Obstetrics – Dr Jimmi Rios http://drjimmirios.com/ Fri, 11 Jun 2021 17:08:23 +0000 en-US hourly 1 https://wordpress.org/?v=5.7.2 https://drjimmirios.com/wp-content/uploads/2021/05/dr-jimmi-rios-icon-150x150.png Obstetrics – Dr Jimmi Rios http://drjimmirios.com/ 32 32 5 Signs of Covid19 Infection Pregnant Women Should Watch Out For https://drjimmirios.com/5-signs-of-covid19-infection-pregnant-women-should-watch-out-for/ https://drjimmirios.com/5-signs-of-covid19-infection-pregnant-women-should-watch-out-for/#respond Fri, 11 Jun 2021 16:42:01 +0000 https://drjimmirios.com/5-signs-of-covid19-infection-pregnant-women-should-watch-out-for/

Dr Aarthi Bharat, consultant in obstetrics and gynecology at maternity hospitals, shares with us some signs that pregnant women should watch out for in connection with the Covid19 infection.

While we were still grappling with the pandemic and trying to lead our lives accordingly, we were hit by the second wave. Therefore, we have to realize that Covid is not going to go away anytime soon and unfortunately the second wave has had a pretty serious impact on children and pregnant women. There are so many new variations and different types of fungal infections that the situation is quite volatile. COVID has a different impact on everyone and it affects pregnant women as well. In this situation, pregnant women should be vigilant and careful.

Why are pregnant women prone to lung or lung disease?

Reports have shown that around 80 percent of pregnant women suffer from shortness of breath. It is a very normal reaction of the body with all the changes that we go through. Early in pregnancy, your body begins to go through changes, including increased oxygen and nutrient requirements as well as hormonal changes. Among these, there is also the increase in the volume of blood that the heart will have to pump, thus causing a slight shortness of breath. Shortness of breath can also be seen in the latter part of pregnancy when your uterus squeezes your abdominal organs and pushes them upward, causing pressure on your diaphragm and decreasing the inflation space of your lungs in the rib cage. Along with this, being pregnant in general can cause anxiety and further increase lung irregularities.

COVID impacts pregnant women

Now that we’ve seen that pregnant women already suffer from lung or respiratory issues during pregnancy, it might be easier to understand why pregnant women might be at greater risk. Even though a pregnant woman does not have asthma, shortness of breath during pregnancy has an impact on the lungs and Covid as we know it has a direct impact on the lungs. It also has an impact on other parts, but it is mainly the lungs that are affected.

5 signs to catch Covid early:

They must know how to detect the first signs of Covid if they have contracted it, so as not to have a serious illness and end up being hospitalized.

1. Be aware that you have a bad cough or body aches, as this could be a sign that the virus is infesting the body.

2. Watch out for chills going through the body and possibly a sore throat.

3. They may not have the usual symptoms like fever or shortness of breath and may also face abdominal pain.

4. Some patients may present to labor for the scheduled delivery and it is only after delivery that they begin to show symptoms of fever. However, the way it presents itself causes confusion and delays in testing, as doctors may think this fever is caused by postpartum reasons. So if you have a fever after giving birth, stay away from people and get tested as soon as possible.

5. We see that most Covid patients who are pregnant are asymptomatic with a mild fever. So women should watch out for a mild fever and take precautions if they think they have covid.

NOTE*

If you see any of these signs in your body, or if you notice that your baby’s movements have decreased, contact your doctor as soon as possible. Try to stay calm if you have Covid, as stress can impact the baby. Doctors recommend taking at least 5 kicks per hour so that you know the baby is there and active. Last but not least, get yourself vaccinated as soon as possible as this will help you avoid a severe case of covid and protect you.

About the Author: Dr Aarthi Bharat, Obstetrics and Gynecology Consultant at Motherhood Hospitals.

Also Read: Nutritionist Kanchan Patwardhan Highlights Post COVID 19 Recovery Diet To Avoid Complications


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Mirvetuximab Soravtansine Plus Bevacizumab gives high responses in platinum agnostic ovarian cancer https://drjimmirios.com/mirvetuximab-soravtansine-plus-bevacizumab-gives-high-responses-in-platinum-agnostic-ovarian-cancer/ https://drjimmirios.com/mirvetuximab-soravtansine-plus-bevacizumab-gives-high-responses-in-platinum-agnostic-ovarian-cancer/#respond Thu, 10 Jun 2021 22:35:11 +0000 https://drjimmirios.com/mirvetuximab-soravtansine-plus-bevacizumab-gives-high-responses-in-platinum-agnostic-ovarian-cancer/

David M. O’Malley, MD, professor in the Department of Obstetrics and Gynecology at Ohio State University College of Medicine and director of the Division of Gynecologic Oncology at the Ohio State University Comprehensive Cancer Center, discusses data from final review of the FORWARD II phase 1b trial of mirvetuximab soravtansine plus bevacizumab (Avastin) in the treatment of patients with platinum agnostic ovarian cancer.

In the overall study population of 60 patients, the overall response rate (ORR) was 50%. Looking at the high-expressing folate receptor cluster, which made up half of the patient population compared to the low-expressing folate receptor, the ORR is even more pronounced by 64%, in the folate receptor alpha cohort. high. When platinum sensitivity versus platinum resistance was assessed in the high-expressing folate alpha receptor group, the ORR was 69% versus 59%, respectively.

