Circumcision

What is it?Circumcision of boys is an operation in which the foreskin is removed from the penis. This is the small flap of skin at the tip that can usually be pulled back over the end of the penis. Some people believe the foreskin is redundant and gets in the way of good hygiene. Others believe it is a very sensitive and vital part of the male anatomy that shouldn't be removed.

Why's it done?

Circumcision is done for a variety of reasons. In some religions, such as Judaism and Islam, it's an important ritual. In some cultures, it's done for hygiene reasons. However, there's no compelling medical reason for circumcision and in the UK it's no longer routinely performed on healthy children - fewer than one in ten teenage boys has been circumcised.
Circumcision may be done when the foreskin is narrowed or tight and cannot be pulled back. Other medical reasons for circumcision include recurrent attacks of balanitis (infection under the foreskin) or an unusual condition that tends to affect adult men called balanitis xerotica obliterans.
It's been shown that tiny patches of lymph glands on the underside of the foreskin may process infectious organisms including HIV, helping them to enter the body. Recent research has suggested that circumcision may help to reduce the risk of contracting HIV.

Who's affected?

Ritual circumcision is performed on newborn babies. Timing may be important - in the Jewish faith, for example, circumcision is done on the eighth day.

What's involved?

Circumcision is a painful operation. However, with small babies, local anaesthetic may be sufficient, but they may still experience pain. Local anaesthetic avoids the risks of a general anaesthetic and is a numbing medicine that can be injected at the base of the penis or in the shaft, or applied as a cream. In older children, circumcision is best performed with the child completely asleep under general anaesthetic.
Once the foreskin has been cut away, healing takes up to seven days. Dissolving stitches that don't need to be removed are usually used. Simple pain relief, such as paracetamol or ibuprofen, should be given regularly after the surgery.
Occasionally, there may be complications after the operation, including infection and scarring. Parents or carers should be vigilant for these and get advice immediately if problems develop.
READMORE:http://www.bbc.co.uk/health/physical_health

How we can help children improve their health

The health of our children and young people matters to us, and it matters to them. We want them to understand what makes them healthy, what keeps them healthy, and what to do when they have worries, are not feeling so good, or are simply ill.

In this week's Scrubbing Up, Barbara Hearn, deputy chief executive of the National Children's Bureau, says the launch of the government's Children's and Young People's Forum presents a key opportunity to improve services for them.

Teenage years are the transition years. Adolescents face choices that will affect their health now and in the future.
But while they can get information from parents, will it be up to date? When they ask their mates, will they be well informed?
While health promotion plays a key role, a significant and early point of private contact with health services for a teenager is their GP.
Some children and young people express feeling embarrassed and judged when they seek advice from their GP. They can find it hard to describe their own health concerns and find it hard to understand their doctor's response.
While GPs continue to improve in terms of their own confidence and capacity to make a child patient feel comfortable it is not yet a guaranteed good experience for those under 18's everywhere.
Practices need to be attuned to just how intimidating an all adult environment can be for teens and pre-teens to enter.
Three changes are required. Firstly, better professional development. GPs do have some training in child development but it is insufficient.
Learning how to talk to 12 -18 year olds; and even more importantly, how to listen to what they have to say; how to encourage them to speak up; and to be confident that they understand what is said to them before they leave, takes time.  

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Practices need to be attuned to just how intimidating an all adult environment can be for teens and pre-teens to enter”

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We can include young people as the 'teachers' here to help GPs learn how to interact effectively with their younger patients.

