Archive for February, 2008

Now rub your fat away

Monday, February 25th, 2008

All fat people know how difficult it is to get rid of their tummy tyres, escpecially if they are lazy.

Now rejoice you lazy bums, according to a new study, help may be just a rub away.
Yes rubbing of a topical cream containing 0.5% aminophylline, two times a day, can burn away the adipose tissue.
This is according to a new study. Though the sample size was small, 50 precisely, with a BMI of 27 and over, still this gives a new hope in research related to weight reduction in the obese.
Aminophylline is a member of the theophylline group and is used in treatment in bronchial asthma.
However this is an add on and is to be used along with calorie maintenance and an exercise regimen.

Gastric cancer and low cholesterol

Monday, February 25th, 2008

Japan has the highest incidence of gastric cancer worldwide.

Lower blood cholesterol is always associated with decrease in the incidence of CHD.

However, in a study conducted in Japan, it was found that low blood cholesterol levels were associated with a greater risk of developing gastric cancer, especially the intestinal types.

Till date, no such co-relation has been found between CHD and Gastric cancer.

Doctors now have advised that people having low cholesterol should go for periodic gastrointestinal check ups. Really strange.

Post-coital contraception:

Saturday, February 23rd, 2008

 

 

This refers to the contraceptive options after unprotected sexual intercourse.

The most popular drug is ‘Ovran’, where the female should take 2 tablets within 72 hours of intercourse and then 1 tablet after 12 hrs of taking the first dose.

Keep in mind that the efficacy of the drug decreases as time goes by, hence it would be better if the pills are taken immediately after intercourse for better results.

  

Prostinar contains levonorgesterol and is to be taken as a single pill within 72 hours and next pill after 12 hours. You can also take 2 pills at a time within 72 hours.

  

Mifepristone is a steroid and is to be taken as a single pill. It is very effective, however very expensive.

  

Centochroman: 2 tablets taken twice in 24 hours within 24 hours of intercourse is also effective

  

The latest entrant in this segment is Cipla’s I-Pill. It is very easily available over the counter and is to be taken as a single dose within 72 hours. It has virtually no side effects and costs Rs. 75.

  

If the female doesn’t want to eat pills then she can opt for Copper T, which is to be inserted within 5 days of intercourse.

  

Non-pharmacological treatment of hypertension:

Saturday, February 23rd, 2008

 
Hypertension, popularly known as high blood pressure is spreading like an endemic in our country.

Let us see what are the non-pharmacological measures that may be used to treat hypertension.

 
    -   Reassurance.

-         Weight reduction in obese patients.

-         Better adjustment at work and in family life.

-         Restriction of salt consumption to 4 grams daily.

-         Restriction of fat consumption.

-         Increase in dietary potassium (fruits and vegetables) and calcium consumption.

-         Cessation of smoking.

-         Reduction in alcohol and caffeine consumption.

-         Physical exercise such as brisk walking and mental relaxation.

 

Methods of contraception

Saturday, February 23rd, 2008

Methods of contraception:

Two main types

-         Temporary

-         Permanent

  

Temporary:

·       Condoms: The most preferred choice of contraception and are easily available over the counter. Male condoms are much more popular than female condoms. Condoms apart from contraception also protect against HIV/AIDS and STDs.

·       IUCDs: Intrauterine contraceptive devices, popularly known as Copper Ts are of different types with varying life span. The have the advantage that they are not to be changed after every sexual intercourse.

·       OCPs: Oral contraceptive pills are also equally popular. They also provide other benefits like prevention against breast cancer.

·       Others: They include spermicidal gels, patches, douches, rings etc, but they can be cumbersome, expensive and not popular.

·       Natural methods:

-         Coitus interruptus: This is a very common method where the male partner withdraws his penis just when he is about to ejaculate. This method though has a fair amount of failure rate.

-         Calendar method: Normally, ovulation occurs 14 days prior to menstruation. Hence if the female has a regular menstrual cycle, then she can predict the date of ovulation and avoid intercourse 4 days prior and 4 days after the day of ovulation. This method too has a fair amount of failure rate.