O’Malley says what’s even more exciting about the data is that duration of response (DOR) persisted beyond 12 months in patients with elevated alpha folate receptor expression who were susceptible. platinum and approached 10 months in those who were platinum resistant. . In the patient population with median alpha folate receptor expression, the DOR was 8 months.

Additionally, 32 of 33 patients who exhibited elevated alpha folate receptor expression exhibited tumor shrinkage, which O’Malley said represents the most impressive waterfall pattern he has seen over time.


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We bring the past to life ‘| News, Sports, Jobs https://drjimmirios.com/we-bring-the-past-to-life-news-sports-jobs/ https://drjimmirios.com/we-bring-the-past-to-life-news-sports-jobs/#respond Thu, 10 Jun 2021 05:17:16 +0000 https://drjimmirios.com/we-bring-the-past-to-life-news-sports-jobs/

– Photo from messenger file

Ruth Bennett, left, who portrays Elizabeth Peters, keeps an eye out for Garrett Savery, who portrays Francis Hoyt Crosby as he does a ghostly shoe repair in Oakland Cemetery in 2018. Bennet will play Dr Mary Eleanor Kenyon McCall and Savery will play Dr. Thomas F. Grayson during the cemetery walk this weekend.

An early obstetrician who never lost his mother in childbirth and an American Civil War surgeon are two unique people from Fort Dodge’s past who can be learned from the presentation of the 18th Oakland Cemetery Walk.

The presentation will take place Sunday at 2 p.m. at the Decker Auditorium on the main campus of Iowa Central Community College. Admission is $ 7. Children 10 and under are admitted free. Headquarters will be socially distanced. Masks are optional.

The following people who are buried in Oakland Cemetery will be represented:

• Dr Sara Pangburn Kime – Kime helped her husband in the treatment of tuberculosis.

• Dr Allie Hoyt Wakeman – Wakeman, an early obstetrician. had a unique record of never losing a mother during childbirth.

– Photo from messenger file

Ruth Bennett, left, who played Elizabeth Peters, walks through Oakland Cemetery with Garrett Savery, who played Francis Hoyt Crosby in the 2018 Oakland Cemetery Walk. Bennet will play Dr Mary Eleanor Kenyon McCall and Savery will play Dr. Thomas F. Grayson during the cemetery walk this weekend.

• Dr. John McNulty – McNulty was one of two people buried north to south at Oakland Cemetery. Most are buried from east to west. McNulty was a Union surgeon during the Civil War.

• Dr. Mary Eleanor Kenyon McCall – McCall was trained by her father to cure cancer with covert treatment.

• Dr. Harley Greenwood Ristine – Ristine was previously invited to testify in a murder trial which is now listed as one of Iowa’s mystery murders.

• Dr Richard Clyde Sebern – Sebern’s life was recorded in 1914 in William Hart’s History of Sac County book.

• Dr. Thomas F. Grayson – Grayson was a Confederate soldier who was once on the list of killed, wounded or missing after the Battle of Bull Run during the Civil War.

• Amanda Cook Pettingell Hastings – Hastings was a Civil War nurse during the Battle of Shiloh and the Battle of Stones River under the command of General Ulysses S. Grant.

Friday night there will be a short walk through Oakland Cemetery for a voluntary donation.

The walk will start at 7 p.m. Participants are asked to park at the Good Shepherd Lutheran Church, 1436 21st Ave. N. A DART bus will take participants to the cemetery.

The bus will leave at 6:45 p.m.

Guides will be at the cemetery to offer a visit, which will last between 30 minutes and an hour.

Ruth Bennett is one of the organizers of the Oakland Cemetery Walk. She writes the scripts for the actors featuring the historical figures.

She enjoys learning the stories of people important to Fort Dodge’s past.

“I am investigating these stories to give them to the performers”, Bennett said. “I’ve always loved history, so I love learning about these characters and their quirks and how important they are to the history of Fort Dodge.

“Sara, for example, there was a tuberculosis camp in Fort Dodge. It was very important to the state of Iowa. It was one of the main places to send people for healing from tuberculosis. Sara Kime’s husband is the one who pushed us to start drilling wells instead of drawing water from the Des Moines River.

The life and death of historical figures can be very interesting, she said.

“You discover a lot of history” she said. “It’s interesting to find out some things about these people and their way of life. And some how they died. One of the richest men in Fort Dodge at one time, he died penniless.

After being postponed to 2020, Bennett looks forward to once again being able to tell the stories of those buried at Oakland Cemetery.

“We bring the past back to life” Bennett said.

Oakland Cemetery Walk

Passage to the cemetery

When: Friday

Where: Oakland Cemetery (grounds at Good Shepherd Lutheran Church, 1436 21st Ave. N.)

Time: Be ready at 6:45 p.m.

Cost: Voluntary donation

Presentation at Iowa Central Community College

When: Sunday

Where: Auditorium Decker

Time: 2 p.m.

