Tuesday, October 26, 2010
Monday, October 25, 2010
Historical Places
Chilkur Balaji Temple
The Balaji Temple is located at Chilkur in R R district. It is 33Kms away from Mehedipatnam. Approximately 75,000 to 1,00,000 devotees visit in a week. Generally temple gets heavy rush on Fridays and Sundays. Sri Balaji Venkateshwara, the Pratyaksha Daiva in kaliyuga, is available at Chilkoor to shower blessings on His devotees who for any reason are unable to go to Tirupati. Many devout worshippers flock to the Chjilkur Balaji Temple, to receive the blessings of the Lord and his consorts throughout the year particularly during the Poolangi, Annakota and Brahmothsavams
Historical Places
Falaknuma Palace
The Falaknuma palace is a remarkable edifice which stands atop a 2000 feet high hillock. It is located 5kms from Charminar Built by NawabVikar - Ul - Ulmara,the Prime Minister of Hyderabad, it is a stupendous palace and connotes the "heavenly abode". This exquisite palace made of Italian marble was built by one of the Paigah nobles Nawab Vicar Ul Umra in 1892.A majesty testimony
to the glory of the Nizams, it stands atop a hill 2000 feet high. It has often been referred to as the 'Mirror of the Sky'. The palace was designed by a Italian architect and follows a western architectural style. Falaknuma houses a large collection of rare treasures collected by the Nizam including paintings, statues, furniture, manuscripts and books. The Jade collection of the Palace is considered to be unique in the world.
The palace is laid out in the shape of a scorpion with two stings spread out as wings on the north. The middle part is occupied by the main building and the kitchen and harem quarters stretch to the south. The Falaknuma palace is a rare blend of Italian and Tudor architecture. Its glass stained windows throw a spectrum of colors into the rooms. The palace has a library with a walnut carved roof, a replica of the one at Windsor Castle. The library had one of the finest collections of the holy Quran in India.
The Falaknuma palace has other unique things to its credit. It includes the largest Venetian chandeliers. It is said that it took six months to clean a 138-arm Osler chandelier and the palace has 40 such chandeliers adorning the halls ! The famed dining hall of the palace could seat 100 guests on a single table. The furniture is also very aesthetic. The chairs are carved rosewood with green leather upholstery. The tableware was made of gold and crystal to which fluted music was added.
Historical Places
Salarjung Museum
The Salar Jung Museum is an art museum on the southern bank of the Musi river in the city of Hyderabad, Andhra Pradesh, India. The museum opened to the public on December 16, 1951; it houses the collection of the
Salar Jung family, who were important nobles in the courts of the Nizams , Muslim rulers of Hyderabad. The collection of Islamic art from all over Asia includes a variety of illuminated Korans,astrolabes, jewelled swords and daggers, and Persian carpets
The museum also houses fine examples of European painting and sculpture, most famously the "Veiled Rebecca" of Italian sculptor Giovanni Maria Benzoni, as well as Chinese and Japanese pieces. The collection was mostly acquired by Mir Yousuf Ali Khan, also known as Salar Jung III. Some of the items he inherited were collected by his father, Nawab Mir Laiq Khan (Salar Jung II) and his grandfather, Nawab Mir Turab Ali Khan (Sir Salar Jung I).
Situated on the southern bank of the river Musi ,the Salar Jung Museum is not far from the other important monuments of the old city. The historic Charminar, Juma Masjid, High Court, State Central Library and the Osmania General Hospital are all within a radius of one mile from the
Salar Jung Museum.
The museum houses the largest and greatest collection of antiques and artifacts by a single person, Nawab Salar Jung III, Prime Minister of the court of Nizam. From minia- tures of Mewar to modern art of Europe; from the daggers of Nur Jehan and Emperor Jahangir the museum houses priceless gems of art A place that will leave you dazed with the dazzle of time-less art.
There are 38 galleries in the Museum spread on two floors. The ground floor has 20 galleries, and the first floor has 18 galleries. Even then, the total exhibited art objects constitute a little over 25% of the entire collection. The Indian Parliament has declared the museum an Institution of National Importance
Historical Places
Hussain Sagar
Hussain Sagar is a lake in Hyderabad, built by Hazrat Hussain Shah Wali in 1562, during the rule of Ibrahim Quli Qutb Shah Wali. It was built on a tributary of the Musi river to meet the water and irrigation needs of Hyderabad, India.It is now popularly known as Tank Bund, and has become a tourist destination as well as a local attraction. Once the source of drinking water for the twin cities of Hyderabad and Secunderabad, the Hussain Sagar lake's current condition is far from desirable. Since the 1980s and 1990s the immersion of Ganesh idols during the festival of Ganesh Chaturthi has led to the further pollution of the lake. Currently there are numerous environmentalist groups and government agencies that are trying to improve the condition of the lake.
Main attractions
An 18- meter- high statue of the Buddha is located on the Gibraltar rock in the center of the lake. The statue, which took 200 sculptors and 2 years to complete, was erected in 1992. Boat rides are provided by the tourism department.
On one side of the Hussain Sagar lake is the Necklace Road, which indeed twinkles like a necklace. On the other side is the Tank Bund, that narrates the history of Andhra Pradesh in granite through the imposing statues of men and women, who have done their motherland proud. Dotting the lake on all sides are parks shimmering with greenery and bustling with life under the glitter and glory of city lights
Historical Places
Mecca Masjid
Mecca Masjid is near Charminar in the old city of Hyderabad is the biggest mosque in the entire south India.In the sheer size it ranks third in the country, next only to Jama Masjid in Delhi and the one at Gulbarga. Though Quli Qutb Shah laid the foundation stone for Mecca Masjid in 1614, it was Emperror Aurangzeb who completed its construction in 1687.Anestimated 10,000 devotees can offer prayers in the vast hall measuring 67 X 54 meters. Though Quli Qutb Shah , gave the name " Baitul Atiq " to this mosque ,a few bricks brought from Mecca ( and still displayed inside the mosque) perpetuated the name " Mecca Masjid " for this place of worship
Historical Places
CHARMINAR
Charminar is a monument located in the City of Hyderabad which is the capital city of the State of Andhra Pradesh in South India.
Charminar is one of the most important landmarks of the city. The monument was built by Muhammad Quli Qutb Shah in 1591 to commemorate the eradication of plague, shortly after he had shifted his capital from Golconda to what now is known as Hyderabad. Legends tell that the emperor Quli Qutb Shah prayed for the end of plague and took the vow to build a mosque on that very place. He ordered the construction of the mosque which became popular as Charminar because of its four characteristic minarets. The top floor of the four-storeyed structure has a mosque which has 45 covered prayer spaces and some open space to accommodate more people in Friday prayers
Muhammad Quli Qutb Shah ,sultan of the Qutb Shahi dynasty, ruled from Hyderabad. The Charminar is a beautiful and impressive square monument, with each side measuring 20 meters, and each of the edges having a pointed high minaret.It derives its name from these four gracefully carved minarets which soar to a height of 48.7 m above the ground, commanding the landscape for miles around.
