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New concerns in the management of the disease with the Covid 19 pandemic have created a state of anxiety amongst expectant mothers.

New Delhi: The rising incidence of gestational diabetes in India and globally is a cause for global concern amongst clinicians and obstetricians. Prevalence of the condition is higher in the urban than the rural population in India. Established risk factors for GDM are a family history of diabetes, obesity, advancing maternal age, reduced physical activity, desk jobs, sedentary lifestyle, unhealthy eating habits, smoking and alcohol consumption, history of PCOD and associated factors such as hypertension.

Due to compromised fetal outcomes in the form of higher incidence of miscarriages, congenital birth defects, higher risk of preterm deliveries, acute respiratory distress and hyaline membrane disease, heart disease, complicated labour due to the large size of the foetus leading to a higher incidence of shoulder dystocia and a higher risk of caesarean sections, hypoglycaemia in the newborn, obesity and a higher incidence of diabetes in the newborn, prevention and active management of altered blood sugars imperative.

How COVID-19 pandemic has changed consultation, diagnosis of gestational diabetes

New concerns in the management of the disease with the COVID-19 pandemic have created a state of anxiety amongst expectant mothers.

The standard glucose tolerance test which was previously held as the gold standard for monitoring women with altered blood sugars has now taken the backseat. Prioritising on social distancing, reducing frequent visits to labs, now monitoring expectant mothers with fasting blood glucose and HbA1c (of 5.7) are now accepted contrary to the glucose tolerance test. Altered routine prenatal visits, lack of personal consultation with the obstetrician and a phobia to visit labs has modified the management criteria. Lifestyle management comprising healthy dietary habits and increased physical activity, regular home monitoring (self) of blood sugars and fortnightly video consultation, routine antenatal tests for maternal well-being with a proper genetic history of any congenital defects or history of consanguinity, an early ultrasound helps rule out the possibility of an extrauterine pregnancy (ectopic) and confirms a healthy heart activity by 5.5 weeks thus ruling out chances of a missed aborption. All expectant mothers are offered the option of prenatal screening for Down’s syndrome (blood tests like the NIPT and dual markers) at 12 weeks, quadruple markers at 14 to 16 weeks, an anomaly scan at 19 weeks and most importantly a fetal cardiac anomaly scan at 23 weeks. Patients prefer to visit stand-alone ultrasound clinics with prior appointments following all the Covid-19 precautions. A repeat ultrasound Doppler at 28 to 30 weeks to check for the interim growth possibility of fetal macrosomia is advisable. At 32 weeks again an HbA1c to monitor blood sugars is advisable with home charting. Known diabetics in pregnancy have to follow up closely with the diabetologist to adjust the dose of insulin. In case of preterm labour, a hospitalization with tocolytics and antenatal betamethasone injection to promote lung maturity is advisable, and should such patients progress to irreversible preterm labour then drugs such as magnesium sulphate are offered as an option after counselling the expectant mother for neuroprotection for the foetus. Delivering such patients is preferred in tertiary care centres where all facilities for neonatal care are available owing to the high incidence of hyaline membrane disease and acute respiratory distress syndrome. COVID-19 evaluation is mandatory for patients prior to admission. Each index case if affected with COVID-19 behaves differently and needs individually tailored treatment for her symptoms. Vertical transmission is not a reason to fear as it is seldom encountered. Commonly encountered heart defects are usually diagnosed early in pregnancy during the anomaly scans. Late-onset issues in infants of diabetic mothers could be macrosomia, fetal cardiomyopathy, cardiomegaly, acute respiratory distress with fetal hypoglycaemia which warrant intensive care.

Maternal issues such as a higher incidence of prolonged labour, obstructed labour, higher incidence of caesarean sections, the associated risk of hypertension, are observed. To avoid these, prevention is better than cure, and hence expectant mothers with a high risk of gestational diabetes with obesity or PCOD are advised monitored weight gain of not more than 7-8 kg. Close monitoring of blood sugars from the first trimester helps reduce the chances of fetal and maternal complications. The TDAP vaccine is offered to all mothers at 32 weeks.

