Vol 43 # 2 June 2011 - Kma.org.kw

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88 What We Need is Not the Will to Believe but the Will to Find Out June 2011 350 years from William Withering’s time. Even now the DIG (digoxin investigation group) group recently failed to find out why digoxin is prescribed for heart failure patients in sinus rhythm Why is the ADR death rate going up exponentially with “so called” scientific advances in modern medicine Was not Hillary Butler right in saying that the present day modern medicine, which has become a corporate monstrosity, would have cut many James Wakelys in the knees. James Wakely was a young doctor in London and a member of the House of Commons who thought in early nineteenth century that the medical profession at that time had become a bad abscess on the body of society which he wanted to cure by taking out the pus using a surgical lancet. He started the now famous medical journal, The Lancet, for that purpose in 1823 AD. He had assessed the profession at that time to be a bunch of “incompetent, corrupt and nepotistic bunch of crooks.” Poor man, even after nearly two hundred years, the abscess that modern medicine then was, is only growing bigger by the day despite his The Lancet! Even the President of NICE, Sir Michael Rawlins, in his Harveian oration at the Royal College, had this to say about RCTs: “that randomized controlled trials (RCTs), long regarded as the ‘gold standard’ of evidence, have been put on an undeserved pedestal”. Sir Michael outlines their limitations in several key areas, arguing that a diversity of approaches should be used to analyze the whole of the evidence base. (Rawlins M, The Harveian Oration of 2008, De Testimonio, On the evidence for decisions about the use of therapeutic interventions, Royal College of Physicians, 2008). Let me remind the readers that the “first pass effect” that we, medical students all over, memorized for the pharmacology examination must have given us the warning that all (I mean all) reductionist chemical molecules, ranging from aspirin to rosiglitazone, are alien to the human system. The body tries to get rid of them. This has now been demonstrated by Douglas C Wallace using his soft ware MITCHIP to be true! (Genetics 2008; 179: 727) You will have the same story for your editorial every year end to welcome the next New Year, if we do not learn from our mistakes. We need another Bernard Shaw to write a drama on Patients’ Dilemma today. When you watch the movie cited above you will come to know how people like you are brainwashed to ask for those wonder drugs, advertised daily as panacea for this or that disease, from your doctor. Many times it is likely that you might even imagine a disease (disease mongering by the industry) to have the treatment “very early”. How does the common man, even the literate one, survive in this polluted atmosphere where the industry and the profession seem to be in cahoots with one another for personal gain To add to this a new industry has grown around this rationality - corporate hospital industry, especially in the developing countries like India, where even today more than 400 million people get less than one clean nutritious meal a day. Sixty-seven million children suffer from nutritional immune deficiency syndrome (NIDS) dying by the thousands daily! Let us have a heart. “Appeals to rationality are mostly bluff. There is no good theory of what it is nor of how to recognize it.” Mellor, D H
June 2011 KUWAIT MEDICAL JOURNAL 89 Review Article The Knowledge of Teratogenicity in the Prevention of Congenital Anomalies Adebisi Sunday Samuel Department of Human Anatomy, Faculty of Medicine, Ahmadu Bello University, Zaria, Nigeria Kuwait Medical Journal 2011; 43 (2): 89-98 ABSTRACT A considerable number of pregnant women need to take ongoing medication for existing health problems such as acute respiratory infection or pregnancy complications like eclampsia. It can be dangerous for such women to avoid prescription drugs, should they have a medical condition or become ill; without treatment, the health and welfare of both the mother and her unborn baby could be at increased risk. Unfortunately, research has shown that women who consumed potentially teratogenic drugs – prescribed or not - during pregnancy had very little information about these drugs and even less information about their effect during pregnancy. For this reason, adequate knowledge of this phenomenon is required both by the pregnant women, to heed necessary precautions and health workers, to give the needed advice - prior to and during gestation - with the onerous task to prevent or reduce the incidence of birth of monsters. Wide consultation was made in the archives and contemporary literature to obtain and compile detailed information on the subject and make them available to interested readers, in particular the pregnant women, health workers and researchers in this field. This paper presents some of the earlier and recent works and publications on the subject, to update knowledge and information. Although presently knowledge is inadequate to combat the incessant menace of birth with defects, the available information, if well publicized and utilized, will help to guarantee the good health of the mother and normal development of the conceptus and hence, lessen the incidence of malformed babies. KEY WORDS: conceptus, health workers, malformation, pregnancy, teratogens INTRODUCTION Teratology from the Greek word teras, meaning “marvel” or “monster” is the science dealing with the causes, mechanisms, and manifestations of developmental deviations of either structural or functional nature otherwise known as congenital anomalies or malformations. These structural or functional abnormalities are present at birth although they may not be diagnosed until later in life. They may be visible on the surface of the body or internal to the viscera. Congenital malformations account for approximately 20% of deaths in the perinatal period [1-3] . Hence, this necessitates interest in the knowledge about the effect of maternal environmental factors on the conceptus during development, as one or combination of these factors may act to derail the normal course, leading to aberrations. Such factors responsible for this deviation are known as teratogens. A teratogen therefore, is a drug, chemical, virus, infectious agent, physical condition, excess or deficiency that, on fetal exposure, can alter fetal morphology or subsequent function in postnatal life. However, teratogenicity depends upon the ability of the agent to cross the placenta; for instance, certain medications such as heparin cannot [4-6] . In general, drugs, food additives, and pesticides are tested to determine their teratogenicity to minimize exposure of pregnant women to teratogenic agents. To prove that a specific agent is teratogenic means to prove that the frequency of congenital malformations in women exposed to the agent is prospectively greater than the background frequency in the general population. These data are often times not available for humans and thus cannot be determined in an unbiased fashion. Therefore, testing is often done in animal models and often times the drug is administered at higher than the usual therapeutic doses. However, there are clearly species differences between teratogenic effects, limiting this testing in animals [7-9] . However, some exposures when tested could be categorized as potent (proven) teratogens (Table 1) [10- 26] ; or probable (possible) teratogens (Table 2) [27-29] , based on the following criteria: • A recognizable pattern of anomalies Address correspondence to: Adebisi Sunday Samuel, PhD, Department of Human Anatomy, Faculty of Medicine, Ahmadu Bello University, Zaria, Nigeria. Tel: +234 805 70 44 301, E-Mail: ssadebisi@abu.edu.ng; sam_adebisi@yahoo.com
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