Female genital mutilation

What is female genital mutilation?

It’s one of the most political areas of women's health. Worldwide it’s estimated that well over 120 million women have been subjected to it. Supporters of the practice say it’s an important part of cultural and religious life, and some compare it to the practice of male circumcision that is more widely accepted in the Western world, but opponents say that not only is it potentially life-threatening – it’s also an extreme form of oppression of women.
In some countries where it’s more widely practised it’s officially illegal - those who persist in the practice in Senegal will now face a prison term of between one and five years, for example. But it’s still carried out quietly, within the family and out of sight of officials.
Female circumcision is mainly carried out in western and southern Asia, the Middle East and large areas of Africa. It’s also known to take place among immigrant communities in the USA, Canada, France, Australia and Britain, where it’s illegal. In total it’s estimated that as many as two million girls a year are subjected to genital mutilation.
There are three main types of circumcision:

• The removal of the tip of the clitoris
• Total removal of the clitoris and surrounding labia
• The removal of the clitoris and labia and the sewing up of the vagina, leaving only a small opening for urine and menstrual blood - a process known as infibulation

So drastic is the mutilation involved in the latter operation that young brides have to be cut open to allow penetration on their wedding night and are customarily sewn up afterwards.

Why is female genital mutilation carried out?

Female genital mutilation conforms to several cultural beliefs.
The aim of the process is to ensure the woman is faithful to her future husband. Some communities consider girls ineligible for marriage if they have not been circumcised.
Girls as young as three undergo the process, but the age at which the operation is performed varies according to country and culture.
Girls who have not been circumcised may be considered ‘unclean’ in many cultures, and can be treated as harlots by other women. Many men believe the folklore which says they will die if their penis touches a clitoris.

What are the risks of female genital mutilation?

Health workers say that the operation is often carried out in unsanitary and so potentially dangerous conditions . Razor blades, scissors, kitchen knives and even pieces of glass are used, often on more than one girl, which increases the risk of infection. Anaesthesia is rarely used. Some girls die as a result of haemorrhaging, septicaemia and shock. Infections and scarring can also lead to long-term urinary and reproductive problems.

What is the future?

Due to health campaigns, female circumcision has been falling in some countries in the last decade. Several international organisations such as the World Health Organisation and the United Nations are actively working to stop the practice, and an increasing number of countries have outlawed it.
In Kenya, a 1991 survey found that 78 per cent of teenagers had been circumcised, compared to 100 per cent of women over 50. In Sudan, the practice dropped by 10 per cent between 1981 and 1990.
Several governments have introduced legislation to ensure the process is only carried out in hospitals by trained doctors.
Other countries such as Egypt have banned the operation altogether, but there is significant opposition to change because of the traditional nature of the process. Health workers think a less confrontational approach such as Ntanira Na Mugambo, which combines education with an understanding of the thinking behind female genital mutilation, could be more successful.
Ntanira Na Mugambo, also known as 'circumcision by words', has been developed in rural areas of Kenya by local and international women's health organisations.
It involves a week-long programme of community education about the negative effects of female genital mutilation, culminating in a coming of age ceremony for young women.
The young women are secluded for a week and undergo classes in:

• Reproduction
• Anatomy
• Hygiene
• Respect for adults
• Developing self-esteem
• Dealing with peer pressure

Family members also undergo health education sessions and men in the community are taught about the negative effects of female circumcision.
Health workers believe the programme works because it does not exert a blunt prohibition on female genital mutilation, but offers an attractive alternative.
READMORE:http://www.bbc.co.uk/health

Smoke inhalation

What is smoke inhalation?

The three major problems associated with inhaling smoke during a fire are:

• Heat damage to the tissues of the respiratory tract.
• Asphyxiation (when the body fails to get sufficient supplies of oxygen to the tissues. Inhaling smoke blocks the intake of oxygen in the lungs, and boosts levels of the gas carbon monoxide which interferes with the ability of the blood to carry oxygen).
• Inhalation of smoke particles and chemicals such as carbon monoxide and cyanide causing direct irritation of the lung tissues. Heat damage is usually limited to the tissues of the mouth and upper throat.

Fortunately, smoke cools rapidly once it is inhaled. Animal experiments have shown that if air at 142C is inhaled it has cooled down to 38C by the time it has reached the chest.

Causes and risk factors of smoke inhalation

One of the main risks of being involved in a fire is smoke inhalation. Inhaling hot smoke can have a devastating effect on the delicate tissues of the respiratory system and their normal functioning.
About four per cent of burn victims die from their injuries - and in many of these cases the crucial factor is smoke inhalation.
The full extent of the damage may only become apparent days after the incident itself.

Symptoms of smoke inhalation

Symptoms may include:

• Cough.
• Shortness of breath.
• Sore throat.
• Headache.
• Confusion.

Heat damage can destroy the cells that line the mouth and throat. Often this leads to the build up of fluids within the lining of the airways (called oedema), which can obstruct the airways and make breathing painful and difficult.
There may also be intense coughing, wheezing, a sore throat and copious production of phlegm or mucus which may be stained with sooty particles.
Maximal airway oedema actually occurs 24 hours after inhaling smoke, so patients with smoke inhalation need close observation and may need respiratory support or even intubation (where a tube is passed down into the airways to assist with breathing).
Serious smoke inhalation can lead to damage to the smaller airways deeper down in the respiratory system. These airways may become blocked by damaged material. The minute hairs, or cilia, that line these airways and help to ferry contaminants out the respiratory system may also be damaged. In this case, the patient may find breathing more and more difficult, as asphyxia sets in. They may become blue or cyanosed, especially around the lips and mucus membranes or noticeable on the fingertips (as oxygen levels in the blood drop), and start breathing faster to try to get more oxygen in.
As oxygen levels drop they may become confused and even lose consciousness. There is also a risk of developing pneumonia, or even complete respiratory failure. Alternatively their lips may appear unusually bright ‘cherry red’ which is the effect of carbon monoxide in the blood and which can disguise the cyanosis of low oxygen levels.
In addition to interfering with oxygen carriage by the blood, carbon monoxide is poisonous and causes headache, nausea and vomiting. Sometimes the person appears well, with no obvious symptoms, until the effects of carbon monoxide become apparent.
As well as direct tissue damage, smoke inhalation may provoke dangerous chemical reactions within the body. Pollutants contained in smoke can trigger the immune system to react, resulting in damage to the tissues. The immune system produces a cellular response and also chemicals called cytokines which seek out and helps neutralise inhaled contaminants.
Too much of a specific cytokine called tumour necrosis factor-alpha (TNF) can stimulate a chain reaction that leads to the death of cells and general irritation in the lung, called a pneumonitis, which further interferes with the process of taking oxygen in to the body.
So anyone who has been involved in a fire and may have inhaled smoke should be carefully checked and monitored for sometime afterwards. They may need intensive medical treatment.
READMORE:http://www.bbc.co.uk/health/physical_health

Soft spot or gap on baby's head (fontanelle)

All babies are born with at least two fontanelles. The anterior fontanelle is a diamond-shaped dip in the top of the head towards the front, measuring about 4cm to 5cm (1.5in to 2in) across. Most babies also have a smaller triangular dip at the back of the head called the posterior fontanelle.

How they are formed

These gaps are formed where the plates, or flat pieces of skull bone, meet. As the baby's head grows, so the plates grow together and the fontanelles disappear. The posterior fontanelle is usually gone by four months and the anterior fontanelle by about 15 months, although it may still be seen on x-rays until two years of age.
Although there's no bone in these spots, the brain is protected by a very tough, thick membrane. The fontanelle may seem to pulsate (it's best to look for this when your baby is quiet), which is simply the pulsation of blood through the veins with every heartbeat.
The fontanelle may also bulge slightly, which is normal if temporary or your baby is crying. However, if the bulge is persistent, see your doctor as this could be a sign that pressure in the skull is abnormally high.
The fontanelle may also sink down considerably - a sign that your baby is dehydrated.

Possible problems

Occasionally, the fontanelles fail to close at the normal time. This is usually a sign of other problems. These are rare but include:

• Hydrocephalus, or 'water on the brain' - increased pressure inside the skull, usually because of abnormal drainage of cerebrospinal fluid, keeps the fontanelles open and causes the baby's head to increase rapidly in size
• Congenital hypothyroidism - a large fontanelle was traditionally used to test for underactivity of the thyroid gland, but blood tests are now done on all newborns to rule this out
• Other rare syndromes, such as dwarfism, developmental delay and bone abnormalities

These problems are rare and you probably would have noticed other symptoms by now. However, if you're still worried, ask your health visitor or doctor to check your baby's head at your next routine visit.
READMORE:http://www.bbc.co.uk/health

Sore throat and cough

What are sore throats and cough?

A cough is a sign that nerves in the pharynx (upper throat), larynx (throat), trachea (main breathing tube) or large bronchi (breathing tubes in the lungs) are irritated.
A sore throat, also known as pharyngitis, is visible as inflammation or redness of the tissues, sometimes with yellowish/white pus on the tonsils.

Symptoms of sore throats and coughs

The symptoms of a cough depend on the type. For example, viral croup typically causes a barking cough with rapid and harsh breathing.
In whooping cough, there's a characteristic spasmodic cough followed by a whooping noise as the child draws in breath.
Coughs associated with asthma are often worse at night or on breathing cold air. Associated symptoms may include fast or noisy breathing, fever, vomiting (especially in small children), a stuffy nose and other symptoms of a cold.
The symptoms of a sore throat include pain, especially on swallowing, sore swollen glands in the neck and drooling of saliva.

Causes of sore throats and coughs

The most common cause of a cough in childhood is an upper respiratory tract infection, usually viral (such as the common cold) but it can be bacterial.
More serious infections include croup (viral laryngotracheitis), bronchiolitis, whooping cough and pneumonia.
It's not unusual for a child to have a recurrent cough due to repeated infections, but this can also be a sign of an underlying problem, such as asthma, allergies, gastro-oesophageal reflux or cystic fibrosis.
Occasionally, a cough may be due to inhalation of a foreign body, such as a small toy or peanut.
Sore throats are usually caused by a viral infections, although as children get older a bacteria called beta-haemolytic streptococcus becomes more common.

Treatments for sore throats and coughs

Treating a cough depends on the cause. For example, if a child has asthma, they will probably need to take inhalers. Over the counter cough medicines have been shown to be of little benefit.
Simple painkillers and plenty of cold drinks, ice cream and jelly can help to soothe a sore throat. Older children may use gargles.
For both a cough and sore throat, it's important to get medical advice and a diagnosis early, especially if the child has a fever or is generally unwell, or if the cough is recurrent. Antibiotics are used to treat bacterial infection.
Croup is treated with steroids. Other viral infections get better by themselves. If breathing problems are present, the child may need to go hospital where they may need to have breathing support.
Get immediate medical help if your child isn't breathing properly, is breathing faster than normal, if it looks as if breathing is hard work for your child, if they can't talk, looks blue around the lips or becomes drowsy.
READMORE:http://www.bbc.co.uk/health