February, 2015 - Best Private Hospital in Dubai Al Mankhool | IMH Dubai

Vitamin D deficiency

Vitamin D deficiency

Why children and adults need vitamin D

Children need vitamin D for bone growth and development. So do babies developing in the womb. This is because vitamin D helps us absorb calcium,
Serious vitamin D deficiency can cause Rickets, delayed motor development, muscle weakness, aches and pains, and fractures.

Vitamin D deficiency in adults has also been linked to osteoporosis, some cancers, heart disease and diabetes
If women don’t get enough vitamin D during pregnancy, their children might develop neonatal hypocalcaemia (not enough calcium in the blood) or rickets later in childhood.

Vitamin D and sunlight

You need sunlight on your skin for your body to make vitamin D. You get about 80% of your vitamin D this way.
No matter where you live, you have to be careful about how much sun you get on your skin. Too much sun can lead to sunburn, skin damage and even skin cancer.

Other factors affecting how much sun you need

People with naturally very dark skin need 3-6 times more sun to make vitamin D than the amount fair-skinned people need.
It’s important to note that there is no conclusive Australian or New Zealand data on how much sun children need for good levels of vitamin D.
To get more information and advice about how much sun is right for you, speak with your GP.

Be sun smart

Spending too long in the sun isn’t good for your skin, so it’s important to use sun protection.
During summer, especially between 10 am and 4 pm, make sure your child is safe in the sun with sunscreen, a hat, sunglasses, clothing that keeps the sun off and access to plenty of shade.

Vitamin D and food

Most children won’t get enough vitamin D from food alone.

But food with lots of vitamin D can add to the vitamin D your child gets from sunshine.

Foods naturally containing vitamin D include fresh fatty fish (salmon, herring, mackerel and sardines), liver, mushrooms and egg yolks. Some of the best food sources of vitamin D:

• 1 ounce salmon: 102 IU
• 6 ounces fortified yogurt: 80 IU
• 1 ounce canned tuna, drained and packed in oil: 66 IU
• 1/2 cup orange juice, fortified with 25 percent of daily value for vitamin D: 50 IU
• 1/2 cup fortified milk (whole, low-fat, or skim): 49 IU
• one slice fortified American cheese: 40 IU
• 1/2 cup fortified, ready-to-eat cereal: 19 IU
• 1 ounce mackerel: 11.6 IU
• 1/2 large egg yolk: 10 IU
• 1/2 teaspoon fortified margarine: 10 IU
• 1/2 ounce Swiss cheese: 6 IU

The amount of vitamin D in a food varies somewhat, depending on the brand of the product.

Some foods have vitamin D added to them. These include margarine and some low-fat milk and dairy products. All infant formula contains vitamin D.

You can boost the benefits of being out in the sun for a little while each day by doing some physical activity while you’re there. This is because daily exercise helps your body make vitamin D.

Vitamin D deficiency

Children might be at risk of vitamin D deficiency if they:

• keep all their skin covered
• spend most of their time indoors and don’t get much or any sun
• have a condition affecting how the body controls vitamin D levels – for example, liver disease, kidney disease, problems with absorbing food (such as celiac disease or cystic fibrosis and some medicines can affect vitamin D levels
• have darker skin
• have been breastfed for a long time and have a mother whose vitamin D is low.

Signs of vitamin D deficiency include rickets, delayed motor development, muscle weakness, aches and pains, and fractures.

How much vitamin D does my child need?

Infants up to 12 months old need 400 international units (IU), or 10 micrograms (mcg), a day. Children older than 1 need 600 IU, or 15 mcg, a day.

Treating vitamin D deficiency

Talk with your Pediatrician if you’re worried about your child’s vitamin D levels, or you’re pregnant and think you might have low vitamin D.

Your Pediatrician can order a blood test, which is the best way to check vitamin D levels.

For mild deficiencies, your Pediatrician might say that your child needs to get a bit more sun.

If you or your child has a severe vitamin D deficiency, your GP might say you or your child should take vitamin D supplements, as well as getting more sun.

If you or your child can’t get more sun, the pediatrician might say that taking vitamin D supplements is the best thing to do. You might take a vitamin D supplement in one large, single dose, or you might take a supplement for several weeks or month.

Solariums aren’t recommended as way to improve vitamin D levels or to treat vitamin D deficiency. Solariums can cause skin cancer.

