LABOUR PAIN (FOR PREGANT&NONPREGNANTWOMAN)
INTRODUCTION:THIS IS PROBABLY THE MOST SEVEREST OF ALL PAINS&IS VARIABLE FROM WOMAN TO WOMAN.

OTHER COMPARABLE PAINS:1)SEVERE CONSTIPATION LEADING TO FOECOLITH FORMATION(SMALL STONE LIKE BALLS OF FOECAL MATTER)2)PAIN OF DEFECATION IN HIRSPRUNGS DISEASE(CONGENITAL MEGA COLON) IN EITHER SEX WHERE PERSON PASSES STOOLS ONCE IN 15 DAYS.IT IS A TYPICAL PAIN COMPARABLE TO LABOUR PAINS.3)OTHER PAINS LIKE KIDNEY STONE ,GALLBLADDER STONE,PAINS OF PEPTIC ULCER ETC,ETC,ETC.

ABOUT PAIN IN GENERAL.
THE PERCEPTION OF PAIN ITSELF IS VARIABLE FROM PERSON TO PERSON AS PER THE PSYCHOLOGICAL MAKE -UP,OF THE INDIVIDUAL.IT SHOULD BE UNDERSTOOD THAT HOWEVER PAINFUL THE LABOUR MAY BE IT DOES NOT RESULT IN SHOCK OR DEATH. PROVIDED ALL OTHER CLINICAL PARAMETERS ARE NORMAL OR THERE IS NO OBSTRUCTED LABOUR,LIKE CEPHALO-PELVIC DIS PROPORTION,CORD PROLAPSE,HAND PROLAPSE CORD-AROUND THE NECK,OR COMBINATION OF MORE THAN ONE OF THE ABOVE.ALL THESE CONDITIONS ARE DIAGNOSABLE WELL IN ADVANCE &IS GENERALLY TAKEN UP FOR OTHER MODALITY OF DELIVERY,LIKE CAESAR IAN SECTION.THERE FORE THE PAIN PERCEPTION IS MAINLY AS PER THE 'PSCHE'OF THE INDIVIDUAL.THE WRITTER HAS COME ACROSS TWO EXT REAMS OF EXAMPLES IN HIS LIMIT TED OG PRACTICE.

ONE 18 YR OLD UNMARRIED ANGLO INDIAN LADY WITH ALL ABUSIVE LANGUAGE SCOLDING HER BOY FRIEND(WHO WAS ABSCENT IN THE VICINITY)AT THE HIGHEST PITCH OF HER VOICE,DURING LABOUR PAINS.ANOTHER 25 YR OLD MARRIED LADY WAS ABSOLUTELY SILENT,THOUGH WRITHING IN PAIN&THROUGHOUT TILL THE BABY WAS DELIVERED


NATURE OF LABOUR PAIN: THE ANATOMY &PHYSIOLOGY OF FEMALE GENITAL TRACT IS SUCH THE UPPER PART IS
BULBOUS&LOWER PART NARROW.WHEN UPPER PART CONTRACTS THE LOWER PART DILATES &VICEVERSA.
SOME TIMES UPPER PART ONLY CONTRACTS BUT LOWER PART DOES NOT DILATE&THIS IS THE CAUSE FOR A DIFFICULT LABOUR.THE NERVES RESPONSIBLE FOR PAIN IS IN THE SPINAL CORD&IS SELECTIVELY POSSIBLE TO PARALISE,
THE NERVE BY A SPINAL INJECTION.
FOR ALL FIRST PREGNANCIES,CUTTING THE LOWER PART OF THE GENITAL TRACT UNDER LOCAL ANAESTHESIA IS NORMALLY DONE IN ORDER TO FACILITATE DELIVERY.
THE MAIN REASON WHY A PREGNANT WOMAN IS SCARED IS BECAUSE SHE HAS BEEN CONDITIONED ALREADY BY OTHER EXPERIENCED WOMEN THAT THE PAIN WILL BE SEVERE ENOUGH THAT SHE WILL BE NEARER TO DEATH.THIS IS ONE MAJOR CONTRIBUTING CAUSE FOR A CAESAR IAN SECTION.FIVE DECADES BACK MOST DIFFICULT LABOURS WERE MANAGED BY FORCEPS ONLY..EVEN THIS WRITER HAS COME ACROSS A CASE DURING HIS EARLY YEARS .IT WAS A CASE WHERE !)MEMBRANES RUPTURED OUTSIDE,2)HAND PROLAPSE),3)UMBILICAL CORD PROLAPSE.THIS IS A FITTING CASE FOR CAESAR IAN.AS FACILITIES WERE LIMITTED IT WAS DELIVERED BY FORCEPS SUCCESSFULLY.WITH AN INTERRUPTED CHLOROFORM ANAESTHESIA.BY THE WRITER WITH THE HELP OF THREE NURSES!.
CONCLUSION:LABOUR PAIN IS A SEVERE TYPE OF PAIN,OFTEN WITH FEAR OF DEATH.
WHEN THERE IS NO EFFECTIVE CONTRACTION OR LOW OR NO LOWER SEGMENT DILATATION THE WOMAN IS SUBJECTED TO PERIODIC SPASMODIC PAIN WITHOUT GOOD OUTCOME.HENCE 'PITOCIN DRIP' TO ACCELERATE THE CONTRACTION IS OFTEN SUCCESSFUL.WHEN IT FAILS &IF THERE IS EVIDENCE OF FOETAL DISTRESS, THEN THE CASE IS GENERALLY TAKEN UP FOR CESAREAN&THAT IS ULTIMATE.
TAKE HOME MESSAGE:ALL LABOUR PAINS ARE BEARABLE THOUGH IT IS VERY MUCH AGONISING,PROVIDED THE MIND IS CONDITIONED ALREADY.PRE-DELIVERY CONDITIONING &COUNSELLING ARE MANDATORY.

