PRETERM LABOR AND BIRTH

INTRODUCTION: Preterm labor is defined as the presence of regular uterine contractions that occur before 37 completed weeks of gestation and are associated with cervical changes. It is often difficult to diagnose preterm labor because of the absence of definitive measurements. Preterm birth is delivery that occurs prior to the completion of 37 completed weeks or an equivalent of 259 days of gestation. Because it is the most common cause of perinatal morbidity and mortality in many countries, prevention and treatment of preterm birth is one of the major focus of obstetric care.

COMPLICATIONS OF PRETERM BIRTH: In addition to perinatal death in the very young fetus, common complications of preterm birth include respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, neurologic impairment, and seizures. Long-term morbidity associated with preterm delivery includes bronchopulmonary dysplasia and developmental abnormalities, including cerebral palsy.

CLASSIFICATION: Preterm births may be classified into two general presentations: Spontaneous and indicated. Approximately 50% of preterm births result from spontaneous preterm labor with intact membranes; around 40% result from preterm premature rupture of membranes. The remaining more than 10% occur following deliberate intervention for a variety of maternal or obstetric complications such as, eclampsia.

CAUSE OF PRETERM LABOR: Preterm labor may represent a final common pathway for a number of pathogenic processes. The four main processes include;

(1) activation of the maternal or fetal hypothalamic–pituitary–adrenal axis due to maternal or fetal stress,

(2) decidual–chorioamniotic or systemic inflammation caused by infection,

(3) decidual hemorrhage, and

(4) pathologic uterine distention.

FACTORS ASSOCIATED WITH PRETERM LABOR

1. Prior history of preterm birth

2. Preterm uterine contractions

3. Premature rupture of membranes

4. Behavorial risk factors: Low maternal pregnancy, weight, Smoking, Substance abuse, Short interpregnancy interval

5. Current pregnancy factors: Short cervical length, Multifetal gestation, Vaginal bleeding, Urinary tract infections, Genital tract infection and Periodontal disease

RELATED;

1.  PREGNANCY AND CHILDBIRTH

2.  PARTURITION AND LABOR

3.  DRUGS USED IN LABOR

REFERENCES

QUANTITATIVE RESEARCH

 

OBJECTIVES:  By the end of this article, the reader/medical student will be able to;

1.  Understand the difference between qualitative and quantitative study designs

2.  Describe the sampling and sample size determination criteria used in quantitative study designs

INTRODUCTION:  This is a second approach to enquiry in the medical sciences that is rooted in rationalism.  Recently we were looking at Qualitative research and to be different,  this type follows a structured, rigid, predetermined methodology and believes in having a narrow focus.  It also, emphasizes greater sample size, and aims to quantify the variation in a phenomenon, and tries to make generalisations to the total population.

SAMPLING AND SAMPLE SIZE STRATEGIES IN QUANTITATIVE RESEARCH:  In quantitative research, the sample size must be predetermined unlike with qualitative type of research.  As we have seen earlier, since we need a large number of participants, we tend to use statistical formulae.  

RELATED;

1.  RESEARCH RIGORS  

2.  OTHER STUDY DESIGNS

3.  HOW TO WRITE A MEDICAL RESEARCH PROPOSAL

4.  RESEARCH METHODOLOGY

5.  STRATEGIES FOR DETERMINING SAMPLE SIZE

REFERENCES

EXCRETION OF DRUGS

INTRODUCTION:  Drugs are removed from the body by the process of excretion. The rate at which medications are excreted determines the concentration of the drugs in the bloodstream and tissues. This is important because the concentration of drugs in the bloodstream determines their duration of action. Pathologic states, such as liver disease or renal failure, often increase the duration of drug action in the body because they interfere with natural excretion mechanisms. Dosing regimens must be carefully adjusted in these patients. Although drugs are eliminated from the body by numerous organs and tissues, the primary site of excretion is the kidney. 

ROLE OF THE KIDNEY IN DRUG EXCRETION:  In an average-size person, approximately 180 L of blood is filtered by the kidneys each day. Free drugs, water soluble agents, electrolytes, and small molecules are easily filtered at the glomerulus. Proteins, blood cells, conjugates, and drug–protein complexes are not filtered because of their large size. After filtration at the renal corpuscle, chemicals and drugs are subjected to the process of reabsorption in the renal tubule.  Mechanisms of reabsorption are the same as absorption elsewhere in the body. Nonionized and lipid soluble drugs cross renal tubular membranes easily and return to the circulation; ionized and water-soluble drugs generally remain in the filtrate for excretion. 

FACTORS AFFECTING DRUG EXCRETION:  There are many factors that can affect drug excretion. These include the following:  Liver or kidney impairment, Blood flow, Degree of ionization, Lipid solubility, Drug–protein complexes, Metabolic activity, Acidity or alkalinity (pH), Respiratory, glandular or biliary activity. 

