2025

What Is Maternal Fetal Medicine and How Does It Help in High-Risk Pregnancy? admin June 20, 2025 3:10 pm Share Post:  Pregnancy is a time of immense change, excitement, and anticipation. However, for some women, it can also bring increased health risks for both the mother and the baby. In such cases, Maternal Fetal Medicine (MFM) provides a highly specialized form of care to support complicated pregnancies. From advanced diagnostics to expert management of underlying medical conditions, MFM plays a crucial role in protecting maternal and fetal health. Let’s explore what Maternal-Fetal Medicine is, what makes a pregnancy high-risk, and how MFM specialists help ensure better outcomes for both mother and baby. What Is Maternal-Fetal Medicine? Maternal-Fetal Medicine is a subspecialty of obstetrics focused on the care of pregnant women with high-risk conditions. Doctors who specialize in MFM—also known as perinatologists—receive advanced training beyond the standard four-year obstetrics and gynecology residency. They are experts in the diagnosis, monitoring, and treatment of complicated pregnancies, whether the risks stem from the mother’s health, fetal concerns, or pregnancy-specific complications. MFM specialists often work in tandem with OB-GYNs, general physicians, pediatricians, genetic counselors, and neonatologists. Their primary role is to provide advanced prenatal care, particularly when there is an increased risk of preterm labor, congenital abnormalities, or other serious complications. What Is a High-Risk Pregnancy? A high-risk pregnancy refers to any pregnancy in which the mother, baby, or both are at an increased risk of health problems before, during, or after delivery. Multiple factors can lead to a high-risk classification. Here are some of the most common contributors: Maternal Age: Age plays a significant role in pregnancy risk. Women under the age of 17 and those over the age of 35 are more likely to experience complications during pregnancy. Older mothers, for example, may face higher chances of miscarriage, chromosomal abnormalities like Down syndrome, or gestational diabetes. Younger mothers may have underdeveloped reproductive systems and face risks like premature labor. Pre-existing Medical Conditions: Women who enter pregnancy with chronic conditions such as diabetes, high blood pressure, thyroid dysfunction, kidney disease, epilepsy, or autoimmune disorders often require additional monitoring and treatment. These conditions can affect the development of the fetus and increase the chances of miscarriage, low birth weight, or premature delivery. Pregnancy-related Complications: Some complications develop during pregnancy, such as: Gestational diabetes: Can lead to large babies and complications during delivery. Preeclampsia: Characterized by high blood pressure and protein in urine; can progress to life-threatening conditions if untreated. Placenta previa: The placenta covers the cervix, leading to bleeding and delivery challenges. Preterm labor: Labor that begins before 37 weeks of pregnancy, increasing the risk of neonatal complications. History of Pregnancy Loss or Complications: Women who’ve experienced multiple miscarriages, stillbirths, or early preterm deliveries are often closely monitored in future pregnancies. A history of cesarean delivery, uterine abnormalities, or other complications may also increase pregnancy risk. Fetal Abnormalities: If prenatal tests or ultrasounds suggest that the baby has a structural defect or genetic disorder, the pregnancy is considered high-risk. Conditions such as congenital heart defects, neural tube defects, or chromosomal disorders like Trisomy 18 or 21 often require specialized care and planning. 🩺 How Does Maternal-Fetal Medicine Help? Maternal-Fetal Medicine specialists provide comprehensive and personalized care through advanced diagnostic tools, collaborative treatment planning, and emotional support. Here’s how they make a difference: 1. Advanced Prenatal Screening and Diagnosis MFM specialists use cutting-edge technology to detect fetal anomalies, monitor development, and assess risks early in pregnancy. These tools include: High-resolution ultrasounds: Provide detailed images of fetal anatomy and development. Doppler ultrasound: Measures blood flow in the umbilical cord and fetal organs. Fetal echocardiography: A detailed ultrasound to examine the baby’s heart. Non-invasive prenatal testing (NIPT): Uses a sample of the mother’s blood to screen for chromosomal abnormalities. Amniocentesis and chorionic villus sampling (CVS): Invasive procedures used for definitive genetic testing. Early and accurate diagnosis allows families and healthcare teams to make informed decisions and prepare for any interventions that might be needed after birth. 2. Individualized Pregnancy Management Plans One of the key strengths of MFM is its customized approach to patient care. Each pregnancy is unique, and treatment plans are tailored based on the mother’s medical history, current condition, and the baby’s development. This might include: Adjusting medications for chronic conditions Developing nutrition and weight management plans Scheduling more frequent prenatal visits and ultrasounds Planning for potential interventions or early delivery By closely monitoring both the mother and baby, MFM specialists can intervene promptly when risks emerge. 3. Collaboration with Other Specialists Maternal-Fetal Medicine thrives on a multidisciplinary approach. MFM doctors often coordinate care with: Cardiologists (for women with heart conditions) Endocrinologists (for diabetes or thyroid disorders) Neonatologists (for premature or at-risk newborns) Genetic counselors (for inherited conditions) Mental health professionals (to support emotional well-being) This holistic coordination ensures that both mother and baby receive the best possible care at every stage of the pregnancy. 4. Labor and Delivery Planning High-risk pregnancies require careful planning for delivery. MFM specialists help decide the ideal timing and mode of delivery—whether vaginal or cesarean—based on factors such as maternal health, fetal position, and presence of complications like placental issues or preterm labor. In some cases, early delivery may be recommended to avoid worsening conditions such as preeclampsia or fetal distress. They also coordinate with neonatal intensive care units (NICUs) when the baby might need immediate medical attention after birth. 5. Postpartum Monitoring and Future Pregnancy Counseling The care provided by our Maternal Fetal Medicine specialists continues even after the baby is born. Postpartum services include: Monitoring the mother’s recovery from pregnancy-related complications Managing ongoing health conditions like hypertension or diabetes Discussing safe contraception and future pregnancy planning Offering emotional support and counseling after traumatic birth experiences For women who have had a high-risk pregnancy, MFM specialists provide guidance to reduce future risks and improve outcomes in subsequent pregnancies. Who Should See a Maternal-Fetal Medicine Specialist? You may be referred to an MFM specialist if: You have pre-existing

Which Vitamins and Minerals During Pregnancy are Important for Woman? EMC Cradle Hospital June 19, 2025 Share Post:  Pregnancy is a transformative journey for both the mother and the baby. To support this growth, a woman’s body needs a higher intake of certain vitamins and minerals. These nutrients not only contribute to the baby’s brain, bone, and organ development but also help the mother maintain her strength and energy levels throughout the pregnancy. Below are key vitamins and minerals during pregnancy & every woman should focus on, along with their benefits and sources. 