  

Permanent:

Males-

Vasectomy: Contrary to the popular notion, the testes are left untouched. The spermatic cord is incised.

  

Females-

Tubal ligation: The fallopian tubes are ligated and cut. This operation can be done anytime expect after normal delivery where it is done after 6 weeks.

  

Photosensitivity

Thursday, February 21st, 2008

Ultraviolet radiation (UVR, ‘sunlight’) may improve some skin diseases like psoriasis and eczema but confusingly may also exacerbate the same diseases and induce a number of specific dermatological conditions. This is usually attributable to ultraviolet-B (UVB) and untraviolet-A (UVA). UVB palys a major role in the induction of skin cancers while UVA majorly causes skin ageing. Determination of the waveband or wavebands that contribute to sensitivity may be clinically important. For instance, UVB does not pass through window glass whereas UVA does. The practical corolarry of this is that patients who are markedly UVA sensitive need to wear sunblock and be protected even when inside a car or inside a building where there is strong natural light.

Overweight and Obesity in Childhood and Adolescence

Friday, February 15th, 2008

Overweight and obesity are issues of concern in children and adolescents. There has been an increase in the incidence of diabetes, hypertension in the adolescent age group, something that was so unheard of. 

Obese children show decreases in physical and social functioning. They suffer from peer pressure, finally going into depression. Overweight and obesity in childhood are risk factors for obesity in young adulthood and middle age.

Causes of Obesity

Friday, February 15th, 2008

Causes of Obesity include the following :

  • Inadequate exercise (sedentary lifestyle) 
  • Poor diet (Fast food culture) 
  • Hormonal factors, 
  • Genetic factors and 
  • Environmental factors.

Consequences of Obesity to Health

Thursday, February 14th, 2008

Obesity should never be taken lightly as it may have the some consquences on your health also. Here listed are few of associated consequences.

  • Obesity in adulthood is associated with significant decrease in life expectancy and increase in early mortality. 
  • Obesity is associated with increased risk for Hypertension 
  • Diabetes (adult type) 
  • Coronary heart disease 
  • Asthma 
  • Gallstones 
  • Cancer (such as breast, colon, cervical, and uterine) 
  • Depression
  • Suicidal Tendency

About Obesity

Wednesday, February 13th, 2008

Overweight is classified as a body mass index (BMI) (weight [kg] /height [m2]) ? 25.0 and obesity as a BMI ? 30.0. Morbid obesity is BMI > 40.0. The prevalence of obesity is nearly identical in men and women and ranges from 18% among adults aged 18 to 29 years to 30% among adults aged 50 to 59 years. Obesity is more common among people with a sedentary lifestyle and often causes multiple health problems in both children and adults, hence should be nipped in the bud before it raises its ugly head.

BULIMIA

Wednesday, February 13th, 2008
Bulimia (bulimia nervosa) is an eating disorder in which the person suffers from a cycle of binging and purging of food
Binge eating: Quickly eating large amounts of food over short periods of time.
 Purging: Forced vomiting, laxative use, excessive exercise, or fasting in an    attempt to lose weight that might be gained from eating food or binging.
Bulimia is mainly seen in young adult women. Their weight is normal or near normal. The exact cause of Bulimia is not known.

 

Signs and Symptoms:

ü      Over-concern with weight and body shape. This is not shared with anybody.
ü      Generalized weakness,
ü      Fatigue,
ü      Abdominal pain
ü      Abnormal and irregular menstrual cycles.
On examination the physician may notice
ü      Dental cavities
ü      Scars on knuckles as a result of chronic self-induced vomiting
ü      Loss of tooth enamel
ü      Signs suggestive of Malnutrition and dehydration like:
-         Dry/Flaky skin
-         Hair fall
-         Brittle nails
-         Vitamin deficiencies
-         Swelling over abdomen and feet.
-         Dry tongue.