Drug–protein complexes and substances too large to be filtered at the glomerulus are sometimes secreted into the distal tubule of the nephron. For example, only 10% of a dose of penicillin G is filtered at the glomerulus; 90% is secreted into the renal tubule. As with metabolic enzyme activity, secretion mechanisms are less active in infants and older adults. 

THE ROLE OF pH IN DRUG EXCRETION:  Certain drugs may be excreted more quickly if the pH of the filtrate changes. Weak acids such as aspirin are excreted faster when the filtrate is slightly alkaline, because aspirin is ionized in an alkaline environment, and the drug will remain in the filtrate and be excreted in the urine. Weakly basic drugs such as diazepam (Valium) are excreted faster with a slightly acidic filtrate, because they are ionized in this environment. This relationship between pH and drug excretion can be used to advantage in critical care situations. To speed the renal excretion of acidic drugs such as aspirin in an overdosed patient, an order may be written to administer sodium bicarbonate. Sodium bicarbonate will make the urine more basic, which ionizes more aspirin, causing it to be excreted more readily. The excretion of diazepam, on the other hand, can be enhanced by giving ammonium chloride. This will acidify the filtrate and increase the excretion of diazepam. 

KIDNEY STATUS AND DRUG EXCRETION:  Impairment of kidney function can dramatically affect pharmacokinetics. Patients with renal failure will have diminished ability to excrete medications and may retain drugs for an extended time. Doses for these patients must be reduced to avoid drug toxicity. Because small to moderate changes in renal status can cause rapid increases in serum drug levels, the medical workers must constantly monitor kidney function in patients receiving drugs that may be nephrotoxic (low margin of safety). 

LEVELS OF EXCRETION OF DIFFERENT DRUGS:  Drugs that can easily be changed into a gaseous form are especially suited for excretion by the respiratory system. The rate of respiratory excretion is dependent on factors that affect gas exchange, including diffusion, gas solubility, and pulmonary blood flow.  The elimination of volatile anesthetics following surgery is primarily dependent on respiratory activity; the faster the respiratory rate, the greater the excretion. Conversely, the respiratory removal of water-soluble agents such as alcohol is more dependent on blood flow to the lungs; the greater the blood flow into lung capillaries, the greater the excretion. In contrast with other methods of excretion, the lungs excrete most drugs in their original nonmetabolized form. 

Glandular activity is another elimination mechanism. Water-soluble drugs may be secreted into the saliva, sweat, or breast milk. The odd taste that patients sometimes experience when given IV drugs is an example of the secretion of agents into the saliva. Another example of glandular excretion is the garlic smell that can be detected when standing next to a perspiring person who has recently eaten garlic. Excretion into breast milk is of considerable importance for basic drugs such as morphine or codeine, because these can achieve high concentrations and potentially affect the nursing infant.  Nursing mothers should always check with their health care provider before taking any prescription medication, OTC drug, or herbal supplement.

RELATED;

1.  PHARMACOKINETICS

2.  PHARMACODYNAMICS

3.  PHARMACOLOGY AND THERAPEUTICS

REFERENCES

OPPORTUNISTIC MYCOSES

INTRODUCTION: Opportunistic mycoses (OM) that affect skin and mucosa as well as internal organs are caused by both yeast and molds. A precondition for development of such infections is a pronounced weakness in the host’s immune defenses. Candidiasis is an endogenous infection. Other OMs are exogenous infections caused by fungi that naturally inhabit the soil or plants. These environmental fungi usually invade via the respiratory tract. The most important are aspergillosis, cryptococcosis, and the mucormycoses. Besides Candida and other yeasts, phaeohyphomycetes and hyalohyphomycetes, which are only very mildly pathogenic, can also cause systemic infections. All OMs have a primary infection focus, usually in the upper or lower respiratory tract. From this focus, the pathogens can disseminate hematogenously and/or lymphogenously to infect additional organs. Infection foci should be removed surgically if feasible. Antimycotic agents are used in chemotherapy. It should be noted that, at least 70% of all human Candida infections are caused by C. albicans, the rest by C. parapsilosis, C. tropicalis, C. guillermondii, C. kruzei, and a few other rare Candida species.

MORPHOLOGY AND CULTURE: Gram staining of primary preparations reveals C. albicans to be a Gram-positive, budding, oval yeast with a diameter of approximately 5 μm. Gram-positive pseudohyphae are observed frequently and septate mycelia occasionally. C. albicans can be grown on the usual culture mediums. After 48 hours of incubation on agar mediums, round, whitish, somewhat rough-surfaced colonies form. They are differentiated from other yeasts based on morphological and biochemical characteristics.

