BOOK
Basic Science in Obstetrics and Gynaecology E-Book
Phillip Bennett | Catherine Williamson
(2014)
Additional Information
Book Details
Abstract
A textbook covering the basic sciences relevant to obstetrics and gynaecology at a level suitable for doctors specialising in the field . The chapters match the syllabus of the specialist UK exam – the MRCOG Part 1
- This new edition completely revised and updated to cover all the basic science required for the new MRCOG Part 1 exam.
- Genetics covered by two new chapters: Structure and function of the genome; and Clinical genetics.
- Extensive revision of immunology, statistics and evidence-based health.
- Many new illustrations, particularly in anatomy and immunology.
- New editorial team, plus nearly 50% new contributors.
- New self-assessment section written in the style of the new exam.
- This new edition completely revised and updated to cover all the basic science required for the new MRCOG Part 1 exam.
- Genetics covered by two new chapters: Structure and function of the genome; and Clinical genetics.
- Extensive revision of immunology, statistics and evidence-based health.
- Many new illustrations, particularly in anatomy and immunology.
- New editorial team, plus nearly 50% new contributors.
- New self-assessment section written in the style of the new exam.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Half title page | i | ||
| Basic Science in Obstetrics and Gynaecology | iii | ||
| Table of Contents | v | ||
| Copyright page | iv | ||
| Contributors | vii | ||
| Preface | ix | ||
| Acknowledgements | xi | ||
| One Structure and function of the genome | 1 | ||
| CHAPTER CONTENTS | 1 | ||
| Chromosomes | 1 | ||
| Gene structure and function | 2 | ||
| The central dogma of molecular biology | 4 | ||
| Transcription | 4 | ||
| Translation | 5 | ||
| Replication | 5 | ||
| Regulation of gene expression | 5 | ||
| Epigenetics | 6 | ||
| Epigenetic modification of DNA | 6 | ||
| Epigenetic modification of histones | 6 | ||
| Mitochondrial DNA | 6 | ||
| Studying DNA | 6 | ||
| Mendelian genetics and linkage studies | 6 | ||
| The sequencing of the genome | 7 | ||
| Analysis of complex traits | 7 | ||
| Molecular biology techniques | 8 | ||
| Restriction endonucleases | 8 | ||
| The polymerase chain reaction | 8 | ||
| Electrophoresis | 9 | ||
| Blotting | 9 | ||
| Sequencing | 9 | ||
| Cloning vectors and cDNA analysis | 9 | ||
| Expression studies | 9 | ||
| In-silico analysis | 9 | ||
| The ‘post-genomic’ era | 10 | ||
| The molecular basis of inherited disease – DNA mutations | 10 | ||
| Two Clinical genetics | 13 | ||
| CHAPTER CONTENTS | 13 | ||
| Chromosome abnormalities | 13 | ||
| Aneuploidy | 14 | ||
| Polyploidy | 14 | ||
| Trisomy | 15 | ||
| Monosomy | 15 | ||
| Sex chromosome anomalies | 15 | ||
| Mosaicism | 16 | ||
| Structural chromosome abnormalities | 16 | ||
| Chromosome deletions | 16 | ||
| Chromosome duplications | 16 | ||
| Chromosome inversions | 16 | ||
| Isochromosome | 17 | ||
| Translocations | 17 | ||
| Chromosome nomenclature | 19 | ||
| Single gene disorders | 19 | ||
| Autosomal dominant diseases | 19 | ||
| Autosomal recessive diseases | 20 | ||
| Cystic fibrosis | 20 | ||
| Thalassaemias | 21 | ||
| Sickle cell disease | 21 | ||
| Sex-linked inheritance | 21 | ||
| X-linked recessive diseases | 21 | ||
| X-linked dominant diseases | 22 | ||
| Y-linked diseases | 22 | ||
