Midwifery research: the past, present and future

This paper examines midwifery research in light of the Research Assessment Exercise and explores the research undertaken in the UK during the last ten years. It compares midwifery and general practice research, as well as a transatlantic comparison as to the research output in the UK and US. It also presents an assessment of the impact of midwifery research.     

Chlamydia: past, present and future

In this overview is observed the history and presence of Chlamydia infections, which accompanied the human in its evolution. As a sexually transmitted disease it affects the fertile age. The unique life-cycle of this intra-cellular microorganism is reason for the difficulties of its identification in the past. The technological development in immunology and microbiology field, in present days made possible its isolation, antigen analysis and antibodies identification in the infected person and as well as serology typification. This allows to diagnose and treat in due time and secondary prophylaxis as well. There is no perfect laboratory test. Humans do not possess natural immunity against Chlamydia and at the same time the infection does not lead to durable immunity.     

Delivery room resuscitation past, present, and the future

Delivery room resuscitation guidelines evolved in the late 1980s in the United States, based largely on clinical experience with some supportive experimental evidence. Subsequently over time, there has been an increasing emphasis toward the practice of evidence-based medicine. Despite difficulties in conducting research in the delivery room, several large randomized studies have been undertaken over the past two decades that have provided a scientific basis for some of the new guidelines.     

Reproductive cloning: past, present and future

This brief outline in reproductive cloning describes the background to these studies and then discusses successive aspects of the subject. These include abnormalities in cloned animals, therapeutic cloning and the ethics of this subject. A reference to further reading is provided.     

宫腔镜临床应用沿革与发展前景

18 6 9年Pantaleoni[1] 在人体进行第一例宫腔镜检查 ,开创了宫腔镜诊断宫内病变的先河。但是 ,由于受当时较低生产力水平的影响 ,宫内光线传导不良 ,宫腔不能适度膨胀 ,宫腔内出血妨碍视野 ,镜体直径偏大 ,不易置入宫腔等问题阻碍了宫腔镜的应用 ,该技术的发展十分缓慢。直到进入 2 0世纪以来 ,随着器械的微型化 ,冷光源的问世 ,持续灌流取代单向灌流膨宫方法 ,宫腔镜技术才逐渐完善起来 ,尤其是近 2 0年来 ,手术宫腔镜的诞生 ,为某些妇科疾病的治疗带来了划时代的变革。 1986年Nd YAG激光子宫内膜去除术被美国食品药品管理局 (FDA)认…     

Gonadotropin stimulation: past,present and future

Gonadotropin therapy is so central to infertility treatment that it is easy to overlook the considerable discovery and research that preceded production of the effective and safe products available today. The history underpinning this development spans over 300 years and provides a splendid example of how basic animal experimentation and technological advances have progressed to clinical application. Following the discovery of germ cells in 1677 and realizing, in 1870, that fertilization involved the merging of two cell nuclei, one from the egg and one from sperm, it took another 40 years to discover the interplay between hypothalamus, pituitary and gonads. The potential roles of gonadotropin regulation were discovered in 1927. Gonadotropin, such as pregnant mare serum gonadotropin (PMSG), was first introduced for ovarian stimulation in 1930. However, use of PMSG leads to antibody formation, and had to be withdrawn. Following withdrawal of PMSG, human pituitary gonadotropin (HPG) and urinary menopausal gonadotropin (hMG) appeared on the market, and 50 years ago the first child was delivered by our group in 1961 and opened the path to controlled ovarian stimulation. HPG produced good results, but its use came to an end in the late 1980s when it was linked to the development of Creutzfeldt–Jakob disease (CJD). HMG preparations containing a high percentage of unknown urinary proteins, making quality control almost impossible, were then the only gonadotropins remaining on the market. With the availability of hMG, clomiphene citrate, ergot derivatives, GnRH agonists and antagonists, as well as metformin, algorithms were developed for their optimal utilization and were used for the next four decades. Following the first human IVF baby in 1978 and ICSI in 1991, such procedures became standard practice. The main agents for controlled ovarian stimulation for IVF were gonadotropins and GnRH analogues, with batch to batch consistent gonadotropic preparations; methods could be developed to predict and select the correct dose and the optimal protocol for each patient. We are now seeing the appearance of gonadotropin with sustained action and orally active GnRH analogues as well as orally active molecules capable to stimulate follicle growth and inducing ovulation. These new developments may one day remove the need for the classical gonadotropin in clinical work.     

Contraception and the media: lessons past,present and future

The rise in social media and the pressure on conventional media to garner online hits has the potential to distort the quality of health information available to the consumer. It should be possible to learn from the ‘scares’ of the past to develop strategies to counter the effects of misinformation and scaremongering so commonly seen in any discussion of contraceptive risks. That balanced, evidence-based information is available to all couples considering their contraceptive options should be a priority for all clinicians, academics and journalists working in this area.     

