Wednesday, October 04, 2023

Tuberculosis in Pregnancy


This is a quick summary of the points taken from the TOG article which was published in July 2023. It is an important exam topic so must be covered thoroughly.


To download the original article: Click Here

To Access All TOGs: Click Here

To Join RK4 MRCOG Courses: Click Here



Introduction

  • Tuberculosis (TB) is one of the leading infectious causes of overall mortality
  • Highest disease burden in low-resource countries 
  • >2/3 cases in Africa and Southeast Asia
  • Co-infection of TB & HIV in reproductive years is significant
  • In UK — increasing due to immigration 
  • Can have adverse effects on mother & fetus


Epidemiology

  • Global incidence - 1990-2020 — 9.9 million with 1.3 million deaths worldwide 
  • Major contributors to the resurging global TB epidemic — Poverty, HIV Coinfection, Drug resistance
  • In 2020 UK had 4700 cases = 6.9 per 100 000
  • Risk of new migrant women having active TB highest in first 5 years of migration
  • Exact worldwide TB prevalence in pregnancy - Uncertain & depends on area
    • Low-prevalence countries 0.06-0.25%
    • High-prevalence countries 
      • 0.07-0.5% (in HIV negative)
      • 0.7-11% (in HIV-positive) 


Pathophysiology

  • Causative organism — Mycobacterium tuberculosis (non-spore-forming, aerobic & non-motile bacteria)
  • Primarily airborne infection
  • Can also occur through ingestion of unpasteurised milk or direct implantation
  • TB particles range from 1-5 microns in size, carried to terminal alveoli and multiply there
  • Alveolar macrophages ingest & destroy most of the particles, but few survive and continue to multiply
  • A granuloma is formed by macrophages around the bacilli
  • Usually, the immune system clears the infection, but if it fails, it remains dormant without clinical manifestations or may cause symptoms.
    • ~10% immunocompromised with latent TB will develop reactivation of TB
    • ~10% healthy acquire infection during their life
  • Most common form of clinical TB — Pulmonary disease
    • 20% active TB can present as extrapulmonary TB with cervical nodes being most common site (31%). 
    • Other sites are CNS, spinal cord, abdomen, pericardium (more common in immunocompromised & HIV-positive)
Outcomes of primary TB infection 
  1. Latent TB
  2. Primary TB (within 2 years)
  3. Secondary TB


Clinical Presentation 

  • Suspect TB if h/o exposure to patients with chronic cough or recent visits to endemic areas
  • Symptoms except for Fever same as non-pregnant — weight loss, night sweats, chills, appetite loss, tiredness & weakness
  • Latent disease will be asymptomatic & non-infectious but can have reactivation
  • Four-symptom screening for TB suggested by WHO 

Thursday, July 20, 2023

MRCOG Part 2 Revision Course | January 2024


MRCOG Part 2 Revision | January 2024



Enrol Now for MRCOG Part 2 Revision Course | January 2024!! 


Features

  • Twice Weekly Interactive Live Sessions 2-3 hours duration conducted using Zoom software
  • Session Recordings accessible until the exam day
  • Total LIVE Sessions: 15
  • Important Exam Topics covered module wise
  • Free Mock Test 1200+ SBAs & EMQs to practice
  • Duration 3 Months
  • Session Timings 18:00 to 21:00 PKT
  • Tips and Tricks to Tackle SBAs and EMQs
  • Focus on concepts and critical thinking — deal with ANY exam question
  • Supervised WhatsApp Study Group to discuss and clarify queries, SBAs, EMQs

 

Course Fee: $259


To Register Visit the Course Website

https://www.rubabk4courses.com/courses/

 

Payment Options:

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  • Direct Bank Transfer in PKR (For Pakistani Candidates ONLY)


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LIVE Sessions Outline

No.

Module

Topics to Cover

1

Early Pregnancy Care

GTG 21 Ectopic Pregnancy 

NICE Miscarriage 

GTG 38 Gestational Trophoblastic Disease 

GTG 69 Hyperemesis Gravidarum

GTG 5 OHSS

2

Urogynaecology

NICE Urinary Incontinence 

Urodynamics Studies 

GTG 46 Post-hysterectomy Vaginal Vault Prolapse

GTG 70 Bladder Pain Syndrome

Thursday, June 15, 2023

Monday, June 12, 2023

RCOG Advice Links — Consent, Clinical Governance, Good / Best Practice

RCOG guidelines clinical governance consent good practice best practise

This post is a compilation of RCOG guidance papers with links — Consent Advice (CA); Clinical Governance Advice (CGA); Good Practice Guidance (GPP); Best Practice Paper (BPP)
All you have to do is to click the link and a pdf file will open in new window.
Thanks

Consent Advice

All Papers Risk Compilation: Click Here



Clinical Governance Advice

CGA 2
CGA 5
CGA 6
CGA 6a
CGA 6b
CGA 7

Good Practice Guidance

GP 3
GP 4
GP 5
GP 6
GP 7
GP 8
GP 9
GP 10
GP 11
GP 12
GP 13
GP 14
GP 15

Best Practice Paper

BPP 1
BPP 2
BPP 3

Some other useful links: