cLiNic fReaK

My students back at Greenbox keeps on chatting about the new xbox 360. I know a little about xbox and how it evolved since it was featured in the TIME Magazine maybe less than 3 years ago. Bill Gates was its proud developer and became the cover person in the TIME Magazine issue back then. I found it so adorable that I have to literally beg my Dad to bring the magazine at home. It was supposed to remain in his office. Since nobody’s really interest with TIME Magazines there except me and my Dad, he ended up giving in to my requests. I thought I was a really spoiled brat back then.

Gone were the days when my brothers and I play with the family computer, the text cards, the POGS of Coca-cola, marbles, and matchbox cars. Gone were the days when my Dad goes home smiling, bringing with him the a box of good matchbox, or new tapes for the computer, or games in the PC. Those days were gone. It’s not that my Dad’s not around here anymore, but it is because me and my brothers have grown up already. We don’t hangout so much together anymore, unlike when we were little kiddos–kids who knew nothing but EAT, PLAY, and SLEEP. Gone were the days when our only concern is waking up everyday, getting washed with a cold water, going to school, and going home. I miss being a child. I miss being treated like I am the dumbest kid on earth when I forgot to bring my lunchbox home because of too much running and gliding in the school grounds. I miss being scolded of how dirty my uniform is. I miss everything, and it makes me sad. *sigh*

post script:

I wonder how Mama would feel if i tell her to go and get a botox injections in Chicago next month. Nah.. I’m just kidding. Hope she’ll never get to see this post. Im sorry I just have to say that.

Jofe told she’s going to the states to have a New York browlifts. I just wish her goodluck. Jofe just recently had took a temperant test, and according to the results, she’s a pureblood sanguine. Here she is

Strengths of a Sanguine

The Extrovert | The Talker | The Optimist

For some, having a tattoo make themselves as a walking canvas. It’s a way of expressing themselves, like art. Thinking about it makes me want to have one, or if there will be any available free tattoo maybe I’d get myself one. Here’s something I found in wikipedia.org about hena tattoo and I’m glad to share it to you..

Mehndi (or Hina) is the application of henna (Hindustani: हेना- حنا- urdu) as a temporary form of skin decoration, most popular in South Asia, the Middle East, North Africa and Somaliland as well as expatriate communities from these areas. It is typically employed for special occasions, particularly weddings. It is usually drawn on the hands and feet, where the color will be darkest because the skin contains higher levels of keratin, with which the colorant of henna, lawsone, enters a permanent bind.

Henna paste is usually applied to the skin using a plastic cone or a paint brush, but sometimes a small metal-tipped jacquard bottle used for silk painting (a jac bottle) is used. Henna can be bought at a store in a plastic or paper cones The painted area is then wrapped with tissue, plastic, or medical tape to lock in body heat, creating a more intense color on the skin. The wrap is worn overnight and then removed. The final color is reddish brown and can last anywhere from two weeks to several months depending on the quality of the paste.

The patterns of mehndi are typically quite intricate and predominantly applied to brides before wedding ceremonies. However, traditions in India, Pakistan, Bangladesh and Sudan sometimes expect bridegrooms to be painted as well. In Rajasthan (north-west India), where mehndi is a very ancient folkart, the grooms are given designs that are often as elaborate as those for brides. In Kerala (south India), henna is known as mylanchi and is commonly used by the Mappila (Muslim) community during weddings and festivals.

In Arabic and Persian speaking countries, such as Morocco, it is done for any special occasion. It is done during the seventh month of pregnancy, after having the baby, weddings, engagements, family get-togethers, as well as many other reasons to simply celebrate an event.

Mehndi decorations became fashionable in the West in the late 1990s, where they are sometimes called “henna tattoos”. This term isn’t accurate, because tattoos are defined as permanent surgical insertion of pigments underneath the skin, as opposed to pigments resting on the surface.

I’m thinking of getting myself an eyelid surgery before Christmas. That’s just a thought. Anyway, here’s the diet guideline of the day:

Eat less of the nutrient-poor foods. 

There is a right number of calories to eat each day based on your age and physical activity level and whether you are trying to gain, lose or maintain your weight. You could use your daily allotment of calories on a few high-calorie foods and beverages, but you probably wouldn’t get the nutrients your body needs to be healthy. Limit foods and beverages that are high in calories but low in nutrients, and limit how much saturated fat, trans fat, cholesterol, and sodium you eat. Read labels carefully — the Nutrition Facts panel will tell you how much of those nutrients each food or beverage contains.