In conclusion, we as physicians have to constantly tailor monitoring techniques, counsel expectant couples with close follow-ups to monitor fetal and maternal well-being. The COVID-19 precautions are here to stay till we see the end of the tunnel in this global pandemic.

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MORE and more experts now recommend that people with high blood pressure regularly check their blood pressure at home. This can give a better reflection of your blood pressure, as being tested in somewhere like a GP surgery can make you feel anxious and can affect the result. It can also allow you to monitor your condition more easily in the long term.

You can buy a variety of low-cost monitors so you can test your blood pressure at home or while you’re on the move. Doing this gives people an idea where their blood pressure stands in between doctor’s appointments and can motivate them to care more about their health. It also helps doctor’s make quick medication adjustments to keep blood pressure in a healthy zone. 

However, home blood pressure monitors aren’t always as accurate as they should be.

It has been reported that home blood pressure monitors may be inaccurate in five per cent to 15 per cent of patients, depending on the threshold for accuracy used.

A study at the University of Alberta in Calgary tested dozens of home monitors used by 85 patients averaging 66 years of age.

Researchers found the units weren’t accurate within five mmHg of blood pressure about 70 per cent of the time and the devices were off the mark by at least 10 mmHg about 30 per cent of the time. Such inaccuracies could end with some people taking too much or too little blood pressure medication.

There are a number of ways to minimize inaccurate readings with the devices. Patients can compare the blood pressure machine measurement with a blood pressure measurement in a clinic before exclusively relying upon home blood pressure readings. It is also important is to do several blood pressure measurements and base treatment decisions over multiple readings.

Whatever you do,  make sure you use equipment that has been properly tested. The British Hypertension Society (BHS) has information about validated blood pressure monitors you can buy.

The post HealHealth News: Accuracy could save a life, blood pressure testing. appeared first on MyMedicPlus.

Welcome to AP Bio, Teen Vogue’s guide to what you need to know about sex and your body before you head to college. Whether it’s getting tested, taking care of a yeast infection, or opting out of so-called hookup culture all together, we’ve got you covered.

Walking into Planned Parenthood’s Margaret Sanger Center in New York to get an STI and HIV test, I felt nervous. You’d think I’d know the deal by now — after all, I’ve gotten them before, and I’m someone who regularly advocates on this very website for others to know their status and take preventative measures against STIs and HIV. In my personal life, I’ve encouraged friends to go get tested (no, it won’t hurt!), and balked when previous partners told me it wasn’t part of their regular health routine (why not?). Still, as I stepped into the waiting room to be tested for gonorrhea, chlamydia, and HIV, I was scared — and that was the whole point.

If I get nervous or don’t know what to expect despite my experience and advocacy around STI and HIV testing, someone who has never gone through this process before probably feels those nerves much more intensely. Like I was, you might be wondering what exactly getting an STI and HIV test entails, particularly whether or not it hurts. So, let’s walk through it step by step.

I set up my testing appointment online via Planned Parenthood’s scheduling portal, which isn’t available for every health center but the option is expanding to more places. Of course, there are many place to get an STI test — including your primary care physician or other local health centers — so your experience might be different than mine depending on where you go. But, if you do head to a Planned Parenthood where the online scheduling via DocASAP is available, it’s fairly easy. I chose the health center that was most convenient for me, and filled out a bunch of personal information about me, my health, and my insurance plan. (You can still visit Planned Parenthood if you don’t have insurance! Visit your clinic’s website for more information on how they charge.) There were only two snags in the process. It took so long to register for the scheduling platform that the appointment time I wanted was taken by the time I was done, and I was only given male and female as gender identification options. According to Planned Parenthood, the options are due to the scheduling platform DocASAP (which isn’t specific to Planned Parenthood). Currently, Planned Parenthood said it is working with DocASAP to provide more inclusive language.