| Mitochondrial inheritance | 22 | ||
| Genomic imprinting | 22 | ||
| Uniparental disomy | 23 | ||
| Multifactorial inheritance | 23 | ||
| Genetic testing and interpretation of a genetic result | 24 | ||
| Chromosome analysis | 24 | ||
| Molecular cytogenetics: FISH | 24 | ||
| Mutation testing | 24 | ||
| Three Embryology | 25 | ||
| CHAPTER CONTENTS | 25 | ||
| Oogenesis, spermatogenesis and organogenesis | 25 | ||
| Oogenesis | 25 | ||
| Spermatogenesis | 26 | ||
| Early embryogenesis: fertilization, transportation and implantation | 27 | ||
| Early development of the embryo | 29 | ||
| Organogenesis | 30 | ||
| Development of the germ layers | 30 | ||
| Pharyngeal region | 31 | ||
| Cardiovascular system | 33 | ||
| Fetal circulation | 33 | ||
| Alimentary system, pulmonary and peritoneal cavities | 33 | ||
| Respiratory organs | 34 | ||
| Central nervous system | 34 | ||
| Skeletal system | 34 | ||
| Muscles, skin and appendages | 36 | ||
| Development of the genital organs | 36 | ||
| Uterus and tubes | 36 | ||
| Vagina | 36 | ||
| External genitalia | 36 | ||
| Gonads | 38 | ||
| Development of the placenta | 40 | ||
| Placental bed | 44 | ||
| Development of membranes and formation of amniotic fluid | 44 | ||
| Membranes | 44 | ||
| Amniotic fluid | 45 | ||
| Composition of amniotic fluid | 47 | ||
| Four Fetal and placental physiology | 49 | ||
| CHAPTER CONTENTS | 49 | ||
| Introduction | 49 | ||
| Fetal growth | 49 | ||
| Maternal smoking and drug use | 50 | ||
| Maternal hypoxia | 50 | ||
| Maternal inflammatory conditions | 50 | ||
| The placenta and fetal growth | 50 | ||
| The IGF (insulin-like growth factors) axis | 50 | ||
| Fetal circulation | 50 | ||
| Development | 50 | ||
| Distribution and pattern of the fetal circulation | 51 | ||
| Changes at birth | 51 | ||
| Response to stress | 52 | ||
| Renal function and amniotic fluid dynamics | 52 | ||
| Amniotic fluid | 52 | ||
| Fetal lung development | 53 | ||
| Surfactants | 53 | ||
| Changes at birth | 54 | ||
| Fetal brain development | 54 | ||
| The placenta | 54 | ||
| Nutrient transport across the placenta | 55 | ||
| Endocrine function of the placenta | 55 | ||
| The placenta in perinatal disease | 55 | ||
| Fetal origins of adult disease | 55 | ||
| References | 55 | ||
| Five Applied anatomy | 57 | ||
| CHAPTER CONTENTS | 57 | ||
| Introduction | 58 | ||
| Body tissues and cells | 58 | ||
| The nervous system | 58 | ||
| The somatic nervous system | 58 | ||
| The autonomic nervous system | 59 | ||
| Clinical application | 59 | ||
| Sympathetic (thoracolumbar) nervous system | 60 | ||
| Sympathetic effects | 60 | ||
| The adrenal medulla | 60 | ||
| Parasympathetic (craniosacral) nervous system | 61 | ||
| Cranial: III, VII, IX, X | 61 | ||
| Sacral: S2 and S3 | 61 | ||
| Parasympathetic effects | 61 | ||
| The spinal cord and meninges | 61 | ||
| Spinal nerve roots and their plexuses | 62 | ||
| Clinical application | 62 | ||
| Anatomy of the brain | 62 | ||
| The thalami | 62 | ||
| The hypothalamus | 62 | ||
| The pineal gland | 62 | ||
| The pituitary gland | 62 | ||
| Clinical application | 63 | ||
| The lymphatic system | 63 | ||
| Lymphatic vessels | 63 | ||
| Lymphatic tissue | 63 | ||
| The vascular system | 63 | ||
| Fetal circulation and changes after birth | 63 | ||
| Oxygenated blood | 63 | ||
| Deoxygenated blood | 63 | ||
| Changes at and after birth | 63 | ||
