So what causes AUB-O?

Blog Post  by Malcolm G. Munro MD, FACOG, FRCS(c), Professor, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Director of Gynecologic Services, Kaiser Permanante, Los Angeles Medical Center, Los Angeles, CA, USA

In the reproductive years, many women with abnormal uterine bleeding (AUB) have a disorder of ovulation – a group of entities designated “AUB-O” in the new FIGO classification system for causes of AUB in the reproductive years.(1) But what are these ovulatory disorders, and how are they diagnosed and treated?

The only thing “typical” about women with ovulatory disorders is that they do not have the characteristics of normal ovulation – ie predictable menstrual bleeding, with a reliable cycle length of 22 to 35 days and duration and flow that is consistent from period to period.(2) Instead, these women are often plagued with uncertainty – uncertainty about the time of onset, and, frequently, the volume and duration of bleeding. 

The changing world of vascular surgery

Blog Post by Mr Vish Bhattacharya MB BS, FRCS (Glas & Edin), FRCS (Gen Surg) Consultant General and Vascular Surgeon, Queen Elizabeth Hospital, Gateshead, UK.

Vascular surgery has changed dramatically over the last 10 years. The major emphasis has been on prevention of vascular disease and on minimally invasive surgery. There has been much better awareness among the general body of doctors especially GPs about arterial disease and their management. Early detection of peripheral arterial disease and its management is gaining increased importance in order to reduce the number of amputations.

Venous disease management has also changed and less invasive forms of treatment for example foam sclerotherapy, radiofrequency ablation and laser treatment of veins have emerged.

Acute heavy menstrual bleeding

Blog Post  by Malcolm G. Munro MD, FACOG, FRCS(c), Professor, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Director of Gynecologic Services, Kaiser Permanante, Los Angeles Medical Center, Los Angeles, CA, USA

Recently a young healthy woman presented with acute heavy menstrual bleeding (HMB) and was placed on a multidose combination estrogen-progestin oral contraceptive (COC) regimen. As the bleeding stopped she developed central neurological symptoms and findings and was diagnosed with internal jugular venous thrombosis that resulted in profound neurological sequellae. Investigation identified the presence of a previously undiagnosed case of von Leiden factor deficiency. This case provides a suitable backdrop for discussion about acute heavy uterine bleeding, the role for medical therapy, and the potential consequences of high dose estrogenic interventions.

The entity of acute HMB has only recently been defined as heavy uterine flow not associated with pregnancy that is of sufficient volume to require urgent or emergent medical intervention.¹  Although research evaluating the causes of this recently defined entity is necessary, it is likely that ovulatory disorders (AUB-O) are the most common cause. However, coagulopathies may also contribute (AUB-C), and, particularly in adolescents with von Willebrand disease, may augment the heavy bleeding associated with perimeharcheal anovulation (AUB-C, -O). Arteriovenous malformations are yet another but admittedly rare entity that can also cause acute HMB.

Quality of life measurement in neurodegenerative and related conditions

Blog post by Crispin Jenkinson, Professor of Health Services Research, Department of Public Health, University of Oxford, and Senior Research Fellow, Harris Manchester College, Oxford, and Michele Peters, Research Officer,  Health Services Research Unit, Department of Public Health, University of Oxford

Patient reported outcome measures (PROMs) are questionnaires that ask people questions about their current health. PROMs assess or measure patients’ quality of life, or what is sometimes referred to as health-related quality of life. Two types of PROMs exists: generic and disease-specific. Generic PROMs can be used across a broad range of diseases as well as the general population; whereas disease-specific PROMs are designed to be used in a specific patient group. Disease-specific instruments are generally regarded as potentially both more precise and sensitive to changes than more generic measures because they are intended to reflect the particular demands of specific conditions. However, generic measures allow comparing health status of (disease) groups to population norms and between disease groups.

Delirium as a Cause of Violent Behavior

Blog Post by James J. Amos MD, University of Iowa, USA

Another reason why it would important to prevent delirium is the risk for violence patients can have for themselves and others. Patients who would not otherwise be violent can sometimes become violent when exposed to medications with which they’re unfamiliar. One combination of drugs that most people tolerate well but which can provoke intoxication delirium in others is Versed and Fantanyl. Versed is a sedative-hypnotic in the benzodiazepine class (Valium is in the same class) and Fentanyl is an opioid pain killer. Demerol is another opioid pain-killer that is a well-recognized cause of delirium.