Cost: $ 7

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Pediatric council should modernize its maternity leave policy https://drjimmirios.com/pediatric-council-should-modernize-its-maternity-leave-policy/ https://drjimmirios.com/pediatric-council-should-modernize-its-maternity-leave-policy/#respond Wed, 09 Jun 2021 08:46:01 +0000 https://drjimmirios.com/pediatric-council-should-modernize-its-maternity-leave-policy/

WWhen my daughter started to reveal how comfortable she was in utero, and had no intention of leaving anytime soon, I immediately sent a message to my obstetrician: “I need to be induced. I was worried that I would have enough time off my Adolescent Medicine scholarship.

She scheduled me for an induction in a few days, nodding gently as she told me that she too was past her due date and watched her maternity leave go by.

My fellow residents and attending physicians, almost all women, have spoken openly about their own struggles as physician mothers. When I returned to work after six weeks, much to the surprise and sympathy of my colleagues, I explained that the direction of our program – and my recovery – was at the behest of the American Board of Pediatrics.

publicity

This council, a licensing body, has a list of strict policies for pediatric scholarships, including this one: a fellow cannot take more than 12 weeks of leave without extending their three-year training program. Because maternity leave is counted in those 12 weeks, I made a calculated decision not to spend all of my leave in one year. What if my daughter, Meera, gets sick, or if my parents or my husband’s? In a year when the unimaginable has become a daily reality, I would have to extend my training, which for adolescent medicine is already undoubtedly too long.

The irony that the American Board of Pediatrics has this stipulation is not lost on interns in the field who are learning the benefits of breastfeeding, including advising patients not to start pumping for six weeks. Realizing the decrease in the sand in the hourglass, I began to draw at three weeks, crying at the sight of how little milk I could produce.

publicity

I was also blissfully unaware of the difficulty of my physical recovery after childbirth. I had run 4 miles a day during my 39th week of pregnancy, had normal blood pressure and reassuring prenatal tests calling me “low risk,” and even the induction was relatively mild: Meera emerged after a hour and a half push. Still, a lip tear left me on my knees for weeks as I was bleeding profusely. For over a month, I had trouble emptying my bowels, urinating, laughing and coughing. To go to the bathroom, I needed to wedge myself against the wall.

Running was my way of staying sane during my pediatric training. In his absence, I found myself sobbing at how weak and bedridden I had become. I hated to hear that real physical and emotional trauma was called something as mild as the “baby blues”.

In any context other than childbirth, even the most negligent of treating physicians would hesitate to send home a patient from the hospital who could not walk, had lost urinary continence and was soaking an industrial-sized compress with blood every hour. . The physical and emotional difficulties continued over the next six weeks.

As a resident, I remembered the countless times I have examined women for postpartum depression on their first visit to a newborn baby without anyone else ever testing positive. In filling out my own form, I felt ashamed to admit depression even though I had a beautiful, healthy baby. “Were my patients also afraid to answer honestly? ” I was wondering.

Even with my training in pediatrics, I have never properly recognized how integral maternal health is to infant well-being – how laborious it is to breastfeed when you are, as stated. a new mother, “sweet and broken”; how long can physical recovery take when caring for a demanding newborn; and the help new mothers need from family, friends, physiotherapists and other health care providers.

And even with all the support I have, I still got to work overwhelmed and unprepared. I was inadvertently breastfeeding, so I made sure I never left the house without wearing a zipped jacket over my shirt. My hips were loose, my walk unsteady. When I walked fast, my bleeding also accelerated, so I continued to wear postpartum pads to work. And my mind was divided by anxiety and postpartum depression: Was I a good mom? Did my parents and in-laws judge me for leaving such a young baby? Could I walk through the clinic without pumping? If I couldn’t, would my colleagues judge me?

It was difficult to deal with worried parents when fears of my own inadequate parenting generated their own statics.

When the American College of Obstetricians and Gynecologists published postpartum care guidelines in 2018, he acknowledged how sloppy the nation’s policies have been in caring for those who literally secure his future and reinvented postpartum care as more than a one-time six-week clearance where the we cross the Rubicon to return to normal. Instead, the guidelines recommend a 12-week interval of examinations that are both more frequent and meaningful than ensuring the healing of stitches – understanding the “fourth trimester” as a complex web of mental, social, sexual changes. and emotional that physician mothers are not exempt from.

It has now been 13 weeks since Meera was born. She now sleeps for longer periods of time (although we are certainly preparing for a regression in sleep). I can comfortably pump enough milk to hold her when I’m at work. I started a postpartum support group that I lean on for the toughest days. I can run again. And I needed each of those 90+ days to heal.

There must be a change in policy on the part of the organization that advocates for the welfare of children. The total number of leaves granted during a pediatric internship cannot be equal to a standard maternity leave of 12 weeks. Pediatric specialists are already scarce due to extensive training requirements and lower salaries. Women continue to be the majority of pediatric providers, and peak childbearing years overlap with stock market education.

Rigorous scholarship training and maternity leave need not be mutually exclusive. There is no more rigorous training for a pediatrician than having a newborn page every two hours requiring you to tinker with a differential diagnosis: drowsy, tired, hungry, wet. There are ways that scholarships can help structure maternity leave in a meaningful way to meet program requirements. My residency program at the University of New Mexico featured a generous elective course for new parents where residents could have a free month after using annual leave to discuss how parenting has changed their approach to children. patients and families; their own challenges and prejudices; and their growth as parents over the month.