As you make daily food choices, base your eating pattern on these recommendations:

• Choose lean meats and poultry without skin and prepare them without added saturated and trans fat.
• Select fat-free, 1 percent fat, and low-fat dairy products.
• Cut back on foods containing partially hydrogenated vegetable oils to reduce trans fat in your diet.
• Cut back on foods high in dietary cholesterol. Aim to eat less than 300 milligrams of cholesterol each day.
• Cut back on beverages and foods with added sugars.
• Choose and prepare foods with little or no salt. Aim to eat less than 2,300 milligrams of sodium per day.
• If you drink alcohol, drink in moderation. That means one drink per day if you’re a woman and two drinks per day if you’re a man.
• Follow the American Heart Association recommendations when you eat out, and keep an eye on your portion sizes.

I watched ETC three days ago and have found out that this one hollywood star has been so into plastic surgery thingy that she looks like a cat more than that of a woman. If she only had considered getting herself in Los angeles, California Rhinoplasty, Im sure she wouldn’t look like that. Anyway, I just found out in the internet that she’s really, really being talked about (like what I am doing now) at the moment. They say, Jocelyn Wildenstein looks like a catwoman–the real catwoman herself. Not that I am teasing or something, but I just can’t believe that people may really be that “addicted” into getting into plastic surgeries.

Just like alcoholism and illegal drug addiction, having plastic surgery is now considered to be another factor for addiction too. People may be that distressed that they tend to cope with their stressful lives thru mechanisms such as drinking, smoking, and as of the moment: having plastic surgeries. C’mon! I am not against-plastic-surgery. But what I am against is that they tend to overdo what has been made and remade of them. I think they should not really be overwhelmed by it because after all, what matters most in this world is not how we look, but it is how human we are.

I wonder how Neil Crespi would react if I say blogging is much better than friendster. Today, I will be posting about exercise.

Being active brings many benefits for your heart and your health. Regular physical activity can help you improve your blood pressure and blood sugar levels and reduce your risk for chronic diseases such as type 2 diabetes, osteoporosis, obesity, depression, and breast and colon cancer.

How much activity do you need? Aim to get at least 30 minutes of moderate physical activity on most, if not all, days of the week. If you are trying to lose weight, aim for 30 to 60 minutes on most days.

• One way to live a more active lifestyle is to incorporate as much physical movement into your usual daily activities as you can. For example, decide to take the stairs instead of riding the elevator. It may sound simple, but small steps do add up. Instead of finding ways to avoid the physical aspects of daily tasks, try to improve your fitness by doing more, not less.
• Keep a written log of your physical activity to help you figure out how much exercise you get versus how much you need.
• Track and cut down on your “screen” time, including watching television, surfing the Web, and playing computer games.

Use this table to estimate how many calories you can burn in 30 minutes of continuous activity. Your current weight will affect the number of calories burned.

Calories Used in 30 Minutes by Activity and Weight
	150 Pounds	200 Pounds
Playing basketball	282	376
Bicycling	163	217
Gardening	195	260
Hiking	204	272
Jogging at 5 mph	270	360
Mowing with a light push mower	135	180
Playing tennis (singles)	234	310
Walking at 1 mile per hour	68	90
Walking at 5 miles per hour	225	300

 

Being physically active can boost your ability to make other lifestyle improvements as well. You’ll feel more confident, have more energy, and serve as a good role model for your family and friends.

Dr. Alvarez was doing some minor surgery earlier this afternoon. It was something like a wart incision, where the client was made to lie down in the clinic bed, while the doctor incises the part of the leg where the large wart was planted. I was okay when Doc Alavarez injected some anesthesia around the part to be incised, then used a blade, size 15 to make a cut along the sides of the wart. I was still okay then. Then dokie cut the real thing, blood was oozing out so fast. One by one, the prepared Sterile OS were used up, but it needed some more. When you know what “giluglog” means in bisaya, then you know what I will be talking about later. Gosh. The next time I laid my eyes on the incised area, it looked like a 5-peso coin, with a depth of maybe about half centimeter. I saw the deepest root of the wart, as well as the cellulites around the area. Blood again is oozing out. Sterile OS were used. Then, dokie got hold of the needle and the thread and started suturing the area, keeping it close. I was still okay in the first stitch. Then came the second one, and the third. But before the fourth stitch was done, I cannot hold it anymore. I felt my stomach turned upside down, making myself want to vomit. My head was aching, and the place was spinning around. I no longer have strength in my knees, I wanted to sit down. I wanted to burp, I thought it was the best thing to do to relieve me from fainting. And yeah, I was fainting. I then gave the bandage and the cream that I was holding to my other groupmate and I went out of the clinic. I sat in one of the benches in the Maternity clinic. I closed my eyes, and let myself experience the art of fainting. I know I’m going pale. “My classmates will laugh at me for this”, I thought. Five minutes more, I can no longer hold it. I should tell somebody about it. So I went inside the TB-DOTS clinic and told my other groupmates about it. They laughed as expected. Good thingy, Ruby was there to massage my hand. It made me feel okay, and really okay. It’s like having a nose surgery and houston rhinoplasty expert before your very eyes.I felt the cold sweat coming out of my skin, and I came to my most normal state. I breathed again.