1. Folic Acid Benefits (Vitamin B9) Folic acid is one of the most crucial vitamins in early pregnancy. It helps in the development of the baby’s neural tube, which later forms the brain and spinal cord. Deficiency of folic acid during the first few weeks can lead to serious birth defects like spina bifida. Doctors recommend starting folic acid even before conception and continuing through the pregnancy.Best Sources: Green leafy vegetables, oranges, lentils, beans, and fortified cereals.Recommended Intake: 400–600 micrograms per day. 2. Iron for Pregnancy During pregnancy, the body produces extra blood to support the baby’s development. Iron helps in making hemoglobin, the oxygen-carrying component of blood. A deficiency can lead to anemia, causing fatigue, weakness, and complications during delivery. Iron also supports the baby’s growth and brain development.Best Sources: Red meat, chicken, spinach, lentils, beans, and iron-fortified foods.Recommended Intake: 27 mg per day. 3. Calcium for Bones Calcium is vital for building your baby’s bones and teeth. If you don’t get enough calcium from your diet, your body will draw it from your bones, which can weaken your own bone density. It also plays a role in heart, muscle, and nerve development.Best Sources: Milk, yogurt, cheese, broccoli, almonds, and fortified plant-based milk.Recommended Intake: 1,000 mg per day. 4. Vitamin D Support Vitamin D works hand-in-hand with calcium to help the baby develop strong bones and teeth. It also supports the immune system of both the mother and baby. Deficiency in vitamin D during pregnancy has been linked to complications like preeclampsia and gestational diabetes.Best Sources: Sunlight, fortified dairy products, egg yolks, salmon, and supplements.Recommended Intake: 600 IU per day. 5. Iodine for Development Iodine is essential for healthy brain and nervous system development in babies. It also supports thyroid function, which helps regulate metabolism. A lack of iodine during pregnancy can lead to developmental delays and intellectual disabilities in the baby.Best Sources: Iodized salt, dairy, seafood, and eggs.Recommended Intake: 220 mcg per day. 6. Vitamin B12 Essentials Vitamin B12 helps in red blood cell formation and supports the nervous system. It’s especially important for vegetarians, as this vitamin is primarily found in animal-based foods. Low levels can result in fatigue, nerve issues, and potential complications in baby’s brain development.Best Sources: Meat, dairy, fish, eggs, and fortified cereals.Recommended Intake: 2.6 mcg per day. 7. Omega-3 Fatty Acids Omega-3 fatty acids, especially DHA, are vital for the baby’s brain and eye development. They also reduce the risk of preterm birth and may improve the mother’s mood and brain function during and after pregnancy.Best Sources: Fatty fish like salmon and sardines, walnuts, flaxseeds, and omega-3 supplements (pregnancy-safe).Recommended Intake: At least 200–300 mg DHA per day. Conclusion: Moving Toward a Brighter Future Pregnancy is a beautiful phase, and with the right nutrition, you can make it healthier for you and your baby. Always consult your gynecologist before starting or adjusting vitamins and minerals for pregnancy. A balanced diet, rich in vitamins and minerals, is the foundation of a healthy pregnancy. Get Free Consultation   Need help or have questions about your pregnancy? Contact us Now! or view our gynaecology’s guide today for a personalized assessment and begin the journey toward healing through movement. FAQs About Pregnancy, Vitamins & Minerals What are the most important vitamins and minerals during pregnancy? The most essential nutrients during pregnancy include folic acid, iron, calcium, vitamin D, iodine, vitamin B12, and omega-3 fatty acids (especially DHA). These support the baby’s development and the mother’s health. Should I take prenatal vitamins even if I eat a healthy diet? Yes. Even if you eat well, it’s hard to get enough of all the essential nutrients through food alone. Prenatal vitamins are designed to meet the extra needs of pregnancy. Can I get too much of vitamins and minerals during pregnancy? Yes. Excessive