| The arterial system | 64 | ||
| The aorta | 64 | ||
| Three ventral branches | 64 | ||
| Three terminal branches | 64 | ||
| Four pairs of branches | 64 | ||
| Four lateral pairs | 64 | ||
| The common iliac arteries | 65 | ||
| The venous system | 65 | ||
| The inferior vena cava | 65 | ||
| Collateral venous drainage pathways | 65 | ||
| Six Pathology | 97 | ||
| CHAPTER CONTENTS | 97 | ||
| General pathological principles | 97 | ||
| Cellular injury and death | 97 | ||
| Response to tissue injury | 98 | ||
| Acute inflammation | 98 | ||
| Tissue repair and wound healing | 98 | ||
| Chronic inflammation | 99 | ||
| Control of cell and tissue growth or differentiation | 99 | ||
| Pathology of gynaecological tumours | 100 | ||
| Vulva | 100 | ||
| Vagina | 100 | ||
| Cervix | 101 | ||
| Endometrium | 101 | ||
| Myometrium | 101 | ||
| Ovary | 101 | ||
| Pathology of miscarriage and gestational trophoblastic disease | 102 | ||
| Chromosomal abnormalities | 102 | ||
| Infection | 102 | ||
| Maternal disease | 102 | ||
| Other factors | 102 | ||
| Gestational trophoblastic neoplasia | 103 | ||
| Pathology of common congenital abnormalities | 103 | ||
| Pathology of the placenta | 104 | ||
| Intrauterine growth restriction and pre-eclampsia | 104 | ||
| Ascending genital tract infection | 105 | ||
| Seven Microbiology and virology | 107 | ||
| CHAPTER CONTENTS | 107 | ||
| Bacteriology, mycology and parasitology | 107 | ||
| Introduction | 107 | ||
| Morphology and structure | 107 | ||
| Classification and typing | 108 | ||
| Pathogenesis | 110 | ||
| Laboratory identification | 110 | ||
| Specimen collection | 110 | ||
| Culture | 111 | ||
| Antigen detection | 111 | ||
| Nucleic acid detection | 111 | ||
| Antibody detection | 112 | ||
| Bacteria and disease | 112 | ||
| Normal flora | 112 | ||
| Normal genital tract flora of women | 112 | ||
| Gram-positive and Gram-negative bacteria | 112 | ||
| Spirochaetes, mycoplasmas, chlamydiae and other bacteria | 116 | ||
| Killing bacteria | 117 | ||
| Action of antibiotics | 117 | ||
| Physical methods | 118 | ||
| Sterilization/disinfection | 118 | ||
| Heat | 118 | ||
| Chemicals | 119 | ||
| Other | 119 | ||
| Mycology | 119 | ||
| Pathogenic fungi | 119 | ||
| Moulds | 119 | ||
| True yeasts | 119 | ||
| Yeast-like fungi | 120 | ||
| Dimorphic fungi | 120 | ||
| Parasites | 120 | ||
| Protozoa | 120 | ||
| Helminths (worms) | 121 | ||
| Virology | 121 | ||
| Introduction | 121 | ||
| Viral nucleic acid | 121 | ||
| Replication | 121 | ||
| Structure of viruses | 122 | ||
| Diagnosis of viral infections | 124 | ||
| Viruses of importance in obstetrics and gynaecology | 124 | ||
| Viruses which may induce severe infection in pregnancy | 124 | ||
| SARS and other coronaviruses | 126 | ||
| Intrauterine infections | 126 | ||
| Rubella | 127 | ||
| CMV | 127 | ||
| Varicella | 127 | ||
| Parvovirus B19 | 128 | ||
| HIV-1 and -2 | 128 | ||
| Enteroviruses (polioviruses, coxsackie A and B viruses, echoviruses) | 128 | ||
| Perinatal infections | 128 | ||
| HSV | 128 | ||
| Hepatitis B | 129 | ||
| Hepatitis C | 129 | ||
| Human papillomavirus (HPV) | 129 | ||
| Human T cell lymphotrophic virus type 1 (HTLV-1) | 129 | ||
| References | 130 | ||
| Eight Immunology | 131 | ||
| CHAPTER CONTENTS | 131 | ||
| Introduction | 131 | ||
| The immune system | 131 | ||
| Adaptive immune systems | 132 | ||
| Antibody molecules | 132 | ||