Once I was registered and my appointment was set, I waited about a month before it was time to go for my screening (if you have symptoms, you definitely should not wait this long). On the morning of my appointment, I arrived a few minutes early and checked in at the front desk of the clinic. I was asked for information about my insurance, marital status, race, and income level. Then I sat in a pleasant and clean waiting room for what seemed like forever because I had to pee SO BAD.

Here is where I made my first mistake: I thought my STI screening would include a urine test, so I drank a ton of water and rolled up to the clinic with a very full bladder. First I sat smugly, thinking this wouldn’t be one of the many times a doctor has asked me to pee in a cup and I couldn’t even squeeze out a drop. But as the minutes ticked by, my smugness wore off. The clinic was running a little behind that morning, so I sat in the waiting room for quite a while, squirming. When I was finally called in to the testing room, though, I realized my pent-up pee was for not — urine testing was not in my future.

The post What Getting an STI and HIV Test Is Like appeared first on MyMedicPlus.

The Centers for Disease Control and Prevention report that of the estimated 1.1 million people in the United States who have the HIV infection, 1 in 7 don’t know their status.

That is especially true for youth ages 13 to 24 that make up 21% of the nearly 40,000 new HIV diagnoses made in 2017. More than 50% of youth who have HIV don’t know about their infection.

Only 9% of high school students report having been tested for HIV. Many people do not get tested because of lack of access to health care, fear and misperceptions about HIV risk and the testing process, and health care settings that lack HIV testing as a routine part of care.

As a nurse at a clinic that treats sexually transmitted infectious diseases, I frequently saw patients visit the clinic requesting HIV testing because their provider did not want to test them for HIV, or their provider said they did not offer HIV testing. We would also see young people at the clinic because they could not always be assured of confidentiality at their doctors’ offices.

Nurse practioners play a valuable role in testing of HIV in youth. A colleague and I recently published an article on HIV testing that showed nurse practitioners are less likely to perform HIV testing on people younger than 18 years of age. That may be in part because of issues related to patient confidentiality, consent, and linkage to care when a person tests positive.

Nurse practitioners are in a unique position to educate youth about HIV, refer youth to health services including HIV testing and perform HIV testing. But currently, nurse practitioners do not have full practice authority in all states. One way to increase HIV testing for all persons might be to include giving nurse practitioners the full authority under state regulations and practice acts to test for HIV.

Testing a major breakthrough
The development of testing technologies has been one of the two leading breakthroughs to the possibility of ending the HIV epidemic; the other is pharmacological interventions that effectively manage the disease and prevent transmission. Our nurse practitioner study concluded that nurse practitioners have an important role to increase HIV testing rates and could help put an end to HIV.

Nevertheless, many people don’t know if they should be tested, and so they are not.

Although it has been nearly 40 years since the beginning of the HIV crisis, the CDC reports that the infection continues to affect gay, bisexual and other men who have sex with men of all races and ethnicities; black and Latino men and women; people who inject drugs; people aged 25-34; and people in the Southern U.S. disproportionately.

There are national recommendations and practice guidelines for nurse practitioners to test for HIV. However, the rate at which they screen for HIV is low, as my colleague Gale Spencer and I reported in our recent study.

We found that the strongest predictor of nurse practitioner HIV testing behavior was the practice setting’s social pressures that influence HIV testing. In other words, when office staff supported routine HIV screening, then nurse practitioners were more likely to test for HIV, even when it took more time.

Also, nurse practitioners believed that when “consent from a parent/guardian should be obtained before screening for HIV in a person younger than 18 years,” they were less likely to screen for HIV. This means that better policy and procedures are needed to help guide providers for testing those younger than 18. We believe this is pivotal, given that among young people between the ages 13 and 24 with HIV, nearly half are not aware of their status.

Testing guidelines for all

A blood test can reveal the presence of the HIV virus. Room’s Studio/Shutterstock.com
According to the CDC recommendations, everyone should be tested at least once between the ages of 13 and 64 as part of routine health care.

Also, if you are pregnant or planning to get pregnant, the CDC recommends that you should get tested as early as possible.

