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Maternal mortality in the developing world – what circumstances lead to the death of this young woman?

18 May, 15 | by Kristy Ebanks

By Midhun Mohan – Student Editor

Read this case about a 25-year-old anaemic woman who died from a massive atonic postpartum haemorrhage

How and why did this happen?

The case report states that on a national scale a culmination of three factors are responsible for the state of healthcare in India, especially in regard to the rural poor.

  1. Poor handling of healthcare funds
  2. Corruption at local and national levels
  3. High levels of illiteracy in the poor, that prevent access to available healthcare and leads to a failure of women asserting their healthcare rights

On a local scale, obstetric care provided by local birth attendants with variable levels of training may be fall far below accepted standards.

The report states:

A 12-h period (one night) was wasted in futile attempts to deliver but also, multiple internal examinations led to development of Gram-negative septicaemia superimposed on existing anaemia, resulting in massive atonic PPH and death

Could this have been avoided if the woman had been transferred to the hospital sooner?

In 2005, the Indian government started a cash incentive scheme for poor pregnant woman to promote institutional deliveries. The aim was to reduce maternal and neonatal mortality.

Read more about it here: http://nrhm.gov.in/nrhm-components/rmnch-a/maternal-health/janani-suraksha-yojana/background.html

Despite this scheme increasing the number of institutional deliveries the maternal mortality has not decreased. Why? The reasons are likely to be multifactorial.

One study conducted in another rural district in India concluded that the following factors contributed to maternal deaths:

  1.     Absence of antenatal care despite high levels of anaemia
  2.     Absence of skilled birth attendants
  3.     Failure to carry out emergency obstetric care
  4.     Referrals that never resulted in treatment

This case report provides a useful insight into the state of obstetric medicine in rural India. Women from deprived nations all over the world suffer from the same sub-standard obstetric care. When a woman dies she leaves behind children who need care.

The statistics released recently by the LifeBox Foundation are staggering. They are as follows:

  1. 1,000,000 BABIES. A million children a year could be saved by safer obstetric surgery
  2. 5 BILLION IN DANGER. Around the world, billions of women, children, and families lack access to the most basic surgical care
  3. 800 WOMEN A DAY. Preventable pregnancy-related causes including unsafe surgery kill hundreds of women daily

Click here to link to learn more about the LifeBox Foundation

What are the causes of maternal mortality worldwide and what has been done to reduce this? What else needs to be done to really improve obstetric care?

This article is published under a CC-BY-NC licence for permissions email bmj.permissions@bmj.com

Genetically-modified embryos

25 Apr, 15 | by Dr Dean Jenkins

This isn’t a case as such but it is early work on human embryos exploring the technique of gene editing.

“The prospect of genetically engineering humans has come a step closer, with the publication of the first paper to describe efforts to modify embryos. There is a long way to go before we can safely tinker with our genes, but at least one group in the US and four in China are aiming to edit human embryos: this will be the first of many studies.”

http://www.newscientist.com/article/dn27402-first-human-embryos-genetically-modified–more-will-come.html

dn27402-1_300

This modification was achieved by ‘editing’ the DNA using a technique called the CRISPR.

“However, the efficiency of homologous recombination directed repair (HDR) of HBB was low and the edited embryos were mosaic. Off-target cleavage was also apparent in these 3PN zygotes as revealed by the T7E1 assay and whole-exome sequencing.”

Screenshot from 2015-04-25 21:37:39

This technique holds promise for genetic diseases such as cystic fibrosis.

Breast pain in a patient on dialysis

24 Apr, 15 | by Kristy Ebanks

Calcific uremic arteriolopathy

We have some very interesting images for you but, can you answer the questions below?

buscher_4 buscher_3 buscher_2

1. What are the indications for dialysis?
2. What are the complications of dialysis?
3. What is calcific uremic arteriopathy?

If you don’t know the answers or want to know more read ’Breast pain in a patient on dialysis: a rare manifestation of calcific uremic arteriolopathy

Acquired savant syndrome

18 Apr, 15 | by Dr Dean Jenkins

Following a head injury whilst skiing an anonymous US lady now complains of remembering too much.