SWINE FLU-A(H1N1) VIRUS VACCINE FEARS

CHINA &USA ARE SHORTLY BRINGING OUT VACCINE AGAINST SWINE FLU,BASED ON 'ROBUST' SUCCESSFUL REPORT AFTER THEIR BTITISH &AUSTRALIAN TRIALS.THE ICMR CHIEF IS VERY CAUTITIOUS ABOUT NOT TO BRING THAT VACCINE TO INDIA,AS HE IS OF OPENION THAT THE VACCINE SHOULD BE MANUFATURED FROM THE VIRUS THAT IS CIRCULATING AMONG INDIAN POPULATION ALONE SHOULD BE CULTURED &USED FOR VACCINE MANUFACTURE.THOUGH THE SIDE EFFECTS LIKELY TO BE THE LEAST ANY THING CAN HAPPEN IN MEDICINE&WE SHOULD OBSERVE VERY CAREFULLY WITH MASTERLY EXPECTANCY ABOUT WHAT IS HAPPENING IN THE REST OF THE WORLD,WHEN A NEW DRUG IS INTRODUSED .PREGNANT WOMEN SHOULD BE GIVEN FIRST PRIORITY FOR VACCINATION ACCORDING TO AMERICAN ACADEMY OF PEDIATRICS.WE SHOULD BE DOUBLY CAREFUL BEFORE SUCH VENTURE AS WE DONT WANT TO SEE ANOTHER THALIDOMIDE -LIKE-TRAGEDY,TO OCCUR IN ANY PART OF THE WORLD.EVEN IF DECIDED TO VACCINATE PREGNANT WOMEN LET US NOT TRY DURING THE FIRST TRIMESTER.THE VIRUS ITSELF CAN CAUSE DAMAGE TO DEVELOPING EMBRIYO.BUT THE VACCINE CAUSING SUCH DAMAGE IS UNACCEPTABLE.

ASPHYXIA NEONATORUM

ASPHYXIA NEONATORUM
A SHORT CUT METHOD TO REDUCE MORTALITY & MORBIDITY.A NEW CONCEPTUAL THOUGHT PRACTICED BY THE AUTHOR FOR THE LAST 20 YEARS.

IF A NEONATE FAILS TO CRY LOUDLY WITHIN 5 MINUTES OF DELIVERY IT NEEDS TO BE RESUSCITATED AGGRESSIVELY.
FOLLOWING STEPS PREFERRED.

1)SUCTION AT LARYNGEAL OPENING.AMNIOTIC FLUID/MECONIUM/VERNICS CASSEOSA ASPIRATION
2)VIGOROUS SQUEEZING OF CHEST WITH THUMB & MIDDLE FINGER AT AXILLAE.
3)SODABICARB 7.5 %+DEXTROSE 10% .5+5=10 ML GIVEN INTRA UMBILLICALLY,THROUGH BUTTERFLY NEEDLE N0 24.
4)WAIT FOR 2-3 MINUTES.OBSERVE THE RESPONSE.TILL ACIDOSIS &HYPOGLYCAEMIA CORRECTION.
IF CRY IS NOT SATISFACTORY-REPEAT DRUGS ONE MORE TIME.
5)DO NT WASTE TIME BY GIVING OXYGEN(MAY BE HELPFUL ONLY FOR R D S.)INTUBATION BY AMBU BAG MAY BE WASTE OF TIME FOR VENTILATION SUPPORT.
6)IF STILL NEONATE DOES NOT CRY ,PUMP IN BECLOMETHASNE INHALER ENDOTRACHEALLY BY A SPECIAL METHOD THROUGH AN ADAPTER.YOUR SUCCESS RATE WILL BE 99%.
7)IF STILL BABY DOES NOT CRY, MILD ELECTRICAL STIMULATION IS WORTH ATTEMPTING THAT IS EQUIVALENT TO DEFIBRILLATION.
8)AN AGGRESSIVE NEONATAL RESUSCITATION SHOULD BE ANTICIPATED IN THE FOLLOWING CONDITIONS PRIOR TO DELIVERY SITUATION.