intake, especially of Vitamin A or iron, can be harmful. Always follow your doctor’s recommendations. Can I take folic acid and multivitamins together during pregnancy? Yes. Most prenatal multivitamins already contain the required amount of folic acid. However, always consult your doctor before combining supplements. When should I start taking prenatal vitamins? Doctors recommend starting prenatal vitamins at least one month before conception and continuing throughout pregnancy to ensure proper neural development in the early weeks. What if I have morning sickness and can’t eat well? Prenatal vitamins can help fill the nutritional gap. Eating small, frequent meals and choosing bland, dry foods may also help. Book Appointment Pop Up Appointment Name * Contact No. * Book Appointment If you are human, leave this field blank. Specialities Paediatrics & Neonatology Gynaecology & Obstetrics NICU PICU Cosmetology Lap. Surgery In Vitro Fertilization (IVF) Fetal Medicine Urology Bariatric Surgery

Gynecologist से मिलना क्यों ज़रूरी है — भले ही आप ठीक महसूस कर रही हों (शीर्ष 10 कारण) admin June 14, 2025 11:41 am No Comments हर महिला को अपने संपूर्ण स्वास्थ्य की देखभाल के लिए गाइनिकोलॉजिस्ट (Gynecologist) से  मिलते रहना चाहिए। गाइनिकोलॉजिस्ट से मिलना महिलाओं को सर्वाइकल कैंसर, ब्रेस्ट कैंसर, पीरियड्स की अनियमितता, प्रजनन स्वास्थ्य, यौन संक्रमण और हार्मोनल असंतुलन जैसी समस्याओं से समय रहते बचाने में मदद करता है। जब आप एकदम फिट महसूस कर रही हों, तो डॉक्टर की अपॉइंटमेंट बुक करना थोड़ा अजीब लग सकता है, है ना? खासकर जब बात गाइनिकोलॉजिस्ट की हो। लेकिन ध्यान दें — महिलाओं की स्वास्थ्य देखभाल केवल इलाज नहीं, बल्कि रोकथाम के बारे में है। तो चलिए जानते हैं वो शीर्ष 10 कारण, जिनकी वजह से आपको गाइनिकोलॉजिस्ट से नियमित मिलना चाहिए — भले ही आप पूरी तरह ठीक महसूस कर रही हों। 1. सर्वाइकल कैंसर की पहचान में गाइनिकोलॉजिस्ट से मिलना (Pap Smear टेस्ट from Gynecologist):    पैप स्मीयर टेस्ट गर्भाशय ग्रीवा (सर्विक्स) की सतह से कोशिकाओं का एक नमूना लेकर किया जाता है, जिससे यह पता चलता है कि कहीं कोई असामान्य कोशिकाएं तो नहीं बन रही हैं। ये असामान्य कोशिकाएं भविष्य में कैंसर में बदल सकती हैं। इस टेस्ट से सर्वाइकल कैंसर की पहचान बहुत ही शुरुआती चरण में हो जाती है, जब उसका इलाज आसान और पूरी तरह संभव होता है। यह एक दर्द रहित और कुछ ही मिनटों की प्रक्रिया है, जिसे हर 3 साल में एक बार कराना फायदेमंद होता है, खासकर 21 से 65 साल की महिलाओं के लिए। 2. प्रजनन स्वास्थ्य की निगरानी: प्रजनन स्वास्थ्य सिर्फ तब महत्वपूर्ण नहीं होता जब आप मां बनने की योजना बना रही हों। यह आपके हार्मोन, ओवरीज़ की कार्यप्रणाली, यूटेरस की स्थिति और मासिक धर्म चक्र aकी नियमितता से जुड़ा होता है। अनियमित पीरियड्स, बार-बार गर्भाशय से खून आना, या ओवुलेशन की समस्या जैसी चीज़ें भविष्य में फर्टिलिटी या दूसरी गंभीर समस्याओं का कारण बन सकती हैं। समय-समय पर की गई जाँच से इनका समय रहते इलाज हो सकता है। 3. सही गर्भनिरोधक चुनने में मदद: हर महिला का शरीर अलग होता है और उसके गर्भनिरोधक विकल्प भी उसकी उम्र, मेडिकल हिस्ट्री और जीवनशैली पर निर्भर करते हैं। कोई महिला गर्भनिरोधक गोली से बेहतर महसूस करती है तो किसी को इंट्रा यूटेरिन डिवाइस (IUD) ज्यादा सूट करता है। गाइनिकोलॉजिस्ट Gynecologist आपकी ज़रूरतों के हिसाब से सबसे सुरक्षित और प्रभावी विकल्प सुझाते हैं, साथ ही यह भी देखते हैं कि उससे कोई साइड इफेक्ट तो नहीं हो रहा है। इससे अनचाहे गर्भ और हार्मोनल असंतुलन से बचा जा सकता है। 4. ब्रेस्ट की समय पर जांच: स्तनों में किसी भी प्रकार की गांठ, असामान्यता, या निपल से डिस्चार्ज जैसी समस्याएं ब्रेस्ट कैंसर के शुरुआती लक्षण हो सकते हैं। सेल्फ एग्जामिनेशन के साथ-साथ एक अनुभवी गाइनिकोलॉजिस्ट द्वारा ब्रेस्ट की शारीरिक जांच और जरूरत पड़ने पर मैमोग्राफी जैसी जांचें कराना समय पर इलाज के लिए जरूरी होता है। जब ब्रेस्ट कैंसर को पहले स्टेज में पकड़ लिया जाता है, तो इसका इलाज बहुत हद तक सफल रहता है। 5. पीरियड्स की अनियमितता का समाधान: पीरियड्स का बहुत अधिक दर्दनाक, बहुत हल्का या बहुत भारी होना, या उनका पूरी तरह रुक जाना कई बार गंभीर बीमारियों जैसे पीसीओएस (PCOS), थायरॉइड डिसऑर्डर, या यूटेराइन फाइब्रॉइड्स का संकेत हो सकता है। Gynecologist इन लक्षणों की जांच करके सही कारण का पता लगाते हैं और मेडिकल या लाइफस्टाइल ट्रीटमेंट से राहत दिलाते हैं। नियमित विज़िट से इन समस्याओं का शुरुआती स्तर पर ही समाधान हो सकता है। 