Medical Monday: Breaking News from the World of Obstetrics and Gynecology

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Vice President Biden has called for the Congress to separate the issue of funding Planned Parenthood from the issue of funding the war against Zika. He has addressed the Republic led Congress in the strongest possible terms. He went so far as to point out the irony of the the fact that the people ostensibly most concerned about the unborn, anti-abortion Republicans, being the least willing to take measure to protect the unborn. Earlier this week, the Senate rejected a 1.1 billion dollar funding bill. Sixty two percent of Americans feel that Congress should approve additional funds to fight Zika, rather than pull them from other programs. 

The CDC (Centers for Disease Control) has reported that Brazil has already noted a doubling of their rate of nervous system defects, including but not limited to, microcephaly. The rate of Guillane-Barre or post viral paralysis has tripled. 

In the mice model, there is some evidence that Zika resides in the eyes. There is speculation, therefore, that it can be spread by tears. 

The WHO ( World Health Organization) has modified their advice for those in or returning from a Zika affected area. Men were to practice safe or no sex for 8 weeks. Now, that recommendation has extended to the same time frame for women: 6 months. This recommendation stands whether or not the couple is trying to conceive. Only 58% of people in the United States know Zika can be spread by sex. 

Not all South American Countries show cases of microcephaly after Zika infection in pregnancy. Not all mosquitos can transmit Zika. For example, Columbia, has had fewer than three dozen cases of microcephaly whereas Brazil has had 2000. Culex mosquitos, which are  20 times more common than Aedes mosquitos, cannot transmit Zika. The sooner basic research is done to find out the reasons behind these observations, the sooner we may get some control over Zika. 

There is other big news. The FDA, Food and Drug Administration, has banned 19 chemicals commonly found in antibacterial soaps, saying not only do they not do any good, but that they actually may do harm. There is concern especially over triclosan and triclocarbon in that they are now felt to promote antibiotic resistance. There is also concern that they may be endocrine disruptors, meaning they may interfere with sex hormones like estrogen and testosterone. Soap and water are the best ways to get clean. While I advise the frequent soaping of hands at work, and routinely upon arriving at home, I prefer my patients avoid soap on the face or any delicate tissues. 

In the good news department, we have several items. First, MRI without contrast appears to be safe in pregnancy. MRI is useful for taking care of pregnant women with many important conditions. 

HPV vaccine provided in the middle school setting met with an 86% adoption rate. This is much better than “ in the wild”. Research of this kind may provide insights into improving vaccine utilization. Maybe some of it boils down to convenience. 

Recent research indicates that use of hormones, in both oral contraceptive and postmenopausal hormone replacement forms, may be responsible for decreasingly mortality rates from ovarian cancer.  Hormone use is known to suppress the ovaries which also seems to suppress the development of this type of cancer. Ovarian cancer is one of the most dreaded Gyn cancers. This is for two reasons:  It usually presents at an advanced stage, and the screening tests for it are not very good.

Help for ovary cancer treatment is coming from an unusual source. IBM’s supercomputer Watson is utilized in a program called Watson for Genomics wherein the genes of known cancer patients are sequenced and uploaded to a database. Personalized treatment plans can be developed for each patient. In the future, this data might be used for better early risk assessment and detection as well. 

Stay tuned next for more breaking news from the world of Obstetrics and Gynecology. Next week should prove very exciting since I will be at Stanford MedX - an amazing conference on innovation in health care. Check it out here :