I came back to the clinic and realized that the surgery was then over. Our Clinical Instructor, Sir Jay Saan and my friend slash groupmate Meg, asked me if I was okay, then I told them what occurred to me. I learned that the client has had seven stitches all in all, and Meg told me that the two last stitches were a lot gross that the other ones. and that the doctor placed a binder around the leg, as to not to have an accidental damage to the suture. Oh well.

Experiences like that makes me ask myself if I am really suited in this kind of profession. I was kind of dishearted about how I took the earlier procedure, but, I just encouraged myself to be better the next time around. hayz. At least, I have something to think about if I want to some good laugh. hehe.

Trichomoniasis (n. pl. trich·o·mo·ni·a·ses) is the most common non viral sexually transmitted disease in the world.

According to the World Health Organization’s annual estimates, there are an estimated 7.4 million trichomoniasis cases each year in the United States, with over 180 million cases reported worldwide

Trichomoniasis is caused by the parasitic protozoan Trichomonas vaginalis, which infects both men and women. There has been a growing body of data implicating trichomoniasis as a contributor to health complications among both women and men.

 

Organism

Trichomonas vaginalis is a pear-shaped, flagellate, motile protozoan, with an undulating membrane. It is about 10-20µm wide, and is ovate. The organism is propelled by four anterior flagella with a flagellum attached to an undulating membrane (Heine, 1993). T. vaginalis is anaerobic and does not contain mitochondria in its cytoplasm, but instead contains specialized granules called hydrogenosomes throughout the region of the cytoplasm. The morphology of T. tenax and T. hominis differ from T. vaginalis in that the trailing flagellum of the protozoa extends past the organism’s undulating membrane

 

Pathogenesis

Although trichomoniasis is the most common non-viral sexually transmitted disease, the pathogenicity of T. vaginalis is not thoroughly understood. Trichomonads participate in a host-parasite relationship, causing them to adhere to epithelial cells. The ability of trichomonads to adhere is affected by time, temperature, and pH level. T. vaginalis grows best in an anaerobic environment with a pH > 6 (Diamond LS, 1986). T. vaginalis binding to vaginal epithelial cells for colonization and infection is dependent upon specific parasite surface proteins. Parasites treated with metronidazole or other nitroimidazoles lose their ability to adhere, making them ineffective disease agents. Hemolysis, the destruction of red blood cells such that hemoglobin is released, is also correlated with virulence. Trichomoniasis has been seen to increase in severity during or slightly after menstruation (Graves, 1993).

The relationship between T. vaginalis growth and protective lactobacilli is a complex one. It is currently unknown whether TV infection alters the vaginal environment by creating an anaerobic situation or if anaerobes in the vagina precede TV growth. The vagina contains glycogen, especially rich in reproductive aged women. Glycogen is broken down into glucose, a nutrient T. vaginalis requires for growth

Several risk factors for acquisition of the organism have been identified, including multiple sexual partners, black race, history of previous STD and coexistent infection with Neisseria gonorrhoeae (Sobel, 1997). Approximately 8% to 50% of patients with T. vaginalis have concomitant infections. T. vaginalis often coexists with Bacterial Vaginosis. Trichomoniasis was associated with the presence of bacterial vaginosis in a study of 871 HIV-seropositive women and 439 HIV-seronegative women in the HIV Epidemiology Research Study (Cu-Uvin, 2002). T. vaginalis was present in 74% of women with BV vs. 35% of women without BV (p=.02).