6. यौन स्वास्थ्य और एसटीआई की जांच: सेक्सुअली ट्रांसमिटेड इंफेक्शन्स (STIs) जैसे क्लेमीडिया, गोनोरिया, एचपीवी आदि कई बार बिना किसी लक्षण के शरीर में फैलते हैं और प्रजनन क्षमता को प्रभावित कर सकते हैं। एक गाइनिकोलॉजिस्ट समय-समय पर स्क्रीनिंग करके इनका जल्दी पता लगा सकते हैं और उचित इलाज दे सकते हैं। साथ ही वे यौन सुरक्षा, पार्टनर के साथ संवाद और सुरक्षित संबंधों के बारे में जानकारी भी देते हैं, जो यौन स्वास्थ्य के लिए अनिवार्य है। 7. मेनोपॉज़ और हार्मोनल बदलाव को संभालना: मेनोपॉज़ यानी मासिक धर्म का स्थायी रूप से बंद होना, एक प्राकृतिक प्रक्रिया है लेकिन इससे जुड़ी समस्याएं जैसे हॉट फ्लैशेस, मूड स्विंग्स, अनिद्रा, योनि में सूखापन या हड्डियों की कमजोरी जीवन की गुणवत्ता को प्रभावित कर सकती हैं। गाइनिकोलॉजिस्ट हार्मोन रिप्लेसमेंट थेरेपी, कैल्शियम और विटामिन सप्लीमेंट्स, और डाइट व एक्सरसाइज की मदद से इन लक्षणों को नियंत्रण में रखते हैं। इससे महिलाएं इस नए चरण को सहज रूप से पार कर पाती हैं। 8. वैक्सीनेशन और रोकथाम जांचें: एचपीवी वैक्सीन से सर्वाइकल कैंसर से बचाव संभव है, और यह वैक्सीन किशोरावस्था से लेकर 26 वर्ष की आयु तक की महिलाओं को दी जा सकती है। इसके अलावा, बोन डेंसिटी टेस्ट, पैप स्मीयर, थायरॉइड प्रोफाइल, और हार्मोनल जांच जैसी रोकथाम जांचें समय-समय पर कराकर महिला अपने स्वास्थ्य को गंभीर बीमारियों से सुरक्षित रख सकती है। प्रिवेंटिव हेल्थ केयर न केवल खर्च बचाता है, बल्कि जीवन को भी बेहतर बनाता है। 9. मानसिक और भावनात्मक स्वास्थ्य में सहयोग: महिलाओं में हार्मोनल बदलाव मानसिक स्थिति को प्रभावित कर सकते हैं, खासकर पीएमएस (PMS), पीएमडीडी (PMDD), या बच्चे के जन्म के बाद होने वाला डिप्रेशन (Postpartum Depression)। ऐसे समय में एक अनुभवी Gynecologist   न सिर्फ सही सलाह देते हैं, बल्कि ज़रूरत पड़ने पर साइकोलॉजिस्ट या मानसिक स्वास्थ्य विशेषज्ञ से भी संपर्क करवाते हैं। इससे महिला को संपूर्ण समर्थन मिलता है और वह खुद को अकेला महसूस नहीं करती। 10. भरोसेमंद डॉक्टर-पेशेंट संबंध बनाना: जब आप एक ही गाइनिकोलॉजिस्ट के पास नियमित जाती हैं, तो वे आपकी मेडिकल हिस्ट्री, बॉडी पैटर्न और विशिष्ट ज़रूरतों को बेहतर समझते हैं। इससे ना सिर्फ बीमारी का सही इलाज होता है, बल्कि आपके शरीर और मन की भाषा को समझने वाला एक भरोसेमंद साथी मिल जाता है। ऐसा संबंध बनाना मानसिक और शारीरिक रूप से सशक्त होने की दिशा में पहला कदम होता है।   निष्कर्ष: अपनी सेहत को प्राथमिकता दें महिलाओं को अक्सर अपनी जिम्मेदारियों के चलते अपनी सेहत को नजरअंदाज करने की आदत होती है, लेकिन यह सोच बदलने की जरूरत है। नियमित गाइनिकोलॉजिकल चेकअप एक सतर्क और जागरूक महिला की पहचान है। अपने स्वास्थ्य

Pediatric Physiotherapy: Healing Young Lives Through Movement admin June 10, 2025 6:22 pm Share Post:  Pediatric physiotherapy is a specialized branch of physical therapy designed to support infants, toddlers, children, and adolescents as they navigate their physical development. When children face physical challenges—whether due to injury, illness, or developmental conditions—movement becomes more than just play. It becomes a pathway to healing. More than treatment, it’s a partnership between therapists, children, and families to help young lives thrive. What Is Pediatric Physiotherapy? Pediatric physiotherapy focuses on improving motor skills, strength, balance, coordination, and mobility in children. It aims to: Support developmental milestones (like sitting, crawling, walking) Manage congenital or acquired conditions (like cerebral palsy, spina bifida, or muscular dystrophy) Aid recovery from injuries or surgeries Improve posture and alignment Enhance participation in daily activities and play Why Is Pediatric Physiotherapy Important? Children are not just “small adults.” Their bones, muscles, joints, and nervous systems are still developing. When a child experiences a physical challenge—whether temporary or permanent—it can significantly impact their growth, learning, and daily activities. Pediatric physiotherapy is crucial because: It supports optimal development of movement patterns. It prevents long-term complications such as joint deformities or muscle contractures. It promotes independence, allowing