Charminar literally means 'Four Minars'. Each minaret has four stories, each looking like a delicately carved ring around the minaret. Every side opens into a plaza through giant arches, which overlook four major thoroughfares and dwarf other features of the building except the minarets. Each arch is 11 m wide and rises 20 m to the pinnacle from the plinth. Once upon a time each of these arches led to four royal roads. Each of the four arches has a clock which were put up in 1889.
There are two galleries within the Charminar, one over another, and above those a terrace that serves as a roof, bordered with a stone balcony. It is vaulted underneath and appears like a dome. There is a large table raised seven or eight feet from the ground with steps to go up to it. Nothing in the town seems so lovely as the outside of that building
A thriving market still lies around the Charminar attracting people and merchandise of every description. In its heyday, the Charminar market had some 14,000 shops, a unique conglomeration of a grand oriental bazaar.The whole market around the Charminar is crowded with shops which sell glass bangles in rainbow colours.
Unlike Taj Mahal, the fluted minarets of Charminar are built into the main structure. Inside the four-storied minarets 149 winding steps guide the visitor to the upper floor, the highest point one can reach, and providing a panoramic view of the city. There are 45 prayer spaces with a large open space in front to accommodate more for Friday prayers.
Built with granite and lime mortar, Charminar is a fine example of the Cazia style of architecture. The Charminar looks spectacular particularly in the nights when it is illuminated.
Historical Places
GOLKONDA FORT
Golkonda is a ruined city and fortress 11 km west of the city of Hyderabad, Andhra Pradesh state, India. The city and fortress are built on a granite hill that is 120 meters high and is surrounded by massive crenellated ramparts. The beginnings of the fort date to the 1143,when the Hindu
Kakatiya dynasty ruled the area. The Kakatiyas were followed by the state of Warangal, which was later conquered by the Muslim Bahmani Sultanate. Golkonda consists of four distinct forts with a 10 km long outer wall having 87 semi circular bastions; some still mounted with cannons, eight gateways, four drawbridges and number of royal apartments & halls, temples, mosques, magazines, stables etc, inside. The lowest of these is the outermost enclosure into which we enter by the 'Fateh Darwaza' ( Victory gate, so called after Aurangzeb’s triumphant army marched in through this gate ) studded with giant iron spikes ( to prevent elephants from battering them down ) near the south
-eastern corner.
At Fateh Darwaza can be experienced the fantastic acoustic effects, characteristic of the engineering marvels at Golkonda. A hand clap at a certain point below the dome at the entrance reverberates and can be heard clearly at the 'Bala Hisar' pavilion, the highest point almost a kilometre away. This acted as the warning note to residents in case of danger.
The tombs of the Qutb Shahi sultans lie about one kilometer north ofGolkonda's outer wall. These graceful structures are made of beautifully
carved stonework, and surrounded by landscaped gardens. Golkonda fort overlooking HyderabadThe fortress city within the walls was famous for its diamond trade, and many famed diamonds including the Koh-i-noor, the Regent Diamond and the Hope are said to have come from here. The wealth of the Golkonda mines enriched the ruling Nizams of Hyderabad, which ruled the area from their independence from the Mughals in1724 to1948 ,when Hyderabad was annexed by India to become an Indian state. Hyderabad state was broken up in 1956, and Golkonda became part of Andhra Pradesh state.
Saturday, October 16, 2010
Friday, October 8, 2010
Tuesday, October 5, 2010
Science
Estrogen Replacement Therapy and Mood
ERT's effect on mood in menopausal women and the mechanics of this effect
ERT's effect on mood in menopausal women and the mechanics of this effect
Depression and Menopause:
Is depression a symptom of menopause?
Controversy is a central aspect of research in estrogen replacement therapy (ERT) for menopausal women and its affect on mood. One area of controversy is whether or not depression is a symptom of menopause. Depression is a low mood state characterized by significant levels of sadness, lack of energy, low self-worth, guilt, or related symptoms. This differs from the symptomology of major depression in which a person has at least five of the symptoms of depression not due to a normal reaction to a life event that last for two weeks or more.
Symptoms of Major Depression:
depressed mood most of the day, nearly every day
markedly diminished interest and pleasure in almost all daily activities
significant weight loss or gain, or a significant increase or decrease in appetite nearly every day
insomnia or hypersomnia nearly every day
psychomotor agitation or retardation nearly every day
fatigue or loss of energy nearly every day
feelings of worthlessness or excessive guilt nearly every day
reduced ability to think or concentrate nearly every day
recurrent thoughts of death or suicide, a suicide attempt, or a specific plan for committing suicide
Depressive mood has been linked to the activity of serotonin and norepinephrine in the brain. Serotonin and norepinephrine are neurotransmitters that, among other things, affect mood. Neurotransmitters are chemical messengers in the brain that are responsible for communication between different brain areas and the body. A higher level of serotonin and norepinephrine activity is associated with positive mood while decreased activity is associated with depressive mood.
During menopause, women experience hormonal and chemical changes. There is a decrease in a woman's level of estradiol, the principal estrogen of women. Also, some serotonin functioning decreases although it is unknown the extent to which serotonin and norepinephrine activity is affected by menopause. In one study, premenopausal women and menopausal women were given a drug that acts in much the same way that serotonin does in the brain, a kind of pseudo-serotonin used to study the activity of serotonin itself. The researchers found that serotonin activity was decreased in postmenopausal women and that this decrease was associated with decreased levels of estradiol in the blood. The premenopausal women did not show this decrease in activity.
Estrogen boosts the activity of serotonin. Women who experience a long duration of menopause or postmenopausal women who have not used ERT have a prolonged deficiency in estrogen. This prolonged estrogen deficiency may be associated with impairment in estradiol receptors in the brain. Estradiol receptors are the sites in the brain where estrogen connects to most readily and does its work. Estradiol receptors may be important in the faciliatory effect that estrogen has on the activity of serotonin and norepinephrine. When the receptors are impaired, estrogen does not work as well and is unable to facilitate the activity of serotonin.
With the above mentioned effects in mind, it may be that menopausal and postmenopausal women are more vulnerable to depression due to lower serotonin and norepinephrine activity. The Manitoba Project, an ongoing study of Canadian women, found that the stress of daily life, chronic disease, and family problems were most likely to trigger depression in menopausal women. Perhaps these triggers have a more powerful effect on menopausal women and postmenopausal women due to their lower serotonin and norepinephrine activity. One study by Weissman found that the occurrence of major depression may increase after menopause. Another study reported by J. Coope stated that depressive illness is not more common at menopause. However, "depressive illness" was not specified in that study. We do not know if they are talking about a person diagnosed with major depression or someone experiencing depressive mood states not severe enough to be classified as major depression. The data is not conclusive in regard to the occurrence or cause of menopausal or postmenopausal depression. However, the physiological effects of menopause may make a woman more vulnerable to other life aspects that may trigger depression.
Estrogen Replacement Therapy and Mood:
Does ERT help mood?