| B cells | 134 | ||
| T cells | 135 | ||
| Antigen recognition | 135 | ||
| Function of T cells | 135 | ||
| Cells of the innate immune system | 137 | ||
| NK cells | 137 | ||
| Macrophages | 138 | ||
| Granulocytes | 138 | ||
| The dendritic cell | 138 | ||
| Regulation of the immune system | 138 | ||
| The danger theory | 138 | ||
| Tolerance | 138 | ||
| The fetus as an allograft | 139 | ||
| Systemic control mechanisms | 140 | ||
| Local immunomodulation | 140 | ||
| Antibodies and pregnancy | 140 | ||
| Other immunological interactions with the fetus | 141 | ||
| Conclusion | 142 | ||
| Nine Biochemistry | 143 | ||
| CHAPTER CONTENTS | 143 | ||
| Structure and function of the normal cell | 143 | ||
| Cells | 143 | ||
| Nucleus | 143 | ||
| Cytoplasm | 144 | ||
| Cell types | 145 | ||
| Intercellular matrix | 145 | ||
| Proteins, peptides and amino acids | 145 | ||
| Amino acids | 146 | ||
| Structure of proteins | 149 | ||
| Purification and analysis of proteins | 151 | ||
| Modification of protein structure | 151 | ||
| Metabolism | 152 | ||
| Overall energy metabolism | 152 | ||
| Glycolysis | 153 | ||
| Citric acid cycle | 153 | ||
| Respiratory chain | 155 | ||
| Fatty acid oxidation | 155 | ||
| Regulation of metabolic pathways | 156 | ||
| Catabolism | 158 | ||
| Haemoglobin | 158 | ||
| Urea cycle | 158 | ||
| Enzymes | 159 | ||
| Enzyme kinetics | 160 | ||
| Vitamins | 160 | ||
| Role of enzymes in digestion | 161 | ||
| Protein | 161 | ||
| Carbohydrate | 161 | ||
| Fat | 161 | ||
| Cell signalling and second messaging | 162 | ||
| General overview | 162 | ||
| Eicosanoid synthesis | 163 | ||
| Gap junctions | 164 | ||
| Nitric oxide is an important signalling molecule | 164 | ||
| Calcium as an intracellular messenger | 165 | ||
| Signals acting on intracellular receptors | 165 | ||
| Ion channels | 166 | ||
| G-protein-linked receptors which increase cyclic AMP | 166 | ||
| Inhibitory G-proteins | 167 | ||
| cAMP-dependent protein kinase (protein kinase A) | 169 | ||
| Inositol phosphate and diacylglycerol second messengers | 169 | ||
| Enzyme-linked receptors | 169 | ||
| Vascular endothelial growth factors | 170 | ||
| Ten Physiology | 173 | ||
| CHAPTER CONTENTS | 173 | ||
| Biophysical definitions | 174 | ||
| Molecular weight | 174 | ||
| Distribution of water and electrolytes | 174 | ||
| Anion gap | 174 | ||
| Transport mechanisms | 175 | ||
| Acid–base balance | 177 | ||
| Normal acid–base balance | 177 | ||
| pH | 178 | ||
| Partial pressure of carbon dioxide (Pco2) | 178 | ||
| Henderson–Hasselbalch equation | 178 | ||
| Control of pH | 178 | ||
| Buffers | 179 | ||
| Buffer base and base excess | 180 | ||
| Standard bicarbonate | 180 | ||
| Abnormalities of acid–base balance | 180 | ||
| Respiratory acidosis | 180 | ||
| Respiratory alkalosis | 180 | ||
| Metabolic acidosis | 180 | ||
| Metabolic alkalosis | 180 | ||
| Cardiovascular system | 181 | ||
| Conduction system of the heart | 181 | ||
| Factors affecting heart rate | 181 | ||
| Cardiac chambers | 181 | ||
| Electrocardiogram (ECG) | 181 | ||
| Pressure and saturation in the cardiac chambers | 183 | ||
| Haemodynamic events in the cardiac cycle and their clinical correlates | 183 | ||
| Control of cardiac output | 184 | ||
| Changes in blood volume and cardiac output during pregnancy | 186 | ||
| Blood pressure control | 186 | ||
| Autonomic nervous system and blood pressure control | 187 | ||
