Archive | May 2011

Ergot

Ergot alkaloids are derived from a fungus, Claviceps purpurea , which grows primarily on rye grain. The fungus forms a hard blackish body known as a sclerotium, which contains alkaloid compounds.

Central Nervous System effects

Ergot affects the central nervous system and in high levels can be toxic. Its central nervous system effects produce irritability, spasms, cramps, and convulsions. Because of its potentially harmful side effects, one ergot-based drug (Ergonovine or Ergotrate) was taken off the American market in 1993. Methylergonovine maleate (Methergine) is now the only ergot derivative in use in the United States.

Applications:

It is given only as a uterine stimulant to control post-partum hemorrhage, PPH. Because of the risk of complications, and because the use of Methergine is contraindicated in many women, it has largely been replaced by the use of hormones prostoglandins, PGs and oxytocin as uterotonic agents. 

Source: http://www.surgeryencyclopedia.com/St-Wr/Uterine-Stimulants.html

Morphea

Morphea, also known as localized scleroderma, is a disorder characterized by excessive collagen deposition leading to thickening of the dermis, subcutaneous tissues, or both.

Morphea is classified into plaque, generalized, linear, and deep subtypes according to the clinical presentation and depth of tissue involvement.

Treatment and Management:

Plaque-type morphea often undergoes gradual spontaneous resolution over a 3- to 5-year period. Treatment of active lesions with superpotent topical or intralesional corticosteroids may help reduce inflammation and prevent progression.

Anti-jka antibodies and hemolytic disease of the newborn

The numerous antigens on the surface of red blood cells have been placed into groups.

Many people are familiar with the Rhesus (Rh) group as it is the most clinically relevant.

However the non-Rh groups such as Kell, MNS and Kidd have assumed increasing importance as the incidence of Rh-D sensitization has decreased in the population with the use of Rh gamma globulins preventing an Rh negative mother from developing Rh negative antibodies following the birth of an Rh positive child.

Sensitization  to Rh antigens (non-D ) is still responsible for the largest proportion of hemolytic disease  in the newborn.

Jka and Jkb antigens:

First reported in 1951 and 1953 respectively.

Anti-Jka and anti-Jkb can both show dosage and are notorious for their evanescence: antibody titres that rise after stimulation but quickly drop, often to undetectable levels.

Kidd system antibodies, (like the well known Rh antibodies)  have also been implicated in delayed and immediate Haemolytic Transfusion Reactions and Haemolytic Disease of the Newborn.

The first reported case of hemolytic disease of the newborn (HDN) secondary to anti-Jka was reported by Allen et al in 1951, and the antibody was named after the mother of the affected child, Mrs. Kidd. The newborn had erythroblastosis fetalis, and testing of Mrs. Kidd’s serum identified a previously unknown antibody (Jka) with a titer of 1:64. It was first thought that the cause of hemolysis was due to the additional presence of anti-Kell antibodies. Later, Mrs. Kidd’s son was grouped as Kell antigen negative, leaving the presumed cause of hemolytic disease as anti-Jka antibodies.

Diagnostics:

  • bilirubin levels
  • direct and indirect coombs test

Treatment:

  • exchange blood transfusion
  • phototherapy

http://www.reproductivemedicine.com/feature/2009/feature032009.php

Fabry disease

Fabry disease is caused by the lack of or faulty enzyme needed to metabolize lipids, fat-like substances that include oils, waxes, and fatty acids.  The enzyme is known as ceramide trihexosidase, also called alpha-galactosidase-A.  A mutation in the gene that controls this enzyme causes insufficient breakdown of lipids, which build up to harmful levels in the eyes, kidneys, autonomic nervous system, and cardiovascular system.  Fabry disease is one of several lipid storage disorders and the only X-linked lipid storage disease.

Biochemistry:

Symptoms:

Friedreich’s ataxia

  • an inherited autosomal recessive disorder that causes progressive damage to the nervous system

Symptoms

  • muscle weakness
  • speech problems
  • heart disease
Symptoms usually begin between the ages of 5 and 15 but can appear as early as 18 months or as late as 30 years of age.

Etiology:

Results from the degeneration of nerve tissue in the spinal cord and of nerves that control muscle movement in the arms and legs.

Caused by a FXN gene mutation that codes for frataxin, located on chromosome 9.

This protein is essential for proper functioning of mitochondria (it has been shown to be connected with the removal of iron from the cytoplasm surrounding the mitochondria, and in the absence of frataxin, the iron builds up and causes free radical damage).

Nerve and muscle cells appear to be particularly sensitive to the deleterious effects of this type of mitochondrial dysfunction.

Canada gets less for health spending than other nations: report

 


May 12, 2011

 

Postmedia News, Thu May 12 2011

 

Canada isn’t getting enough bang for its health-care buck, suggests a Conference Board of Canada report that compares health spending here to more than a dozen other nations. The report found that Canada’s health spending per person was the fourth highest of the countries assessed, but it ranked 10th in overall health performance. “Canada has relatively high overall spending and middle-of-the-pack health outcomes,” David Stewart-Patterson, the conference board’s vice-president of public policy, said Thursday in a statement released with the report. “Countries such as Australia and Sweden spend less than Canada per person, and generally get better results.”

The report looked at spending on health compared to gross domestic product levels for 2008, or for the most recent year for which data was available. The countries surveyed included Canada, the United States, the United Kingdom, the Netherlands, France, Switzerland, Germany, Austria, Belgium, Denmark, Sweden, Italy, Ireland, Australia, Norway, Finland and Japan. The report found that in 2008, 10 per cent of Canada’s gross domestic product went to health spending. That’s the equivalent of $4,079 US per person, the report said.

Despite the money spent, Canadians ranked only seventh when it came to life expectancy. This country also had the second highest infant mortality rate among its peers. In a stark contrast, Japan, the country with the lowest level of health spending per person – estimated at $2,729 US – had the highest life expectancy and the second-lowest infant mortality. However, while the Canadian numbers weren’t great, the situation south of the border appeared worse. The United States was found to spend the most – more than $7,500 US per person in 2008. However, the U.S. had the worst results by far of any country assessed. It ranked last when it came to overall on population health. The States also had the lowest life expectancy and the worst infant mortality.

Sacral (pilonidal) dimple

A small fossa located just above the buttocks. Located at or near the sacrum, the tail bone. 

Indication:

may be a sign of Spina bifida

 Sacral dimples are usually spotted in post-natal checks by a pediatrician

Assessment:

  1. Can the floor of the dimple be seen to be covered with skin? If not, it may be that the neural tube is not completely closed.
  2. Is there a tuft of hair in the dimple? This may also indicate problems.
  3. Are there any other problems in the examination of the baby, such as weak lower limbs? This may indicate neural involvement.
  4. How close to the buttocks is the dimple? This determines the region of the spinal column which may be affected.

 

Ultrasound assessment will provide further information as to level of vertebral and or neural involvement.

Surgical intervention may be required to close neural tube defect.