Does estrogen in combination with progestin help mood?
There is also some controversy about the effectiveness of ERT in alleviating depressive mood, however there is much evidence in support of its beneficial effects. A meta-analysis of 26 hormone replacement studies found that in a majority of these studies ERT helped significantly in the alleviation of depressed mood as rated by scales such as the Hamilton Scale of Depression and Beck Depression Inventory (BDI). These scales investigate the behavioral and bodily symptoms (Hamilton Scale) and the cognitive and mood symptoms (BDI). More recent studies have also shown support for the positive effects of ERT on mood as rated by scales similar to those mentioned above. However, J. Coope reported two studies that did not show these effects.
An interesting point to this controversy is the differences in report scales that have been used to measure depressed mood states. J. Zweifel and W. O'Brien report that the BDI yields smaller effect sizes, or the amount of change exhibited by the women of these studies compared to the effect sizes of the Hamilton Scale. Previous research also suggests that the BDI yields smaller effect sizes in comparison with other measures of depression. In other words, results from the BDI may not indicate as much change as another scale would. The BDI investigates cognition and feelings while the Hamilton Scale looks at behavioral and bodily symptoms. It may be that the BDI is less sensitive to the changes caused by ERT. Another difference in the scales is how they are taken. The BDI is a self-report measure whereas the Hamilton Scale utilizes a trained observer's ratings of symptoms. Women may be reluctant to endorse symptoms related to depression when they are doing the self-evaluation. Consequently, the BDI may not be an accurate measure of these symptoms.
Other evidence for the ERT's effectiveness in enhancing mood comes from it's effects on the chemistry of the brain. Estrogen enhances norepinephrine and serotonin activity, and inhibits production of monoamine oxidase. As mentioned earlier, serotonin and norepinephrine are involved in the regulation of depressive moods. Decreased activity of serotonin and norepinephrine are associated with increased depressive mood.
Estrogen's effects on serotonin:
estrogen increases the sensitivity of the receptors that receive serotonin (they are more likely to connect with serotonin)
increases the number of serotonin receptors which increases the activity level of serotonin
increases the reuptake of serotonin by the neuron it was released from in order that the serotonin may be made available once again in the synapse (the space between the neuron that releases the serotonin and the receptor that may connect with it)
increases the synthesis, or production, of serotonin
Estrogen's effects on norepinephrine
increases the binding rate of particular norepinephrine receptors (which increases norepinephrine activity)
increases "turnover" of norepinephrine, the rate at which it is "remade" available to be released into the synapse- this may be due to decreased metabolism or destruction of norepinephrine due to inhibition of MAO
Monoamine oxidase (MAO) is an enzyme that acts on other molecules, changing them in small ways that make the molecules more useful to the body. MAO acts on a variety of neurotransmitters, two of which are norepinephrine and serotonin. MAO destroys excessive amounts of norepinephrine and serotonin in healthy individuals. The activity level of MAO is used as an indicator of the activity level of serotonin and norepinephrine. If the activity level of MAO is high, the activity level of serotonin and norepinephrine is high. E. Klaiber and colleagues have demonstrated that increased levels of MAO platelet activity are indeed associated with lower levels of depression after two cycles of ERT.
Estrogen also acts as a MAO inhibitor by decreasing the production of MAO. The result is that there is less MAO to destroy serotonin and norepinephrine and hence, there is more of these two neurotransmitters available to be released into the synapse and their activity is increased. This action of estrogen is the same as MAO-inhibitors that are used as a therapy for depression. However, ERT alone may not be effective as an antidepressant but may be helpful as part of a larger regimen. The research for ERT as an antidepressant is not yet conclusive.
Estrogen Replacement Therapy and Progestin:
What are the effects of adding progestin to ERT?
Progestin is taken in combination with estrogen to diminish the risks of continual estrogen administration. One of the major risks of taking only estrogen is a significant increase in a woman's risk of endometrial cancer. Many studies however, have shown that the combination of estrogen and progestin has diminishes the positive effects that estrogen alone has on mood. However, not all women have such a negative reaction to the addition of progestin.
E. Klaiber and colleagues investigated the individual differences in women that may account for the differential reactions to the addition of progestin. They found that women who experienced an increase in positive mood during ERT and did not react adversely to the addition of progestin had the following characteristics:
short menopausal duration
high pretreatment estradiol levels in the blood
high pretreatment testosterone levels in the blood
low pretreatment levels of follicle stimulating hormone in the blood
****these above characteristics reflect early menopausal stages***
Women who had positive mood reaction to estrogen alone but experienced a reduction in the positive effect with the addition of progestin had the following characteristics:
long menopausal duration
low pretreatment estradiol level in the blood
low pretreatment testosterone level in the blood
high pretreatment follicle stimulating hormone in the blood
***these characteristics reflect the later stages of menopause***
Women whose benefits from estrogen were not completely countered by progestin had the following characteristics:
pretreatment adverse mood states
low pretreatment MAO activity (indicative of lower serotonin and norepinephrine activity)
older age (in an age span of 45-65 years)
The enhancing effect of estrogen on MAO activity (indicative of serotonin and norepinephrine activity) is diminished in some women by the addition of progestin. Women who did show an increase in MAO activity during ERT were woman who had short menopausal duration and high pretreatment levels of testosterone in their blood. These women showed a decline in MAO activity every time progestin was administered. An interesting occurrence is that the greater the rise in MAO activity during ERT, the less impairment there was in mood due to addition of progestin.
A paradox was found in the expected blood levels of estradiol in women with long menopausal duration. These women had higher levels of estradiol during ERT than did women with short menopausal duration but this raise in estradiol level did not counter the negative effects of progestin. They still experienced a reduction in the positive effects of estrogen. E. Klaiber and colleagues put forth an interesting hypothesis. Women with long duration of menopause also have experienced a prolonged deficiency in estrogen. The hypothesis is that the prolonged estrogen deficiency causes impairment of estradiol receptors in the brain which in turn causes a decrease in the use of estrogen resulting in more estradiol being left over in the brain (= high levels of estradiol in the blood). This impairment of estradiol receptors also impedes normal reactions to estrogen which means estrogen is not as able to have it's beneficial effects on the serotonin and norepinephrine activity.
However, women with long duration menopause do react positively to estrogen alone. S. Carranza and M. Valentino-Figueroa found that ERT was useful in alleviating depressive mood in postmenopausal women who had these depressive symptoms before ERT, but S. Girdler and colleagues found that it did not have a mood effect for women who did not have depression. It may be that in lieu of the already diminished number of healthy estradiol receptors, the progestin causes a further "down regulation" of estradiol receptors resulting in a lessening of the positive effects of estrogen. If this hypothesis of the impairment of estradiol receptors is true, it is not know if ERT can reverse it. If it can't, this is a strong argument for early intervention with ERT. However, this hypotheses have not been proven yet and further research needs to be done to investigate these probabilities.