Prostitution and AIDS

Saturday, February 9th, 2008

PROSTITUTION and HIV/AIDS

 
Prostitution means sexual intercourse in exchange for remuneration and is one of the oldest professions in the world.

Females indulging in prostitution are often termed as ‘commercial sex worker’ (CSW) and their organizers are known as pimps.

Poverty is the root cause of prostitution. In villages with large families and low socio-economic conditions, young girls are forced into prostitution. They are brought to bigger cities and sold to pimps/brothels, often by relatives. These girls are trafficked to the red light areas like, Kamathipura in Mumbai, Sonagachi in Kolkata, Budhawar Peth in Pune and G.B. Road in New Delhi

However, now, even girls from good family background are seen indulging in prostitution since it provides easy money, known as Call Girls/ High Class Escorts.

Prostitutes don’t have a proper standard of living, many of them illiterate. They suffer from Sexually Transmitted Diseases (STDs) and HIV/AIDS.

Truck drivers and their helpers, constitute their major clientele, since they stay away from their families for a long period of time and are known to be major vectors of HIV transmission by engaging in unprotected sexual intercourse with multiple partners.  

AIDS was first detected in India in 1986. Since then HIV has spread its tentacles in our country. In India, the main mode of HIV transmission is via heterosexual route. Females are more susceptible than males.
The risk of infection per single sex act, from a HIV-positive male to HIV-negative female in a developing country is much higher than in a developed country due to better hygiene and health care standards. The risk increases if one of them is suffering/ suffered from STDs. This along with low condom increases the risk four-fold. It is speculated that the spread of HIV depends in the short term by prevalence of STIs and condom use and are considered as the only factors that can be manipulated to limit the spread of the infection.

There is a very low level of awareness amongst the prostitutes and their clients regarding HIV/AIDS and STDs. The clients often refuse to use condoms and the prostitutes fearing loss of clientele submit to it.

These prostitutes often get pregnant, though many of them are sterile due to STDs and some of them also conceive. These children are at a higher risk of contracting STDs and HIV during the process of childbirth.

Although prostitution is banned in our country, it is very much etched in our society. There have been calls to legalize it, but nothing has come of it so far.

The only way to prevent or reduce the risk of HIV/AIDS is by providing better living conditions and health facilities to the prostitutes. Supplying condoms at a subsidized rate along with Condom Vending Machines in Red light areas, Railway stations, major joints/dhabas, Bus Depots, etc can decrease the risk of HIV/AIDS transmission.

HIV/AIDS is spreading rapidly amongst our youth who are the future of our country, just think what will happen if they succumb to AIDS.

Clubfoot

Saturday, February 9th, 2008

CLUB FOOT

Clubfoot, medically known as Congenital Talipes Equino Varus (CTEV), is one of the most common congenital anomaly with an incidence of 1 in every 1000 live births. Over the centuries it has been treated by various modalities and has also been described by Hippocrates in 400 BC. Though it has been known since ages, there has been no definite management as it keeps showing tendencies of relapse

NOMENCLATURE

Equinus:

 There is plantar flexion of foot. Derived from equine i.e. horse, which walks on toes.

Calcaneus:

Reverse of Equinus, where the foot is in dorsiflexion

Varus:

The foot is inverted and adducted so that the sole of the foot faces ‘inwards’.

Valgus:

The foot is everted and abducted so that the sole faces ‘outwards’

Usually the foot has a combination of deformities, commonest being Equino-Varus which would be considered as the reference henceforth.

Causes:

A.    Congenital:

1.      Idiopathic i.e. cause is unknown

2.    Non-Idiopathic:

-Genetic Syndromes

-Myopathies like Arthrogryposis multiplex congenita    where there is defective development of muscles

-Neurological Disorders like Spina Bifida

B.    Acquired:

    Neurogenic causes like, meningitis, poliomyelitis, etc 

    Vascular causes like Volkmann’s Ischaemic Paralysis.
Clubfoot is usually detected very early during infancy, though in developing countries, the patient may present late due to various social and economic causes

In 60% cases, there is bilateralism

Secondary changes: These changes occur if the child starts walking on the deformed foot. Weight bearing exaggerates the deformity resulting in the development of callosities and bursae over the lateral side of the foot.

