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APPENDIX 3 ALLOCATION OF HEALTH FACILITIES TO DATA COLLECTORS PROVINCE 1 COAST FACILITIES Coast General Hospital Port Reitz District Hospital Shimo la Tewa Health Centre Likoni Health Centre Diani Health Centre Mtwapa Dispensary Kenyatta National Hospital Mbagathi District Hosp. GSU Training ; Health Centre Chandaria Health Centre Embakasi Health Centre Langata Women's Prison Health C. Embu Provincial General Hospital Runyenjes Sub-District Hospital Karurumo RHDC Kibugu Health Centre Ena Dispensary Police Headquarters Dispensary Nakuru Provincial General Hospital Bahati Health Centre Njoro Health Centre Kapkures Dispensary Mang'u Dispensary Lengenet Dispensary Kisumu Provincial General Hospital Rachuonyo District Hospital Nyamira District Hospital Kodiaga Health Centre Ahero Health Centre Sondu Dispensary DATA COLLECTORS Dr. J. S. Mukoko Dr. N. Mucheru Dr. J. Ombogo.
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1. Hull MG. 1987 Epidemiology of infertility and polycystic ovarian disease: endocrinological and demographic studies. Gynecol Endocrinol. 1: 235240. 2. Nestler JE. 1997 Role of hyperinsulinemia in the pathogenesis of the polycystic ovary syndrome and its clinical implication. Semin Reprod Endocrinol. 15: 111117. 3. Speroff L. 1994 Anovulation and the polycystic ovary. In: Speroff L, Glass R, Kase N, eds. Clinical gynecology endocrinology and infertility. Baltimore: William & Wilkins; 457 482. 4. Nestler JE, Jakubowicz DJ, Evans WS, et al. 1998 Effects of metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome. N Engl J Med. 338: 1876 1881. Velazquez E, Mendoza S, Hamer T, Sosa F, Glueck C. 1994 Metformin therapy in polycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenism, and systolic blood pressure, while facilitating normal menses and pregnancy. Metabolism. 43: 647 654. Velazquez E, Acosta A, Mendoza S. 1997 Menstrual cyclicity after metformin therapy in polycystic ovary syndrome. Obstet Gynecol. 90: 392395. 7. Diamanti-Kandarakis E, Kouli C, Tsianateli T, Bergiele A. 1998 Therapeutic effects of metformin on insulin resistance and hyperandrogenism in polycystic ovary syndrome. Eur J Endocrinol. 138: 269 274. Morin-Papunen LC, Koivunen RM, Ruokonen A, Martikainen HK. 1998 Metformin therapy improves the menstrual pattern with minimal endocrine and metabolic effects in women with polycystic ovary syndrome. Fertil Steril. 69: 691696. 9. Nestler J, Jakubowicz D. 1996 Decreases in ovarian cytochrome P450c17 activity and serum free testosterone after reduction of insulin secretion in polycystic ovary syndrome. N Engl J Med. 335: 617 623. Nestler JE, Jakubowicz DJ. 1997 Lean women with polycystic ovary syndrome respond to insulin reduction with decreases in ovarian P450c17-alpha activity and serum androgens. J Clin Endocrinol Metab. 82: 4075 4079. Laatikainen TJ, Apter DL, Paavonen JA, Wahlstrom TR. 1980 Steroids in ovarian and peripheral venous blood in polycystic ovarian disease. Clin Endocrinol Oxf ; . 13: 125129. 12. McClamrock HD, Adashi EY. 1992 Gestational hyperandrogenism. Fertil Steril. 57: 257270. 13. Ben-Chetrit A, Greenblatt EM. 1995 Recurrent maternal virilization during pregnancy associated with polycystic ovarian syndrome: a case report and review of the literature. Hum Reprod. 10: 30573062 and clozapine.