Women with pretreatment adverse mood states and low MAO activity (indicative of low serotonin and norepinephrine activity) may already be vulnerable to depression before the onset of menopause. Their MAO level may already be low, and although estrogen may raise it, it may not be enough to protect against the effects of progestin.
ERT's effect on mood in menopausal women and the mechanics of this effect
ERT's effect on mood in menopausal women and the mechanics of this effect
Depression and Menopause:
Is depression a symptom of menopause?
Controversy is a central aspect of research in estrogen replacement therapy (ERT) for menopausal women and its affect on mood. One area of controversy is whether or not depression is a symptom of menopause. Depression is a low mood state characterized by significant levels of sadness, lack of energy, low self-worth, guilt, or related symptoms. This differs from the symptomology of major depression in which a person has at least five of the symptoms of depression not due to a normal reaction to a life event that last for two weeks or more.
Symptoms of Major Depression:
depressed mood most of the day, nearly every day
markedly diminished interest and pleasure in almost all daily activities
significant weight loss or gain, or a significant increase or decrease in appetite nearly every day
insomnia or hypersomnia nearly every day
psychomotor agitation or retardation nearly every day
fatigue or loss of energy nearly every day
feelings of worthlessness or excessive guilt nearly every day
reduced ability to think or concentrate nearly every day
recurrent thoughts of death or suicide, a suicide attempt, or a specific plan for committing suicide
Depressive mood has been linked to the activity of serotonin and norepinephrine in the brain. Serotonin and norepinephrine are neurotransmitters that, among other things, affect mood. Neurotransmitters are chemical messengers in the brain that are responsible for communication between different brain areas and the body. A higher level of serotonin and norepinephrine activity is associated with positive mood while decreased activity is associated with depressive mood.
During menopause, women experience hormonal and chemical changes. There is a decrease in a woman's level of estradiol, the principal estrogen of women. Also, some serotonin functioning decreases although it is unknown the extent to which serotonin and norepinephrine activity is affected by menopause. In one study, premenopausal women and menopausal women were given a drug that acts in much the same way that serotonin does in the brain, a kind of pseudo-serotonin used to study the activity of serotonin itself. The researchers found that serotonin activity was decreased in postmenopausal women and that this decrease was associated with decreased levels of estradiol in the blood. The premenopausal women did not show this decrease in activity.
Estrogen boosts the activity of serotonin. Women who experience a long duration of menopause or postmenopausal women who have not used ERT have a prolonged deficiency in estrogen. This prolonged estrogen deficiency may be associated with impairment in estradiol receptors in the brain. Estradiol receptors are the sites in the brain where estrogen connects to most readily and does its work. Estradiol receptors may be important in the faciliatory effect that estrogen has on the activity of serotonin and norepinephrine. When the receptors are impaired, estrogen does not work as well and is unable to facilitate the activity of serotonin.
With the above mentioned effects in mind, it may be that menopausal and postmenopausal women are more vulnerable to depression due to lower serotonin and norepinephrine activity. The Manitoba Project, an ongoing study of Canadian women, found that the stress of daily life, chronic disease, and family problems were most likely to trigger depression in menopausal women. Perhaps these triggers have a more powerful effect on menopausal women and postmenopausal women due to their lower serotonin and norepinephrine activity. One study by Weissman found that the occurrence of major depression may increase after menopause. Another study reported by J. Coope stated that depressive illness is not more common at menopause. However, "depressive illness" was not specified in that study. We do not know if they are talking about a person diagnosed with major depression or someone experiencing depressive mood states not severe enough to be classified as major depression. The data is not conclusive in regard to the occurrence or cause of menopausal or postmenopausal depression. However, the physiological effects of menopause may make a woman more vulnerable to other life aspects that may trigger depression.
Estrogen Replacement Therapy and Mood:
Does ERT help mood?
Does estrogen in combination with progestin help mood?
There is also some controversy about the effectiveness of ERT in alleviating depressive mood, however there is much evidence in support of its beneficial effects. A meta-analysis of 26 hormone replacement studies found that in a majority of these studies ERT helped significantly in the alleviation of depressed mood as rated by scales such as the Hamilton Scale of Depression and Beck Depression Inventory (BDI). These scales investigate the behavioral and bodily symptoms (Hamilton Scale) and the cognitive and mood symptoms (BDI). More recent studies have also shown support for the positive effects of ERT on mood as rated by scales similar to those mentioned above. However, J. Coope reported two studies that did not show these effects.
An interesting point to this controversy is the differences in report scales that have been used to measure depressed mood states. J. Zweifel and W. O'Brien report that the BDI yields smaller effect sizes, or the amount of change exhibited by the women of these studies compared to the effect sizes of the Hamilton Scale. Previous research also suggests that the BDI yields smaller effect sizes in comparison with other measures of depression. In other words, results from the BDI may not indicate as much change as another scale would. The BDI investigates cognition and feelings while the Hamilton Scale looks at behavioral and bodily symptoms. It may be that the BDI is less sensitive to the changes caused by ERT. Another difference in the scales is how they are taken. The BDI is a self-report measure whereas the Hamilton Scale utilizes a trained observer's ratings of symptoms. Women may be reluctant to endorse symptoms related to depression when they are doing the self-evaluation. Consequently, the BDI may not be an accurate measure of these symptoms.
Other evidence for the ERT's effectiveness in enhancing mood comes from it's effects on the chemistry of the brain. Estrogen enhances norepinephrine and serotonin activity, and inhibits production of monoamine oxidase. As mentioned earlier, serotonin and norepinephrine are involved in the regulation of depressive moods. Decreased activity of serotonin and norepinephrine are associated with increased depressive mood.
Estrogen's effects on serotonin:
estrogen increases the sensitivity of the receptors that receive serotonin (they are more likely to connect with serotonin)
increases the number of serotonin receptors which increases the activity level of serotonin
increases the reuptake of serotonin by the neuron it was released from in order that the serotonin may be made available once again in the synapse (the space between the neuron that releases the serotonin and the receptor that may connect with it)
increases the synthesis, or production, of serotonin
Estrogen's effects on norepinephrine
increases the binding rate of particular norepinephrine receptors (which increases norepinephrine activity)
increases "turnover" of norepinephrine, the rate at which it is "remade" available to be released into the synapse- this may be due to decreased metabolism or destruction of norepinephrine due to inhibition of MAO
Monoamine oxidase (MAO) is an enzyme that acts on other molecules, changing them in small ways that make the molecules more useful to the body. MAO acts on a variety of neurotransmitters, two of which are norepinephrine and serotonin. MAO destroys excessive amounts of norepinephrine and serotonin in healthy individuals. The activity level of MAO is used as an indicator of the activity level of serotonin and norepinephrine. If the activity level of MAO is high, the activity level of serotonin and norepinephrine is high. E. Klaiber and colleagues have demonstrated that increased levels of MAO platelet activity are indeed associated with lower levels of depression after two cycles of ERT.
Estrogen also acts as a MAO inhibitor by decreasing the production of MAO. The result is that there is less MAO to destroy serotonin and norepinephrine and hence, there is more of these two neurotransmitters available to be released into the synapse and their activity is increased. This action of estrogen is the same as MAO-inhibitors that are used as a therapy for depression. However, ERT alone may not be effective as an antidepressant but may be helpful as part of a larger regimen. The research for ERT as an antidepressant is not yet conclusive.
Estrogen Replacement Therapy and Progestin:
What are the effects of adding progestin to ERT?
Progestin is taken in combination with estrogen to diminish the risks of continual estrogen administration. One of the major risks of taking only estrogen is a significant increase in a woman's risk of endometrial cancer. Many studies however, have shown that the combination of estrogen and progestin has diminishes the positive effects that estrogen alone has on mood. However, not all women have such a negative reaction to the addition of progestin.
E. Klaiber and colleagues investigated the individual differences in women that may account for the differential reactions to the addition of progestin. They found that women who experienced an increase in positive mood during ERT and did not react adversely to the addition of progestin had the following characteristics:
short menopausal duration
high pretreatment estradiol levels in the blood
high pretreatment testosterone levels in the blood
low pretreatment levels of follicle stimulating hormone in the blood
****these above characteristics reflect early menopausal stages***
Women who had positive mood reaction to estrogen alone but experienced a reduction in the positive effect with the addition of progestin had the following characteristics:
long menopausal duration
low pretreatment estradiol level in the blood
low pretreatment testosterone level in the blood
high pretreatment follicle stimulating hormone in the blood
***these characteristics reflect the later stages of menopause***
Women whose benefits from estrogen were not completely countered by progestin had the following characteristics:
pretreatment adverse mood states
low pretreatment MAO activity (indicative of lower serotonin and norepinephrine activity)
older age (in an age span of 45-65 years)
The enhancing effect of estrogen on MAO activity (indicative of serotonin and norepinephrine activity) is diminished in some women by the addition of progestin. Women who did show an increase in MAO activity during ERT were woman who had short menopausal duration and high pretreatment levels of testosterone in their blood. These women showed a decline in MAO activity every time progestin was administered. An interesting occurrence is that the greater the rise in MAO activity during ERT, the less impairment there was in mood due to addition of progestin.
A paradox was found in the expected blood levels of estradiol in women with long menopausal duration. These women had higher levels of estradiol during ERT than did women with short menopausal duration but this raise in estradiol level did not counter the negative effects of progestin. They still experienced a reduction in the positive effects of estrogen. E. Klaiber and colleagues put forth an interesting hypothesis. Women with long duration of menopause also have experienced a prolonged deficiency in estrogen. The hypothesis is that the prolonged estrogen deficiency causes impairment of estradiol receptors in the brain which in turn causes a decrease in the use of estrogen resulting in more estradiol being left over in the brain (= high levels of estradiol in the blood). This impairment of estradiol receptors also impedes normal reactions to estrogen which means estrogen is not as able to have it's beneficial effects on the serotonin and norepinephrine activity.
However, women with long duration menopause do react positively to estrogen alone. S. Carranza and M. Valentino-Figueroa found that ERT was useful in alleviating depressive mood in postmenopausal women who had these depressive symptoms before ERT, but S. Girdler and colleagues found that it did not have a mood effect for women who did not have depression. It may be that in lieu of the already diminished number of healthy estradiol receptors, the progestin causes a further "down regulation" of estradiol receptors resulting in a lessening of the positive effects of estrogen. If this hypothesis of the impairment of estradiol receptors is true, it is not know if ERT can reverse it. If it can't, this is a strong argument for early intervention with ERT. However, this hypotheses have not been proven yet and further research needs to be done to investigate these probabilities.
Women with pretreatment adverse mood states and low MAO activity (indicative of low serotonin and norepinephrine activity) may already be vulnerable to depression before the onset of menopause. Their MAO level may already be low, and although estrogen may raise it, it may not be enough to protect against the effects of progestin.
Science
Musculoskeletal Care During Pregnancy:
Despite the high prevalence of musculoskeletal pain during pregnancy, few women in underserved populations receive therapy for their low back pain, as per a February 2007 study in the Journal of Manipulative and Physiological Therapeutics (JMPT). Moreover, scientists observed that pain in a prior pregnancy may predict a high risk for musculoskeletal complaints in future pregnancies.
85 percent of women surveyed reported that they had not received therapy for their musculoskeletal pain, and of the small percentage who perceived that their back complaints were addressed, less than 10 percent were satisfied with the symptom relief they obtained.
"Based on the findings of this study, doctors of chiropractic and other health care professionals need to expand the musculoskeletal care available during pregnancy, particularly in underserved populations," Dr. Skaggs said. "As a proactive step, health professionals should consider including back pain screening as part of early obstetrical care to help identify musculoskeletal risk factors and allow for early education and/or therapy".
Scientists surveyed more than 600 women at a clinic that serves predominantly an uninsured, underinsured or Medicaid-insured population. Surveys were offered to all obstetrical patients and were designed to collect information about pregnancy-related pain and quality of life issues. Of those women who responded to the survey, two-thirds reported back pain and nearly half of all women reported pain at two or more locations, including pelvic pain and mid-back pain.........
Steroid Use Fails To Boost Pregnancy Rates:
There is no clear benefit from a hormone usually prescribed to enhance the effectiveness of infertility therapys, as per a new review of studies.
The steroid hormones called glucocorticoids have potent effects on the bodys inflammatory and immune responses, so a number of fertility specialists prescribe them in hopes of making the lining of the uterus more receptive to embryo implantation. But lead review author Carolien Boomsma says that routine practice should stop.
This meta-analysis shows that empirical use of glucocorticoids is not supported by evidence from studies, she said. Moreover, we dont know enough about the possible adverse effects of glucocorticoids in early pregnancy. Therefore, at present, glucocorticoids should not be prescribed in this way, said Boomsma, a researcher at the University Medical Centre Utrecht in the Netherlands.
The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
The review compares success rates between would-be mothers who took glucocorticoids around the time of embryo implantation and those who did not. All of the women underwent one of two types of assisted reproductive technology. In vitro fertilization (IVF) involves removing mature eggs from a womans ovary, mixing them with sperm in the laboratory, and placing the embryos in the womans reproductive tract. Intracytoplasmic sperm injection (ICSI) is another in vitro fertilization practice where a single sperm is injected directly into a harvested egg.........
Menstrual Cycle And The Female Brain:
What influence does the variation in estrogen level have on the activation of the female brain? Using functional Magnetic Resonance Imaging, Jean-Claude Dreher, a researcher at the Cognitive Neuroscience Center (CNRS/Universit Lyon 1), in collaboration with an American team from the National Institute of Mental Health (Bethesda, Maryland) directed by Karen Berman, has identified, for the first time, the neural networks involved in processing reward-related functions modulated by female gonadal steroid hormones. This result, which was published online on January 29, 2007 on the PNAS website, is an important step in better comprehension of certain psychiatric and neurological pathologies.