These medications are often used on outpatient minor surgical procedures to produce sedation and analgesia. Occasionally, the relaxed and pain-free states they produce can cause an altered mental state that make people appear as though they’ve been on an all-night bender on alcohol.

What can be done about the poor state of global health?

Blog Post By Solomon Benatar, University of Cape Town & Gillian Brock Department of Philosophy, University of Auckland

What can be done about the poor state of global health? How are global health challenges linked to the global political economy and to issues of social justice? What are our responsibilities and how can we improve global health? These questions are addressed from the perspective of medicine, philosophy and the social sciences. Offering a wealth of empirical data and both practical and theoretical guidance, this is a key resource for bioethicists, public health practitioners, and philosophers.

Non-invasive ventilation for acute cardiogenic pulmonary oedema

Blog Post by Mr Tim Case MPhil MA (Cantab) Medical Student, Hughes Hall, University of Cambridge, Cambridge, CB1 2EW, UK, and Dr Stephen T Webb MB BCh BAO FRCA EDIC, Consultant in Anaesthesia & Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK

Acute cardiogenic pulmonary oedema (ACPO) is a life-threatening consequence of acute heart failure that affects more than 17000 patients in the UK per year[i].  As the left ventricle fails, increased hydrostatic pressure causes fluid to leave the pulmonary capillaries and fill the alveoli.  Clinical features of ACPO include dyspnoea, tachypnoea, wheeze, pulmonary crepitations and hypoxaemia. 

The Evolution of Disease in a Rapidly Changing World

Joy Henry is a blogger for An Apple A Day and a writer specializing in online nursing degrees for Guide to Healthcare Schools.

As humans evolve and the world they live in changes, the types and prevalence of disease they get changes as well. And while both environment and genes can be responsible for different diseases, a new study is shedding light on the crossroads between them. New research out of Stanford Medical School shows that as humans’ environments change quickly and drastically (which often happens), genes can become selected which simultaneously make them more fit and more susceptible to a certain disease. The old Darwinian mantra of positive benefit, positive selection becomes complicated when environment changes at an unprecedented pace.

The Customer is Always Partly Right

Blog Post by James J. Amos MD, University of Iowa, USA  

Recently our Psychosomatic Medicine/Consultation Psychiatry (PM/CLP) service received a request to evaluate a patient on the Bone Marrow Transplantation (BMT) inpatient unit. There are no worries about revealing personally identifying characteristics of the patient. The issue was general enough to apply to many thousands of patients and inpatient general and specialty medical units everywhere. As the BMT specialist saw it, the patient was severely depressed and needed an antidepressant. As the patient saw it according to the junior psychiatry resident, depression was not the issue and antidepressant was unnecessary and unwanted, adding that nearly all of the vegetative symptoms of fatigue, appetite and sleep disturbance as well as other somatic suffering could be explained by the medical illness and its treatment. After the resident’s excellent presentation and my visit, there seemed to be no difficulty. The patient simply denied feeling depressed and declined the offer of antidepressant. Aside from the vague sense I got that the patient was indifferent even to visits from our psychiatric nurses, I had no reason to doubt the resident’s conclusion, which was that supportive psychotherapy from psychiatric nurses continue and to call us back if there were a change.

‘So you want to be… an intensivist’

Blog Post by Dr Darcy M Pearson FRCA, Specialty Trainee in Anaesthesia & Intensive Care, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK, Dr Stephen T Webb MB BCh BAO FRCA EDIC, Consultant in Anaesthesia & Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK, and Dr Kamen Valchanov MD FRCA, Consultant in Anaesthesia & Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK

DMP: How long have you worked as an Intensive Care Consultant?

STW: 2 years

DMP: When did you decide that you wanted to pursue a career in Intensive Care Medicine?

STW: During my training in anaesthesia I realised I enjoyed managing sick patients in intensive care as well as anaesthetising high-risk patients in theatre. Both interests led my down the road of a career in ICM and cardiothoracic anaesthesia.

DMP: Did you have an opportunity to experience Intensive Care Medicine as a medical student?