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Associate Clinical Professor Department of Obstetrics, Gynecology and Women's Health St. Louis University School of Medicine St. Louis, Missouri Richard Gimpelson is board certified in Obstetrics and Gynecology. Dr. Gimpelson received a Bachelor of Science in Electrical Engineering from Washington University in St. Louis. He graduated from the University of Missouri School of Medicine in Columbia, Missouri and did his internship and residency at St. John's Mercy Medical Center in Creve Coeur, Missouri. He is currently Associate Clinical Professor of Obstetrics & Gynecology in Women's Health at St. Louis University School of Medicine. In 1988 Dr. Gimpelson founded the Missouri Laser Institute to teach laser surgery and all aspects of minimally invasive gynecologic surgery. In the mid 1990's the Missouri Laser Institute put on educational programs to teach general surgeons how to perform minimally invasive surgery with emphasis on cholecystectomy, appendectomy, and inguinal hernia repair. Dr. Gimpelson has authored 35 professional publications, nine book chapters and has collaborated with an artist to publish four cartoons. He has participated in 24 FDA Trials as either principal investigator or sub-investigator. He has been issued five U.S. patents and has one patent pending. He has lectured extensively since 1983 and has been a candidate for the U.S. House of Representatives and U.S. Senate. Dr. Gimpelson has been a member of the AAGL since 1983 and has served on the board of trustees both as a regular board member and an advisory committee member. He has been the secretary treasurer for the AAGL and Editor-in-Chief of NewsScope. He is currently the President of AAGL. He is an hoc reviewer for the Journal of Reproductive Medicine, the Journal of the AAGL, and presently is the AAGL delegate to the American Medical Association, a position he has held for five years. Dr. Gimpelson is an outspoken advocate for physician rights and since 1999 has written a monthly column for St. Louis Metropolitan Medicine, the Journal of the St. Louis Metropolitan Medical Society. Dr. Gimpelson also served as President of the St. Louis Metropolitan Medical Society and is a delegate to the Missouri State Medical Association. Dr. Gimpelson is very proud of his two sons Jon, who works for Cingular and Josh, who works for Smith Barney as well as his daughter-in-law, Megan, heiress to the Snowbowl Ski Resort in Missoula, Montana. Dr. Gimpelson owes everything to his wife, Nan, head nurse in the operating room when they first met, who tries to keep him from being too sophomoric, for instance, clomiphene citrate drug.
Polycystic ovary syndrome PCOS ; is a common endocrinologic disorder in women, characterized by chronic anovulation and hyperandrogenemia. Clomiphrne citrate CC ; is still accepted as the initial treatment of choice for infertile women with PCOS. PCOS is the most common cause of anovulatory infertility affecting between 4% and 6% of women of reproductive age [1]. Approximately 5070% of women treated with CC will ovulate [1]. Furthermore, there is a difference between the ovulation rate and the conception rate, and the abortion rate is high. On the other hand, risk for atherosclerosis is increased in women with polycystic ovary syndrome [2]. It has been suggested that the homocysteine levels are higher in PCOS patients than in control subjects, which may explain the coronary artery disease risk 3 ; . Elevated levels of plasma homocysteine have recently been implicated as a significant risk factor for cardiovascular disease, pre-eclampsia and recurrent pregnancy loss [47]. Women who are resistant to clomiphene citrate can be treated with gonadotropin or pulsatile LH-releasing hormone [8]. An alternative method to the medical approach is surgical treatment. Many surgical modalities such as laser, unipolar and bipolar cauteries and techniques have been used [912]. However, most investigators have reported on a small series of patients treated with a given technique or instrument, and the results have been reported the pregnancy rates with various durations of follow-up [1321]. The patient population has also been heterogeneous; some had only ultrasound findings of polycystic ovaries without hyperandrogenemia, and some had never been treated with clomiphene. Women with PCOS having high LH levels have significantly lower rates of ovulation, fertilization and pregnancy when compared with normal LH levels of PCOS patients [22, 23]. Ovarian drilling has been proposed as an alternative surgical treatment in women with PCOS [24, 25]. However, none of the studies could give details the postoperative hormone levels between those who ovulated and those who did not. Thus, the relationship between hormone and the ovarian response to electrocautery remains unclear. The purposes of this study are to evaluate the hormonal changes and clinical outcome in infertile women with PCOS who treated with laparoscopic ovarian drilling and zidovudine.
