jan 1st 1997
Liver Transplantation: Content older than 1 year back to Vol 1, 1995
Molecular Microbiology: Content older than 18 months back to Jan 1st 1997
New Phytologist: Content older than 1 year
Palaeontology: Content older than 7 years
Parasite Immunology: Content older than 1 year back to Jan 1st 1997
Plant Cell & Environment: Content older than 3 years back to Jan 1st 1997
Plant Pathology: Content older than 3 years back to Jan 1st 1997
Protein Science: Content older than 12 months
Psychiatry and Clinical Neurosciences: Content older than 2 years back to Jan 1st 1997
Scandinavian Journal of Immunology: Content older than 1 year back to Jan 1st 1997
Sociology of Health & Illness: Content older than 4 years
Stem Cells: Content older than 12 months back to Jan 1st 1996
Swiss Political Science Review: Content older than 3 years not including the current year volume
The Anatomical Record: Advances in Integrative Anatomy and Evolutionary Biology: Content older than 1 year back to 1996
The Developing Economies: Content older than 2005
The Journal of Physiology: Content older than 1 year
The Obstetrician & Gynaecologist: Content older than 2 years
The Plant Journal: Content older than 1 year
Traffic: Content older than 6 months
Tropical Medicine & International Health: Content older than 1 year
Ultrasound in Obstetrics & Gynaecology: Content older than 12 months
Value In Health: Content older than 12 months


01 September 2011

Female Genital Cutting

Female Genital Cutting
By:Safa Magid

Female Genital Cutting(FGC)
* Also known as: female circumcision & female genital mutilation
* Female circumcision is the term preferred by cultures who practice this custom

FGC -Definition
* Procedure involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious, or other non-therapeutic reasons.

WHO Classification of FGC
* Type 1: Excision of prepuce w/ or w/o excision of all of the clitoris
* Type 2: Clitoridectomy and partial or total excision of labia minora
* Type 3: Infibulation, includes removing all or part of ext. genitalia and re-approximation of remnant labia majora, leaving a small interoitus for passage of urine and menstrual blood

* Type 1 and Type 2 are the most common forms
* Type 1 and Type 2 account for 80% of the cases
* Infibulation accounts for 15% of the cases

* Currently ~ 130 million women and girls have had the procedure
* An estimated 2 million girls worldwide are at risk per year

FGC in the US

* Data from 2000 census suggests:
228,000 women and girls are with or at risk for FGC in the United States
* CA, NY, and MD have the most female immigrants and refugees from countries where FGC is prevalent.
* Occurs mostly in 28 sub-Saharan African countries
* FGC is practiced by Christians, Muslims, and adherents to traditional African religions
* Also practiced in Middle East and Asia

Origins and History
* Origins remain unclear
* FGC practiced in Pre-Islamic Arabia, ancient Rome, and Tsarist Russia
* Female circumcision was discovered in ancient Egyptian mummies in 200 B.C.
* Practiced in the United States until the 1970’s to tx hysteria, lesbianism, and erotomania

FGC and Religion
* Christianity:
FGC is not an obligatory religious requirement
* Islam:
FGC is not an obligatory religious requirement

* Performed between the ages of 5-10, or prior to marriage
* Performed by a member of community who is not a healthcare worker
* Often performed w/o anesthesia
* However in metropolitan areas the use of anesthesia is more common

FGC Procedure
* Performed w/o surgical instruments. Razor blades or other instruments which may or may not be sterile are used
* Depending on socio-economic factors FGC may also be performed in a health care facility by qualified health personnel
* WHO is opposed to medicalization of all types of female genital mutilation.
* Reasons currently practiced:
o Rite of passage to womanhood
o Maintains chastity
o Ensure marriageablity
o Belief that it improves hygiene
o Social pressure to adhere to custom
o Belief that it is a religious requirement

* Prevalence of complications is unknown
* Rate of complications increase with severity of procedure( i.e. women with type III have > complications that women w/type I)
* A study of 120 Somalian women suggests rate of complications are inversely proportional to the age of the child when FGC was performed
* Women who had FGC btwn the ages of 5-8, had more complications than their 9-12 y.o counterparts
* Long and short term complications
* Some women with FGC do not experience complications

Short term complications
* Hemorrhage
* Severe pain
* Shock
* Infection
* Urine retention
* Ulceration of genital region injury to adjacent tissue
* HIV?-Possibly transmitted due to use of unsterilized equipment

Long Term Complications
* Cysts and abscesses
* Post-partum fistulaes: vesico-vaginal
* Keloid scar formation
* Damage to the urethra resulting in urinary incontinence
* Dyspareunia and sexual dysfunction
* Infertility
* Difficulties with labor.

Case Report

* 16 y.o female presents w/severe dysmenorrhea
* PE revealed the absence of a clitoris and fused labia majora with a 1cm opening
* Physicians initially thought pt had corrective surgery for ambiguous genitalia
* Later determined that while visiting Africa with her mother she had FGC performed
* Perinealography revealed:
o Filling of the vagina,urethra, and bladder simulating a urogenital sinus.
o Dilated vagina suggested obstruction

Case Report
* Defibulation procedure was performed
* The patients symptoms of dysmenorrhea eventually resolved

FGC and Obstetric outcomes
* WHO Study

FGC & Length of maternal hospital stay
* FGC and length of maternal hospital stay
o FGC Type I- RR: 1.15
o FGC Type II-RR:1.51
o FGC Type III-RR:1.98

FGC and Mental Health
* Anxiety
* Depression
* Feeling of incompleteness

* Corrective procedure
* Involves division of the fused labia majora with suturing of each labia for hemostasis
* Thus the infibulated scar, which is a flap obstructing the introitus and urethra, is removed
* WHO Indications for defibulation:
* Urinary retention
* Recurrent UTI’s or kidney infections
* Dysmenorrhea
* Dyspareunia or apareunia
* Prior to coitus
* Prior to labor
* It is also reasonable that defibulation can be performed to alleviate any mental health consequences for women who do not meet the WHO indications

Approach to patients with FGC
* Some physicians remain unfamiliar w/FGC & have expressed their shock during PE
* Some women report being reprimanded by physicians for having the procedure done
* Despite the fact the majority had FGC while they were children and were not given a choice

Patients perspective of FGC
* Many pts w/FGC who have immigrated to the West do not feel as if they abused
* Some feel that FGC was done “for them” and not an attack against them

Patients perspective of FGC
* 1st generation pts born in the West who had FGC while traveling abroad often have very different views than their foreign born counterparts
* HC workers may need to modify their approach depending on the pts perspective

Legality of FGC
* U. S. passed a law in March 1997:
* Made performing any medically unnecessary surgery on the genitalia of a girl younger than 18 years of age a federal crime.
* Reinfibulation was not included as a federal crime, so it may be performed with absorbable sutures in a running fashion if a woman chooses the procedure

Resources for pts and HC providers
* African’s Women’s Health Center
o Established in 1999 by Dr. Nawal Nour a Sudanese-American OB/GYN
o Goal of clinic is to provide culturally appropriate holistic care to African women who are refugees who may or may not have undergone FGC
o Defibulation is performed at this clinic

Resources for pts and HC providers
* Website with information about FGC
* Includes fact sheet about FGC and guidelines for healthcare workers
* http://www.who.int/topics/female_genital_mutilation/en/
* http://www.who.int/reproductive-health/publications/rhr_01_18_fgm_policy_guidelines/index.html

Dedicated to all of my sisters who have had FGC.
To those who have suffered physical or mental consequences, I am inspired by your courage and strength.

Female Genital Cutting.ppt

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