A)MOTHER HAVING HIGH B.P MEDICATIONS/ALCOHOLISM
B)MOTHER ON ANTI DIABETIC ANTI-CONVULSANT DRUGS
C)CORD AROUND THE NECK
D)MOTHER HAVING SPINAL SHOCK DUE TO DRUGS THROUGH L.P.
E)BIG BABY,TWINS,LBW BABIES,&PRECIOUS BABIES.
F)PROLONGED LABOUR(FOETAL DISTRESS)+/- CLINICAL HYPOGLYCAEMIA.

single visit/ONE JAB POLYIMMUNISATION

FOR JUNIOR PEDIATRICIANS:
Indian &American academy of pediatrics permit children to have vaccination for multiple vaccine preventable diseases,in one shot or two shots on the same day as patient compliance is better.DPT(TRIPLE ANTIGEN),MMR,CHICKENPOX ,Hib ,are usually combined.they have produced unwanted side effects in India&USA,though in a small number The chief ill effect is intracranial hemorrhage sub cutaneous bleeding with reduced platelet count(bone marrow depression).So it is better to give single than double trple in the same,though at different sites.Life is precious,specially for parents..Better to avoid the following combinations:1)Qvac,dtp+hepatitisB
2)PENTAVAC(dtp+hep.B .+Hib. 3)quadrivac(dpt+Hib+4)MMR+varicella.these two are preferably never combined with any other vaccine. DTaP IS PREFERRED OVER DPT.always LEAVE THE DOCTOR'S CLINIC 30 MINUTES AFTER INJECTION TO SEE IF THERE IS ANY IMMEDIATE ANAPHYLACTIC REACTIONS.There are many doctors who advocate multiple injections do no harm.Thes are purly author's views &experience.

single visit/ONE JABpoly immunisation

unpublished concepts in medicine

there are many.every experienced physician develops his own concept after seeing same cases repeatedly.for years1).mothers are immunised against tetanus,during 6,7,8,th month of pregnancy.if for some reason it was not given better to give late.than never..If no TT given till delivery ,a dose of tetanus immunoglobulin could be given to baby to prevent tetanus neonatorum.2)To all cases of clinical septicaemia,better to give dose of blood transfusion to supply immunoglobulin. 3)in certain selective cases of clinical radiological asthma,antihelminthic may be be given empirically&,as the chief offender is migrating larva repeatedly .4)In certain selective case of rhumatoid disease,where anti rheumatics fail,antimalarial are worth a trial.

UNPUBLISHED MEDICAL CONCEPT--2

CHILD'S BRAIN &MOTHER'S THYROXIN:
THE NEUROLOGICAL DEVELOPMENT IF HUMAN BRAIN GREATLY DEPENDS UPON THYROXIN HORMONE,IS AN ESTABLISHED FACT.THE DEVELOPING EMBRYO GETS ITS BLOOD SUPPLY,FROM MOTHER WHOSE THYROXIN LEVEL IN BLOOD SHOULD BE ADEQUATE THERE ARE MANY PREGNANT MOTHERS LIVING IN MANY VILLAGES,DRINK WATER WITH LESS IODINE, MAIN SOURCE OF WHICH IS WATER &SALT.AS A RESULT IF AN EMBRYO IS GROWING IN A BLOOD DEPRIVED OF IODINE WILL RESULT IN THE NEURAL TISSUE DEVELOPEMENT BEING QUALITATIVELY AFFECTED.UNLESS THE BLOOD LEVEL OF IODINE ARE MONITORED THRICE DURING PREGNANCY HYPOTHYROID STATE DEVELOPING BECOMES INEVITABLE.A BABY BELOW SUB CLINICAL LEVEL OF THYROXIN WILL NOT APPEAR LIKE A CRETIN,BUT WILL HAVE POOR ACADEMIC PERFORMANCE&ALSO EXHIBIT EVIDENCE OF LOWERED MENTAL MOTOR MILESTONES