Essential guide

When a consultant gynaecologist and obstetrician with over 10 years practical experience in obstetrics at the busy Badulla and Anuradhapura General Hospitals, with high academic qualifications and also a senior lecturer at the Sri Jayewardenepura University, publishes a book for obstetric trainees, it is a major event in the Sri Lankan obstetric field. 

And when I have to review such a work, from a former student and later colleague, it becomes a personal pleasure. Both these are true of the recently published book "Essential Antenatal Care" by Deepal S. Weerasekera.

The book with its lucid, concise style of writing and clear presentation is a useful, ready reference and a pocket guide, not only for practising and trainee doctors and medical students but also for midwifery nursing staff as well. It provides an easy source of information for comprehensive ante-natal management while giving the reader an insight into areas like pre-pregnancy counselling and ultrasound in pregnancy that have not been given their due place in ante-natal services of Sri Lanka.

The book brings the reader up to date on the technological advances made in such important fields as growth retarded foetus and antenatal foetal surveillance. Even more interesting are the chapters on more mundane but extremely important subjects like malaria, diabetes and hypertension in pregnancy, which constitute most of the antenatal complications faced in day-to-day obstetric practice.

Professor David James, Professor of Feto-maternal Medicine of the University of Nottingham reviewing this book stated that it was a very useful ready reference book for trainees. I would go further by saying that Essential Antenatal Care is, in fact, essential reading for our Sri Lankan obstetric trainees and provides a valuable insight to obstetric management in Sri Lanka to foreign medical graduates sitting for the Act 16 examination. 

A joint problem

Arthritis means joint inflammation. In a normal joint, where two bones meet, the ends are coated with cartilage, a smooth, slippery cushion that protects the bone and reduces friction during movement. A tough capsule lined with synovial membrane seals the joint and produces a lubricating fluid. Ligaments surround and support each joint, connecting the bones and preventing excessive movement. Muscles are attached to bone by tendons on each side of a joint. Inflammation can affect any of these tissues and is a complex process that causes swelling, redness, warmth, and pain. 

The most common type of arthritis is osteoarthritis. This degenerative joint disease is common in people over 65, but may appear decades earlier. It begins when cartilage breaks down, sometimes eroding entirely to leave a bone-on-bone joint in extreme cases. 

Any joint can be affected, but the feet, knees, hips, and fingers are the most common. It may appear in one or two joints and spread no further. Painful and knobby bone growths in the fingers are common, but usually not crippling. The disease is often mild, but can be quite severe. 

The second most common form is rheumatoid arthritis. It can strike at any age, but usually appears between 20 and 50 years. The hands are most commonly affected, but it can affect most joints of the body. Inflammation begins in the synovial lining and can spread to the entire joint. Highly variable and difficult to control, the disease can severely deform joints. Some people become bedridden. 

Rheumatoid arthritis can also cause weakness, fatigue, loss of appetite, muscle pain, and weight loss. Proper treatment depends on correct diagnosis of the specific disease, and varies with severity and location, as well as from person to person. But one need not wait for a final diagnosis to begin treatment, because initial treatment options, such as anti-inflammatory drugs and exercise, are similar for many forms of the disease. Treatment should begin early to reduce joint damage. 

Treatment

Anti-inflammatory agents generally work by slowing the body's production of prostaglandins, substances that play a role in inflammation. Many anti inflammatory agents have a painkilling, effect at low doses. Usually, higher, sustained doses are required to see sufficient anti-inflammatory activity for treating arthritis. The commonest of these drugs are the non-steroidal anti-inflammatory drugs (NSAIDs). Some steroids are also used as anti-inflammatory drugs. Disease modifiers slow the disease process in autoimmune diseases such as rheumatoid arthritis. Patients taking these drugs are closely monitored. It may take weeks or months to learn if a drug works. During that wait, it's important to keep taking other medications such as NSAIDs. Gold salts have been used to treat rheumatoid arthritis for 60 years, although nobody knows why this treatment works. Penicillamine, methotrexate, and antimalarials such as hydroxychloroquine are also used. Most people with arthritis never need surgery, but when all else fails, surgery can dramatically improve independence and quality of life by reducing pain and improving mobility. The surgeon may remove damaged or chronically inflamed tissue, or replace the joint entirely. Artificial replacements are available for all of the most commonly affected joints. 