With a three-year postgraduate pediatric education, sufficient optional time could allow a similar approach. In adolescent medicine, this could be a month-long internship in which new physician parents could virtually meet with adolescent parents once a week. There are so few opportunities for patients and physicians to speak truly and as equals, humbled by the same challenge. I can imagine similar approaches where a mentor could guide other specialist fellows through cases around their areas of interest once a week to discuss how they might approach counseling, discussing a diagnosis, and limits patient expectations differently with the experience of parenthood.

If we expect women to continue caring for children as doctors and parents, we cannot continue to burden them with short and impossible maternity leave. the American Board of Obstetrics and Gynecology offers up to 12 weeks of leave in a single year for their scholarships, a total of up to 20 weeks of leave for their three-year scholarships and 16 weeks for their two-year scholarship. If the American Board of Pediatrics cannot be the leader on this issue, it must at least become a follower.

Megana Dwarakanath is a Fellow in Adolescent Medicine at the University of Pittsburgh Medical Center.


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Maintenance Olaparib / Bevacizumab Offers Substantial Benefits for PFS and PFS2 in HRD + Ovarian Cancer, Regardless of Stage of Disease https://drjimmirios.com/maintenance-olaparib-bevacizumab-offers-substantial-benefits-for-pfs-and-pfs2-in-hrd-ovarian-cancer-regardless-of-stage-of-disease/ https://drjimmirios.com/maintenance-olaparib-bevacizumab-offers-substantial-benefits-for-pfs-and-pfs2-in-hrd-ovarian-cancer-regardless-of-stage-of-disease/#respond Tue, 08 Jun 2021 20:17:25 +0000 https://drjimmirios.com/maintenance-olaparib-bevacizumab-offers-substantial-benefits-for-pfs-and-pfs2-in-hrd-ovarian-cancer-regardless-of-stage-of-disease/

The results, which were presented in a poster session at the ASCO annual meeting in 2021, showed that at a median follow-up of 24.8 months, the median PFS was 39.3 months. (95% CI, 36.0 – not evaluable [NE]) with olaparib / bevacizumab in patients with HRD-positive tumors and stage III disease vs. 19.9 months (95% CI, 17.7-23.4) with bevacizumab alone (HR, 0, 32; 95% CI 0.22 to 0.47).

In patients with HRD-positive tumors and stage IV disease, the median PFS with the combination was 25.1 months (95% CI, 22.0-37.2) vs 12.8 months (CI 95%, 10.4-15.8) with bevacizumab alone (RR: 0.32; 95% CI, 0.20 to 0.52).

In addition, in patients with low-risk disease, defined as those with stage III disease who had no residual disease after initial surgery, the median PFS2 was not achieved with the doublet versus 44.3 months (95% CI: 37.9 – NE) with bevacizumab alone.

In patients at higher risk of disease, defined as those with stage III disease who have residual disease after initial surgery or who have received neoadjuvant chemotherapy or those with stage IV disease, the median PFS2 with the association was 50.3 months (95% CI, 34.6 to 50.3) vs 32.6 months (95% CI, 25.7 to 42.2) with bevacizumab alone (RR: 0 , 66; 95% CI, 0.47 to 0.93).

“Remarkably, 2 and 3 year PFS2 rates were over 90% with maintenance olaparib plus bevacizumab in low risk patients with HRD-positive tumors who received complete resection during initial surgery. Patricia Pautier, MD, lead study author and head of the Gustave Roussy Institute Cancer Campus Day Hospital Medical Unit, during a poster presentation on data.

In the PAOLA-1 / ENGOT-ov25 study, the addition of olaparib to bevacizumab in the first-line maintenance treatment of patients with HRD-positive advanced high-grade ovarian cancer resulted in significant improvement in PFS. The benefit was most pronounced in people with HRD positivity, including those with BRCA mutations (RR: 0.33; 95% CI: 0.25-0.45). In this subgroup of patients, the median PFS was 37.2 months and 17.7 months in the investigation and control arms, respectively. In people with HRD-positive tumors without BRCA mutations, the median PFS was 28.1 months and 16.6 months in the investigation and control arms, respectively (RR: 0.43; 95% CI: 0.28-0.66).2

These data supported the May 2020 FDA approval of olaparib plus bevacizumab for maintenance therapy; the diet has also been approved in other countries such as Europe and Japan. In the analysis presented at the meeting, researchers sought to explore the effectiveness of the regimen in patients with HRD-positive tumors by stage of FIGO disease and surgical outcome.

Patients enrolled in the study had recently been diagnosed with high grade FIGO stage III to IV serous or endometroid cancer of the ovary, fallopian tubes and / or peritoneum. Patients received first-line treatment with initial or interval surgery, platinum / taxane chemotherapy, and 2 or more cycles of bevacizumab.

Study participants were randomized 2: 1 to either receive 300 mg olaparib twice daily for 2 years plus bevacizumab or placebo plus bevacizumab. Patients were stratified according to BRCA mutation status and the outcome of first-line treatment. Of the 806 patients randomized to the study, 48% (n = 387) had positive HRD status; 70% (n = 272) had stage III disease and 30% (n = 115) had stage IV disease.

