Sex in Pregnancy: Is it safe to have sex during pregnancy, and if so, what is the best sexual position?

Sex during pregnancy can be a touchy subject between couples and most of us are too embarrassed to consult with our doctors about such an intimate topic. Register for this week’s webinar and get all your intimate sex during pregnancy questions answered!

www.pregnancynme.com is proud to present Dr Jasmine Mohd, Associate Consultant with the Department of Obstetrics and Gynaecology in KK Women’s and Children’s Hospital in Singapore. Dr Jasmine will be joined by Dr Wei Siang Yu a.k.a Dr Love to share with you everything you always wanted to know about sex in pregnancy, but were too embarrassed to ask.

Dr Jasmine Mohd’s main subspecialty interest is in Minimally Invasive Gynaecological Surgery including laparoscopic removal of ovarian cysts, laparoscopic hysterectomies, endometriosis surgery, transcervical surgeries including transcervical removal of polyps and fibroids as well as vaginal hysterectomies and surgery for prolapse.

Join Dr Jasmine Mohd, Dr Wei and hundreds of mothers-to-be for the unprecedented SEX IN PREGNANCY WEBINAR on Tuesday, 29th September 2009 at 1pm (SG time).


For more information on Dr Jasmine Mohd, visit: www.pregnancynme.com
https://www2.gotomeeting.com/register/483089930

Geriatric Cardiac Function

Afterload increases in the geriatric patient. This is largely due to increased vascular tone and decreased vascular elasticity. Vascular tone increases secondary to stimulation of the renin-angiotensin system in an attempt to maintain perfusion of aging kidneys. Stimulation of the renin-angiotensin system results in vasoconstriction, which increases vascular tone and blood pressure. Vascular elasticity decreases over time as a result of the atherosclerotic process. These effects cause a decrease in arterial vascular elasticity (compliance).

In the elderly patient, cardiac output decreases due to atherosclerosis and decreased perfusion of the heart. Previous cardiac insults, such as unstable angina and myocardial infarction, add to the dysfunction. The sympathetic nervous system is one of the compensatory mechanisms that maintain blood pressure in different body positions. The sensors that stimulate the sympathetic nervous system become blunted in the elderly patient, leading to orthostatic hypotension.

Keep these changes in mind when assessing your elderly patient: decreased cardiac output will result in decreased systolic pressure, unless compensatory mechanisms take over and cause vasoconstriction. Decreased arterial compliance and increased arterial pressure causes additional stress on the elderly heart leading to heart failure over time. Lastly, watch carefully for orthostatic hypotension which can cause the elderly patient to fall and become injured.

From: Magauran, B, Kahn, J, & Olkshaker, J. (2006). Geriatric Emergency Medicine, An Issue of Emergency Medicine Clinics. St. Louis: Saunders.

"Cardinal sign” of SIADH

The syndrome of inappropriate antidiuretic hormone release (SIADH) results in too much antidiuretic hormone being released. The patient inappropriately "hangs on" to fluid which dilutes the serum sodium resulting in hyponatremia.

The increased release of ADH usually occurs as a result of a central nervous system insult, such as a stroke. Ischemia or injury to the brain causes the pituitary gland to malfunction and release an inappropriate amount of ADH into the bloodstream. Antidiuretic hormone causes the patient to conserve water which dilutes the serum sodium and results in hyponatremia.

You can find SIADH quickly in your patients by assessing the urine and the serum sodium. In SIADH the urine will be concentrated (which looks like the patient is dehydrated). If the patient were dehydrated then the serum sodium would be increased. In the patient with SIADH the urine is concentrated and the serum sodium is decreased.

Treatment for SIADH includes fluid restriction, hypertonic saline, corticosteroids, and thiazide diuretics.

“Borderless Healthcare Introductory Workshop"

Fly Free for Health, the largest medical tourism ecosystem in the world, is having the Philippines’ first medical tourism workshop entitled “Borderless Healthcare Introductory Workshop on October 10-11, 2009 in SM Manila. Nurses like you have a dual role in medical tourism: to help medical tourists find appropriate destinations in which to obtain healthcare and to inform them of ethical or legal dilemmas. To find out more about what medical tourism has for you, join us and take advantage of the following benefits:

1. Become the pioneer in borderless healthcare in the Philippines
2. Meet the best and leading experts in medical tourism and be a part of the dynamic Q and A sessions with them
3. Network with representatives from large healthcare institutions in Thailand and Singapore
4. Be part of the video CV and get the chance to be seen by international hospitals
5. Get 4 exclusive certificates from the large medical tourism institutions
6. With the expansion of medical tourism, increase your employability rate in hospitals around the world
7. Have the chance to be a medical butler, a healthcare trained online concierge

The 2-day workshop fee is as follows:

Solo Group of 3 Group of 10
Early Bird
(Sept.15-30) 2,750 2,500 2,250
After Sept.30 3,250 3,000 2,750

Reserve your seats now and get these early bird prices.