The human brain has a recompense system that predicts different types of reward (food, money, drugs). The normal functioning of this system plays a fundamental role in a number of cognitive processes such as motivation and learning. This reward system, composed of dopaminergic neurons1 situated in the mesencephalon (a very deep region of the brain) and their projection sites2, is crucial for neural coding of rewards. Its dysfunction can result in disorders such as addictions and is also implicated in various psychiatric and neurological pathologies, such as Parkinson's disease and schizophrenic disorders. A number of studies on animals prove that the dopaminergic3 system is sensitive to gonadal steroid hormones (estrogen, progesterone). For example, female rats self-administer cocaine (a drug that acts on the dopamine system) in higher doses after estrogens have been administered to them. The influence of gonadal steroid hormones on the activation of the reward system remained to be studied in humans. A better knowledge of this influence should make for better understanding of the differences between men and women, especially as observed in the prevalence of certain psychiatric pathologies and in vulnerability to drugs, (for which the dopaminergic system plays an important role.) It is known, for example, that the female response to cocaine is greater in the follicular phase of the menstrual cycle4 than in the luteal phase5.Moreover, schizophrenia tends to appear later in women than in men.........
Aspirin For Conception And Healthy Pregnancy:
Scientists at the University at Buffalo and the University of Utah are beginning a clinical trial to test whether aspirin can improve a woman's chances of becoming pregnant and of maintaining a pregnancy to term.
UB's portion of the study is funded by a $2.8 million grant from the National Institute of Child Health and Development.
The trial is aimed at women who have miscarried a pregnancy in the past years.
"In women who have had their first miscarriage, the reasons for losing that pregnancy are in a number of instances unknown," said Jean Wactawski-Wende, Ph.D., UB associate professor of social and preventive medicine and principal investigator of the UB clinical center.
"These women generally are advised to try to get pregnant again, but health-care providers can offer limited assistance on any specific actions to take to improve their next pregnancy outcome," she noted. "If aspirin can help some women become pregnant or maintain a health pregnancy, it will be a critically important finding.
"Aspirin is available, inexpensive and has very few side effects," she added. "We're hopeful that this trial could produce an important finding".
Statistics show that in the United States, 10-15 percent of couples trying to become pregnant are not able to conceive, 15-31 percent of pregnancies that do occur end in miscarriage, and 8-15 percent of pregnancies that continue beyond 20 weeks end in premature birth, putting these infants at risk for increased health problems.........
Protecting Women's Mood Under Stress:
German scientists have found additional evidence that the stress hormone cortisol can have positive effects in certain situations. Eventhough chronic stress, which brings long-term elevations of cortisol in the bloodstream, can weaken the immune system and induce depression, this new study adds to mounting evidence that cortisol given near in time to a physical or psychological stress may lessen the stressor's emotional impact. Psychology experts are particularly interested in what this means for preventing and treating post-traumatic stress disorder. The findings are reported in the recent issue of Behavioral Neuroscience, which is published by the American Psychological Association (APA).
Psychology experts Serkan Het, MSc, and Oliver Wolf, PhD, of the University of Bielefeld, enlisted 44 healthy women for a double-blind study, in which neither scientists or participants knew the condition to which the women were assigned. One hour before a psychosocial stress test, participants were given either a 30 mg. dose of oral cortisol or a placebo. That 30 mg. dose is considered high, translating to a severe stressor. Experimenters tracked participant mood through self report, and measured their cortisol levels with a simple swab check of their saliva, before and after the psychosocial stress test.........
New smear test policy puts young women at risk:
The BMJ reported a fall in the number of young women attending smear tests. Now, two senior doctors warn that a new policy not to screen women aged 20-24 may be a factor in falling coverage and could increase the risk of cancer developing in young women.
Prevalence of carcinoma in situ (a precursor to cancer known as CIN3) has increased in women aged 20-24, write consultants Amanda Herbert and John Smith. This new policy will add more than 3000 women with untreated CIN3 to the larger numbers failing to accept their invitations later on, they warn.
The authors accept that CIN may regress, that invasive cervical cancer (ICC) is rare in women under 25, and that screening does little to reduce its incidence in such young women. However, they argue that ICC can develop within a couple of years of missed cell analysis, failure to investigate cell abnormalities, or incomplete therapy, emphasising the importance of treating high-grade CIN when it is found.
Screening in the UK has been highly successful and, since 1988, incidence and mortality have fallen by more than 40% despite increased risk of disease. This has been achieved by treating high-grade CIN, especially CIN3, in young women, say the authors. The peak prevalence of CIN3 is in women aged 25-29 amongst whom the fall in coverage has been greatest.........
Abortion -- where do we draw the line?:
Any challenge to the upper limit of 24 weeks poses big questions about viability, infant suffering, and the capabilities of neonatal care, writes Gornall and the danger is that this vital debate is taking place increasingly on emotional rather than scientific grounds.
The ProLife Alliance can take much of the credit for having put abortion back on the public and political agenda over the past decade. The organisation was set up in 1996 as a political party to show the reality of abortion and was also behind the ultimately failed attempt in 2003 by Joanna Jepson, a trainee vicar, to have police prosecute two doctors over the late abortion of a fetus with a cleft lip and palate.
Now the alliance has turned its attention away from pictures of dead babies to 4D ultrasound images of live ones in the womb.
The technique was pioneered by Stuart Campbell, head of obstetrics and gynaecology at St Georges Hospital, London, who is convinced that his 4D images have undermined the validity of the current time limit for abortion.........
Benchmark fetal surgery study:
It's one of the biggest controversies in fetal surgery and the cause of heated debate among surgeons and maternal-fetal medicine physicians around the world: What's the best way to treat twin-twin transfusion syndrome (TTTS), one of the most common conditions requiring fetal surgery and the leading cause of mortality in twins?
The benchmark, NIH-funded study on TTTS, conducted at 17 centers in the United States, will be presented February 9 at the annual meeting of the Society for Maternal-Fetal Medicine in San Francisco, and it won't likely resolve the question of which is the best procedure. The study, led by Timothy Crombleholme, M.D., director of the Fetal Care Center of Cincinnati, shows that the question isn't which surgical procedure is better, it's when the procedure is done.
Dr. Crombleholme issued a clarion call to fetal care specialists around the world. "The earlier in gestation TTTS is diagnosed, the more severe the syndrome tends to be," says Dr. Crombleholme, who is also a pediatric surgeon at Cincinnati Children's Hospital Medical Center. "We have to shift attention to diagnosing this earlier in the progression of the syndrome and being more aggressive about intervention. We can't conclude that one treatment is better than another, but it's apparent that we're going to compromise survival if therapy isn't initiated before it gets to be severe".........
African-American mothers more likely to deliver prematurely:
African-American women are three times more likely to deliver babies three to 17 weeks prematurely than Caucasian women, as per a review of Missouri birth statistics by scientists at Washington University School of Medicine in St. Louis.
In addition, African-American women are more likely to deliver babies prematurely in subsequent pregnancies.