Age, BRCA mutation status and surgical status were found to be well balanced between treatment arms within each subgroup. However, a higher proportion of patients with stage IV disease had residual disease after surgery in the bevacizumab alone arm compared to the combined arm, at 38.9% and 29.7%, respectively.

Additional data showed that in patients with HRD positivity and stage III disease, the rate of 2-year PFS with olaparib / bevacizumab was 72% versus 36% with bevacizumab alone. In patients with HRD positivity and stage IV disease, the 2-year PFS rates in the investigation and control arms were 52% and 17%, respectively.

When examining patients with low-risk disease, the 2-year PFS2 rates in the investigation and control arms were 94.7% versus 90.6%, respectively; at 3 years, these rates were 91.9% vs. 65.7%, respectively. In patients at higher risk of disease, the 2-year PFS2 rates in the investigation and control arms were 73.9% and 69.1%, respectively; the 3-year PFS2 rates were 57.1% and 42.3%, respectively.

The references

  1. Pautier P, Harter P, Pisano C, et al. Progression Free Survival (PFS) and Second PFS (PFS) by Stage of Disease in Patients (Pts) with Newly Diagnosed Positive Advanced Ovarian Cancer (HRD) Receiving Bevacizumab (bev) with Olaparib / Placebo d ‘interview in the phase III PAOLA -1 / ENGOT-ov25 trial. J Clin Oncol. 2021; 39 (suppl 15) 5514. doi: 10.1200 / JCO.2021.39.15_suppl.5514
  2. Ray-Coquard I, Pautier P, Pignata S, et al. Olaparib plus bevacizumab as first-line maintenance treatment in ovarian cancer. N English J Med. 2019; 381 (25): 2416-2428. doi: 10.1056 / NEJMoa1911361

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Majority of women do not meet exit criteria for cervical cancer screening https://drjimmirios.com/majority-of-women-do-not-meet-exit-criteria-for-cervical-cancer-screening/ https://drjimmirios.com/majority-of-women-do-not-meet-exit-criteria-for-cervical-cancer-screening/#respond Tue, 08 Jun 2021 00:49:00 +0000 https://drjimmirios.com/majority-of-women-do-not-meet-exit-criteria-for-cervical-cancer-screening/

Current guidelines recommend stopping cervical cancer screening at age 65, but women over 65 account for more than one in five new cervical cancer diagnoses and are twice as likely to die after one diagnosis cervical cancer than younger women. New research from Boston Medical Center has found that less than one in three women aged 64 to 66 met the criteria for discontinuing cervical cancer screening while examining patients receiving both. private insurance and a hospital with a safety net. Posted in Gynecological oncology, the researchers found that even among women with 10-year continuous insurance coverage, 41.5% were not eligible to end screening and most women had not received a adequate screening in the ten years preceding this important screening decision.

The majority of women aged 65 and over may be at risk for cervical cancer due to inadequate screening or high-risk pre-existing conditions. Study results show that up to 20 percent of women reported a medical condition or a history of screening abnormalities that made screening necessary beyond age 65. This highlights the need to educate patients and health care providers on the importance of ensuring adequate screening for cervical cancer. between 55 and 65 years of age, as well as for high-risk conditions that require screening beyond 65 years. When the data are adjusted for patient hysterectomies, the incidence of cervical cancer is highest in women aged 65 to 69 and remains high until the age of 85.

Providers should be aware that cervical cancer is a growing problem in women 65 years of age and older and is preventable. It is imperative that providers proactively ensure their patients receive adequate screening between ages 55 and 65 to reduce preventable cancers in women over 65, and to ensure their patients are screened. adequate to be able to safely exit screening, if their medical history is admissible. “

Rebecca Perkins, MD, MPH, MD, Obstetrics and Gynecology at BMC

Study data included 590,901 women aged 64 with employer-sponsored insurance enrolled in the national Truven MarketScan database between 2016 and 2018, and 1,544 women aged 64 to 66 receiving primary care in a safety net health center in 2019, identified through an electronic health record. to question. Eligibility to exit screening was determined using current guidelines which include: no evidence of cervical cancer or seropositivity, no evidence of pre-cervical cancer during of the past 25 years and evidence of a hysterectomy with removal of the cervix or fulfilling the discharge selection criteria. Discharge criteria are defined as two human papillomavirus (HPV) tests or HPV plus Pap co-tests or three Pap tests in the past 10 years without evidence of an abnormal result (screening with HPV test or HPV / Pap co-test provides more long-term assurance against the development of cancer than the Pap test alone).

Data from both the hospital and national safety net claims database indicated that less than half of women aged 64 to 66 had sufficient screening documentation to meet screening criteria. exit. The guidelines specify that patients with immunosuppression, a history of abnormal results, or cervical precancer or cancer should continue screening. Current exit criteria for screening are complex and require a detailed review of at least ten years of medical record documentation, which can create barriers to applying the guidelines to clinical practice.

