Brazilian baby ‘born healthy with two heads… and both are suckling mother’s breasts’

• Mother only found about her baby’s abnormalities minutes before birth
• This is the second registered case of a two-headed baby being born in Brazil this year
  

A Brazilian woman who has given birth to a baby with two heads, admitted she had initially expected twins.

Maria de Nazare, gave birth by caesarean at a hospital in Anajas, in Brazil’s northern Para state, with her newborn weighing 9.9lbs.

And in a tribute to the religious celebrations at Christmas, she has decided to call the pair Emanoel and Jesus.

Following the birth of her baby, mother Maria, 25, admitted that she had been told she was set to welcome twins.

But following a number of tests, doctors have revealed that the baby has two brains and two spines but shares one heart, lungs, liver and pelvis.

The hospital’s director, Claudionor Assis de Vasconcelos, told Brazil’s O Povo newspaper that the woman decided to travel to the hospital because she was feeling strong abdominal pains.

 The 25-year-old mother, who lives in a rural area of the state, had no ultra-sound scans during her pregnancy and only found out about the abnormality minutes before the baby was born at 1am on Monday morning.

He said: ‘When doctors scanned her they realised that the baby had two heads and that a normal birth would be a great risk both for mother and baby. The caesarean took an hour because the baby was sitting down.

‘Despite all the problems we have as a small interior hospital we managed to save both mother and baby, which was our aim. And for us it was a great surprise to find out that the child was in really good health.’

Mr Vasconcelos added that at no point did the mother, who has three other children, appear distraught that her son has two heads.

He said: ‘On the contrary, the baby was received with much happiness by the family.

‘The mother fed both mouths and the baby stayed with her in her room the whole time. Her desire was to take her baby straight home.’

The mother and baby were taken by air ambulance yesterday afternoon to a specialist hospital in the state capital, Belem, to carry out further tests. They are expected to be allowed home later this week.

Remarkably, this is the second time a two-headed baby has been born in Brazil this year. Sueli Ferreira, 27, gave birth to a two-headed baby in Paraiba State, but it died a few hours later because of lack of oxygen to one of the child’s heads.

Source: Daily Mail

How can I prevent further episodes of bacterial vaginosis?

Most episodes of BV occur for no apparent reason, and cannot be prevented. However, the following are thought to help prevent some episodes of BV. The logic behind these tips is to try not to upset the normal balance of bacteria in the vagina:

• Do not push water into your vagina to clean it (douching).
• Do not add bath oils, antiseptics, scented soaps, perfumed bubble bath, shampoos etc, to bath water.
• Do not use strong detergents to wash your underwear.
• Do not wash around your vagina too often. Once a day is usually enough

Source: Patient.co.uk

Scalp dissecting cellulitis

A 27 year-old Caucasian male presented with tender progressing fluctuant nodules and alopecia on his scalp for seven years.  The lesions often oozed a serosanguinous discharge and bled occasionally.  All cultures of the discharge were negative.   He had been treated with courses of doxycycline, isotretinoin, and intralesional kenalog without significant improvement.   A trial of oral steroids relieved the tenderness and reduced the discharge temporarily.  Past medical history was significant for scarring acne on the face, multiple pilonidal cysts, and hidradenitis suppurativa.  Family history was negative for any similar skin conditions.   He was not taking any medications or supplements.

On examination, flesh-colored tender fluctuant nodules with scarring alopecia were noted on the scalp (Figure 1).  The nodules formed intercommunicating sinuses that expressed a serosanguinous discharge when palpated.   Deep pitting scars were seen on the face.  Scars were noted in bilateral axillae and adjacent to the gluteal cleft from prior surgical incisions.   Lymphadenopathy was absent.  The remainder of the physical exam was unremarkable.