Menopause in Egypt: past and present perspectives.

The mean age of the menopause in Egypt is 46.7 years, which is low compared to many countries, but this age has been rising recently. The incidence of menopause-associated symptoms in Egyptian women is higher than in the West, probably because of the different 'sociocultural attitudes' towards the menopause in different communities. Bone mineral density charts have been constructed for Egyptian women and show that, in general, they have a lower bone mineral density compared to their Western counterparts. After the menopause, they suffer from osteoporosis, particularly at the femoral neck. Egyptian women do not know much about the menopause, except that the incidence of osteoporosis is increased. Their attitude towards the menopause is generally positive and about one-third of them regard the menopause as 'a normal physiological change'. Nevertheless, there exists a need for an awareness campaign in order to educate them about this important stage of their lives.     

Radical hysterectomy: past, present, and future

After an analysis of 3,441 radical hysterectomies performed in our department, we found, after modification of the operative technique in 1983, the more lateral the excision the less the recurrence rate. The recurrence rate for Stage 1b-2a and Stage 2b patients comparing the years before 1983 to the years after decreased to 12.4% from 15.7% (158/1,006 vs 268/2,163; p = 0.009) in Stage 1b-2a and 24.6% from 55.8% (38/68 vs 47/191; p = 0.0007) in Stage 2b, respectively. With the modern trend of aspiring for an easier lifestyle, most physicians practice earlier. Therefore only very few physicians study radical hysterectomy. As the skill of surgery needs a longer period of education and training, it may only interest physicians who work with medical professionals as part of a team at a medical center. In the future, we should provide gynecological residents not only with a training program using the classic textbooks, but also with different points of view on changes and developments in radical hysterectomy. We hope to promote an attitude of offering patients access to different choices and opportunities of therapy. Radical hysterectomy is in fact a treatment option for patients with bulky cervical lesions and Stage 2b in particular.     

Magnesium sulfate: past, present, and future

First used anecdotally for the control of eclamptic seizures in the early 1900s, magnesium sulfate remains 1 of the most commonly used medications in obstetric practice today. Over the past 95 years, there have been countless research studies investigating the efficacy of magnesium sulfate for the management of eclampsia, preeclampsia, preterm labor, and most recently for prevention of cerebral palsy. The majority of this evidence undeniably supports the use of magnesium sulfate as the drug of choice for the prevention and treatment of eclampsia when evidence of severe disease is present. On the other hand, studies have not shown magnesium sulfate to be comparably more effective than other tocolytics for treating preterm labor, nor is there agreement on whether the evidence supports its use as a neuroprotective agent for prevention of cerebral palsy. The exact mechanism of action of magnesium sulfate remains largely hypothetical, and parenteral use has the potential to cause significant morbidity in high doses. This article reviews magnesium sulfate's remarkable history in obstetric practice and includes a summary of the evidence related to each of the controversies. An initial review of the physiology of magnesium sulfate is essential to understanding pharmacodynamic actions, dosing guidelines, and safety requirements.     

Influenza pandemics: past, present and future.

Influenza A virus is well known for its capability for genetic changes either through antigen drift or antigen shift. Antigen shift is derived from reassortment of gene segments between viruses, and may result in an antigenically novel virus that is capable of causing a worldwide pandemic. As we trace backwards through the history of influenza pandemics, a repeating pattern can be observed, namely, a limited wave in the first year followed by global spread in the following year. In the 20th century alone, there were three overwhelming pandemics, in 1918, 1957 and 1968, caused by H1N1 (Spanish flu), H2N2 (Asian flu) and H3N2 (Hong Kong flu), respectively. In 1957 and 1968, excess mortality was noted in infants, the elderly and persons with chronic diseases, similar to what occurred during interpandemic periods. In 1918, there was one distinct peak of excess death in young adults aged between 20 and 40 years old; leukopenia and hemorrhage were prominent features. Acute pulmonary edema and hemorrhagic pneumonia contributed to rapidly lethal outcome in young adults. Autopsies disclosed multiple-organ involvement, including pericarditis, myocarditis, hepatitis and splenomegaly. These findings are, in part, consistent with clinical manifestations of human infection with avian influenza A H5N1 virus, in which reactive hemophagocytic syndrome was a characteristic pathologic finding that accounted for pancytopenia, abnormal liver function and multiple organ failure. All the elements of an impending pandemic are in place. Unless effective measures are implemented, we will likely observe a pandemic in the coming seasons. Host immune response plays a crucial role in disease caused by newly emerged influenza virus, such as the 1918 pandemic strain and the recent avian H5N1 strain. Sustained activation of lymphocytes and macrophages after infection results in massive cytokine response, thus leading to severe systemic inflammation. Further investigations into how the virus interacts with the host's immune system will be helpful in guiding future therapeutic strategies in facing influenza pandemics.