“No patient should stop screening based on age alone without their health care provider performing a thorough review of their medical history,” says Perkins, also an associate professor of obstetrics and gynecology at the faculty. of Medicine from Boston University. “Better screening for cervical cancer in women 55 and older can reduce cancer rates and mortality in women 65 and older.”

Possible solutions to improve these rates include a Medicare-funded cancer prevention visit where the need for cervical cancer screening is discussed, and optimization of electronic medical records to prompt review of criteria for cervical cancer screening. screening for cervical cancer before stopping a patient’s screening.

Source:

Journal reference:

Mills, JM, et al. (2021) Eligibility for discharge from cervical cancer screening: comparison of a national cohort and a safety net. Gynecological oncology. doi.org/10.1016/j.ygyno.2021.05.035.


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Trying to avoid racist healthcare, black women seek out black obstetricians https://drjimmirios.com/trying-to-avoid-racist-healthcare-black-women-seek-out-black-obstetricians/ https://drjimmirios.com/trying-to-avoid-racist-healthcare-black-women-seek-out-black-obstetricians/#respond Mon, 07 Jun 2021 09:00:00 +0000 https://drjimmirios.com/trying-to-avoid-racist-healthcare-black-women-seek-out-black-obstetricians/

In South Florida, when people want to find a black doctor, they often contact Adrienne Hibbert through her website, South Florida Black Doctors.


This story is part of a partnership that includes NPR, WLRN and KHN. It can be reposted for free.

“There are a lot of black networks that are behind the scenes,” said Hibbert, who runs his own marketing business. “I don’t want them to be backstage, so I bring it to the fore.”

Hibbert said she came up with the idea for the website after giving birth to her son 15 years ago.

Her obstetrician was white, and the suburban hospital outside of Miami didn’t feel welcoming to Hibbert as a black woman pregnant with her first child.

“They didn’t have any singular photos of a black woman and her black child,” Hibbert said. “I want someone who understands my past. I want someone who understands the foods I eat. I want someone who understands my upbringing and the things my grandmother used to tell me.

In addition to a shared culture and values, a black doctor can provide black patients with a sense of security, validation, and trust. Research has shown that racism, discrimination, and unconscious bias continue to plague the U.S. healthcare system and can cause unequal treatment racial and ethnic minorities.

Black patients saw their complaints and symptoms dismissed and their pain subcontracted, and they are referred less frequently for specialized care. Older black Americans still remember when parts of the country separated hospitals and clinics, not to mention deeply unethical medical failures and abuse, such as the 40-year-old. Tuskegee Syphilis Study.

But even today, say black patients, too many clinicians can be dismissive, condescending or impatient, which does little to restore confidence. Some black patients would prefer to work with black doctors for their care, if they could find any.

Hibbert is working to transform its website into a more comprehensive and searchable directory. She said the most wanted specialist is the obstetrician-gynecologist: “Oh my God, the # 1 call I get is [for] a black OB-GYN.

For black women, the impact of systemic racism can appear abruptly during childbirth. They are thrice as likely to die after childbirth as white women in the United States.

Nelson adams is a black OB-GYN at Jackson North Medical Center in North Miami Beach, Florida. He said he understood some women’s preference for a black OB-GYN, but that couldn’t be the only answer: “If every black woman wanted to have a black doctor, it would be next to impossible. The numbers are not there.

And it’s also not just about recruiting more black students into medicine and nursing, he said, although that would help. He wants systemic change, which means medical schools must teach all students – regardless of race, culture or background – to treat patients with respect and dignity. In other words, how they themselves want to be treated.

“The golden rule says, ‘Do to others what you would like them to do to you,’ so a doctor’s heart has to be that kind of heart where you take care of people the way you want them to do to you. be treated or want your family to be treated, ”he said.

The murder of George Floyd in Minneapolis in May 2020, and the wave of protests and activism that followed, prompted US businesses, universities, nonprofits and other institutions to reassess their own history and their race policies. Medical schools were no exception. In September, the Miller School of Medicine at the University of Miami revamped its four-year program to to integrate anti-racist training.

New training has also been incorporated into the curriculum at the Charles E. Schmidt College of Medicine at Florida Atlantic University in Boca Raton, where students learn to ask patients about their history and experiences in addition to their bodily health. New questions may include: “Have you ever felt discriminated against? Or “Do you feel safe to communicate your needs?” “

“Different things that were questions we may never have asked historically, but we have to start asking ourselves,” said Dr Sarah Wood, Senior Associate Dean for Medical Education at Florida Atlantic.

Medical students begin to learn about racism in healthcare in their first year, and as they go, they also learn to communicate with patients from different cultures and backgrounds, Wood added.

These changes come after decades of racist teaching in US medical schools. Adams, the OB-GYN, completed his residency in Atlanta in the early 1980s. He recalls learning that if a black woman went to the doctor or hospital with pelvic pain, “the assumption was that it was probably a sexually transmitted disease, what we call PID, pelvic inflammatory disease. Typical causes are gonorrhea and / or chlamydia.

This initial assumption was consistent with a racist view of the sexual activity of black women – a presumption that white women were spared. “If the same symptoms were exhibited by a young white woman, Caucasian, the hypothesis would not be an STD, but endometriosis,” Adams said. Endometriosis is not sexually transmitted and is therefore less stigmatizing, less linked to the behavior of the patient.