Figure 1

Diagnosis

Dissecting cellulitis as part of the follicular occlusion tetrad

About the condition

Dissecting cellulitis, also referred to as perifolliculitis capitis abscedens et suffodiens (PCAS) or Hoffman Disease, is a progressive chronic suppurative condition most commonly affecting African American males between the ages of 18 and 40 years old.1   Although less common, females and children can be affected.2, 3  The specific etiology of this uncommon condition is unknown, but the mechanism is thought to be due to follicular blockage or occlusion.1  Sebaceous material accumulates and causes dilation and rupture of the follicle resulting in a localized neutrophilic and granulomatous response.   Secondary bacterial infection can occur, but it is not the primary cause.

The condition begins with simple folliculitis on the scalp progressing to perifollicular pustules, fluctuant nodules, and sinus tract formation.  Alopecia initially begins as telogen effluvium secondary to inflammation and then progresses to patchy scarring alopecia.  Regional lymphadenopathy is characteristically absent, unless a secondary infection is present. Serosanguinous or seropurulent fluid may be expressed from the nodules.  Culture of the discharge is typically negative.

Although spondyloarthorpathy has been reported, most patients do not have systemic symptoms or disease.  Osteomyelitis of the skull and squamous cell carcinoma can rarely occur in patients with dissecting cellulitis.

On histological examination, early lesions will show dense neutrophilic, lymphocytic, histiocytic, and plasma cell infiltrates.  Abscesses may be seen in the dermis and subcutaneous tissue.  Granulomas, foreign body giant cells, scarring, and fibrosis may be seen later in the disease process.

Dissecting cellulitis is considered to be a part of a follicular occlusion tetrad.  Patients with the tetrad present with scarring acne conblogata, pilonidal cysts, hidradenitis suppurativa, and dissecting cellulitis. This patient had all four components of the tetrad. 

Clinically, dissecting cellulitis can mimic acne keloidalis nuchae, pseudopelade of Brocq, tinea capitis, tufted folliculitis, and discoid lupus erythematous. Table 1 lists the differential diagnosis for dissecting cellulitis with the defining clinical characteristics and treatments included. 

    Table 1: Differential Diagnosis

Dissecting cellulitis is a difficult condition to treat.   Medical therapies include antibiotic soaps (chlorohexidine and benzoyl peroxide), dapsone, intralesional kenalog, zinc supplements,8 topical and oral isotretinoin, oral antibiotics (tetracycline and doxycycline), and oral steroids.1,4  Of these, an extended course of oral isotretinoin appears to be the most effective therapy.1   CO2, 800nm, long-pulse non-Q-switched ruby, and long-pulsed Nd:YAG lasers have been used with variable success.9-12  Although reported as being effective, x-ray therapy is not routinely used because of undesirable side effects including skin cancer.1,4  However, in 2005, Chinnaiyan et al reported the use of modern external  beam radiation to successfully treat refractory dissecting cellulitis without long-term complications.13  More commonly, surgical methods are used for severe and intractable cases.   Simple incision and drainage and wide excision with split-thickness skin grafting have been used to treat severe cases.   Medical therapy is usually used first.  If not responsive, the patient may benefit from more aggressive destructive or surgical therapies.  Patients with dissecting cellulitis typically benefit from early dermatology consultation.

The patient described above is currently awaiting dermatology evaluation for surgical treatment.  He has failed multiple medical therapies. 

In addition to sending these patients to dermatology, the primary care provider should evaluate the lesions for secondary bacterial or fungal infections with culture and KOH preparation.   Although rare, if osteomyelitis is suspected, a CT scan should be considered.  A careful skin examination of the affected site should be preformed to identify squamous cell carcinomas, especially if previously treated with x-ray therapy.  

 Source:Priory.com

Buried Penis

A buried penis occurs where the shaft of the penis is literally buried under excess skin and fat – often as a result of obesity and significant weight loss.