Due to T. vaginalis’ anaerobic characteristics, the organism’s growth is enhanced at elevated pH levels. T. vaginalis grows over a wide pH range of 3.5-8. However, a vaginal pH below 4.5 decreases motility. Therefore a vaginal pH above 4.5 would be conducive to infection (Thomason, 1989). Failure to use barrier contraceptives increases an individual’s susceptibility to infection.

MOT

nfection of the genitourinary tract occurs through sexual transmission. Evidence for sexual transmission of T. vaginalis is very strong as prevalence is highest among patients with increased sexual activity and multiple partners. Approximately 14-65% of male partners of infected females are also infected (Krieger, 1995, Sena, 2003). The incubation period before symptoms arise is 4-28 days in approximately 50% of infected women (Weston, 1963). Asymptomatically infected individuals are in important vector and act as a stealth factor in trichomoniasis transmission. Many studies have shown that treatment of the male partner(s) of infected women improves both cure rates and recurrence rates (Hager 1980, Lyng, 1981).

Live T. vaginalis organisms in urine and semen samples have been found after being exposed to air for several hours. Also, organisms are able to survive for hours on damp towels and clothes of infected women (Lossick, 1989). There have been no well-documented cases regarding transmission through the aforementioned means. Nonsexual transmission is extremely rare since T. vaginalis infection is generally restricted to a specific site, namely the urogenital tract (Thomason, 1989). The only known nonvenereal form of transmission is through perinatal acquisition. Approximately 5% of female babies born of infected mothers contract the infection (Bramley, 1976).

SITES

T. vaginalis infection is generally confined to the urogenital tract. There have, however, been rare reports of trichomonads being found in other sites such as the lungs and cerebrospinal fluid. These cases have usually been accompanied by a severe underlying disease. Rarely have the organisms been identified as T. vaginalis, but were most likely T. tenax or T. hominis (Rein, 1990).

Recently, a 41 year old HIV+ male was hospitalized due to fever and dyspnea. A cytologic examination of his bronchoalveolar lavage fluid revealed numerous T. vaginalis organisms. This is the first case where T. vaginalis was found in the lungs of an adult. Data collected suggest that trichomonads are overlooked parasites and may be implicated in various human pathologies (Duboucher, 2003).

Sites - Women

T. vaginalis organisms may be isolated from the cervix, vagina, Bartholins glands, bladder, urethra and occasionally the upper reproductive/urinary tract (Rein, 1990). Over 95% of infections have been isolated from the vagina and only 5% from the urinary tract of adult women (Grys, 1964). The urethra and Skene’s glands are infected in 90% of cases. There have also been instances where organisms were isolated from bladder urine (Thomason, 1989). T. vaginalis may also act as a carrier for other pathogenic organisms. Keith conducted an in vitro study in 1986 to observe the attachment between T. vaginalis and other bacteria that inhabit the urogenital areas. Using scanning electron microscopy, one finding displayed a cluster of cocci attached to a trichomonad and two other demonstrated multiple cocci and E. coli attached to a T. vaginalis organism. Trichomonads have been shown to migrate to the fallopian tubes and peritoneal cavity. Thus, by carrying bacteria or viruses on their surfaces, it is possible that T. vaginalis organisms contribute to upper genital tract infections (Keith, 1986).

In 2003, Rendón-Maldonado, et al. cited that STDs caused by bacteria and protozoa are important factors in the epidemiology of HIV-1. The research team incubated three subtypes of HIV-1 (A, B, and D) with HIV-1 infected lymphocytes and observed the interactions with immunofluorescence microscopy and transmission electron microscopy. Results showed that trichomonads may internalize HIV-1 particles for a short time period. Under in vitro conditions, trichomonads ingest and digest HIV-1 infected lymphocytes (Rendón-Maldonado, et al., 2003).

Results of a study by Pindak (1989), also indicate that viruses may be transmitted by T. vaginalis. Virus containing cell fragments were engulfed by trichomonads and internalized in vacuoles. Viable reoviruses were recovered from the trichomonads for nine days and genital herpes simplex virus for six days, suggesting the possibility of transmission of viruses by T. vaginalis (Pindak, 1989).

Sites - Men

In men the urethra is the most common site for T. vaginalis infection. Organisms can also be detected in the epididymis, semen, and urine (Krieger, 1981). T. vaginalis was first located in prostatic fluid by Drummond who examined prostatic secretions from husbands of infected women (Drummond, 1936).