Menopause - it's only a pause

Why does a woman's body change at the menopause? 

A woman's ovaries normally produce the female hormone oestrogen as part of the process of releasing eggs. Oestrogen helps to keep many parts of the body healthy. As a woman gets older the supply of eggs in the ovary slowly runs out. Once she stops producing eggs, the major supply of oestrogen is lost and levels in the body drop considerably. This is signaled by the loss of regular monthly periods which at first become irregular and then cease altogether.

The average age at which this occurs is about 50 years, although it can begin as early as 40 or as late as 60. 

This drop in oestrogen causes hot flushes and night sweats, difficulty in sleeping, tiredness, headaches, irritability and mood swings, poor memory and concentration, thinning and drying of the skin, vaginal discomfort, dryness and urinary problems and, in the long term, increased risk of heart disease and an increased risk of osteoporosis and cancers of the genital tract. 

Most women will experience some symptoms at menopause other than the cessation of their periods and these are usually mild and transient. But because of the risks associated with osteoporosis, heart disease and genital tract cancers, it would be useful to consult a doctor on these issues, especially if there is a family history of these illnesses. He may then screen you further for these conditions and even offer Hormone Replacement Therapy (HRT), which is increasingly being resorted to, even if only for cosmetic reasons.

Research does show that, if persisted with, HRT can dramatically reduce the risk of heart disease and osteoporosis. There are many different types of HRT and sadly many women don't persist long enough with treatment to find one that suits them. This evaluation needs a discussion with your doctor.

Dump the mumps

Possible symptoms of mumps infection...

It has a relatively long incubation period of around 14 to 21 days. However, those who are noticeably affected suffer malaise, fever, muscle aches and shivers. This is followed by enlargement of one or both of the parotid salivary glands, just below the angle of the jaw, in front of and below the ears. They swell up and feel painful making it difficult for people to open their mouth, talk, eat and drink. The virus spreads in saliva or in tiny droplets of fluid when someone coughs or sneezes. Those who have mumps are infectious from up to seven days before and up to ten days after the glands first start to swell.

The vast majority of people make an easy recovery from mumps infection. However, it can in a few cases cause unpleasant and painful complications. Acute pancreatitis and inflammation of the ovaries (called oophoritis) can occur. Inflammation of the testicles (called orchitis) is very painful and affects around one in four teenage boys who have gone through puberty. Mumps infection can also cause meningitis and before the introduction of immunisation it was a leading cause of viral meningitis. Fortunately a very safe and effective vaccination is available to protect people from developing mumps infection. This is combined with the measles and rubella vaccination and is the MMR vaccination. The first dose is given between the age of 12-15 months and the second, booster, dose between the ages of 3- 5 years. Immunisation against the mumps virus provides lifelong protection and since its introduction the number of cases has steadily fallen. In time, if enough people are vaccinated, mumps infection and the possible problems it causes may become a thing of the past.

Medical news and events

The College of Venereologists of Sri Lanka will conduct a seminar on "Current management of sexually transmitted infections" on Sunday, August 12, at the auditorium of the Central STD complex, 29, De Saram Place, Colombo 10 from 9.00 a.m. onwards. A registration fee of Rs. 350 per participant will be levied and is payable at the office. The programme includes lecture/discussions on genital ulcers (by Dr. Iyanthi Abeywickrema), vaginal discharge (by Dr. Lilani Rajapakse), urethral discharge (by Dr. K. Buddhakorale) and laboratory diagnosis and interpretation of reports (by Dr. Sujatha Mananwaththa).

Book launch, annual sessions

The fifth annual academic sessions of the Faculty of Medical Sciences, University of Sri Jayewardenepura were held on Friday, July 27 at the Faculty with Vice-Chancellor of the Open University, Prof. Uma Coomaraswamy, as the Chief Guest and with the faculty lecture delivered by Dr. Palitha Abeykoon, Director, World Health Organization South Asian Regional Office. The highlight of the occasion was the launch of a book, 'Developing a Medical School: Concepts, Constraints and Challenges" by the Faculty's Founder Dean Prof. M. T. M. Jiffry. 

More Plus

Return to Plus Contents