Although size isn’t meant to matter when a man’s endowment isn’t big enough to use it definitely becomes an issue for him. Believe it or not, it’s thought that up to 1 out of every 200 men is born with what’s medically known as ‘micro-penis’. Micro penis is as simple as it sounds – the sufferer’s penis is considerably smaller than anyone’s estimate of ‘average’. It’s an exclusive club and members (pun intended) need to be less than 7 centimetres to join. Whilst the free Wi-Fi and friendly bar staff may be great perks of the clubhouse it also has its downsides; those with micro penis may (though not always) have trouble urinating and having sexual intercourse. Whilst there is no real health risk it clearly has detrimental effects on a man’s personal life often resulting in serious confidence issues such as low self esteem which could in turn lead to a more serious mental illness like depression. There are a number of potential causes for the condition such as a congenital growth hormone deficiency, a reduced rate of androgen production, inadequate levels of testosterone at 2nd and 3rd stages of pregnancy and the inability to respond to testosterone in general. Micro penis is often noticed at a young age and can therefore be treated with hormone therapy which would typically use injections of testosterone and human chorionic gonadotropin. However if it goes unnoticed treatment in adulthood is far more complicated but new research has refined a surgical process called phalloplasty which involves taking skin from the patient’s forearm to make a penis with, fitting it with a plastic urethra and inflatable mechanism to enable erections. Whilst this might sound daunting it still sounds more appealing than an old solution which saw doctors recommend that parents bring their micro penis inflicted baby boys up as baby girls. Yikes.

Source: Embarassing bodies

The 5p-a-day wonder: Cheap blood pressure drug ‘slashes breast cancer risk’

A drug used to treat high blood pressure costing less than 5p a day could cut the risk of women dying from breast cancer.

Researchers found the beta blocker propranolol, a drug developed 40 years ago, cut the chances of dying by up to 81 per cent.

Women using it in the year before falling ill were 76 per cent less likely to be diagnosed with advanced cancer than those not using it.

Beta blocker: Propranolol, a drug developed 40 years ago, could cut the chances of dying from breast cancer by up to 81 per cent

The breakthrough could lead to the drug being investigated for both the treatment of breast cancer and prevention of recurrence.

The findings, published in the Journal of Clinical Oncology, support the results from a smaller study last year by scientists from Nottingham University.

That showed a 71 per cent reduction in breast cancer deaths among women already using beta blockers for high blood pressure.

Propranolol was developed in the 1960s to treat high blood pressure, angina, heart failure, anxiety and even migraine.

There is growing evidence that the effect of beta  blockers on stress hormones could also have major benefits in cancer.

Laboratory studies suggest the drugs prevent stress hormones reaching their target which, in cancer cells, prevents the hormones from stimulating and activating them.

Seat of learning: The research was carried out in part at Trinity College, Dublin, pictured, with help from colleagues at Johns Hopkins University Hospital in Baltimore

The latest study at Trinity College, Dublin, and Johns Hopkins University in Baltimore in the U.S., looked at more than 5,000 women in Ireland diagnosed with breast cancer between 2001 and 2006.

Altogether 70 women were taking propranolol for conditions such as high blood pressure before their diagnosis and 525 were on another type of beta blocker, atenolol.

When they compared survival rates with another 4,738 breast cancer patients who had not been taking the drugs, they found propranolol users were 81 per cent less likely to have died from their condition after five years than non-users.

ACE inhibitor: One of the cheap blood pressure drugs that have become prevalent in recent years

Mortality rates among women on atenolol were similar to those not taking blood pressure medication.

Researchers believe this may be because propranolol acts on two types of receptors on the surface of cells but atenolol only acts on one.

The researchers said: ‘The results suggest that the use of propranolol is associated with less advanced disease at diagnosis and lower breast cancer-specific mortality.’

They said women using propranolol in the year before a breast cancer diagnosis were significantly less likely to have an advanced tumour that had spread to other parts the body.

They added that the ‘most notable result’ was the finding that propranolol users had a significantly lower risk of dying of breast cancer.

The team acknowledged the number of propranolol patients in the study was low and said: ‘We cannot exclude the possibility that the results were due to chance.’

It is estimated that two million Britons take beta blockers, which are prescription-only drugs.

However, in recent years newer drugs such as ACE inhibitors have been used to control high blood pressure.

Although beta blockers are long-established and cheap because they are available as generics, they can have side-effects such as dizziness, sleeping problems and may raise the risk of type two diabetes.