S/S FM

In women, the infection is often characterized by a yellow-green, frothy vaginal discharge, vaginal odor, pain with sexual intercourse, pain with urination, and vulvovaginal soreness and itching (Rein, 1990). Common clinical signs include vulvar erythema, inflammation, excess of white blood cells seen on a wet mount preparation of vaginal discharge, motile trichomonads in the wet mount preparation, and a vaginal pH above 5, most of which overlap with BV signs and symptoms, complicating diagnosis. The following is a differential diagnosis chart comparing several vaginal infections.

 

S/SM

In men, the infection is more difficult to detect as the majority of infections remain asymptomatic and readily available diagnostic techniques are inadequate. This is problematic since long term carriage of T. vaginalis in asymptomatic men has been documented up to 4 months (Krieger, 1993). Most men seeking treatment do so because of an infected partner (Hager, 1994).

Symptoms in men typically include urethral discharge, dysuria, mild pruritis, or burning after intercourse. Forty percent of symptomatic males have infected prostate glands. Men who are unresponsive to antimicrobial therapy for nonspecific urethritis should be tested for T. vaginalis since 15-20% will be infected with the organism (Thomason, 1989, Schwebke, 2003). The following table summarizes common symptoms found in T. vaginalis infected men.

RISK

Recently, a growing body of literature has linked T. vaginalis infection to a variety of health complications among both men and women. Among both women and men, T. vaginalis is emerging as one of the most important factors in transmission and acquisition of HIV infection (Sorvillo, 1998). In women, the health complications include increased risks for the following: infertility, development of atypical pelvic inflammatory disease, infection following gynecologic surgery, and cervical inflammatory neoplasia. There have also been high rates of correlation between trichomoniasis and pregnancy complications in women. In men, T. vaginalis has been linked to male factor infertility and as a common cause of non-gonococcal urethritis (NGU) (Schwebke, 2002, Soper, 2004).

Trichomoniasis as a Risk Factor for Cervical Neoplasia

The association between T. vaginalis and cervical neoplasia has been reported in many studies since the early 1950s. It has been suggested that this organism is responsible for the induction of changes in the human cervical mucosa resulting in dysplasia or carcinoma (Bechtold, 1952). A prospective, longitudinal cohort study followed over 19,000 women in Finland in a mass cervical cancer screening program for up to a 10 year period, to determine if women with cytologically diagnosed infections (T. vaginalis, herpes, or HPV) preceded development of cervical neoplasia. T. vaginalis was shown to be associated with a high relative risk (OR 6.4) of subsequent CIN. This was similar to risks found with either HPV (OR = 5.5) or herpes infection (OR = 12) and development of subsequent CIN (Viikki, 2000).

Zhang (1994) conducted a combined analysis of 2 cohort and 22 case-control studies examining the association between T. vaginalis infection and cervical neoplasia. The results from the analysis indicated that T. vaginalis is associated with increased risk of cervical neoplasia. The following table is a summary of the 24 studies used in Zhang’s data analysis.

 

 

Breastfeeding is the feeding of an infant or young child with milk from a woman’s breasts. Babies have a sucking reflex that enables them to suck and swallow milk.

Experimental evidence suggests that, with few exceptions, human breast milk is the best source of nourishment for human infants. Experts still disagree about how long breastfeeding should continue to gain the most benefit, and how much extra risk is involved in using breast milk substitutes. An infant may be breastfed by its own mother or by another lactating female, a wet nurse. Breast milk may be expressed (such as with a breast pump) and fed to a baby through a bottle, and pasteurized donor human milk may also be used. The pasteurization process on human breast milk, such as for donation purpose, is known to destroy most nutritional content and renders the donor milk of questionable benefit compared to fortified infant formulas. Breast milk substitutes are available for mothers or families who cannot or prefer not to breastfeed their children. While there are conflicting studies about the relative value of breast milk substitutes, the use of commercial infant formulas is acknowledged to be inferior to breastfeeding for both full term and premature infants. In many countries, artificial feeding is associated with a greater mortality from diarrhoea in infants but where there is clean water, many consider artificial feeding to be acceptable.

Governmental strategies and international initiatives promote breastfeeding as the best method of feeding infants in their first year and beyond. The World Health Organization (WHO) and the American Academy of Pediatrics (AAP) also promote breastfeeding

Breastmilk

The exact properties of breast milk are not entirely understood, but the nutrient content of mature milk is relatively stable. Its ingredients come from the mother’s food supply and the nutrients in her bloodstream at the time of feeding. If that is not enough, nutrients come from the mother’s bodily stores. Some studies estimate that a woman who breastfeeds her infant exclusively uses 500–600 more calories a day just producing milk for her offspring. The exact composition of breast milk varies from day to day, and even hour to hour, depending on both the manner in which the baby nurses and the mother’s food consumption and environment, so the ratio of water to fat fluctuates.