Examination:

1.      The affected foot is smaller in size

2.    Inability to touch the dorsum of the foot to the shin of leg, i.e. inability to bring the foot in the opposite direction which is seen in normal cases

3.    The heel is small in size

4.    Deep skin creases on the back of the heel and on the medial side of the sole.

5.    X-Ray/Radiography

Antenatal Diagnosis

By Ultrasonography (USG), clubfoot can be diagnosed at 18-20 weeks of gestation. But this is only 80% accurate. Clubfoot is also associated with genetic anomalies like congenital heart defects Trisomy18, Larsen’s syndrome, and neural tube defects.
Treatment

In principle, the treatment of clubfoot consists of correction of the deformity by non-operative and operative means, followed by maintenance of the foot in the corrected position. This is to be continued till the foot (and the bones) grows to a reasonable size so that the deformity doesn’t occur.

The treatment should be started as early as possible.

Non-Operative treatment

Hippocrates in 400 BC proposed the first non-operative treatment where he recommended gentle manipulation followed by splinting. 
With the advent of plaster of Paris in 1836, plaster casts were used to treat clubfoot.

Kite   was the first to recommend gentle manipulation and cast immobilization.

There are many techniques to treat Clubfoot; hence the International Clubfoot Study Group has approved Ponseti’s technique, Kite’s technique and Bensahel’s technique as the standardized conservative regimes for the treatment of clubfoot all over the world.
Of these, Ponseti’s method is high successful where the doctor corrects the deformity and applies a plaster cast which is changed every 2 weeks and continued till it is possible to ‘overcorrect’ all the deformities, usually after 6-8 casts. Once this happens, the foot is kept in a suitable maintenance device (discussed subsequently).

One more method is to teach the mother to manipulate the foot after every feed. Minor deformities can be corrected by this method. (Kite’s technique)

Operative Treatment

The list of operative procedures is endless as no single procedure gives a long-lasting correction. Phelps, in 1891 described the first operative procedure.

The optimal age for surgical intervention has always been controversial, with experts settling in the range of 5-6 months to upto 1 year of age. The details of surgery are beyond the context of this post and the reader is advised to refer to specific sites/books.

Maintenance of correction

-         CTEV Splint: made of plastic, hold the foot in overcorrected position

-         Dennis-Brown Splint/ DB Splint: Holds the foot in corrected position. To be worn by the child throughout the day till he starts walking. Once the child starts walking the splint is to be worn during the night and CTEV shoes during the day.

     – CTEV Shoes: These are modified shoes used once the child   starts walking until 5 years of age
Summary

Clubfoot is an enigmatic condition because it can make the best orthopedic surgeons eat humble pie. Clubfoot shows a strong tendency of relapse upto 4 years of age. The incidence is seen to decline after 4 years. One of the main causes of this relapse is patient non-compliance. Though there are many treatment modalities, Ponseti’s Technique holds lot of promise. Clubfoot is definitely curable.
 

TUBERCULOSIS

Friday, February 8th, 2008

TUBERCULOSIS:
 
Tuberculosis (TB) is a major health problem in India.
It is a communicable disease caused due to infection with a bacterium called Mycobacterium tuberculosis (MTB), which mainly causes Pulmonary TB
It is mainly diagnosed by Microscopic examination of smear of sputum (Sputum Smear) , Chest X-ray and by culture of Mycobacterium tuberculosis bacilli.
Around 18 Lakh people develop TB and 4 Lakh die from it every year. India contributes 20 % to this statistical data. Following are some startling figures about TB in India.
-         > 40,000 people get infected by TB daily.
-         > 5000 people develop TB disease daily.
-         > 1000 people die of TB everyday, which roughly comes to 2 deaths every 3 minutes!!!!
 