PATHOGENESIS AND CLINICAL PICTURES: Candida is a normal inhabitant of human and animal mucosa (commensal). Candida infections must therefore be considered endogenous. Candodoses usually develop in persons whose immunity is compromised, most frequently in the presence of disturbed cellular immunity. The mucosa are affected most often, less frequently the outer skin and inner organs (deep candidiasis). In oral cavity infections, a white, stubbornly adherent coating is seen on the cheek mucosa and tongue. Pathomorphologically similar to oral soor is vulvovaginitis. Diabetes, pregnancy, progesterone therapy, and intensive antibiotic treatment that eliminate the normal bacterial flora are among the predisposing factors. Skin is mainly infected on the moist, warm parts of the body. Candida can spread to cause secondary infections of the lungs, kidneys, and other organs. Candidial endocarditis and endophthalmitis are observed in drug addicts. Chronic mucocutaneous candidiasis is observed as a sequel to damage of the cellular immune system.

DIAGNOSIS: This involves microscopic examination of preparations of different materials, both native and Gram-stained. Candida grows on many standard nutrient mediums, particularly well on Sabouraud agar. Typical yeast colonies are identified under the microscope and based on specific metabolic evidence. Detection of Candida-specific antigens in serum is possible using an agglutination reaction with latex particles to which monoclonal antibodies are bound. Various methods are used to identify antibodies in deep candidiasis (agglutination, gel precipitation, enzymatic immunoassays, immunoelectrophoresis).

THERAPY: Nystatin and azoles can be used in topical therapy. In cases of deep candidiasis, amphotericin B is still the agent of choice, often administered together with 5-fluorocytosine. Echinocandins (e.g., caspofungin) can be used in severe oropharyngeal and esophageal candidiasis.

EPIDEMIOLOGY AND PREVENTION: Candida infections are, with the exception of candidiasis in newborn children, endogenous infections.

RELATED;

1. HIV/AIDS  

2. IMMUNITY  

3. NORMAL FLORA OF THE HUMAN BODY

4.  MEDICAL MICROBIOLOGY

REFERENCES

BARBITURATES

 

Examples:  Amobarbital, Butabarbital, Mephobarbital, Pentobarbital, Phenobarbital, Secobarbital

Mechanism of action and drug effects:  Bind to specific GABA_A receptor subunits at CNS neuronal synapses increasing duration of GABAmediated chloride ion channel opening and then enhance membrane hyperpolarization.

Pharmacological effects:  Dose-dependent depressant effects on the CNS including sedation and relief of anxiety, amnesia, hypnosis, anesthesia, coma and respiratory depression, steeper dose-response relationship than benzodiazepines.

Clinical applications:  Anesthesia (thiopental), insomnia (secobarbital), seizure disorders (phenobarbital).

Pharmacokinetics, toxicity and drug-drug interactions:  Half-lives from 4–60 h, oral activity.  Hepatic metabolism-phenobarbital 20% renal elimination.  Toxicity: Extensions of CNS depressant effects;  dependence liability benzodiazepines.  Interactions: Additive CNS depression with ethanol and many other drugs.  Induction of hepatic drug-metabolizing enzymes.

RELATED;

1.  DRUGS USED IN INDUCTION OF SLEEP

2.  BENZODIAZEPINES

3.  PHARMACOLOGY AND THERAPEUTICS

REFERENCES

PREVAILING RESEARCHABLE PROBLEMS 2023

PREVAILING RESEARCHABLE PROBLEMS 2023:  It sometimes take time for a medical student to generate a research topic and although we frequently talk about a research problem first, it becomes a hard topic for many of us.  There are thousands of problems being faced in the field of medicine and social sciences today that can be researchable.  The only thing is that because we are living in regions with different environment, policies and we are using different foods let say, most of the problems we face tend to be regional-based and therefore somehow restricted globally.  

For some can be generalized to the entire globe and for others, we can only talk about them being regional and or specific to some group of people. Many times students find hard time generating research problems and therefore be able to come up with a creditable research topic.  On this page, we are going to look at some of the current, prevailing researchable medical and social problems.  It should be noted however that, these problems are not words of "Mega Mover Empire" page, but day-to-day issues published in media, reports from the government and non government organizations plus results from previous studies as will be cited and referenced.

NUTRITION AND FOOD SECURITY

1.  Uganda has continued to suffer periods of food insecurity and higher than expected cases of childhood malnutrition despite Government efforts to sensitize communities about good agricultural practices.  It is postulated that, 12% of the Ugandan population is still experiencing episodes of food insecurity and this is especially true for most parts of North and North East of the country.  Karamoja and some parts of Teso, have registered over 1000 deaths related to famine and hunger.  