| Local control of blood flow | 187 | ||
| Blood pressure changes in pregnancy | 188 | ||
| Endothelium in pregnancy | 188 | ||
| Endothelium as a barrier | 188 | ||
| Endothelium as a modulator of vascular tone | 189 | ||
| Endothelium-derived vasodilators | 189 | ||
| Nitric oxide | 189 | ||
| Prostacyclin | 190 | ||
| Endothelium-derived hyperpolarizing factor | 190 | ||
| Vascular endothelial growth factor | 190 | ||
| Placental growth factor | 190 | ||
| Thromboxane | 191 | ||
| Endothelin | 191 | ||
| Angiotensin II | 191 | ||
| Oestrogen and the endothelium | 191 | ||
| Endothelium and haemostasis | 191 | ||
| Endothelium and inflammation | 192 | ||
| Pre-eclampsia | 192 | ||
| Endothelial dysfunction in pre-eclampsia | 192 | ||
| Nitric oxide in pre-eclampsia | 192 | ||
| Prostanoids in pre-eclampsia | 193 | ||
| Prothrombotic states | 193 | ||
| Aetiology of maternal endothelial dysfunction in pre-eclampsia | 193 | ||
| Conclusion | 193 | ||
| Respiration | 193 | ||
| The lungs, ventilation and its control | 193 | ||
| Gas composition | 193 | ||
| Dead space | 194 | ||
| Oxygen consumption | 194 | ||
| Lung volumes | 194 | ||
| Mechanics of ventilation | 194 | ||
| Resistance to air flow | 195 | ||
| Oxygen transfer | 195 | ||
| Effect of pregnancy | 195 | ||
| Control of respiration | 195 | ||
| Response to hypercapnia | 196 | ||
| Response to hypoxia | 196 | ||
| Effect of changes in hydrogen ion concentration | 196 | ||
| Oxygen and carbon dioxide transport | 197 | ||
| Oxygen transport | 197 | ||
| Carbon monoxide | 198 | ||
| Carbon dioxide transport | 199 | ||
| Urinary system | 199 | ||
| Microanatomy | 199 | ||
| Renal clearance | 200 | ||
| Glomerular filtration rate | 200 | ||
| Renal blood flow | 201 | ||
| Handling of individual substances | 201 | ||
| Glucose and amino acids | 201 | ||
| Sodium and chloride | 201 | ||
| Bicarbonate | 201 | ||
| Potassium | 202 | ||
| Hydrogen ions | 202 | ||
| Water | 202 | ||
| Urea | 202 | ||
| Endocrine functions of the kidney | 202 | ||
| Effects of pregnancy | 203 | ||
| Renal glomerular function during pregnancy | 203 | ||
| Renal tubular function during pregnancy | 203 | ||
| Renal endocrine function during pregnancy | 204 | ||
| Physiology of micturition | 205 | ||
| Passive phase | 205 | ||
| Active phase | 205 | ||
| Urodynamic data in the normal adult female | 205 | ||
| Gastrointestinal tract | 205 | ||
| Mouth | 205 | ||
| Mechanics | 205 | ||
| Digestive processes | 205 | ||
| Oesophagus | 206 | ||
| Eleven Endocrinology | 231 | ||
| CHAPTER CONTENTS | 231 | ||
| Introduction | 232 | ||
| Mechanisms of hormone action and second messenger systems | 232 | ||
| Cell surface receptors | 232 | ||
| Nuclear receptors | 233 | ||
| Hormone types | 233 | ||
| Peptide hormones | 233 | ||
| Steroid hormones | 234 | ||
| Ovary | 234 | ||
| Adrenal | 234 | ||
| Testis | 234 | ||
| Placenta | 236 | ||
| Steroid binding and metabolism | 236 | ||
| Amino acid hormones | 236 | ||
| Prostaglandins and leukotrienes | 236 | ||
| Hypothalamus and pituitary | 236 | ||
| Embryology | 238 | ||
| Anatomy | 238 | ||
| Boundaries | 238 | ||
| Blood supply | 239 | ||
| Structure | 239 | ||
| Hypothalamic products | 239 | ||
| Pituitary gland products | 240 | ||
| Pineal gland | 240 | ||
| Reproductive hormones | 240 | ||
| Function | 240 | ||
| Oestrogen and progesterone | 241 | ||
| Androgens | 242 | ||
