Vaginal seeding of newborn C-section babies

Bismillah, alhamdulillah: interesting podcast on a very new topic. Babies born by C section versus normal delivery have been noted to have different risks of non communicable diseases. The risks of obesity and asthma are greater in C section babies. The biome bacterial commensal flora between these two babies is different. So it has been the request of some mothers that vaginal seeding be done after a C section.

A gauze of vaginal fluid from the mother is applied to the newborn, starting from the mouth and then all over the body. This is an attempt to direct bacterial colonisation and make it resemble a vaginal delivery.

The author of an editorial in the BMJ discusses the lack of evidence for the practice and cite possible worries of introducing infection to the newborn but estimate the risk is unlikely to be greater than a vaginal delivery. The  benefits are as of yet uncertain but this is likely to be a hot topic of research in the future and mothers may ask what we would advise.

What is vaginal seeding – and is it safe
The BMJ Podcast
http://feeds.bmj.com/~r/bmj/podcasts/~5/RG5R0Guhdd4/248513030-bmjgroup-what-is-vaginal-seeding-and-is-it-safe.mp3

How should health professionals engage with this increasingly popular but unproved practice?

Aubrey Cunnington, a consultant pediatrician from Imperial College London joins us to discuss.

Read the f…

Subscribe the podcast http://feeds.bmj.com/bmj/podcasts

Clash between Issac Newton and Robert Hooke

Bismillah, alhamdulillah: Robert Hooke v Issac Newton an interesting clash of personalities between the two. Newton won because he was better at maths!

In Our Time
http://open.live.bbc.co.uk/mediaselector/5/redir/version/2.0/mediaset/audio-nondrm-download/proto/http/vpid/p03jyjtb.mp3

Melvyn Bragg and guests discuss the life and work or Robert Hooke (1635-1703) who worked for Robert Boyle and was curator of experiments at the Royal Society. The engraving of a flea, above, is taken …

Zika and genetically modified mosquitoes …

Bismillah, alhamdulillah:

My take home points from the latest and excellent virology podcast on Zika with Prof. Vincent Racaniello and his guests and his blog notes:

  • Where does the name Zika come from? The Zika forest of Uganda.
  • When was it discovered? 1947 when it was found to cause an infection in a monkey kept in a cage in the forest by the Rockefeller foundation.
  • How long has it affected humans for? Serological studies in the 1950’s show human antibodies against it. Isolated from humans in Nigeria in 1968
  • Where is it present? Serologically speaking: Africa (Uganda, Tanzania, Egypt, Central African republic, Sierra Leon, Gabon) and Asia (India, Malaysia, Philippines, Thailand, Vietnam)
  • When did it migrate from Africa and Asia? 2007/13 arrived in French Polynesia (South Pacific ocean half way between Australia and the South America). 2014 arrived with the World Cup to South America in 23 countries in S America
  • Is the Brazilian virus different? Brazilian virus has an Asian genotype.
  • What type of virus is it? Flavivirus – like Yellow fever, Dengue, West Nile and Japanese encephalitis.
  • What mosquito carries it? Aedes
  • Signs and Symptoms? 75% are asymptomatic. 25%: rash, fever, joint pain, red eyes and headache. Occur 2-10 days after infection. Fatality: rare.
  • Is microcephaly a proven association? Not yet
  • What is the difference between Colombia and Brazil? High incidence of Zika in Columbia but no microcephaly reported – early or different? Not sure yet.
  • Any other fetal damage? Not known.
  • Test of choice? Quick serology tests not yet FDA approved. Reverse Transcriptase PCR is the test of choice.
  • Are genetically modified mosquitoes released in a part of Brazil to blame? Unlikely, because they were released far away from current high incidence areas in Brazil and mosquitoes cannot fly far.  My comment: Eradicating mosquitoes using GM modified mosquitoes – I am not sure if this is amazing or horrifying. Time will tell. Nevertheless the release of GM modified mosquitoes in Brazil is quite a milestone. I wonder what legal framework and environmental checks were put into place to make sure that this experiment did what it was supposed to and not anything else. The TWiV team note that the mosquitoes have a gene which allows them to reproduce when tertacycline is given to them. But they become sterile when there is no tetracycline. The modified gene coding which gives rise to sterility is transmitted to all offspring. The place it was released had a 90% drop in mosquitoes. Does the company Oxitec who GM’ed the mosquitoes know that Doxycycline is used as a prophylaxis against malaria and as a treatment for infection? And that it happens to be a “a broad-spectrum antibiotic of the tetracycline group”?  Did they factored this in to their risk assessment? As for these GM mosquitoes being far away, mosquitoes have a bad habit of hitching rides in planes and cars as the cases of  ‘airport malaria’ have shown in the UK. I hope the TWiV team are right and the GM mosquitoes are nothing but a conspiracy theorists best friend but it does raise an eyebrow that this fairly innocuous virus to date has started behaving oddly in a country where these GM mosquitoes just happen to be. I also wonder how such an experiment was sanctioned in the first place? How many more GM modified insects are roaming around? 
  • Is there a window of infection? Not known.
  • Could there be another explanation? Yes, blood bone other pathogen, pesticides, water born agent – all unclear.
  • Sexually transmitted? The TWiV team not too convinced by the case reports.
  • Transmitted versus transmissible – a neat point: the majority of transmission is via mosquitoes but possible sexual transmission is possible.