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If Kerala's life expectancy rate is on par with Hungary, the same cannot be said of Kerala's expenditure on Health. Lower investment on education has resulted in deterioration in the quality of education in the state. The famed `Kerala model' can't survive until and unless the state invests heavily on health and education.
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The guide, which took 3 years to produce, relies on flow charts and a no-nonsense approach to drugs. "We picked the products we use, " explains Stewart. The physicians decided to selfpublish after talking with David Chilton, of Wealthy Barber fame. Within 3 months of publication, the 2 doctors were able to reprint the guide with the magic word "bestseller" on the cover: it had already sold more than 10 000 copies. Feedback from colleagues has been positive, and they're now planning a similar publication for seniors. The authors say their guide should help save money by eliminating inappropriate visits and prescribing. "A doctor feels under pressure to prescribe even if the patient only has a cold, " says Stewart. -- Charlotte Gray.
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Letrozole and other aromatase inhibitors have been studied as a replacement for colmiphene citrate cc ; , a drug commonly used to induce ovulation, and as co-treatment with gonadotropins injectible fertility drugs ; to achieve controlled ovarian hyperstimulation.
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It is my pleasure to address you at the end of my first year as President of Arthritis New Zealand. It has been a challenging year but I believe we can look forward to a more successful future. work being done internationally, are: increasing the amount of teaching in the medical school curriculum on musculo-skeletal disease. increasing Osteoporosis awareness amongst health professionals. I was asked to join the committee as a patient advocate. As a patient advocate I was also invited to attend the 2004 International Bone and Joint Decade conference in Beijing.
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Clin Endocrinol Oxf ; 2004; 60: 241-9. Wang HS, Chard T. IGFs and IGF-binding proteins in the regulation of human ovarian and endometrial function. J Endocrinol 1999; 161: 1-13. Genazzani AD, Battaglia C, Malavasi B, Strucchi C, Tortolani F, Gamba O. Metformin administration modulates and restores luteinizing hormone spontaneous episodic secretion and ovarian function in nonobese patients with polycystic ovary syndrome. Fertil Steril 2004; 81: 114-9. Kashyap S, Wells GA, Rosenwaks Z. Insulin-sensitizing agents as primary therapy for patients with polycystic ovarian syndrome. Hum Reprod 2004; 19: 2474-83. Weerakiet S, Tingthanatikul Y, Sophonsritsuk A, Choktanasiri W, Wansumrith S, Rojanasakul A. Efficacy of metformin on ovulation induction in Asian women with polycystic ovary syndrome. Gynecol Endocrinol 2004; 19: 202-7. Palomba S, Orio F, Jr., Falbo A, Manguso F, Russo T, Cascella T, Tolino A, Carmina E, Colao A, Zullo F. Prospective parallel randomized double-blind doubledummy controlled clinical trial comparing clomiphene citrate and metformin as the first-line treatment for ovulation induction in non-obese anovulatory women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005; 90: 4068-74. Glueck CJ, Wang P, Goldenberg N, Sieve-Smith L. Pregnancy outcomes among women with polycystic ovary syndrome treated with metformin. Hum Reprod 2002; 17: 2858-64. Vanky E, Salvesen KA, Heimstad R, Fougner KJ, Romundstad P, Carlsen SM. Metformin reduces pregnancy complications without affecting androgen levels in pregnant polycystic ovary syndrome women: results of a randomized study. Hum Reprod 2004; 19: 1734-40.
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