This diagnostic rule of thumb is no longer taught, but physicians can still bring unconscious racial bias to their encounters with their patients, Adams said.

While reorganizing their programs, medical schools are also trying to increase diversity within their student ranks. The Schmidt College of Medicine at Florida Atlantic established in 2012 a partnership with Florida A&M University, the historically black state university. Undergraduates who wish to become physicians are mentored as they complete their pre-medical education, and those who meet certain criteria are admitted to Schmidt after graduation.

Dr. Michelle Wilson took this route and graduated from Schmidt this spring. She is traveling to Phoebe Putney Memorial Hospital in Albany, Georgia for a family medicine residency. Wilson was drawn to this specialty because she can do primary care but also give birth. She wants to build a practice focused on the needs of black families.

“We have changed the code. Being able to be as comfortable with your patient I think is important when building a long term relationship with them, ”Wilson said.

“Being able to relax and talk to my patient like family – I think being able to do that really strengthens the relationship, especially makes a patient want to come back another time and say to themselves, ‘ I really like this doctor. ‘”

She said she hopes her work inspires the next generation of black doctors.

“I didn’t have a black doctor growing up,” Wilson said. “I’m kind of paving the way for other little black girls who look like me, who want to be a doctor. I can let them know it’s possible.

This story is part of a partnership that includes NPR, WLRN and KHN.


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Vaccine concerns for pregnant women remain https://drjimmirios.com/vaccine-concerns-for-pregnant-women-remain/ https://drjimmirios.com/vaccine-concerns-for-pregnant-women-remain/#respond Sun, 06 Jun 2021 13:57:22 +0000 https://drjimmirios.com/vaccine-concerns-for-pregnant-women-remain/

No clear data available on vaccines in India; Gynecologists’ union wants Pfizer vaccine to be given to expectant mothers

As COVID-19 continues to kill more pregnant women and put many more in critical condition in state intensive care units, obstetricians and gynecologists are pushing again for immunizations for pregnant women.

There is no evidence to suggest that the vaccines available in the country are currently unsafe for pregnant women, but it is the lack of research and data that is preventing authorities from making a formal recommendation for pregnant women. But the news that Pfizer vaccines would soon be available in India has raised new hopes for expectant mothers.

“About 90,000 pregnant women in the United States have been vaccinated, primarily with vaccines manufactured by Pfizer and Moderna, and there have been no safety concerns. Based on this data, the UK Joint Committee on Vaccination and Immunization (JCVI) recently suggested that pregnant women in the UK be offered the Pfizer-BioNTech or Moderna vaccines. Now that the Pfizer vaccine is available in India, we call on the government to offer this vaccine to pregnant women as soon as it becomes available, ”said senior consultant obstetrician VP Paily.

The Federation of Obstetricians and Gynecologists of Kerala (KFOG) has already written to Union and state governments that if the Pfizer vaccine is made available in the country, it should first be offered to pregnant women.

31 deaths in 3 months

Between March and May, Kerala lost 31 pregnant women to COVID-19, while several others are critically ill in intensive care units. For every maternal death, there are several near-misses, most of which are underreported.

The clinical presentation of COVID and the prognosis for pregnant women have been very different since April, when the second wave of COVID hit and the mutant Delta virus (B.1.617.2) began to sweep the state, according to the doctors.

“During the first wave, although we had the highest number of deliveries to pregnant women with COVID, there were no deaths. But since April we have had almost 30 pregnant women with COVID requiring intensive care and we have lost five, ”said KJ Jacob, chief of obstetrics and gynecology, Government Medical College Hospital, Manjeri.

Increase in premature births

Besides a sharp increase in maternal deaths, COVID has led to an increase in prematurity, stillbirth and cesarean delivery also in the state, said S. Ajith, head of the ObGyn department at Government Medical College Hospital, Kannur, who is also the president of KFOG. Almost 50% of deliveries to pregnant women with COVID are cesarean sections.

COVID also appears to have induced high levels of anxiety, stress and depression in pregnant women, which in itself could be very risky. In addition to comorbidities and risk factors such as age over 35 and obesity, a crucial aspect affecting the outcome of those who contract COVID is the delay or reluctance to recognize symptoms such as a mild cough or fatigue as being those of COVID. None of these symptoms should be ruled out during pregnancy and care should be sought early, says Dr Ajith.

“It is the responsibility of the family and the community to take special precautions to ensure that pregnant women are protected from COVID-19. But this is an area where there is a lot of laxity, ”explains Dr Jacob.


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At Georgia immigration prison, warnings about women’s medical care have gone unheeded https://drjimmirios.com/at-georgia-immigration-prison-warnings-about-womens-medical-care-have-gone-unheeded/ https://drjimmirios.com/at-georgia-immigration-prison-warnings-about-womens-medical-care-have-gone-unheeded/#respond Sat, 05 Jun 2021 19:59:11 +0000 https://drjimmirios.com/at-georgia-immigration-prison-warnings-about-womens-medical-care-have-gone-unheeded/

The detention center, about 200 miles south of Atlanta, is owned by Irwin County and operated by a private company under contract to ICE. It has been under intense scrutiny since last September, when a whistleblower complaint from a former employee cited forced sterilizations and other abuse.