Doctors would be unlikely to prescribe them for treatment of breast cancer but the hope is that new drugs could exploit the newly discovered anti-cancer mechanism.

Experts at the University of California Los Angeles said future breast cancer treatment trials should collect data on beta blocker use because it could be a ‘critical target’ for future treatment and prevention of recurrence.

Cancer Research UK stressed bigger trials were needed before beta blockers could be considered as an anti-cancer treatment.

Around 48,000 women in Britain are diagnosed with breast cancer each year.

 Source: Daily mail

Orthostatic hypotension is an excessive decrease in blood pressure that occurs when a person stands up, resulting in reduced blood flow to the brain and dizziness or fainting.

• Dizziness or light-headedness that occurs when a person sits up or stands abruptly is the most common symptom.
• Measuring blood pressure while the person is sitting and standing may reveal orthostatic hypotension.
• When the cause cannot be cured, people are taught to stand up gradually and to drink plenty of fluids.

Orthostatic hypotension is particularly common among older people.

Orthostatic hypotension is not a specific disease but an inability to compensate quickly for changes in blood pressure. When a person stands up suddenly, gravity causes about a pint of blood to pool in the veins of the legs and lower body. As a result, the amount of blood returned to the heart and pumped out by the heart is reduced, and blood pressure falls. Normally, the body quickly responds to a decrease in blood pressure: The heart beats faster and more forcefully to increase its output of blood and the arterioles (small arteries) constrict to increase resistance to blood flow (see Low Blood Pressure: Introduction). If these compensatory mechanisms malfunction or function too slowly—both of which commonly occur in older people—orthostatic hypotension may occur.

Causes

Orthostatic hypotension is caused by conditions that interfere with the compensatory mechanisms that control blood pressure. These conditions include many disorders and drugs as well as normal age-related changes.

Some conditions cause orthostatic hypotension by affecting the heart’s ability to increase its output enough when a person stands. This problem can be caused by heart disease, such as abnormal heart rhythms and heart valve disorders. Also, with aging, the body becomes less able to increase the heart rate (and thus the heart’s output) when a person stands.

Some conditions cause orthostatic hypotension by reducing blood volume. Diuretics, which are used to treat high blood pressure, can reduce blood volume by removing fluid from the body. Diuretics, especially potent ones given in high doses, are a common cause of orthostatic hypotension. Other causes of reduced blood volume include bleeding and an excessive loss of fluid due to severe vomiting, diarrhea, excessive sweating, or excessive urination (which is a common symptom of untreated diabetes or Addison’s disease). Among older people, dehydration during an illness is a common cause of low blood volume leading to orthostatic hypotension. People who are ill may not be able to obtain fluids without assistance. Also, during an illness, the leg muscles are not used regularly. As a result, blood pools in the leg veins and is not pumped back to the heart (see Venous Disorders: Introduction). Because this pooling reduces the amount of blood returning to the heart, it, in effect, reduces blood volume and thus reduces blood pressure.

Some conditions cause orthostatic hypotension by dilating arterioles and veins. Drugs that dilate arterioles (vasodilators) can cause orthostatic hypotension. They include nitrates, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, alpha blockers, alcohol, and antidepressants. Disorders such as diabetes, amyloidosis, and spinal cord injuries may damage the nerves that regulate blood vessel diameter. In addition, veins dilate when body temperature increases, for example, because of a warm day, a warm room, or too much clothing. Fever also has this effect.

Fatigue, exercise (which causes blood vessels to dilate), or consumption of a heavy meal (which requires increased blood flow to the intestine) can contribute to orthostatic hypotension.

Symptoms and Diagnosis

Most people with orthostatic hypotension experience some faintness, light-headedness, dizziness, confusion, or blurred vision when they get out of bed abruptly or stand up after sitting for a long time. Symptoms are worse if people are tired, have been exercising, have consumed alcohol, or have eaten a heavy meal. A severe decrease in blood flow to the brain can cause the person to faint and even to have seizures.