[Sources:  (FAO, 2022)]

2.  According to UNICEF (2022) in their article about nutrition and it's impact in children, Uganda still faces one of the biggest burden of undernutrition in children below five years of age.  It is estimated that 4 in every 10 children in the country die from causes related to undernutrition, and stunted growth is estimated to affect a third of all children in the country. UNICEF, 2022)

TROPICAL DISEASES

1.  In struggle to fight malaria through provision of mosquito nets and community sensitization, Uganda continues to have one of the highest burden of the disease.  In Uganda malaria is responsible for up to 50% of all outpatient visits and up to 20% of hospital admissions in health facilities, with 90% of the general population at risk of contacting the disease.  (Kayondo J., 2022)

2.  Pneumonia has remained as big burden among childhood illness in Uganda.  In a research conducted by African health sciences (2021) about the prevalence of pneumonia and associated factors related to respiratory conditions, the disease was found to contribute 25.6% of all children admitted with respiratory symptoms. 

3.  HIV/AIDS still pose a big burden in many communities across the globe with a staggering more than 38 million individuals affected of which more than 60% are found in sub Saharan Africa (WHO, 2021)

MATERNAL, CHILD AND INFANT HEALTH

1.  The infant mortality rate in Uganda 2022 stands at 40 per 1000 live birth, higher that the Sustainable development goals target 3.2, which is aiming at ending it by 2030.  (WHO; 2022)

2.  The under five mortality rate in Uganda in 2022 is reported to be 40.564 per 1000 live birth.  The trend to reduce the number is on the course but still higher than the the Sustainable development goal target 3.2 of reducing it to at most 25 per 1ooo live birth. (Macrotrends, 2022:  UNICEF, 2022)

3.  The maternal mortality rate in Uganda stands at 336 per 100,000 live birth by 2016.  There is an annual decrease of about 1.7% on average from 2011 however, the number is still higher compared to Sustainable development target of 70 per 100,000 live birth by 2030.  (WHO, 2022)

4.  Following the 2 year of COVID 19 pandemic in Uganda in the years 2020 and 2022, the rate of teenage pregnancy rose by 28-30% leaving an enomous school dropouts especially in primary schools (Ojulu, 2021)

RELATED;

1.  HOW TO WRITE A RESEARCH PROPOSAL

2.  THE PROBLEM STATEMENT

3.  RESEARCH METHODOLOGY

REFERENCES

UGANDAN GOSPEL MUSIC

UGANDAN GOSPEL MUSIC

JUDITH BABIRYE

1.  Butonotono

Download mp3

2.  Nzijukira

Download mp3

3.  Judith Babirye non-stop music 2015

Download Mp3

JOSEPH SEGAWA

1.  Nina omubeezi

2.  Nze ngumye

3.  Aligabanaki

4.  Omuntu kyasiga

5.  Biyinzika

SILVER KYAGULANYI

1.  Ekisa ekinondoola

Download mp3

RELATED;

1.  GOSPEL MUSIC DOWMLOADS

2.  NON-STOP MUSIC DOWNLOAD LINKS

3.  ANDROID APPS DOWNLOAD

PASSIVE IMMUNIZATION

 

INTRODUCTION:  Human immunity can either be induced artificially, or acquired naturally.  Passive immunization consists of transfer of immunity to a host using preformed immunologic products. From a practical standpoint, only immunoglobulins have been used for passive immunization, because passive administration of cellular components of the immune system has been technically difficult and associated with graft-versus-host reactions.  Graft-versus-host reactions are complications that result from donation of organs or products from a different individual or external source in which the body may view it as foreign due to the differences in the Major histocompatibility complex (MHC).   

Products of the cellular immune system such as interferons have also been used in the therapy of a wide variety of hematologic and infectious diseases.  Passive immunization with antibodies may be accomplished with either animal or human immunoglobulins in varying degrees of purity.  These may contain relatively high titers of antibodies directed against a specific antigen or, as is true for pooled immune globulin, may simply contain antibodies found in most of the population. Passive immunization is useful for;

(1) individuals unable to form antibodies for example, congenital agammaglobulinemia

(2) prevention of disease when time does not permit active immunization such as, postexposure

(3) for treatment of certain diseases normally prevented by immunization such as, tetanus and  

(4) for treatment of conditions for which active immunization is unavailable or impractical (eg, snakebite).  

Complications from administration of  human  immunoglobulins are rare. The injections may be moderately painful and rarely a sterile abscess may occur at the injection site. Transient hypotension and pruritus occasionally occur with the administration of intravenous immune globulin (IVIG) products, but generally are mild. Individuals with certain immunoglobulin deficiency states (IgA deficiency, etc) may occasionally develop hypersensitivity reactions to immune globulin that may limit therapy.

RELATED;

1.  THE BCG IMMUNISATION FOR NEONATES 

2.  IMMUNOGLOBULINS 

3.  IMMUNOLOGY

4.  SPECIFIC IMMUNITY

5.  MAJOR HISTOCOMPATIBILITY COMPLEX

[REFERENCES]