children to participate in school, play, and family life. It enhances quality of life, building physical confidence and emotional resilience. Common Conditions Treated Pediatric physiotherapists work with children experiencing a wide range of conditions, including: Developmental delays (not reaching movement milestones) Neurological disorders (e.g., cerebral palsy, Down syndrome) Orthopedic issues (e.g., fractures, scoliosis, growing pains) Genetic conditions affecting muscles and movement Respiratory conditions like cystic fibrosis Conditions Treated by Pediatric Physiotherapists Pediatric physiotherapists are trained to work with a wide variety of conditions, including: 1. Developmental Delays Some children take longer to reach milestones like sitting, crawling, or walking. Physiotherapy can help by strengthening muscles and improving coordination. 2. Cerebral Palsy This is a neurological condition that affects movement and muscle tone. Physiotherapists work to increase mobility, reduce spasticity, and enhance functional skills. 3. Muscular Dystrophy and Genetic Disorders Children with conditions like Duchenne muscular dystrophy benefit from physiotherapy that helps maintain function and slow down the progression of muscle weakness. 4. Orthopedic Conditions Injuries such as fractures or conditions like scoliosis, flat feet, or torticollis can be addressed through manual therapy, exercises, and postural correction techniques. 5. Premature Birth Complications Preemies often have weaker muscles and delayed motor skills. Early physiotherapy can help these children catch up developmentally. 6. Respiratory Conditions Physiotherapists can assist in clearing the airways, strengthening breathing muscles, and teaching breathing techniques—especially in conditions like cystic fibrosis or asthma. Conclusion: Moving Toward a Brighter Future Pediatric physiotherapy is more than a medical service—it’s a lifeline for children whose physical challenges may otherwise limit their potential. By promoting strength, mobility, and independence, pediatric physiotherapists help children not only move better, but live better. Through expert care, playful methods, and family involvement, pediatric physiotherapy opens doors to new abilities and brighter tomorrows. Because every child deserves the chance to move, grow, and thrive—one step, one stretch, one smile at a time.   Need help or have questions about your child’s development? Contact us Now! or view our pediatric physiotherapy team today for a personalized assessment and begin the journey toward healing through movement. FAQs About Pediatric Physiotherapy What is pediatric physiotherapy and how is it different from regular physiotherapy? Pediatric physiotherapy is tailored specifically for infants, children, and teens. It focuses on supporting developmental milestones, motor skills, and mobility, using age-appropriate techniques and play-based therapy. When should I take my child to a pediatric physiotherapist? If your child shows delayed milestones (e.g., not sitting, crawling, or walking on time), has a diagnosed condition like cerebral palsy or muscular dystrophy, or is recovering from injury/surgery, early intervention is highly recommended. Is pediatric physiotherapy painful or difficult for children? No. Sessions are designed to be fun, engaging, and tailored to a child’s comfort level. Therapists often use toys, games, and play-based activities to make therapy enjoyable. How can I support my child’s physiotherapy progress at home? Your physiotherapist will likely provide home exercises, positioning tips, or play ideas to reinforce therapy goals. Consistent family involvement greatly enhances outcomes. Book Appointment Pop Up Appointment Name * Contact No. * Book Appointment If you are human, leave this field blank. Specialities Paediatrics & Neonatology Gynaecology & Obstetrics NICU PICU Cosmetology Lap. Surgery In Vitro Fertilization (IVF) Fetal Medicine Urology Bariatric Surgery