In the year 1992, the Government of India introduced the National TB Programme. However this Programme was a failure since it could not achieve its objectives because of
-         Low priority
-         Over dependence on X-Rays for diagnosis
-         Managerial weakness
-         Lack of Supervision
-         Lack of funds
 
Hence, the government came up with Revised National tuberculosis Control Programme (RNTCP), which was implied in a phased manner since its concept of as a Pilot project in 1993.
 
Objectives of RNTCP:
Maintain atleast 85% cure rate of new sputum smear-positive patients and to achieve and maintain detection of atleast 70% of such cases in the population.
RNTCP uses the DOTS (Directly Observed Treatment Short course) in which the patient has to go to the concerned Health clinic and have the medicines in front of the Doctor/Health worker. This increases patient compliance and the patient takes the whole course.
 
Identification of TB suspects:
It is very important to identify suspects who have symptoms of TB early since it is an infectious disease and spreads very easily.
Anyone who is suffering from cough of 3 or more weeks is to be considered as TB suspects and such persons should get their sputum checked immediately.
3 sputum samples are collected over 2 consecutive days:
-         Spot sample on the 1st day
-         One early morning sample on 2nd day.
-         One spot sample on the 2nd day.
 
Please remember that Sputum examination and anti-TB treatment are FREE of CHARGE at govt. facilities under RNTCP.
 
-Patients with 2-3 sputum positive smear results are diagnosed as having pulmonary sputum smear-positive TB
 
-Patients with only 1 sputum smear-positive results will have to undergo a chest X-Ray examination and if the chest X-Ray is suggestive of pulmonary TB then the physicians diagnosis it as pulmonary sputum smear-positive TB.
 
-Patients in whom all 3 smears are negative are prescribed broad spectrum antibiotics, none of which having any anti-TB effects.

Nutritional benefits of Breast Feeding

Friday, February 8th, 2008

Nutritional benefits of Breast Feeding

Feeding of an Infant/ Child by a woman’s breats is known as BREAST FEEDING.
WET NURSE: A mother feeding another infant and not her own.
Breast Feeding is aggresively promoted by the WHO and Indian Association of Peadiatrics.
Breast milk is the best source of nourishment and in our country, also the cheapest.

Colustrum: It is the milk secreted during the first three days after delivery. It is rich in antibodies, cells, increased amounts of vitamins A, D, E and K. It is yellow and thick in consistency.

Nutritional Benefits:

-Carbohydrates, escpecially Lactose is in high concentration(6-7g/dL). Lactose helps in absorption of calcium and enhances the growth of Lactobacilli.

-Protiens, though they are in lower concentration(0.9-1.1 g/dL), since the infant’s kidney cannot filter too much of protiens, breast milk has high amount of amino acids like Taurine and Cysteine which are essential for neurotransmission. These proteins are lacking in cow’s milk and milk formaula.

-Fats: Breat milk is rich in Poly unsaturated Fatty acids which are required for proper development of the brain.

-Vitamins and Minerals

-Water and electrolytes: Breast milk contains 88% water content, hence a breast fed baby doesn’t require additional water in the first few months.

Dandruff

Thursday, February 7th, 2008

Dandruff

There is a dinner tonight and you wearing your favorite black suit. As you are adjusting your tie in the mirror you suddenly notice white colored flakes on your shoulders. Congratulations, you just have been diagnosed with DANDRUFF.

The cell cycle is approximately of 30 days, after that the skin cell is shed off from the body. This is a very controlled process. However when this process goes out of control, the cells are shed at a faster rate forming those very troublesome flakes, which is known as DANDRUFF (cell cycle of 2-7 days), a form of dermatitis in which the shedding of dead skin cells from the scalp flake and fall off at faster than normal rate. Although a small amount of flaking and shedding of the skin cells is normal and common, approx. 1/3 of the population show prolonged history of dandruff.
Dandruff has been shown to be the result of the following three factors

  1. The metabolic by-products of the fungus, Malassezia .
  2. Excessive secretion of Sebum.
  3. Individual susceptibility.