Foremilk, the milk released at the beginning of a feed, is watery, low in fat and high in carbohydrates; hindmilk, which is increasingly released as the feed progresses is creamier. There is no sharp distinction between foremilk and hindmilk, the change is very gradual. Research from Peter Hartmann’s group tells us that fat content of the milk is primarily determined by the emptiness of the breast—the less milk in the breast, the higher the fat content. The breast can never be truly “emptied” since milk production is continuous.

Breastfeeding benefits both mother and child physically and psychologically. Nutrients and antibodies are passed to the baby while hormones are released into the mother’s body. The bond between baby and mother can also be strengthened during breastfeeding.

Benefits for the infant

Breastfed babies have a lower risk of sudden infant death syndrome (SIDS) and other diseases. Suckling at the breast encourages the proper development of the infant’s teeth and speech organs. Suckling also helps prevent obstructive sleep apnea. Also, breast milk is at the right temperature and is immediately available from the breast.

Breastfeeding is associated with lower risk of the following diseases:

1. Allergies
2. Asthma
3. Autoimmune thyroid diseases
4. Bacterial meningitis
5. Breast cancer
6. Celiac disease
7. Crohn’s disease
8. Diabetes
9. Diarrhea
10. Eczema
11. Gastroenteritis
12. Hodgkin’s lymphoma
13. Necrotizing enterocolitis^[
14. Multiple sclerosis
15. Obesity
16. Otitis media (ear infection)
17. Respiratory infection and wheezing
18. Rheumatoid arthritis
19. Urinary tract infection

Breast milk has several anti-infective factors. These include the anti-malarial factor para-amino benzoic acid (PABA), the anti-amoebic factor BSSL, , lactoferrin, the second most common protein in human milk, that binds to iron and inhibits the growth of intestinal bacteria like E. coli and Salmonella, and IgA which protects breastfeeding infants from microbial infection. Breast milk contains the right amount of the amino acids cystine, methionine and taurine that are essential for neuronal (brain and nerve) development. A New Zealand study tracking over 1000 children for 8 to 18 years found small but measurable increases in cognitive ability and education achievement. This remained even after adjusting for other factors (such as maternal education level).

One study suggests that in resource-poor settings where safe infant formula is unavailable, exclusive breastfeeding (as compared with “mixed” feeding where breastfeeding is combined with formula, solids or animal milk) may reduce the risk of HIV transmission from mother to child in infants less than 6 months old.

Unlike human milk, the predominant protein in cow’s milk is beta-lactoglobulin, an important factor in cow milk allergies.

Benefits for the mother

Breastfeeding benefits the mother. It releases hormones such as oxytocin and prolactin that have been found to relax the mother and make her feel more nurturing toward her baby. Breastfeeding within a short time after giving birth increases levels of systemic oxytocin. This makes the uterus contract more quickly and decreases maternal bleeding.

As the fat accumulated during pregnancy is used in milk production, prolonged breastfeeding can help mothers to return to their previous weight. Frequent and exclusive breastfeeding can cause lactational amenorrhea, a delay in the return of menstruation and therefore fertility. Sometimes this is deliberately used as a birth control method, which has a 98% success rate if certain criteria are met:

• Breastfeeding must be the infant’s only (or almost only) source of nutrition. Feeding formula, pumping instead of nursing, and feeding solids all reduce the effectiveness of LAM.
• The infant must breastfeed at least every four hours during the day and at least every six hours at night.
• The infant must be less than six months old.
• The woman must not have had a period after 56 days post-partum (when determining fertility, bleeding prior to 56 days post-partum can be ignored).

Breastfeeding is possible throughout pregnancy, but generally milk production will be reduced at some point during the pregnancy.

Breastfeeding mothers have less risk of many diseases including breast cancer, ovarian cancer, decreased insulin requirements in diabetic mothers, stabilizing maternal endometriosis, less risk of post-partum hemorrhage, less risk of endometrial cancer, less risk of osteoporosis and beneficial effects on insulin levels of mothers with polycystic ovary syndrome.

Mothers who breastfeed longer than eight months have better bone re-mineralisation.

On the other hand, some breastfeeding women have pain from thrush or staph infections of the nipple.

From a financial standpoint, breastfeeding is roughly half the cost of infant formula.

Bonding

The hormones released during breastfeeding strengthen the mother’s nurturing feelings towards the child. Strengthening the maternal bond is very important as up to 80% of mothers suffer from some form of postnatal depression, though most cases are very mild. The woman’s partner and other caregivers can support her in a variety of ways and this support is an important factor in successful breastfeeding. Teaching partners how to manage common difficulties is associated with higher breastfeeding rates.

Breastfeeding can have an impact on the personal relationship between a mother’s partner and the child. While some partners may feel left out when the mother is feeding the baby, others see it as an opportunity for strengthening family bonds. Looking after a new baby and breastfeeding take time. This can add pressure to the partner and the family, because the partner has to care for the mother as well as performing tasks she would otherwise do. However, as partners are often very willing to give this support, this pressure can help to strengthen family bonds.

If the mother is away, an alternative caregiver may be able to use expressed breast milk (EBM) to feed the baby. The various breast pumps available for sale and rent make it possible for working mothers to breastfeed their babies for as long as they want. However, the mother must produce and store enough milk to feed the child for the time she is away and this may not always be practical. Also, the other caregiver must be comfortable in handling breast milk. These two factors may prompt the mother - perhaps against her wishes - to switch to artificial feeding, either temporarily or permanently.

Breastfeeding complications

Despite being a natural human activity, there are cases where breastfeeding can be difficult or contraindicated.

While breastfeeding difficulties are not uncommon, putting the baby to the breast as soon as possible after birth helps to reduce them greatly. The AAP breastfeeding policy says: Delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed. Many breastfeeding difficulties can be resolved with proper hospital procedures, properly trained nurses and hospital staff, and lactation consultants.

Breastfed infants generally gain weight according to the following guidelines:

0–4 months: 170 grams per week^†

4–6 months: 113–142 grams per week

6–12 months: 57–113 grams per week

^† It is acceptable for some babies to gain 113–142 grams (4–5 ounces) per week. This average is taken from the lowest weight, not the birth weight.

The average breastfed baby doubles birth weight in 5–6 months. By one year, the typical breastfed baby will weigh about 2½ times birth weight. At one year, breastfed babies tend to be leaner than bottle fed babies. By two years, differences in weight gain and growth between breastfed and formula-fed babies are no longer evident.

Exclusive Breastfeeding

Exclusive breastfeeding is when an infant receives no other food or drink, or even water, besides breast milk (whether expressed or through breastfeeding).

International guidelines recommend that all infants be breastfed exclusively for the first six months of life. While each country has its own policy regarding infant feeding, it is generally accepted that newborns should be exclusively breastfed for around 6 months, and that breastfeeding should continue with the addition of appropriate foods, for two years or more. The practice of exclusive breastfeeding has dramatically reduced infant mortality in developing countries due to a reduction in diarrhea and infectious diseases.

Exclusively breastfed infants feed, anywhere from 6 to 14 times a day. Their requirements vary greatly. Newborns consume from 30 to 90 ml (1 to 3 US fluid ounces). After the age of four weeks, babies consume about 120ml (4 US fluid ounces) per feed. Each baby is different, and as it grows the amount will increase. It is important to recognise the baby’s hunger signs and it is advised that the baby should dictate the number, frequency, and length of each feed, based on the assumption that it knows how much milk it needs. The supply of milk in the breast is determined by the frequency and length of these feeds or the amount of milk expressed. The birth weight of the baby may affect its feeding habits, and mothers may be influenced by what they perceive its requirements to be. For example, a baby born small for gestational age may lead a mother to believe that her child needs to feed more than if it larger; they should, however, go by the demands of the baby rather than what they feel is necessary.

It can be hard to accurately measure the amount of food a breastfed baby consumes, but babies normally feed to meet their own requirements. Babies that fail to eat enough may exhibit symptoms of failure to thrive. If necessary, it is possible to estimate output from wet and soiled nappies (diapers): 8 wet cloth or 5–6 wet disposable, and 2–5 soiled per 24 hours suggests an acceptable amount of input for newborns older than 5–6 days old. After 2–3 months, stool frequency is a less accurate measure of adequate input as some normal infants may go up to 10 days between stools. Babies can also be weighed before and after feeds.

 

Pyelonephritis is an ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney (nephros in Greek). If the infection is severe, the term “urosepsis” is used interchangeably (sepsis being a systemic inflammatory response syndrome due to infection). It requires antibiotics as therapy, and treatment of any underlying causes to prevent recurrence. It is a form of nephritis. It can also be called pyelitis.