The inspector general of the US Department of Homeland Security, which oversees the ICE, and congressional investigators are still investigating the allegations. President Joe Biden’s administration said last month it would cancel Irwin’s contract and remove all detainees “as soon as possible.” The ICE said last year it typically housed around 800 undocumented immigrants in Irwin, most of them awaiting deportation proceedings.

By email on Saturday, an ICE spokeswoman said the agency is cooperating with investigators and has banned Amin from treating detainees.

The alleged abuses are “shocking and disturbing,” said Paige Hughes, ICE’s acting press secretary. “No one should be able to have doubts about their medical care. … Detainees should be provided with sufficient information to enable them to give informed consent to their medical care, as should patients who are not in detention.

An Amin lawyer did not respond to a request for an interview. Lawyer Scott Grubman has previously denied Amin’s wrongdoing, saying the doctor only performed medically necessary procedures, always with patients’ consent.

Amin, 69, practices obstetrics and gynecology in Ocilla and Douglas, 40 kilometers east. He has also incorporated at least 17 companies in addition to his medical practice over the past 25 years, running motels, convenience stores – and a management company that operated Irwin County Hospital, where he performed numerous procedures at the center of the allegations. against him.

Dr Mahendra Amin’s management company operated Irwin County Hospital in Ocilla, Georgia, where inmates at the Irwin County Detention Center say he performed unwanted gynecological procedures. (Alan Judd / alan.judd@ajc.com)

Credit: TNS

Credit: TNS

In court documents, 40 former detainees detailed their experiences with Amin. Some said they woke up from what they thought were minor surgeries to learn they were no longer able to have children. Others said Amin placed his fingers and ultrasound wands in their vaginas without permission or lubrication and that his exams left them bruised and bleeding.

One described a visit to Amin’s office as “the most medical way to be raped that you can experience.”

But the ICE has taken no action after complaints from the detainees, their lawyers and the Mexican consulate in Atlanta, according to recently released documents.

When the consulate asked about the whistleblower’s allegations last fall, a senior ICE official said the allegations would be fully investigated – but said he had already made up his mind .

“Any claim or assertion is false and intentionally misleading,” the official wrote.

In a memo last September, the ICE said “off-site specialists” such as Amin were responsible for obtaining informed consent from inmates before medical procedures. “All detainees retain the right to refuse any medical treatment,” the memo said.

But the agency admitted that it had not inspected or collected consent forms or ensured that Amin treated women with their permission. Because so many inmates did not speak English, the agency gave Amin access to a service that would translate over the phone. “However,” one manager wrote in a memo, “we don’t track its usage.” Many women said they did not have access to interpreters when they saw Amin.

Dr Mahendra Amin's office in Douglas, Georgia, 40 kilometers east of Ocilla, where the gynecologist treated inmates at a migrant detention center.  (Alan Judd / alan.judd@ajc.com)

Dr Mahendra Amin’s office in Douglas, Georgia, 40 kilometers east of Ocilla, where the gynecologist treated inmates at a migrant detention center. (Alan Judd / alan.judd@ajc.com)

Credit: Alan Judd

Credit: Alan Judd

The new documents also show that ICE previously underestimated the number of invasive procedures Amin performed.

The agency said last September that only two women at Irwin’s facility had undergone hysterectomies. The new documents, however, show that Amin billed ICE for at least eight hysterectomies from 2015 to 2020. Two of those procedures were canceled.

Amin also submitted invoices for 75 other invasive procedures, such as dilation, curettage and laparoscopy, and for 740 inmate office visits over five years.

How much Amin earned is unclear. But for five hysterectomies between 2017 and 2020, records show the government paid him more than $ 70,000.

Amin scheduled the last hysterectomy for May 2020. In September, when ICE banned him from treating inmates, he still had not submitted an invoice.


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Dialysis centers installed in 3 Wapda hospitals https://drjimmirios.com/dialysis-centers-installed-in-3-wapda-hospitals/ https://drjimmirios.com/dialysis-centers-installed-in-3-wapda-hospitals/#respond Sat, 05 Jun 2021 00:53:09 +0000 https://drjimmirios.com/dialysis-centers-installed-in-3-wapda-hospitals/

LAHORE: True to its commitment to providing improved healthcare facilities to employees and their families, Wapda has set up dialysis centers at three of its hospitals in Lahore, Multan and Gujranwala as part of a system of private public partnership.

Before the creation of these centers, patients had to be referred to public and private hospitals for their dialysis. Wapda also plans to expand dialysis facilities at its other hospitals across the country in the coming months. Previously, Wapda also set up fully equipped obstetrics units at its hospitals in Lahore, Guddu, Gujranwala, Quetta, Hyderabad and Multan. Such obstetric units will also be set up very soon in Wapda hospitals located in other regions of the country.

Wapda has also started corona vaccination as well as the admission of corona patients to all of its hospitals. In addition to improving its health care system, Wapda Medical Services has also started collecting feedback from owners of medical facilities to address their grievances. It should be mentioned that Wapda also provides healthcare facilities for employees of electric utility companies, generation companies and the national transmission and distribution company across the country.


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