Understanding and Combating the Evil of Ebola: A Holistic View on Emerging Treatments and Challenges

1. ObG Watch Narayanan R November 2014

2. The evil of EBOLA

3. The spread

4. Deadly Virus Enters body thru contact with body fluids Incubation period: 2-20 days Kills cells & Makes them explode Wrecks immune system Hemorrhagic crisis Mortality >55%

5. No vaccine No specific drug Only supportive therapy Flu like symptoms Vomiting Diarrhoea DIC Multi organ Failure

6. Relevance to ObG • Virus persists in semen for >3 mths • Transmitted through Breast milk • Mode of transmission to fetus not known • Mortality in pregnancy higher even if unaffected (Congo 1999: Overall: 77% - Pregnant: 95.5% - NNM: 100%) • Collateral damage

7. Uterine Transplantation

8. Indications: Absence of uterus Hypoplasia Morbid adhesions Post Hysterectomy Drawbacks: Surgical skill Miscarriage IUGR Preterm Risks: Need for ART Immunosuppression Organ or embryo rejection Ethical: Uterus not a vital organ Unlike heart & kidney Consider quality of life

9. Research project 1999 at Gothenburg, Sweden Team led by Mats Brännström 9 women received a womb from live donors PE due to Immunosuppression 3 mild rejection episodes First delivery in Sept 2014 At 32 wks – CS - fetal distress World’s First Child Born After Uterus Transplantation

10. Penile Transplantation • Difficult to make this organ serving dual purposes of voiding urine and experiencing sexual response • Penis made from regenerated tissue from the patient's own groin or from a donor • Atala’s team transplanted the first bladder in1999 - urethra 2004 - vagina in 2005 Atala

11. Fecal transplantation Youngster et al, MGH Boston, JAMA 2014.

12. Poop Pills • Used to treat the dangerous Clostridiumdifficile, which kills 14,000 Americans annually • Stool samples taken from healthy relatives is processed and the isolated bacteria alone are packed into pill cases that dissolve when they reach the intestines • Single shot therapy • Canadian study: All 27 patients were cured Infectious Diseases Society of America, Oct 2013

13. Harnaam Kaur 23, is suffering from PCOS She had been struggling with hair growth since she was 11 and was being teased in school She is now growing a beard after being baptised as a Sikh. She would never ever remove her facial hair because it’s the way God made her and she is happy with the way she is Indian origin UK woman grows beard

14. Frida Kahlo

15. Veggies & semen YELLOW / ORANGE Motility ---------------------------------------------------------------- RED Morphology ---------------------------------------------------------------- Sweet Potato / Melon / Oats Quantity & Quality Fertil Steril Dec 2013

16. Milk, Fractures and Death • 61,433 women 39 to 74 years and 45,339 men 45 to 79 years • 22 years of follow-up • Women who drank >3 glasses of milk a day had twice the risk for death compared with women who drank less than one glass a day • Women who drank more milk also had a higher risk for any type of fracture • Uppsala university, Sweden

17. Plasma Kisspeptin Level May Predict Miscarriage • Found in placenta & is critical for reproduction • Low levels of K in 1st trimester predicts miscarriage even in asymptomatic women • Single blood test may be better than serial hCG • Kisspeptin level >1306 pmol/L strongly indicates reduced risk for miscarriage • It may also prove to be an Indicator for PE/IUGR Abbara A,Jt Meeting of the International Society of Endocrinology and the Endocrine Society: ICE/ENDO 2014;  June 21, 2014.

18. 30-40% of Scottish women drink in excess • Habit has doubled in 30 yrs • 1 in 30 deaths in women are drink-related • Scottish campaign for ‘Smaller glasses’ • ‘Drinking Mirror’ app for cell phones

19. App shows women how booze affects looks How you look today 10 years later If you drink in excess If you reduce the Size of your glass

20. Study of 823 women all over the world >39451 cycles >20% started periods around full moon Best time to conceive? Around new moon! The Moon and Menses Philip Chennette 2014

21. Thank you!