Signs and Symptoms

It presents with dysuria (painful voiding of urine), abdominal pain (radiating to the back on the affected side) and tenderness of the bladder area and the side of the involved kidney (“renal angle tenderness”). In many cases there are systemic symptoms in the form of fever, rigors (violent shivering while the termpature rises), headache and vomiting. In severe cases, delirium may be present.

Diagnosis

The presence of nitrite and leukocytes (white blood cells) on a urine dipstick test in patients with typical symptoms are sufficient for the diagnosis of pyelonephritis, and are an indication for empirical treatment. Formal diagnosis is with culture of the urine; blood cultures may be needed if the source of the infection is initially doubtful.

If a kidney stone is suspected (e.g. on the basis of characteristic colicky pain, disproportionate amount of blood in the urine), X-rays of the kidneys, ureters and bladder (KUB) may assist in identifying radioopaque stones.

In patients with recurrent ascending urinary tract infections, it may be necessary to exclude an anatomical abnormality, such as vesicoureteral reflux (urine from the bladder flowing back into the ureter) or polycystic kidney disease. Investigations that are commonly used in this setting are ultrasound of the kidneys or voiding cystourethrography

Causes

Most cases of “community-acquired” pyelonephritis are due to bowel organisms that enter the urinary tract. Common organisms are E. coli (70-80%) and Enterococcus faecalis. Hospital-acquired infections may be due to coliforms and enterococci, as well as other organisms uncommon in the community (e.g. Klebsiella spp., Pseudomonas aeruginosa). Most cases of pyelonephritis start off as lower urinary tract infections, mainly cystitis and prostatitis.

Risk is increased in the following situations:

• Mechanical: any structural abnormalities to the kidneys and the urinary tract, calculi (kidney stones), urinary tract catheterisation, urinary tract stents or drainage procedures (e.g. nephrostomy), pregnancy, neuropathic bladder (e.g. due to spinal cord damage, spina bifida or multiple sclerosis) and prostate disease (e.g. benign prostatic hyperplasia) in men
• Constitutional: diabetes mellitus, immunocompromised states
• Behavioural: change in sexual partner within the last year, spermicide use
• Positive family history (close family members with frequent urinary tract infections)

Pathology

Acute pyelonephritis is an exudative purulent localized inflammation of the renal pelvis (collecting system) and kidney. The renal parenchyma presents in the interstitium abscesses (suppurative necrosis), consisting in purulent exudate (pus): neutrophils, fibrin, cell debris and central germ colonies (hematoxylinophils). Tubules are damaged by exudate and may contain neutrophil casts. In the early stages, glomeruli and vessels are normal. Gross pathology often reveals pathognomonic radiations of hemorrhage and suppuration through the renal pelvis to the renal cortex. Chronic infections can result in fibrosis and scarring.

Treatment

As practically all cases of pyelonephritis are due to bacterial infections, antibiotics are the mainstay of treatment. Mild cases may be treated with oral therapy, but generally intravenous antibiotics are required for the initial stages of treatment. The type of antibiotic depends on local practice, and may include fluoroquinolones (e.g. ciprofloxacin), beta-lactam antibiotics (e.g. amoxicillin or a cephalosporin), trimethoprim (or co-trimoxazole) or nitrofurantoin. Aminoglycosides are avoided due to their toxicity, but may be added for a short duration.

If the patient is unwell and septic, intravenous fluids may be administered to compensate for the reduced oral intake, insensible losses (due to the raised temperature) and vasodilation and to maximise urine output.

In recurrent infections, additional investigations may identify an underlying abnormality. Occasionally, surgical intervention is necessary to improve chances of recurrence. If no abnormality is identified, some studies suggest long-term preventative (prophylactic) treatment with antibiotics, either daily or after sexual intercourse.In children at risk of recurrent UTIs, the evidence is inconclusive as to whether long-term prophylactic antibiotics are of use. Ingestion of cranberry juice has been studied as a prophylactic measure; while studies are heterogenous, many suggest a benefit.

Epidemiology

Pyelonephritis is very common, with 12-13 cases annually per 10,000 population in women and 3-4 cases per 10,000 in men. Young women are most likely to be affected, traditionally reflecting sexual activity in that age group. Infants and the elderly are also at increased risk, reflecting anatomical abnormalities and hormonal status.