I could remember everywhere, like flicking through the pages of a book. Every place I had ever been, but specifically the buildings.

http://www.xojane.com/it-happened-to-me/acquired-savant-sydnrome

The lady goes on to say that her neurologist is considering writing up her case. I wonder if it will be submitted here?

The story has been reported in the press:

Woman claims ski accident has given her extraordinary mental powers (Independent)

‘A ski accident left me with advanced mental abilities’: US woman tells her extraordinary story (Telegraph)

Picture of skiier

The Case of an ACL deficient knee

9 Apr, 15 | by Kristy Ebanks

Anterior Drawer test in an ACL deficient knee

We have some very interesting images for you but, can you answer the questions below?

ant_draw_1

1. What is the anterior draw test?
2. What do you see in these figures?
3. How else might the ACL be tested?

If you don’t know the answers, want to see a video or want to know more read ’Patient self-demonstration of the Anterior Drawer test in an ACL deficient knee

A rare but potentially fatal cause of diarrhoea and weight loss

2 Apr, 15 | by Kristy Ebanks

Enteropathy associated T-cell Lymphoma

We have some very interesting images for you but, can you answer the questions below?

Figure_2 (3) Figure_3 Figure_4 (1)

1. Diarrhoea can kill – under what circumstances may diarrhoea be fatal?
2. What types of enteropathy do you know?
3. How would you manage life-threatening diarrhoea due to a range of causes?
4. How would the different causes affect your management?

If you don’t know the answers or want to know more read ’A rare but potentially fatal cause of diarrhoea and weight loss: Enteropathy associated T-cell Lymphoma

Virchow-Robin spaces

19 Mar, 15 | by Kristy Ebanks

Hydrocephalus due to extreme dilatation of Virchow-Robin spaces

We have some very interesting images for you but, can you answer the questions below?

Image3 Image2 Image1

1. What are Virchow Robin spaces?
2. What do these images show?
3. How would you manage this hydrocephalus?

If you don’t know the answers or want to know more read ’Hydrocephalus due to extreme dilatation of Virchow-Robin spaces

Student Editor BMJ Case Reports

19 Feb, 15 | by Kristy Ebanks

BMJ Case Reports is looking for a medical student to work with us to enhance the journal for student authors and readers. BMJ Case Reports is an award winning online journal that publishes articles in all specialties – there are currently more than 10,000 published articles from 70 countries.

We want the Student Editor to identify the cases that are of most value for medical students and highlight these in our Blog – these will be the cases that have excellent learning points for students at all stages of their training and may be “textbook cases”.

You will also work on our newly created Global Health blog where where we feature case reports that discuss the social determinants of health and challenges (and potential solutions) to important Global Health problems. We are keen to develop this collection and to attract articles based on student electives.

We estimate that you will need to devote two to three hours per week to the role. You will have access to all the published articles and you may submit your own to be peer reviewed. You will be listed on our Editorial Board with a brief biography and we will support your attendance at events for medical students so you can promote BMJ Case Reports.

You can work remotely and you are welcome to visit us at BMA House and to attend any editorial meetings.

If you are interested in applying for the role please send your CV and ideas on how to improve the value of BMJ Case Reports for medical students to bmjcasereports@bmj.com before 31st March 2015. We welcome applications from students in any year.

A straight-forward stroke?

6 Feb, 15 | by Kristy Ebanks

A typical presentation of type A aortic dissection

We have some very interesting images for you but, can you answer the questions below?

fig_3 (6) fig_2 (6) fig_1 (8)

1. How common is non-carotid disease stroke?
2. How would you routinely investigate a patient who presents with stroke?
3. Which patients benefit from anti-coagulation to prevent a first stroke?

If you don’t know the answers or want to know more read ’A straight-forward stroke? May be not: atypical presentation of type A aortic dissection

Quiescent infective endocarditis in a patient with bronchopneumonia

30 Jan, 15 | by Kristy Ebanks

Splenic abscess

We have a very interesting image for you but, can you answer the questions below?

Nayak_July_2014_Figure_1

1. What would be your differential diagnosis in Figure 1?
2. What factors would determine whether you perform a splenectomy?
3. What is the latest evidence in terms of post-splenectomy sepsis?

If you don’t know the answers or want to know more read ’Splenic abscess as a potential initial manifestation of quiescent infective endocarditis in a patient with bronchopneumonia

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