| Sex differentiation in utero | 242 | ||
| Puberty | 242 | ||
| Female | 242 | ||
| Male | 243 | ||
| Endocrinology of puberty | 243 | ||
| Leptin | 243 | ||
| Menstrual cycle | 243 | ||
| Inhibin and activin | 245 | ||
| Pregnancy | 245 | ||
| Biochemistry of human labour | 246 | ||
| Pro-pregnancy factors | 246 | ||
| Placental clock | 247 | ||
| Labour: an inflammatory reaction | 247 | ||
| A unified hypothesis of the onset of labour in humans | 247 | ||
| Lactation | 247 | ||
| Menopause | 247 | ||
| Growth | 248 | ||
| Physiology | 248 | ||
| Dysfunction | 248 | ||
| Pancreas | 248 | ||
| Embryology | 248 | ||
| Anatomy | 248 | ||
| Function | 249 | ||
| Dysfunction | 249 | ||
| Thyroid | 249 | ||
| Embryology | 249 | ||
| Anatomy | 249 | ||
| Thyroid hormone synthesis | 249 | ||
| Function | 252 | ||
| Dysfunction | 253 | ||
| Therapy of thyroid disease | 253 | ||
| Adrenal gland | 253 | ||
| Embryology | 253 | ||
| Anatomy | 253 | ||
| Adrenal cortisol synthesis | 253 | ||
| Function | 253 | ||
| Metabolism | 254 | ||
| Connective tissue | 254 | ||
| Haematology and immunology | 254 | ||
| Cardiovascular and renal effects | 254 | ||
| Miscellaneous effects | 254 | ||
| Dysfunction | 254 | ||
| Adrenal androgens | 254 | ||
| Adrenal medulla | 254 | ||
| Calcium homeostasis | 255 | ||
| Parathyroid hormone (PTH) | 255 | ||
| PTH anatomy and embryology | 255 | ||
| PTH synthesis | 255 | ||
| PTH function | 255 | ||
| PTH dysfunction | 255 | ||
| Vitamin D | 256 | ||
| Vitamin D synthesis | 256 | ||
| Vitamin D function | 256 | ||
| Vitamin D dysfunction | 256 | ||
| Calcitonin | 256 | ||
| Calcitonin synthesis | 256 | ||
| Calcitonin function | 256 | ||
| Calcitonin dysfunction | 256 | ||
| Osteoporosis | 256 | ||
| Twelve Drugs and drug therapy | 259 | ||
| CHAPTER CONTENTS | 259 | ||
| Introduction | 259 | ||
| Language of clinical pharmacy | 260 | ||
| Teratogenesis | 261 | ||
| Organogenesis | 261 | ||
| Pharmacokinetics | 261 | ||
| Drugs can undergo different types of transport | 262 | ||
| Pharmacodynamics | 263 | ||
| Factors that influence drug action | 263 | ||
| Drug metabolism | 263 | ||
| Drug interactions | 263 | ||
| Impaired liver function | 264 | ||
| Physiological changes that affect drug metabolism in pregnancy | 264 | ||
| The placental barrier | 264 | ||
| Some commonly used drugs | 265 | ||
| Selective β2 agonists | 265 | ||
| Vasodilators | 265 | ||
| α2-Adrenergic agonists | 265 | ||
| b-Adrenoceptor antagonists | 265 | ||
| Calcium channel blockers | 265 | ||
| Ergot alkaloids | 266 | ||
| General anaesthetics | 266 | ||
| Mechanism of action | 266 | ||
| Intravenous anaesthetics | 266 | ||
| Inhalational anaesthetics | 266 | ||
| Neuromuscular blocking agents | 266 | ||
| Local anaesthetics | 267 | ||
| Drugs affecting uterine activity | 267 | ||
| Prostaglandins | 267 | ||
| Oxytocin | 267 | ||
| Tocolytics | 267 | ||
| Diuretics | 267 | ||
| Opioids | 268 | ||
| Retinoids | 269 | ||
| Cytotoxic drugs | 269 | ||
| Anticoagulants | 269 | ||
| Warfarin | 269 | ||
| Heparin | 269 | ||
| Anticonvulsants | 270 | ||
| Anti-inflammatory drugs | 270 | ||
| Non-steroidal anti-inflammatory drugs (NSAIDs) | 270 | ||
| COX-2 inhibitors | 270 | ||
| Colchicine | 270 | ||
| Antimicrobials | 270 | ||
| Antibiotics | 270 | ||
| Macrolides | 271 | ||
| Antiviral agents | 272 | ||
| Antifungals | 272 | ||
| Antithyroid drugs | 272 | ||
| Sulphonylureas | 272 | ||