GPs would benefit from feedback about their manner, the quality and simplicity of their communication, their clarity in explaining diagnoses, treatments and next steps -thereby going beyond theory to learning by doing.
Secondly, the 10-minute patient slots are simply too short to establish a relationship with a tentative young person.
Once it was clear that a patient was under 18, a double slot could automatically be booked, and re-booking done with the same GP or only GPs that have had the training.
Thirdly, to ensure the services GPs are offering are the right ones, young patients should be involved - alongside other patients - in decisions about the services their GP surgery provides.
'Break the myth' In addition, children and young people are rightly a target for public health services.
The fact of their youth means there is time to prevent damaging behaviours and flippant attitudes developing. And time to help them establish good patterns of managing their health for the rest of their lives.
It is time to break the myth that has grown-up over the 60 years of the NHS, that health services manage your health for you making it OK to get 'hammered' and end up in A&E; or to try a drug and see what happens; or remain ignorant of what is going on inside your body while fretting over glamour and goodies on the outside.
Involvement of young people invariably moves into the 'too difficult' box, to be dealt with later, but later never comes.
Young people are avid learners. They contribute through voluntary activity far more than adults and are deeply committed to and interested in the health services.
We need to think of these reforms not as 'do to populations' but 'do with them'.
Children and young people are those with the time and energy to put into making our communities healthy. And in doing so they are able to educate themselves and their peers in ways which can change lives.
READMORE:http://www.bbc.co.uk/news/health

Molar pregnancy

What is a molar pregnancy?

A molar pregnancy is one condition in a range of problems known as trophoblastic disease, where a pregnancy doesn’t grow as it should. It's sometimes called a hydatiform mole.
There are two different types of molar pregnancy, which differ in how they form and how they need to be treated.
In a normal pregnancy, genetic material from the mother and father combines to form new life. In a molar pregnancy, this process goes wrong. In a complete molar pregnancy, the maternal chromosomes are lost, either at conception or while the egg was forming in the ovary, and only genetic material from the father develops in the cells. In a partial molar pregnancy, there is a set of maternal chromosomes but also two sets of chromosomes from the father (ie, double the normal paternal genetic material).
Complete molar pregnancies develop as a mass of rapidly growing cells but without a foetus – it cannot therefore develop into a baby.
In a partial molar pregnancy, a foetus may start to develop but because of the imbalance in genetic material, it's always abnormal and can't survive beyond the first three months of pregnancy.
A molar pregnancy is often harmless, but if untreated can keep on growing and become invasive, spreading to the organs around it, or even further afield to the lungs, liver or brain. Very rarely, in two to three per cent of cases, it may become malignant. These cancerous types of trophoblastic disease are called choriocarcinoma and placental site trophoblast tumours.

Symptoms of molar pregnancy

A woman with a hydatidiform mole often feels pregnant and has symptoms such as morning sickness, probably because the cells of the molar pregnancy produce the pregnancy hormone hCG (human chorionic gonadotrophin). This is also the hormone that is used in a pregnancy test, so she may have a positive result. Some women have no pregnancy symptoms (as with many normal pregnancies).
As the mole grows faster than a normal foetus would, the abdomen may become larger more quickly than would be expected for the dates of the pregnancy. The woman may experience abdominal pain, and also severe nausea and vomiting (hyperemesis).
Bleeding from the vagina is another common warning sign that things are not as they should be. Symptoms similar to pre-eclampsia - high blood pressure, protein in the urine, swelling of the feet and legs - may also occur in the first trimester or early in the second.
Most molar pregnancies are diagnosed at the first ultrasound scan, which shows a mass of cells without the presence of a foetus in a complete molar pregnancy or an abnormal non-viable foetus and placenta in a partial mole.

Causes of molar pregnancy

It remains unclear why a hydatidiform mole develops. However, there are a number of possible reasons, including defects in the egg, maternal nutritional deficiencies and uterine abnormalities. Women under 20 or over 40 are at higher risk.
Having a diet that's low in protein, folic acid and carotene also increases the risk of a molar pregnancy. The number of times a women has been pregnant, however, doesn't influence her risk.

