1. Genetic conflict theory --> that NVP is a byproduct of maternal-fetal genetic conflict --> it is triggered by increasing beta HCG levels --> but NVP peaks ahead of the beta HCG peak --> it leads, where it should lag!
11) But this relationship is not 100% proved.
It is believed that different beta HCG isoforms +/- receptor sensitivity may alter the risk of developing NVP!
2. It is believed that NVP signals to other males and kin that the woman is pregnant --> it signs low sexual activity and need for help.
But sexual activity may not be dangerous during the 1st trimester --> the time of peak NVP incidence!
13)
3. Some early studies proposed that NVP may be a psychosomatic illness --> it is a manifestation of a pregnant woman's desire to reject her fetus --> they found that women with NVP had a higher rates of unplanned/undesired pregnancies.
14) As you can see, NVP is far from a cut and dried topic!
Theories abound!
But this should not distract from the fact this is a clinical situation which ranges from merely troublesome to life threatening ie hyperemesis gravidarum!
I hope you liked this small window into evolutionary medicine!
1) I am a big fan of evolutionary medicine --> the study of human evolution and how it can be harnessed for the practice of medicine.
I recently went in for a deep dive into an important topic --> HYPERURICEMIA
Here is what I learnt!
2) Uric acid is the endproduct of purine metabolism in humans --> this is an exception among mammals!
Why does this happen?
1. Lack of uricase 2. Avid renal reabsorption of uric acid
3) Why happened to uricase?
This ancient enzyme, present since bacteria, accumulated a number of mutations approx 10-30 million years ago and gradually lost its function in humans, some higher primates and some New World monkeys.
1) I'm no expert but the Dolo 650 controversy is either a meaningless or a malignant one.
PCM is an OTC drug --> it is almost never the only drug in a prescription.
Why?
2) PCM doesn't provide any significant analgesia unless you are taking 2-3 gm/day.
Its good for the myalgia and arthralgia of febrile illnesses especially if NSAIDs are contraindicated --> like dengue which has a risk of thrombocytopenia.
3) For everything beyond this, you will need an adequate dose of an NSAID +/- local or systemic glucocorticoid therapy --> even DMARDs if its rheumatological!
Most patients in India don't go to a doctor for mild aches and pains --> they will buy PCM directly!