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TB in Pregnancy and Lactation

Before initiating treatment for TB in women, she should be asked about current or planned pregnancy
• EXCEPT Streptomycin, all first line anti –TB drugs are safe for use in pregnancy
–Streptomycin is ototoxic to the fetus and should not be used during pregnancy

In case of MDR –TB: Test for pregnancy
• If not pregnant advised to use birth control
– OCPs should be avoided
– Use of barrier methods or IUD is recommended

Integrated Management of Neonatal and Childhood Illness (IMNCI)

• The most common causes of infant and child mortality in developing countries (including India) are:
– Acute respiratory infections
– Diarrhoea
– Malaria
– Measles and
– Malnutrition
• Making a single diagnosis may not be feasible or appropriate
– Because many children present with overlapping signs and symptoms of diseases
– Clinical outcome depends upon treating not only the immediate presenting symptom but the underlying disorders as well

Role of Genetic Predisposition in Common Disorders

• Some traits like intelligence, physical ability and longevity are genetically determined but the effect of external and environmental influences are the main determinants of health and survival
• With increased control of environment, genetic makeup is becoming more important determinant of individual health
• Genetic predisposition may lead to the premature onset of common diseases of adult life such as
– Cancer
– Coronary heart disease
– Diabetes
– Hypertension and
– Mental disorders
• Cancer:

Erythroblastosis Foetalis

• This occurs:
– If the fetus is Rh positive and
– mother is Rh negative

• Some fetal red cells cross the placenta and enter maternal circulation in all pregnancies
– The Rh +ve fetal cells act as foreign antigen and stimulate production of Rh antibodies in the Rh negative mother

• The Rh antibodies are of two main types:
– The ‘strong’ or saline antibodies and
– The ‘weak’ or albumin antibodies: these are small 7s gamma globulins which can cross the placental barrier.

Gene therapy

It is the introduction of a gene sequence into a cell with the aim of modifying the cell’s behaviour in a clinically relevant fashion

It may be used in several ways, e.g.
o To correct a genetic mutation (as for cystic fibrosis),
o To kill a cell (as for cancer) or
o To modify susceptibility (as for coronary artery disease)

Euthenics

• “Euthenics" is “improvement in the environment.”
• Mere improvement of the genotype is of no use unless the improved genotype is given access to a suitable environment which will enable the genes to express themselves readily
• Thus the solution of improving the human race does not lie in contrasting heredity and environment but rather in the mutual interaction of heredity and environment factors
• This environmental manipulation is called euthenics and has considerable broader prospects for success

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