| Adrenocortical steroids | 272 | ||
| Antineoplastic drugs | 273 | ||
| Alkylating agents | 273 | ||
| Antimetabolites | 274 | ||
| Antibiotics | 274 | ||
| Platinum-based drugs | 274 | ||
| α-Cisplatin | 274 | ||
| Vinca alkaloids | 274 | ||
| Taxanes | 274 | ||
| Psychotropic drugs | 275 | ||
| Lithium | 275 | ||
| Antidepressants | 275 | ||
| Selective serotonin re-uptake inhibitors (SSRIs) | 275 | ||
| Tricyclic antidepressants | 275 | ||
| Oral contraceptives | 275 | ||
| Mechanism of action of the combined pill | 275 | ||
| Mechanism of action of the progestogen-only pill and depot injections of progestogen | 275 | ||
| Metabolic effects of the combined oral contraceptive pill | 275 | ||
| The combined oral contraceptive pill and cancer | 276 | ||
| Drugs of choice in breastfeeding | 276 | ||
| Conclusion | 276 | ||
| Thirteen Physics | 279 | ||
| CHAPTER CONTENTS | 279 | ||
| Diagnostic ultrasound | 279 | ||
| Intensity | 279 | ||
| Characteristic impedance and reflections | 279 | ||
| Absorption | 280 | ||
| Diffraction | 280 | ||
| Focusing | 280 | ||
| Ultrasound reception | 281 | ||
| Doppler effect | 281 | ||
| Radioactivity and X-rays | 281 | ||
| Ionization and excitation | 283 | ||
| Quantity of radioactive material | 284 | ||
| Radiation exposure and dose | 284 | ||
| Stable isotopes | 284 | ||
| Lasers | 285 | ||
| Magnetic resonance imaging (MRI) | 286 | ||
| Fourteen Statistics and evidence-based healthcare | 289 | ||
| CHAPTER CONTENTS | 289 | ||
| Introduction | 289 | ||
| Some basic statistical principles | 290 | ||
| Sampling and inference to the population at large | 290 | ||
| Type 1 error | 290 | ||
| Type 2 error | 291 | ||
| The null and active hypotheses | 291 | ||
| Bias and generalizability | 291 | ||
| Confidence intervals, accuracy and precision | 291 | ||
| Independence and matched data | 291 | ||
| Data types, distribution assumptions and parametric tests | 292 | ||
| Quantitative or continuous | 292 | ||
| Ordinal | 292 | ||
| Categorical | 292 | ||
| Binary | 292 | ||
| Time-dependent data | 292 | ||
| The normal distribution | 292 | ||
| Parametric and non-parametric tests | 293 | ||
| Deciding whether to use parametric or non-parametric tests | 293 | ||
| Data collection and presentation | 294 | ||
| Example | 295 | ||
| Mean | 295 | ||
| Variance | 295 | ||
| Standard deviation (SD) | 295 | ||
| Standard error of the mean (SEM) | 296 | ||
| Confidence interval for the mean | 296 | ||
| Mode | 296 | ||
| Median | 296 | ||
| Range | 296 | ||
| Interquartile range | 296 | ||
| Proportion and risk | 296 | ||
| Odds | 297 | ||
| Rate | 297 | ||
| Measures of outcome, exposure and effect | 297 | ||
| Prevalence | 297 | ||
| Incidence | 297 | ||
| Question 1 – Is there any difference in the use of hypertensive therapy between men and women? | 297 | ||
| Question 2 – Is there any difference in mortality between men and women? | 298 | ||
| Confounding and interaction | 298 | ||
| Types of study and experimental design | 299 | ||
| Types of bias | 300 | ||
| Selection bias | 300 | ||
| Responder or observer bias | 300 | ||
| Types of study | 301 | ||
| Ecological studies | 301 | ||
| Cross-sectional studies | 301 | ||
| Cohort studies | 301 | ||
| Case–control studies | 301 | ||
| Randomized controlled trials (RCTs) | 302 | ||
| The intention-to-treat principle | 302 | ||
| Diagnostic testing studies | 302 | ||