Treatment of molar pregnancy

Once it has been established that a woman is carrying a hydatidiform mole rather than a healthy foetus, suction evacuation is used to remove the pregnancy from the womb. This is curative in about four out of five molar pregnancies.
It's then important to monitor the woman’s progress and repeatedly measure human chorionic gonadotropin (hCG) to be sure that everything settles back down to a normal, non-pregnancy level.
About 15 per cent of women who have had a complete molar pregnancy and 0.5 per cent of those with a partial molar pregnancy will require additional treatment, either because hCG levels hit a plateau or start to rise again, or because of persistent heavy vaginal bleeding.
Further treatment may involve the use of chemotherapy (usually methotrexate combined with folinic acid), especially if there's any concern about invasive or malignant disease.
More than 99 per cent of hydatidiform moles are cured, and even the more aggressive choriocarcinoma has a cure rate over 90 per cent.

Subsequent pregnancies

Following successful treatment, most women can have children if they wish. However, it's strongly recommended that a woman who has had a molar pregnancy doesn't become pregnant again for 12 months. Although the likelihood is small, there's a real risk of malignant disease developing and the increase in pregnancy hormones this would cause can't be distinguished from those of a real pregnancy. Consequently, good contraception is required, as is regular monitoring by a hospital specialist.
READMORE:http://www.bbc.co.uk/health

Malaria

What is malaria?

Malaria is caused by an infection of the red blood cells with a tiny organism or parasite called a protozoa. There are four important species of the malaria protozoa (Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale and Plasmodium malariae) and each has a slightly different effect.
These organisms are carried from person to person by the Anopheles mosquito. When it bites an infected person, the mosquito sucks up blood containing the parasite, which may then be passed on to the mosquito's next victim.

Symptoms of malaria

The main symptom of malaria is a fever that occurs in regular episodes, with sweating and shivers (known as rigors), and exhaustion (because of anaemia). In some cases, it can affect the brain or kidneys.

Who'sat risk of malaria?

Malaria occurs where the Anopheles mosquito breeds, predominantly in rural tropical areas. From a UK perspective, it's a threat to people travelling to malarial regions in Africa, the Middle East, Asia and central America.
Each year about 2,000 people return to the UK with malaria, and approximately 12 people a year die as a consequence of the disease.
Malaria is a major killer in many countries where resources for prevention, proper diagnosis and drug treatments are lacking. If diagnosed promptly, it can be easily treated but the symptoms can be vague and UK doctors may not immediately be thinking about tropical infections.
About 90 per cent of travellers who contract malaria do not become ill until after they return home. Only about 12 per cent of these will become seriously ill.
On average, symptoms develop 10 days to four weeks after being bitten, but symptoms can appear up to a year later.
The most severe form of the disease is cerebral malaria, which is fatal in up to six per cent of adults, mainly because it's not diagnosed until it's too late.
Don't make the mistake of assuming you're safe from infection if you have previously lived in a malarial region - you may build up some immunity to the disease but this can be lost quickly. And if your children were born in the UK, they'll have no immunity at all.
If you're going to visit, travel through, or even just stop over in a malarial country you'll be at risk, even if you have lived there before.

Preventing malaria

By far the most important step is to avoid being bitten by mosquitoes by:

• Using effective insect repellent
• Wearing long sleeves and full-length trousers
• Staying in accommodation with screen doors and closing windows

Before you travel, check whether your holiday destination is affected by malaria. You can find your destination on the Scottish Centre for Infection & Environmental Health website.
Take the recommended antimalarial drugs. Generally speaking, these are taken from one week before you travel until one month after you return, but this can vary depending on the type of drug and the country you're visiting.
Even when taken exactly as advised, antimalarial drugs are not 100 per cent effective, so you should still take the other preventive measures listed above.
A major problem is the steady increase in malaria's resistance to drugs used in both prevention and treatment. Always talk to your doctor if you are worried - don't just stop taking antimalarials without getting medical advice.
If you develop symptoms, get help quickly - and don't forget to tell the doctor you've travelled to a malarial area.
Treatment is with antimalarial medication.
In the past decade, considerable progress has been made in the search for a malaria vaccine, and it's hoped one will be available within the next five to 10 years.
Readmore:http://www.bbc.co.uk/health