These symptoms suggest orthostatic hypotension. The diagnosis can be confirmed if the blood pressure falls significantly when the person stands and returns to normal when the person lies down. Doctors then look for the cause of orthostatic hypotension, because treatment and prognosis depend on the cause.

Treatment

Even when the cause of orthostatic hypotension cannot be treated, certain measures can often reduce or eliminate symptoms. For example, susceptible people should not sit or stand up rapidly or remain standing still for long periods. They should sit or stand up slowly. Wearing fitted elastic stockings up to the waist may help reduce pooling of blood in the leg veins. If orthostatic hypotension results from prolonged bed rest, gradually increasing the time spent sitting up each day may help.

Several measures help maintain blood volume. People with orthostatic hypotension should drink plenty of fluids and little or no alcohol. People who do not have heart failure or high blood pressure are often told to salt their food liberally or to take salt tablets. However, a doctor’s supervision is necessary, because a high-salt diet can lead to heart failure in certain people, particularly older people. For people who have severe symptoms, taking hormones that cause salt to be retained, such as fludrocortisone, can increase blood volume. However, use of such hormones increases the risk of heart failure, particularly for older people and people who have heart disease. Use of fludrocortisone can also cause a loss of potassium, so taking a potassium supplement may be necessary. Midodrine Some Trade Names
PROAMATINE
may be taken with fludrocortisone to help prevent blood pressure from falling. Midodrine Some Trade Names
PROAMATINE
constricts arterioles, thereby reducing their capacity to hold blood and increasing resistance to blood flow.

If these measures are ineffective, other drugs (such as pindolol and clonidine Some Trade Names
CATAPRES
), which work in various ways, may help relieve orthostatic hypotension in certain people. However, the risk of side effects from these drugs may make their use undesirable, particularly by older people.

Source: Merk

Hundreds of posts, including the jobs of doctors and nurses, are to be axed at a leading London hospital, it was revealed today.

About 450 positions will be slashed at the Royal Free in Hampstead as bosses struggle to make £40 million savings this year.

The cull of almost 10 per cent of the hospital’s staff is the latest in a string of cuts to hit the NHS within weeks after the Government announced the need for £20 billion in “efficiency savings” over the next four years.

The new plans were announced as David Cameron and Nick Clegg launched an attempt to prop up Andrew Lansley’s crisis-hit NHS reforms.

The Prime Minister and his deputy today joined the Health Secretary at Frimley Park Hospital, Surrey, at the start of a two-month exercise to hear patients’ and professionals’ concerns.

They vowed to make “any necessary changes” – with Mr Cameron saying it was a “genuine chance” for workers to influence the plans and Mr Clegg ad-
mitting it was an “unusual” move. The Royal Free Trust revealed that 16 doctors’ posts will go and 107 nursing jobs will be axed as part of its plans.

Of the positions due to be cut, only 131 are currently vacant – meaning the rest could involve possible redundancies and staff transfers.

Royal College of Nursing chief executive Dr Peter Carter said: “It is very difficult to believe that a single trust can shed 450 posts and maintain the same high level of patient care.”

St George’s Hospital in Tooting has already said it is axing up to 500 posts, including consultants and nurses. Kingston Hospital also plans to cut almost 500 posts. Draft plans involve 22 fewer consultants and 214 fewer nurses, midwives and health visitors.

Barts and The London NHS Trust announced it will slash 250 nursing posts among 630 jobs set to go there.

David Sloman, chief executive of the Royal Free Hampstead NHS Trust, said: “We are not immune to financial pressure on the NHS. All hospitals are being asked to contribute to the 20 per cent productivity improvement needed.”

He added that a further £5 million will be saved by reducing the number of agency staff employed by the trust.

Source: Evening Standards

Antibiotics have ‘little effect’ on cough and phlegm

Coloured phlegm and a bad cough is not necessarily a good indicator for antibiotic treatment

Taking antibiotics for a bad cough which produces green or yellow phlegm is of little benefit, says Cardiff University research.

A study of over 3,000 adults from across Europe found that patients producing coloured phlegm are more likely to be prescribed antibiotics by their GP.