| Equations for basic power calculations | 304 | ||
| For continuous outcomes | 304 | ||
| For categorical outcomes | 304 | ||
| Acknowledgement | 304 | ||
| Recommended statistics texts | 304 | ||
| Fifteen Clinical research methodology | 305 | ||
| CHAPTER CONTENTS | 305 | ||
| Introduction | 305 | ||
| Types of clinical investigation | 306 | ||
| Types of study | 306 | ||
| What is audit? | 306 | ||
| The clinical research process | 307 | ||
| Integrated Research Application System (IRAS) | 307 | ||
| Research and development approval | 307 | ||
| International Conference on Harmonisation guideline on Good Clinical Practice (ICH GCP) | 308 | ||
| The European Union (EU) Clinical Trials Directive | 308 | ||
| Investigational medicinal products | 308 | ||
| Medical devices | 308 | ||
| Responsibilities of an investigator | 308 | ||
| When are studies not covered by the EU directive? | 309 | ||
| The Medicines and Healthcare products Regulatory Agency | 310 | ||
| Registration of trials | 310 | ||
| EudraCT | 310 | ||
| International Standard Randomised Controlled Trial Number (ISRCTN) | 310 | ||
| metaRegister of Controlled Trials (mRCT) | 310 | ||
| Data | 311 | ||
| Data security | 312 | ||
| Consent, information and sponsors | 313 | ||
| Patient information sheet | 313 | ||
| Informed consent form | 313 | ||
| Sponsorship | 313 | ||
| Trial Steering Committees (TSC) and Data Monitoring and Ethics Committees (DMEC) | 313 | ||
| Review of the literature | 313 | ||
| Amendments and reports | 314 | ||
| Substantial amendments | 314 | ||
| Non-substantial amendments | 314 | ||
| Reporting adverse reactions | 314 | ||
| Serious adverse events and serious unexpected adverse events | 315 | ||
| The end of the trial | 315 | ||
| Promoting and maintaining a trial | 315 | ||
| Common statistical terms used in clinical trials | 315 | ||
| Power | 315 | ||
| Incidence | 315 | ||
| Intention to treat | 315 | ||
| Likelihood ratio (LR) | 315 | ||
| Sensitivity | 315 | ||
| Specificity | 315 | ||
| Positive predictive value | 316 | ||
| Negative predictive value | 316 | ||
| Numbers needed to treat (NNT) | 316 | ||
| Numbers needed to harm (NNH) | 316 | ||
| Relative risk reduction (RRR) | 316 | ||
| Odds ratio (OR) | 316 | ||
| Risk | 316 | ||
| Risk ratio (can be referred to as relative risk) | 316 | ||
| P values | 316 | ||
| Type I and type II errors | 316 | ||
| References | 316 | ||
| Useful sources of information | 316 | ||
| Sixteen Multiple choice questions | 317 | ||
| CHAPTER CONTENTS | 317 | ||
| The cell, chromosomes and molecular genetics | 317 | ||
| Questions | 317 | ||
| Answers | 320 | ||
| Clinical genetics | 321 | ||
| Questions | 321 | ||
| Answers | 322 | ||
| Embryology | 322 | ||
| Questions | 322 | ||
| Answers | 325 | ||
| The fetus | 326 | ||
| Questions | 326 | ||
| Answers | 328 | ||
| Anatomy | 328 | ||
| Questions | 328 | ||
| Answers | 336 | ||
| Pathology | 338 | ||
| Questions | 338 | ||
| Answers | 341 | ||
| Microbiology and virology | 342 | ||
| Questions | 342 | ||
| Answers | 345 | ||
| Immunology | 346 | ||
| Questions | 346 | ||
| Answers | 348 | ||
| Biochemistry | 349 | ||
| Question | 349 | ||
| Answers | 351 | ||
| Physiology | 352 | ||
| Questions | 352 | ||
| Answers | 359 | ||
| Endocrinology | 361 | ||
| Questions | 361 | ||
| Answers | 362 | ||
| Drugs and drug therapy | 363 | ||
| Questions | 363 | ||
| Answers | 365 | ||
| Index | 367 |