Chadwick’s sign

Chadwick’s sign is a bluish discoloration of the cervix, vagina, and labia caused by the hormone estrogen which results in venous congestion. It can be observed as early as 6-8 weeks after conception, and its presence is an early sign of pregnancy.

Fetal Development

2 weeks  – endo, meso and ectoderm.

ectoderm becomes

• nervous system
• skin
• hair
• nails

Mesoderm becomes

• connective tissue
• urinary tract
• skeleton
• musculature

Endoderm

• forms the lining of the intestinal tract
• forms lining of organs

Week 3

• cephalic differentiable from caudeus

Week 4

• spinal cord and brain formation
• eyes, ears, nose and mouth develop
• organ formation begins
• heart beats by day 25
• arm and leg buds present
• 1/5th of an inch long

Week 6

• 1/2 in. in length
• fingers begin to form
• primitive reflexes are present
• brain controls functioning of other organs
• some ossification of skull plates
• complete skeleton is present, but in cartilage matrix only

Week 7

• fetus responds to touch – grasp reflex

Week 10

• nail formation on fingers
• hair growth o head
• kidneys begin functioning, secretion of  urine

12 Weeks

• 3 in. long, weight = 1 ounce
• able to bend arms and legs
• fetus becomes quite active at this stage of development
• fetus begins to swallow amniotic fluid

14 weeks

• lanugo forms, covering the fetus
• sex can easily be determined
• calcification of long bones begins
• fetus is 7-8inches, weighs 5 ounces

5 months

• fetus is 10-11 inches, weighs 1 pound
• fat is stored
• vernix covers skin
• primitive breathing reflex begins

6 months

• 12-13 inches, 1.5 pounds

7 months

• 16 inches, weighs 3-3.5 pounds
• fetus gains 1/2   pound a week from this point forward
• sucking reflex is present

8 months

• 18 inches long, 6-7 pounds

9 months

• 20 inches, weighs 7-7.5 pounds

Gaskin, Ina May. 2002. Spiritual Midwifery. 4th ed. Green Press Initiative, Summerton, TN.

Athetosis

Athetosis is a continuous stream of slow, sinuous, writhing movements, typically of the hands and feet.

Movements typical to athetosis are sometimes called athetoid movements.

Etiology:

It is said to be caused by damage to the corpus striatum of the brain.

eg. may occur in cerebral palsy, huntington’s disease.

Ottawa Charter for Health Promotion

The Ottawa Charter for Health Promotion is a 1986 document produced by the World Health Organization. It was launched at the first international conference for health promotion that was held in Ottawa, Canada.

Action areas of the Ottawa Charter

Building healthy public policy – health promotion policy combines diverse but complementary approaches, including legislation, fiscal measures, taxation and organisational change. Health promotion policy requires the identification of obstacles to the adoption of healthy public policies in non-health sectors and the development of ways to remove them.

Creating supportive environments – the protection of the natural and built environments and the conservation of natural resources must be addressed in any health promotion strategy. Work, leisure and living environments should be a source of health for people.

Strengthening community action – community development draws on existing human and material resources to enhance self-help and social support, and to develop flexible systems for strengthening public participation in, and direction of, health matters. This requires full and continuous access to information and learning opportunities for health, as well as funding support.
Developing personal skills through information and education skills – enabling people to learn (throughout life) to prepare themselves for all of its stages and to cope with chronic illness and injuries is essential. This has to be facilitated in school, home, work and community settings.

Re-orientating health care services toward prevention of illness and promotion of health – the role of the health sector must move increasingly in a health promotion direction, beyond its responsibility for providing clinical and curative services. Reorientating health services also requires stronger attention to health research, as well as changes in professional education and training.

Three basic strategies for health promotion are:

Advocate: Health is a resource for social and developmental means, thus the dimensions that affect these factors must be changed to encourage health.

Enable: Health equity must be reached where individuals must become empowered to control the determinants that affect their health, such that they are able reach the highest attainable quality of life.