Yet the antibiotic treatment did not appear to speed up their recovery.

The study appears in the European Respiratory Journal.

An acute cough or a lower respiratory tract infection is a very common reason for people going to see their GP in the UK, says the study.

Coughing up phlegm coloured green or yellow is also one of the most common reasons for GPs prescribing antibiotics, because they believe it is more likely to indicate a bacterial cause.

The team from the School of Medicine at Cardiff University collected data from 13 European countries for their research, asking patients and doctors to record symptoms and treatments for the condition.

The researchers found that patients who produced green or yellow phlegm were prescribed antibiotics “considerably more often” then those with clear or white phlegm.

They also found that, after seven days, the biggest difference between those who were and were not treated with antibiotics was less than one half of a percentage point on a symptom severity scale.

Side effects

Professor Chris Butler, who led the study, said: “Our findings resonate with findings from randomised trials where benefit from antibiotic treatment in those producing discoloured phlegm has been found to be marginal at best or non-existent.”

“Our findings add weight to the message that acute cough in otherwise well adults is a self-limiting condition and antibiotic treatment does not speed recovery to any meaningful extent.

“In fact, antibiotic prescribing in this situation simply unnecessarily exposes people to side effects from antibiotics, undermines future self care, and drives up antibiotic resistance,” Professor Butler said.

The study also found that GPs from Scandinavia are good at targeting their prescribing of antibiotics while The Netherlands use half as many antibiotics than the UK.

Professor Butler added: “Antibiotics can save people’s lives, but we need to keep them away from people who will not benefit from them.”

“The more we use them, the less likely they are to work.”

Source: bbc news

‘Last resort’ osteoporosis drug that is ’17 times better than standard treatment’

Third time lucky: Patients have to endure two other failed treatments before being allowed Protelos

A drug considered a last resort in the fight against osteoporosis is 17 times more effective than the standard initial treatment, an international study has found.

Protelos is radically different from other therapies because it promotes the growth of fresh bone rather than just preventing deterioration.

But under NHS guidelines it is a ‘third-line’ treatment, meaning patients with bone thinning or a fracture are not allowed it until two other approaches have been tried.

In most cases, symptoms also have to worsen before they qualify.

The new research compared the effectiveness of Protelos with the ‘standard’ – but much cheaper – first-line treatment alendronate, from a class of drugs known as bisphosphonates.

Doctors found that samples from women taking Protelos for six months contained almost 14 times more new bone than those on alendronate – around 3 per cent compared with 0.2 per cent.

Following a year of treatment with Protelos, also known as strontium ranelate, the bone growth was 17 times greater.

Samples from 268 post-menopausal women with osteoporosis in several countries were analysed for the study, led by doctors at Hopital Edouard Herriot, Lyon.

Their results were presented at the European Congress on Osteoporosis and Osteoarthritis in Valencia, Spain.

Option: Protelos is much more effective, has less side effects than usual treatment, and is cheaper than a hip replacement

Osteoporosis, which causes bones to become weak and brittle, affects around three million in the UK and the study was welcomed by medical experts.

Professor Roger Francis, of Newcastle University, said: ‘Helping patients to build new bone is an important goal in the treatment of osteoporosis.

‘These results are so important as strontium ranelate is a proven drug already available on the NHS.

‘This study clearly suggests strontium ranelate helps patients to build new bone to a far greater extent than alendronate, the current standard of care.’

Despite protests from doctors and campaigners, the National Institute for Health and Clinical Excellence last year restricted first-line treatment for women at risk of osteoporosis, or having suffered a fracture, to alendronate.

But a quarter of patients do not respond or suffer crippling stomach side effects.

A woman in her early 70s unable to tolerate alendronate has to become 20 per cent worse to qualify for second-line medication – and 60 per cent worse to be eligible for Protelos.

Protelos treatment costs £300 a year compared with £50 for alendronate. But campaigners say it has fewer side effects and the price compares well with the £12,000 bill for fixing a broken hip.

Source: Daily Mail