Reference:

The Zika update from Professor  Vincent Racaniello Ph.D., Professor of Microbiology & Immunology in the College of Physicians and Surgeons of Columbia University and his podcast team. TWiV 375: Zika and you will find This Week in Virology with Vincent Racaniello
 http://feedproxy.google.com/~r/twivmp3/~5/Q-br7pcccxU/TWiV375.mp3
TWiV is a weekly netcast about viruses - the kind that make you sick. Brought to you by four university professors and a science writer.
Subscribe the podcast http://feeds.feedburner.com/twivmp3

Stents in stable angina – yes or no?

Bismillah, alhamdulillah:

In short: no. The podcast makes for an interesting listen. The cardiologist who has authored a paper on the subject concludes the opposite. Not based on evidence of prognostic improvement but a ‘if this was my dad what would I do analysis’. Symptomatic relief versus a 1% complication risk including MI or CVA to the cardiologist looked like a good trade off. The degree of enthusiasm of the cardiologist made him sound like a salesman. To me it underlined the greatest role of a family doctor: to save the patient from the health system. 

Have a listen:

The role of stenting in stable angina
The BMJ Podcast
http://feeds.bmj.com/~r/bmj/podcasts/~5/bgv_xqOhCWU/245551067-bmjgroup-stenting-stable-angina.mp3

Iqbal Malik, consultant cardiologist at Imperial College Healthcare NHS Trust in London, joins Mabel Chew to discuss the role of angioplasty and stenting in patients with stable angina.

Read the fu…

Subscribe the podcast http://feeds.bmj.com/bmj/podcasts

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iPICT – Insulin Patient Information Communication Tool

Bismillah, alhamdulillah:

Communication tools are great for communication and getting the health message across to patients. The recent example from the Mayo clinic on CVD risk assessment was one such example. My personal favourite is Dr Rupert Payne’s CVD risk calculator.  Framingham Rupert PayneOnce I draw the hba1c-chartattention of the patient to their risk and then unclick their smoking status the jump from a red or yellow zone to a green zone has an amazing effect on patients. Many patients have given up smoking after seeing this! I loved the speedometer concept by Diabetes.co.uk with regard to the HbA1c.

 

i-PICT

Insulin PICT (6)Insulin PICT (12)But what about instructing patients on how to take insulin and set up their own ‘slow sliding scale’. In the UK a lot of this work is done by diabetic educators but with the case load in diabetes being very high I have been looking around for a simple answer.  I have had a rummage through the Internet but did not find much. So I came up with my own little Patient Instruction Communication Tool which I am trialling out on patients.

 

  • Presentation link – note you can download this to your desktop as a Powerpoint file.
  • The slides use what I call the Slow Sliding Scale i.e. changes in insulin dosage based on a 3 day set of readings – if 2 out of 3 or 3  out of 3 readings are above the target then a change to the insulin dose is made.
  • Each slide has a small explanatory text in the bottom right hand corner which suggests how to use it.
  • Use and/or modify it as you need.

Let me know if you have any: suggestions, find it useful, develop it further or translate it into a different language.

 

Big Data & Big Brother – meet the two new Big’s of medicine

Bismillah, alhamdulillah:

In case you have not heard the terms already Big Data is the study of very large data sets which come from huge sources of data such as genome analysis of patients or genomics or the rapid analysis of the millions of proteins in a drop of blood or in cells, proteomics. The data is called ‘big’ because not only can a single patient give potentially huge amounts of data, with newer and increasingly faster techniques of analysis large populations of patients can be analysed rapidly with the data being pooled.  The data collected will range in the billions of points of data, all requiring super fast computers and clever mathematicians to analyse the difference between patients give a certain medication. Trying to find what makes some patients respond well to medication and others not.

On the flip side of the coin is what could be called “Big Brother” medicine. Here researchers collect real time data with multiple sensors. Sensors that monitor whether or not you are in the kitchen or at the local pizza place, that monitor how much you have moved, did you just open the fridge door, who is next to you and then send you a reminder in real time to rethink your dietary choices or do some more exercise. This might sound like science fiction but we are on the brink of this revolution in medicine. Have a listen to Eric Topol who interviews Donna Spruijt-Metz on how mobile sensors can be used to both understand childhood obesity and change eating behavior.

http://bi.medscape.com/pi/editorial/studio/audio/2016/core/857590.mp3