Mediate: Health promotion cannot be achieved by the health sector alone; rather its success will depend on the collaboration of all sectors of government (social, economic, etc.) as well as independent organizations (media, industry, etc.).

http://dictionary.sensagent.com/ottawa+charter+for+health+promotion/en-en/

Castleman’s disease (angiofollicular hyperplasia)

a rare disorder characterized by non-cancerous growths (tumors) that may develop in the lymph node tissue at a single site or throughout the body.

The neoplasm is an angiofollicular hyperplasia – a follicular hyperplasia of lymph nodes with abnormally increased interfollicular vascularity.

Etiology:

Herpes Simplex virus 8, HSV-8, has been associated with Kaposi’s sarcoma, Primary Effusion lymphoma and multicentric Castleman’s Disease.

Castleman’s is characterized by a hyperproliferation of cytokine producing B cells.

Prolotherapy

An unregulated, unproven therapy for chronic musculoskeletal pain.

An irritant solution is injected into painful ligaments and adjacent joint spaces to promote inflammatory response with the goal to stimulate repair of damaged connective tissue, promote healing and alleviate musculoskeletal pain.

Algiatry

Algiatry is the branch of medicine specializes in pain management.

Typically involves an interdisciplinary team in the treatment and management of chronic pain.

Pain management team members:

• medical practitioners
• clinical psychologists
• physiotherapists
• occupational therapists
• nurse practitioners

Treatment approaches of long term pain

1. pharmacologic measures – analgesics
2. tricyclic antidepressants
3. anticonvulsants
4. interventional procedures – epidural steroid injections, facet joint injections, neurolytic blocks, spinal cord stimulators and intrathecal drug delivery system implants.
5. physical therapy – physical exercise
6. application of ice and/or heat
7. psychological measures – biofeedback and cognitive behavioral therapy.

Marasmus

Marasmus is a form of severe protein-energy malnutrition characterized by energy deficiency. It can result from inadequate intake of food or from malabsorption or metabolic disorders.

kwashiorkor

A severe malnutrition in children resulting from a diet excessively high in carbohydrates and low in protein.

Characterized by edema, irritability, anorexia, ulcerating dermatoses, and an enlarged liver with fatty infiltrates.

Eczema Herpeticum: clinical characteristics

Clinical Presentation:

1. multiple clusters of vesicles in areas of pre-existing skin disease involvement.
2. Vesicles spread, become hemorrhagic and then crust over.
3. Painful “punched out” erosions result, these may coalesce to form large bleeding erosions.

The majority of patients will also have fever and malaise.

Patient history:

Patients will often deny previous HSV infection.

In most cases the patient carries HSV asymptomatically

Sub-clinical HSV infection note:

• 90% of adults have antibodies to HSV-1
• 20% of adults have antibodies to HSV-2
• however, far fewer adults manifest the disease.

Differential diagnosis:

• In any patient presenting with multiple coalescing vesicles and fever HSV infection should be queried.
• Other causes must be considered.
• Other viruses are capable of creating a similar clinical picture — most commonly animal pox viruses. A history of zoo keeping or laboratory work should raise suspicion of such viruses.
• Exacerbation of the primary skin disease should be considered.
• Blistering disorders, such as pemphigus vulgaris or bullous pemphigoid, may present with a similar appearance, but would not be accompanied by fever.

Diagnosis:

1. Punched-out erosions 
2. vesicles
3. fever
4. extreme pain at site(s)

Diagnostics:

Tzanck preparation

•  A #15 surgical blade should be used to open the top of a vesicle, scraping the underside of the vesicle as well as the base.
• The blade is then wiped across a glass slide, heat-fixed, and stained with toluidine blue.
• A positive prep reveals multinucleated giant cells with molded, jigsaw-puzzle nuclei in addition to acantholytic balloon cells.

WebMD. (2011). Eczema Herpeticum: A dermatologic emergency:  clinical characteristics and diagnosis. Retrieved March 8, 2011 from http://www.medscape.com/viewarticle/443521_5.