The scientists analyzed data from the Missouri Department of Health's maternally linked database of all births in Missouri between 1989 and 1997, adjusting for such variables as socioeconomic status, education level, cigarette smoking and maternal medical conditions such as diabetes, high blood pressure and eclampsia. Full-term birth is considered to be between 37 weeks and 42 weeks of gestation.
Results of the analysis appear in the recent issue of the American Journal of Obstetrics and Gynecology.
The data showed that 8.8 percent of births to African-American women were between 20 weeks and 34 weeks gestation, or nearly three times the 2.95 percent of premature births to Caucasian women. In addition, African-American women were nearly four times as likely to deliver babies between 20 weeks and 28 weeks gestation than Caucasian women.
African-American women also were nearly 5.5 times more likely to have recurrent preterm births than Caucasian women.........
Helping women with PCOS achieve pregnancy:
Metformin, a drug used to treat diabetes and once thought to have great promise in overcoming the infertility linked to polycystic ovary syndrome (PCOS), is less effective than the standard fertility drug therapy, clomiphene, as per scientists from the University of Pennsylvania School of Medicine and the National Institutes of Health Reproductive Medicine research network. This is the largest, most comprehensive effort yet to compare the two drugs in helping PCOS patients achieve successful pregnancy. The findings are reported in the February 8th, 2007 issue of the New England Journal (NEJM).
"With this study, my colleagues and I recommend and support the use of clomiphene alone and NOT in combination with Metformin as a first-line treatment for infertility in women with PCOS," said Christos Coutifaris, MD, PhD, Director of the Division of Reproductive Endocrinology and Infertility and the principal investigator from Penn. "These results emphasize the need to test any new application rigorously, no matter how promising it may seem initially."
As per the study authors, women who took metformin ovulated more that the women who were given the standard therapy. Similarly, women in the combination treatment group ovulated more frequently than did the women in either the clomiphene-alone or the metformin-alone groups. However, as the current study revealed, an increase in ovulation did not result in more successful pregnancies and deliveries for either the metformin alone, or combination group.........
Despite the high prevalence of musculoskeletal pain during pregnancy, few women in underserved populations receive therapy for their low back pain, as per a February 2007 study in the Journal of Manipulative and Physiological Therapeutics (JMPT). Moreover, scientists observed that pain in a prior pregnancy may predict a high risk for musculoskeletal complaints in future pregnancies.
85 percent of women surveyed reported that they had not received therapy for their musculoskeletal pain, and of the small percentage who perceived that their back complaints were addressed, less than 10 percent were satisfied with the symptom relief they obtained.
"Based on the findings of this study, doctors of chiropractic and other health care professionals need to expand the musculoskeletal care available during pregnancy, particularly in underserved populations," Dr. Skaggs said. "As a proactive step, health professionals should consider including back pain screening as part of early obstetrical care to help identify musculoskeletal risk factors and allow for early education and/or therapy".
Scientists surveyed more than 600 women at a clinic that serves predominantly an uninsured, underinsured or Medicaid-insured population. Surveys were offered to all obstetrical patients and were designed to collect information about pregnancy-related pain and quality of life issues. Of those women who responded to the survey, two-thirds reported back pain and nearly half of all women reported pain at two or more locations, including pelvic pain and mid-back pain.........
Steroid Use Fails To Boost Pregnancy Rates:
There is no clear benefit from a hormone usually prescribed to enhance the effectiveness of infertility therapys, as per a new review of studies.
The steroid hormones called glucocorticoids have potent effects on the bodys inflammatory and immune responses, so a number of fertility specialists prescribe them in hopes of making the lining of the uterus more receptive to embryo implantation. But lead review author Carolien Boomsma says that routine practice should stop.
This meta-analysis shows that empirical use of glucocorticoids is not supported by evidence from studies, she said. Moreover, we dont know enough about the possible adverse effects of glucocorticoids in early pregnancy. Therefore, at present, glucocorticoids should not be prescribed in this way, said Boomsma, a researcher at the University Medical Centre Utrecht in the Netherlands.
The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
The review compares success rates between would-be mothers who took glucocorticoids around the time of embryo implantation and those who did not. All of the women underwent one of two types of assisted reproductive technology. In vitro fertilization (IVF) involves removing mature eggs from a womans ovary, mixing them with sperm in the laboratory, and placing the embryos in the womans reproductive tract. Intracytoplasmic sperm injection (ICSI) is another in vitro fertilization practice where a single sperm is injected directly into a harvested egg.........
Menstrual Cycle And The Female Brain:
What influence does the variation in estrogen level have on the activation of the female brain? Using functional Magnetic Resonance Imaging, Jean-Claude Dreher, a researcher at the Cognitive Neuroscience Center (CNRS/Universit Lyon 1), in collaboration with an American team from the National Institute of Mental Health (Bethesda, Maryland) directed by Karen Berman, has identified, for the first time, the neural networks involved in processing reward-related functions modulated by female gonadal steroid hormones. This result, which was published online on January 29, 2007 on the PNAS website, is an important step in better comprehension of certain psychiatric and neurological pathologies.
The human brain has a recompense system that predicts different types of reward (food, money, drugs). The normal functioning of this system plays a fundamental role in a number of cognitive processes such as motivation and learning. This reward system, composed of dopaminergic neurons1 situated in the mesencephalon (a very deep region of the brain) and their projection sites2, is crucial for neural coding of rewards. Its dysfunction can result in disorders such as addictions and is also implicated in various psychiatric and neurological pathologies, such as Parkinson's disease and schizophrenic disorders. A number of studies on animals prove that the dopaminergic3 system is sensitive to gonadal steroid hormones (estrogen, progesterone). For example, female rats self-administer cocaine (a drug that acts on the dopamine system) in higher doses after estrogens have been administered to them. The influence of gonadal steroid hormones on the activation of the reward system remained to be studied in humans. A better knowledge of this influence should make for better understanding of the differences between men and women, especially as observed in the prevalence of certain psychiatric pathologies and in vulnerability to drugs, (for which the dopaminergic system plays an important role.) It is known, for example, that the female response to cocaine is greater in the follicular phase of the menstrual cycle4 than in the luteal phase5.Moreover, schizophrenia tends to appear later in women than in men.........
Aspirin For Conception And Healthy Pregnancy:
Scientists at the University at Buffalo and the University of Utah are beginning a clinical trial to test whether aspirin can improve a woman's chances of becoming pregnant and of maintaining a pregnancy to term.
UB's portion of the study is funded by a $2.8 million grant from the National Institute of Child Health and Development.
The trial is aimed at women who have miscarried a pregnancy in the past years.
"In women who have had their first miscarriage, the reasons for losing that pregnancy are in a number of instances unknown," said Jean Wactawski-Wende, Ph.D., UB associate professor of social and preventive medicine and principal investigator of the UB clinical center.
"These women generally are advised to try to get pregnant again, but health-care providers can offer limited assistance on any specific actions to take to improve their next pregnancy outcome," she noted. "If aspirin can help some women become pregnant or maintain a health pregnancy, it will be a critically important finding.
