Cardio Pulmonary Resuscitation In Patients Who Have Had Recent Heart Attack. Is It Necessary?

Many people do not like to give mouth to mouth resuscitation to a stranger who has had a heart attack. A recent article in the Lancet, a British Medical Journal claims that mouth to mouth resuscitation is not necessary in heart attack victims because their blood contains enough oxygen to sustain them for several minutes until the heart recovers. Chest compressions are far better than rescue breathing which requires regular pauses in the chest compressions.

The authors believe the benefit from continuous chest compressions far outweighs that from so-called "rescue breathing", which necessitates regular pauses in the compressions. Studies show less than a third of people who collapse in public are helped by people because of the “yuk” factor. If people realize that they don’t have to give mouth to mouth resuscitation they will be more willing to help a heart attack victim. On the other hand near drowning patients will need chest compression and mouth to mouth resuscitation

"The forward blood flow that you get from pumping on the chest is so marginal that if you stop for anything it's bad for the brain," Gordon Ewy

Reference:

The Lancet 2007; 369:920-926

DOI:10.1016/S0140-6736(07)60451-6

Articles

Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study

SOS-KANTO study group

Maternal Fish Consumption in Pregnancy Provides “Brain Food” For Baby’s Brain

"Seafood is the main food source of omega-3 fatty acids, which are essential for optimum neural development. However, in 2004, the FDA and the Environmental Protection Agency advised women who were pregnant or might become pregnant to limit seafood intake during pregnancy to 340 g per week (less than three portions) to avoid exposure to trace amounts of neurotoxins, especially methylmercury"

Judith Groch

Many of my patients are afraid of eating fish because of the fear that they will ingest too much mercury to affect the developing baby's brain. This deprives them of the Omega 3 Acid that is good for the development of the baby's brain. It is therefore very encouraging that a recent Lancet article summarized in Medpage Today, showed evidence to the contrary. According to many pregnant women, this is serious enough for them not to eat fish in pregnancy.

"A U.S. survey showed that two-thirds of Americans believe that 1,000 to 100,000 U.S. children are poisoned by mercury from eating fish every year. In fact, Drs. Myers and Davidson said that there has never been even one child with prenatal mercury poisoning from consuming fish documented outside Japan." Judith Groch

Joseph Hibbeln, MD of the National Institute of Alcoholic Abuse and Alcoholism and colleagues, showed that:

"After adjustment, maternal seafood intake during pregnancy of less than 340 g per week was associated with an increased risk at age eight years of the child being in the lowest quartile for verbal IQ (no seafood consumption, odds ratio [OR] 1.48, 95% CI 1.16-1.90; some seafood, 1.09, CI 0.92-1.29; overall trend, P=0.004), compared with mothers who consumed more than 340 g per week. At seven years, low maternal seafood intake was also associated with an increased risk of suboptimum outcomes for prosocial behavior 1.44 (CI 1.05-1.97) for no seafood consumption versus more than 340 g/week. Overall, the investigators said, the higher the maternal seafood intake, the less likely the infant was to have a poor score. At ages up to 3.5 years, scores were also lower for fine-motor skills, communication, and social development, they reported. Maternal seafood consumption reached a mean of 235 g a week, resulting in estimated weekly intakes of zero to 15.6 g, and a mean intake of 1.06 g of omega-3 fatty acids a week. " Judith Groch

Hence it is important that pregnant women know that fish, the major source of Omega 3 Acid is important for the development of the baby's brain. The benefits far outweigh the risks of Mercury poisoning from seafood. A risk largely attributed to fatty fish.

"Additional source: The Lancet

Source reference:

Hibbeln, JR, et al "Maternal seafood consumption in pregnancy and neurodevelopmental outcome in childhood (ALSPAC study): an observational cohort study" Lancet 2007; 369: 578-585. "



"Additional source: The Lancet

Source reference:

Myers, GJ, Davidson PW "Maternal fish consumption benefits children's development" Lancet 2007; 369: 537-539."

Cancer Of The Ovary-Screening Test for Women Is In The Horizon

Ovarian cancer is one of the most difficult cancers to diagnose in its early stages. It does not have any specific symptoms and most patients are diagnosed in the advanced stages when the results of treatment are poor. On the other hand when they are diagnosed in its early stage the five year survival rate is about 90% as compared to 20% in the late stage.

Up till now there have not been any significant screening tests such as Pap smear to screen for cervical cancer. According to Alisa Leisa, MD of Yale University, a highly sensitive blood test comprising of six biological markers can be used to detect the disease in its early stages. The positive predictive value is 93% in the test population and a negative predictive value of 99.2%. Yale University is currently enrolling women at high risk of ovarian cancer and healthy controls.

Is Testosterone Too Much of a Good Thing for Women’s Health?

I see many women in my office complaining of decreased libido. Most of these women are in the middle age with its change in hormones and life's uncertainties. In our world we are used to taking medications for anything that bothers us. Many life changes can decrease women's desire for sex. However, tell the modern woman that her stress from the fear of loosing her job is causing her decreased libido and she will seek another physician who would be prepared to slap the testosterone patch on her without much protest. A recent article in the Star Tribune shows that testosterone is not a panacea for women suffering from decreased libido.

Genital Herpes in Pregnancy-A Health Hazard for the Baby

Question:

I got married a week ago and I have missed my period. I saw my doctor who did a pregnancy test and pelvic ultrasound and told me I was 6 weeks pregnant. Two weeks ago I started having painful urination and multiple blisters on my vulva. My doctor diagnosed me with genital herpes and started me on medications. I have finished the treatment but I am supposed to take the medication throughout the pregnancy. Is my baby going to be alright?

Answer:

Genital Herpes is a common sexually transmitted disease which is under diagnosed because sometimes patients with the disease don’t have any symptoms. In your case, your doctor did the right thing by treating you and giving you medication to prevent recurrent infections during your pregnancy and after delivery. Your husband has to have blood test to ensure that he does not have the disease. If he has it he should also be treated as he may have outbreaks and transmit the disease to you again. I will suggest that even if his test is negative you should use condoms for sexual intercourse.

The effect of the infection on the new born baby is severe. About 80% of the babies may be infected by the virus at birth if untreated. Hence if you are found to have the disease at the time of your delivery, you would be delivered by cesarean section to prevent the baby from being infected by the virus. Other prevention measures include giving you prophylactic antiviral medications to suppress the infection during the pregnancy. Three medications are available for treatment. Valacyclovir and Famciclovir would be more convenient as prophylaxis than Acyclovir because of convenience in their dosing.

Since many people with genital herpes don’t know they have the disease, it will seem to be reasonable to screen all pregnant women for genital herpes with blood test. This way, if their test is positive, they would receive prophylactic medication to prevent possible herpes infection in the pregnancy and the postpartum period.