Reservation is a nonrefundable fee of PHP500. Email lloyd@flyfreeforhealth.com to reserve your seats. Register at www.medicalbutler.com. If you have questions, please email info@medicalbulter.com.

Borderless Healthcare Introductory Workshop

Fly Free for Health, the largest medical tourism ecosystem in the world, is having the Philippines’ first medical tourism workshop entitled “Borderless Healthcare Introductory Workshop on October 10-11, 2009 in SM Manila. Nurses like you have a dual role in medical tourism: to help medical tourists find appropriate destinations in which to obtain healthcare and to inform them of ethical or legal dilemmas. To find out more about what medical tourism has for you, join us and take advantage of the following benefits:

1. Become the pioneer in borderless healthcare in the Philippines
2. Meet the best and leading experts in medical tourism and be a part of the dynamic Q and A sessions with them
3. Network with representatives from large healthcare institutions in Thailand and Singapore
4. Be part of the video CV and get the chance to be seen by international hospitals
5. Get 4 exclusive certificates from the large medical tourism institutions
6. With the expansion of medical tourism, increase your employability rate in hospitals around the world
7. Have the chance to be a medical butler, a healthcare trained online concierge

The 2-day workshop fee is as follows:

PHP 2750- solo
PHP 2500- group of 3
PHP 2250- group of 10

These promo prices only run from Sept 10-20, 2009. Reserve your seats now and get these early bird prices.

Reservation is a nonrefundable fee of PHP500. Email lloyd@flyfreeforhealth.com to reserve your seats. Register at www.medicalbutler.com. If you have questions, please email info@medicalbulter.com.

Magnesium sulfate may be given to the asthmatic who is unresponsive to traditional therapy

Magnesium sulfate acts as a smooth-muscle relaxant and causes bronchodilation, which might be helpful in treating asthma. However, magnesium relaxes all smooth muscle including the heart which can lead to bradycardia and hypotension -- undesirable side effects in a patient already in distress!

Magnesium sulfate administered by itself (either IV or nebulized) does not improve pulmonary function sufficient to overcome an asthma attack. Given in combination with traditional treatment IV magnesium does improve pulmonary function in patients with moderate to severe asthma. Magnesium is not recommended for treatment of mild to moderate asthma.

Nebulized magnesium is an attractive alternative that might decrease cardiovascular side effects, but has not been shown to have the same benefits as IV magnesium.

Regardless of how sick the asthmatic appears, the first line treatment is always bronchodilators and steroids. Magnesium may be used as an adjunct to traditional treatment to improve pulmonary function when the cardiovascular side effects can be tolerated.

From:
Aggarwal P et al. (2006). Comparison of nebulised magnesium sulphate and salbutamol combined with salbutamol alone in the treatment of acute bronchial asthma: A randomized study. Emerg Med J, 23; 358-62.

Silverman, R.A., et al. (2002). IV magnesium sulfate in the treatment of acute severe asthma. Chest, 122(2); 498-97.

Complication of Pantoprazole Therapy

Acid-suppressive therapy with proton-pump inhibitors, such as pantoprazole, significantly increases the risk of hospital-acquired pneumonia, community-acquired pneumonia, and intestinal infections like C-difficile. Histamine-2-receptor antagonists, such as famotidine, did not increase the incidence of hospital-acquired pneumonia in a recent study.

Proton-pump inhibitors decrease stomach acid by blocking the mechanism (pump) that pushes acid into the stomach, thereby decreasing the amount of acid in the stomach and lowering the risk of ulceration. The unwanted side effect of decreasing stomach acid is that gastric contents become less acidic and make the stomach a better place for bacteria to live. Bacteria like C-difficile are not killed by the stomach acid and can reproduce and cause infection. In addition, microaspirations occur in most people (70% have some gastric reflux) and small amounts of gastric secretions migrate up to the trachea and into the lung causing infection.

It is important to prevent your patient from developing gastric ulceration, but it is equally important to know that proton-pump inhibitors increase the risk of pneumonia and to implement interventions to prevent pneumonia. Coughing, deep breathing, and incentive spirometry are part of a plan of great pulmonary hygiene that can help prevent pneumonia. Brushing the patient's teeth every 12 hours is the best intervention for preventing pneumonia.

Pantoprazole is metabolized by the liver and excreted in the urine, but rarely causes damage to either of these organs. Pantoprazole would not cause coronary artery spasm because it does not have vasoactive effects.

From: Herzig, S.J. et al. (2009). Acid-suppressive medication and the risk for hospital-acquired pneumonia. JAMA, May 29; 301:2120.