"Aspirin is available, inexpensive and has very few side effects," she added. "We're hopeful that this trial could produce an important finding".
Statistics show that in the United States, 10-15 percent of couples trying to become pregnant are not able to conceive, 15-31 percent of pregnancies that do occur end in miscarriage, and 8-15 percent of pregnancies that continue beyond 20 weeks end in premature birth, putting these infants at risk for increased health problems.........
Protecting Women's Mood Under Stress:
German scientists have found additional evidence that the stress hormone cortisol can have positive effects in certain situations. Eventhough chronic stress, which brings long-term elevations of cortisol in the bloodstream, can weaken the immune system and induce depression, this new study adds to mounting evidence that cortisol given near in time to a physical or psychological stress may lessen the stressor's emotional impact. Psychology experts are particularly interested in what this means for preventing and treating post-traumatic stress disorder. The findings are reported in the recent issue of Behavioral Neuroscience, which is published by the American Psychological Association (APA).
Psychology experts Serkan Het, MSc, and Oliver Wolf, PhD, of the University of Bielefeld, enlisted 44 healthy women for a double-blind study, in which neither scientists or participants knew the condition to which the women were assigned. One hour before a psychosocial stress test, participants were given either a 30 mg. dose of oral cortisol or a placebo. That 30 mg. dose is considered high, translating to a severe stressor. Experimenters tracked participant mood through self report, and measured their cortisol levels with a simple swab check of their saliva, before and after the psychosocial stress test.........
New smear test policy puts young women at risk:
The BMJ reported a fall in the number of young women attending smear tests. Now, two senior doctors warn that a new policy not to screen women aged 20-24 may be a factor in falling coverage and could increase the risk of cancer developing in young women.
Prevalence of carcinoma in situ (a precursor to cancer known as CIN3) has increased in women aged 20-24, write consultants Amanda Herbert and John Smith. This new policy will add more than 3000 women with untreated CIN3 to the larger numbers failing to accept their invitations later on, they warn.
The authors accept that CIN may regress, that invasive cervical cancer (ICC) is rare in women under 25, and that screening does little to reduce its incidence in such young women. However, they argue that ICC can develop within a couple of years of missed cell analysis, failure to investigate cell abnormalities, or incomplete therapy, emphasising the importance of treating high-grade CIN when it is found.
Screening in the UK has been highly successful and, since 1988, incidence and mortality have fallen by more than 40% despite increased risk of disease. This has been achieved by treating high-grade CIN, especially CIN3, in young women, say the authors. The peak prevalence of CIN3 is in women aged 25-29 amongst whom the fall in coverage has been greatest.........
Abortion -- where do we draw the line?:
Any challenge to the upper limit of 24 weeks poses big questions about viability, infant suffering, and the capabilities of neonatal care, writes Gornall and the danger is that this vital debate is taking place increasingly on emotional rather than scientific grounds.
The ProLife Alliance can take much of the credit for having put abortion back on the public and political agenda over the past decade. The organisation was set up in 1996 as a political party to show the reality of abortion and was also behind the ultimately failed attempt in 2003 by Joanna Jepson, a trainee vicar, to have police prosecute two doctors over the late abortion of a fetus with a cleft lip and palate.
Now the alliance has turned its attention away from pictures of dead babies to 4D ultrasound images of live ones in the womb.
The technique was pioneered by Stuart Campbell, head of obstetrics and gynaecology at St Georges Hospital, London, who is convinced that his 4D images have undermined the validity of the current time limit for abortion.........
Benchmark fetal surgery study:
It's one of the biggest controversies in fetal surgery and the cause of heated debate among surgeons and maternal-fetal medicine physicians around the world: What's the best way to treat twin-twin transfusion syndrome (TTTS), one of the most common conditions requiring fetal surgery and the leading cause of mortality in twins?
The benchmark, NIH-funded study on TTTS, conducted at 17 centers in the United States, will be presented February 9 at the annual meeting of the Society for Maternal-Fetal Medicine in San Francisco, and it won't likely resolve the question of which is the best procedure. The study, led by Timothy Crombleholme, M.D., director of the Fetal Care Center of Cincinnati, shows that the question isn't which surgical procedure is better, it's when the procedure is done.
Dr. Crombleholme issued a clarion call to fetal care specialists around the world. "The earlier in gestation TTTS is diagnosed, the more severe the syndrome tends to be," says Dr. Crombleholme, who is also a pediatric surgeon at Cincinnati Children's Hospital Medical Center. "We have to shift attention to diagnosing this earlier in the progression of the syndrome and being more aggressive about intervention. We can't conclude that one treatment is better than another, but it's apparent that we're going to compromise survival if therapy isn't initiated before it gets to be severe".........
African-American mothers more likely to deliver prematurely:
African-American women are three times more likely to deliver babies three to 17 weeks prematurely than Caucasian women, as per a review of Missouri birth statistics by scientists at Washington University School of Medicine in St. Louis.
In addition, African-American women are more likely to deliver babies prematurely in subsequent pregnancies.
The scientists analyzed data from the Missouri Department of Health's maternally linked database of all births in Missouri between 1989 and 1997, adjusting for such variables as socioeconomic status, education level, cigarette smoking and maternal medical conditions such as diabetes, high blood pressure and eclampsia. Full-term birth is considered to be between 37 weeks and 42 weeks of gestation.
Results of the analysis appear in the recent issue of the American Journal of Obstetrics and Gynecology.
The data showed that 8.8 percent of births to African-American women were between 20 weeks and 34 weeks gestation, or nearly three times the 2.95 percent of premature births to Caucasian women. In addition, African-American women were nearly four times as likely to deliver babies between 20 weeks and 28 weeks gestation than Caucasian women.
African-American women also were nearly 5.5 times more likely to have recurrent preterm births than Caucasian women.........
Helping women with PCOS achieve pregnancy:
Metformin, a drug used to treat diabetes and once thought to have great promise in overcoming the infertility linked to polycystic ovary syndrome (PCOS), is less effective than the standard fertility drug therapy, clomiphene, as per scientists from the University of Pennsylvania School of Medicine and the National Institutes of Health Reproductive Medicine research network. This is the largest, most comprehensive effort yet to compare the two drugs in helping PCOS patients achieve successful pregnancy. The findings are reported in the February 8th, 2007 issue of the New England Journal (NEJM).
"With this study, my colleagues and I recommend and support the use of clomiphene alone and NOT in combination with Metformin as a first-line treatment for infertility in women with PCOS," said Christos Coutifaris, MD, PhD, Director of the Division of Reproductive Endocrinology and Infertility and the principal investigator from Penn. "These results emphasize the need to test any new application rigorously, no matter how promising it may seem initially."
As per the study authors, women who took metformin ovulated more that the women who were given the standard therapy. Similarly, women in the combination treatment group ovulated more frequently than did the women in either the clomiphene-alone or the metformin-alone groups. However, as the current study revealed, an increase in ovulation did not result in more successful pregnancies and deliveries for either the metformin alone, or combination group.........
Monday, October 4, 2010
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