You should also get tested at least once a year if:

You are a sexually active gay or bisexual man
You have had sex with an HIV-positive partner
You have had more than one partner since your last HIV test
You have shared needles or “works” to inject drugs
You have exchanged sex for drugs or money
You have another sexually transmitted disease, hepatitis or tuberculosis
You have had sex with anyone who has done anything in this list, or with someone whose sexual history you do not know.
Also, the CDC recommends testing before having sex for the first time with a new partner. The agency also recommends that you talk about sexual and drug-use history.

In January, 2019, the World Health Organization made the proposal to declare 2020 the “Year of the Nurse and Midwife.” Nurses provide the essential link between the people of the community and the complex health care system. With their help, more youth – and others – can get tested.

The post Should you be tested for HIV? appeared first on MyMedicPlus.

HIV testing is recommended as part of routine health care, yet many Americans are not being tested as often as advised. According to the Centers for Disease Control and Prevention (CDC), one in seven people living with HIV in the U.S. today are unaware of their status.

“Walgreens continues to support HIV testing since it is a critical first step in developing effective prevention and care strategies, regardless of status,” said Glen Pietrandoni, senior director, patient care and advocacy, Walgreens. “With more than 3,000 HIV-trained Walgreens pharmacists in communities across the nation, we can uniquely support HIV testing, education and care, working towards an end to HIV/AIDS.”

In addition to offering on-site free and fast HIV testing, counselors from local agencies will answer questions about HIV prevention and treatment options, including PrEP. No appointment is required.

The use of antiretroviral (ARV) medications to prevent HIV transmission, as well as PrEP, a daily pill to protect against HIV, offer new pathways to ending HIV. Based on the strength of the scientific advances, the White House and many states have set ambitious goals of significantly reducing HIV infections over the next decade.

“Public knowledge has not always kept up with the science,” said Tina Hoff, Senior Vice President and Director of Health Communications and Media Partnerships at KFF (Kaiser Family Foundation). “Public-private partnerships like this help to close the knowledge gaps about HIV and connect people with services in their communities to get the care they need.”

According to a recent national survey by KFF, which runs Greater Than AIDS, fewer than half of Americans know about PrEP, and many understate the health and preventative benefits of HIV treatment.

The National HIV Testing Day community partnership is part of an ongoing commitment by Walgreens and Greater Than AIDS to extend the reach of HIV testing and information to non-traditional settings and support the outreach of local agencies. More than 48,000 free HIV tests have been provided since 2011 as part of the annual event.

BioLytical Laboratories, Chembio Diagnostics, and OraSure Technologies, Inc. are contributing donated test kits and Abbott Rapid Diagnostics is providing support for outreach for the 2019 activation.

For a complete list of participating Walgreens locations and supporting partners for this year’s National HIV Testing Day, as well as additional information about HIV testing, including year-round testing sites, visit www.greaterthan.org/walgreens.

About Walgreens

Walgreens (walgreens.com), one of the nation’s largest drugstore chains, is included in the Retail Pharmacy USA Division of Walgreens Boots Alliance, Inc. (NASDAQ: WBA), the first global pharmacy-led, health and wellbeing enterprise. Approximately 8 million customers interact with Walgreens in stores and online each day, using the most convenient, multichannel access to consumer goods and services and trusted, cost-effective pharmacy, health and wellness services and advice. As of Aug. 31, 2018, Walgreens operates 9,560 drugstores with a presence in all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands, along with its omni-channel business, Walgreens.com. Approximately 400 Walgreens stores offer Healthcare Clinic or other provider retail clinic services.

About Greater Than AIDS

Greater Than AIDS is a leading national public information response from KFF focused on communities most affected. Through targeted media messages and community outreach, Greater Than AIDS and its partners works to increase knowledge, reduce stigma and promote actions to stem the spread of the disease.

About Kaiser Family Foundation

Filling the need for trusted information on national health issues, KFF (the Kaiser Family Foundation) is a nonprofit organization based in San Francisco, California.

The post Walgreens and Greater Than AIDS Partner with Health Departments and Local HIV Organizations Across the Nation to Offer Free Testing on National HIV Testing Day appeared first on MyMedicPlus.