The root cause is a fungus called Malassezia furfur (pityrosporum ovale), which a normal inhabitant of the scalp but when there is an overgrowth of this fungus, it leads to dandruff. Further research now says about a new pathogen, though from the same family, called Malassezia globosa.

Figure 1 Skin scrap of Malassezia furfur.
The triglycerides present in the sebum are metabolized by this fungus resulting in the formation of Oleic acid, a lipid by-product. Oleic acid, on the other hand, acts on Stratum corneum, the outermost layer of skin, disturbing its homeostasis, leading to its shedding.

Precipitating Factors for Dandruff
Though Malassezia is the main cause, dandruff has been link to a lot of factors though there is no conclusive evidence for any of the following causing dandruff

  • Stress
  • Hormonal fluctuations
  • Cold weather (winter)
  • Poor personal hygiene
  • Vitamin B deficiency
  • Yeast infection
  • Hair curlers and blow dryers
  • Use of hair sprays, gels and hair coloring chemicals,
  • Excessive consumption of oily and sweet foodstuffs.

Treatment:

Shampoos: The most popular is Nizoral, which contains an ingredient called Ketoconazole (discovered by Dr. Paul Janssen in Belgium). Ketoconazole is an antifungal, which inhibits the growth of Malassezia.

Other options are

-Head & Shoulders: Selenium sulphide
-Pantene Pro-V: zinc pyrithione.
These ingredients slow the growth and formation of the top skin layer (epidermis) on the scalp.
-Neutrogena: Coal Tar
Coal Tar reduces the growth of skin cells on top of the scalp. Use this as the last resort
One problem with dandruff is that they can build up resistance, short term, against a shampoo, hence it is advisable to use a couple of them

Home remedies:

- Onions: Onions are high in sulfur. Cut a fresh onion in half and rub it on the scalp. Wash your hair once a week with sulfur based soap.

- Apple Cider Vinegar: Apple Cider Vinegar can decrease dandruff by balancing the skin’s PH. Use 1/4 cup of vinegar to 1/4 cup of water. Apply to the hair and massage it into the scalp, leave it in for 5 to 10 minutes then rinse. Do not try this method if your scalp is irritated


- Aloe Vera: About 10-15 minutes before you wash your hair, rub a lot of aloe vera gel into your scalp. Leave it on for 10 minutes, and then shampoo.

Benefits of Moderate Alcohol Consumption

Thursday, February 7th, 2008

Moderate alcohol intake is defined as an average of one to two drinks per day for men and one drink per day for women. A drink is considered 12 oz beer, 5 oz of wine, 1.5 oz of 80-proof spirits, or 1 oz of 100-proof spirits, all of which contain approximately 13 to 15 grams of ethanol.
Consumption of alcohol is akin to a double-edged knife when we consider its health effects. Depending upon how it is used, alcohol can cause damage in either direction than perhaps any other single aspect of lifestyle. Cardio-protective benefits are seen in mild to moderate consumption of alcohol, while increasingly excessive consumption results in negative outcomes on health.
Moderate consumption= 1- 2 drinks/day for males and 1 drink/day for females.
A drink= 12 oz of beer, 5 oz of wine, 1.5 oz of 80-proof spirits, or 1 oz of 100-proof spirits i.e. approximately 13-15 grams of ethanol

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Black Men are more at Risk of Kidney Disease Complications

Tuesday, February 5th, 2008

Feb. 4 (HealthDay News) — Among Americans diagnosed with kidney disease and high blood pressure, black men are least likely to have their blood pressure under control, which puts them at risk of life-threatening complications, a new study says.

Among people in the later stages of kidney disease, both black men and women were less likely than white men and women to have their blood pressure under control.

High blood pressure can worsen kidney disease, and some research suggests that controlling hypertension may play a major role in slowing progression of kidney disease, according to background information in the study, which looked at more than 10,000 people with kidney disease and hypertension.

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