November 2014 Narayanan R

The evil of EBOLA

The spread

• Deadly Virus• Enters body thru

contact with body fluids

• Incubation period: 2-20 days

• Kills cells & Makes them explode

• Wrecks immune system

• Hemorrhagic crisis• Mortality >55%

• No vaccine• No specific drug• Only supportive

therapy

Flu like symptoms

VomitingDiarrhoea

DIC

Multi organFailure

Relevance to ObG

• Virus persists in semen for >3 mths• Transmitted through Breast milk• Mode of transmission to fetus not

known • Mortality in pregnancy higher even if

unaffected (Congo 1999: Overall: 77% - Pregnant: 95.5% -

NNM: 100%)

• Collateral damage

Uterine Transplantation

Indications:

Absence of uterusHypoplasia

Morbid adhesions Post Hysterectomy

Ethical:

Uterus not a vital organUnlike heart & kidneyConsider quality of life

Risks:

Need for ARTImmunosuppression

Organ or embryo rejection

Drawbacks:

Surgical skillMiscarriage

IUGRPreterm

World’s First Child Born After Uterus Transplantation

• Research project 1999 at Gothenburg, Sweden

• Team led by Mats Brännström

• 9 women received a womb from live donors

• PE due to Immunosuppression

• 3 mild rejection episodes• First delivery in Sept 2014• At 32 wks – CS - fetal

distress

Penile Transplantation

• Difficult to make this organ serving dual purposes of voiding urine and experiencing sexual response

• Penis made from regenerated tissue from the patient's own groin or from a donor

• Atala’s team transplanted the first bladder in1999 - urethra 2004 - vagina in 2005

Atala

Fecal transplantation

Youngster et al, MGH Boston, JAMA 2014.

Poop Pills

• Used to treat the dangerous Clostridium difficile, which kills 14,000 Americans annually

• Stool samples taken from healthy relatives is processed and the isolated bacteria bacteria alone are packed into pill cases that dissolve when they reach the intestines

• Single shot therapy• Canadian study: All 27 patients were cured

Infectious Diseases Society of America, Oct 2013

Indian origin UK woman grows beard

• Harnaam Kaur 23, is suffering from PCOS

• She had been struggling with hair growth since she was 11 and was being teased in school

• She is now growing a beard after being baptised as a Sikh.

• She would never ever remove her facial hair because it’s the way God made her and she is happy with the way she is

Frida Kahlo

YELLOW / ORANGE Motility----------------------------------------------------------------RED Morphology----------------------------------------------------------------Sweet Potato /Melon / Oats Quantity & Quality

Fertil Steril Dec 2013

Milk, Fractures and Death

• 61,433 women 39 to 74 years and 45,339 men 45 to 79 years • 22 years of follow-up • Women who drank >3 glasses of milk a day had twice the risk for death compared with women who drank less than one glass a day • Women who drank more milk also had a higher risk for any type of fracture Uppsala university, Sweden

Plasma Kisspeptin Level May Predict Miscarriage

• Found in placenta & is critical for reproduction

• Low levels of K in 1st trimester predicts miscarriage even in asymptomatic women

• Single blood test may be better than serial hCG

• Kisspeptin level >1306 pmol/L strongly indicates reduced risk for miscarriage

• It may also prove to be an Indicator for PE/IUGR

Abbara A,Jt Meeting of the International Society of Endocrinology and the Endocrine Society: ICE/ENDO 2014;  June 21, 2014.

• 30-40% of Scottish women drink in excess

• Habit has doubled in 30 yrs

• 1 in 30 deaths in women are drink-related

• Scottish campaign for ‘Smaller glasses’

• ‘Drinking Mirror’ app for cell phones

How you look today

10 years laterIf you drink in excess

If you reduce theSize of your glass

App shows women how booze affects looks

The Moon and Menses

• Study of 823 women all over the world• >39451 cycles• >20% started periods around full moon• Best time to conceive?• Around new moon!

Philip Chennette 2014

Thank you!