Vitamin D, pregnancy and breastfeeding

A baby’s vitamin D stores go up during development in the womb and go down after birth until the baby starts getting vitamin D from sunlight along with diet.
If a pregnant woman has low levels of vitamin D, she might not pass on enough vitamin D to her baby.
Breastfeeding babies don’t get much vitamin D from breast milk, because breast milk doesn’t have much. And if a breastfeeding mum has low vitamin D, it can be even harder for her baby to get enough vitamin D.
If you have any concerns about whether your baby is getting enough vitamin D, you can talk with your pediatrician about using a vitamin D supplement. Doctors often say a daily supplement of 400 micrograms is good for mothers who are breastfeeding babies at risk of vitamin D deficiency.
It’s still OK for you to breastfeed your baby if you’re taking a vitamin D supplement.
Infant formula has higher levels of vitamin D, so formula-fed babies don’t usually need a supplement.

Gestational Diabetes

Gestational Diabetes

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Diabetes that develops during pregnancy is known as gestational diabetes. It occurs because body cannot produce enough insulin (a hormone important in controlling blood glucose) to meet its extra needs in pregnancy. This results in high blood glucose levels.

Gestational diabetes usually starts in the middle or towards the end of pregnancy.It may affect up to 18 in 100 women during pregnancy.

Following are the risk factors to develop gestational diabetes :

• Body mass index (BMI) is 30 or higher
• History of previously given birth to a large baby, weighing 4.5 kg (10lbs) or more
• Have had gestational diabetes before2
• Have a parent, brother or sister with diabetes
• Family origin is South Asian, Chinese, African-Caribbean or Middle Eastern.

Patients having any of the above risk factors, should be offered a glucose test during pregnancy. This may be a simple blood test in early pregnancy and/or a glucose tolerance test (GTT) between 24 and 28 weeks pregnant.
Most women who develop diabetes in pregnancy have healthy pregnancies and healthy babies but occasionally gestational diabetes can cause serious problems, especially if it goes unrecognised. Diagnosing and treating gestational diabetes reduces these risks.It is important to control the level of glucose in your blood during pregnancy. If not controlled well baby can become bigger thereby increasing the risk of caesarean section, serious birth trauma and still birth. Baby may also be at greater risk of developing obesity and/or diabetes in later life.Controlling your levels of blood glucose during pregnancy and labour reduces the risks of all thesecomplications.

Having gestational diabetes will mean more clinic visits at the hospital.Healthy eating and exercise. The most important treatment for gestational diabetes is a healthy eating plan and exercise. Gestational diabetes usually improves with these changes although some women, despite their best efforts, need totake tablets and/or give themselves insulin injections. A dietician can help to choose foods that will help to keep blood glucose at a healthy and stable level.If it does not reach a satisfactory level after 1–2 weeks, or if an ultrasound scan shows that your baby is larger than expected, there might be a need to take tablets or insulin injections.
Ideally delivery should be planned between 38 and 40 weeks of pregnancy, depending on individual circumstances.It is important that your blood glucose level is controlled during labour and birth and it should be monitored every hour during labour to ensure it stays at a satisfactory levelDuringlabour, baby’s heart rate should be continuously monitored.

• Breastfeeding is best for babies,
• Baby should have his or her blood glucose level tested a few hours after birth to make sure that it is not too low.
• Gestational diabetes usually gets better after birth and all diabetes medications should be stopped immediately after baby is born.

Being the right weight for height (having a normal BMI), eating a healthy diet and taking regular physical exercise before next pregnancy reduces the risk of developing gestational diabetes again.

Dr. Sagimole Tojichen
Specialist Obstetrics / Gynecology
International Modern Hospital Dubai
For Appointments : 971 4 406 3000

Endometriosis

Endometriosis is a very common condition where cells of the lining of the womb (theendometrium) are found elsewhere, usually in the pelvis and around the womb,ovaries and fallopian tubes. It mainly affects women during their reproductiveyears. It can affect women from every social group and ethnicity. Endometriosis isnot an infection and it is not contagious. Endometriosis is not cancer.

The main symptoms of endometriosis are pelvic pain, pain during or after sex,painful, sometimes heavy periods and, for some women, problems with gettingpregnant.Endometriosis can affect many aspects of a woman’s life including her generalphysical health, emotional wellbeing and daily routine.Some women do not have any symptoms at all.

Endometriosis occurs when the cells ofthe lining of the womb are found in otherparts of the body, usually the pelvis. Eachmonth this tissue outside the wombthickens and breaks down and bleeds inthe same way as the lining of the womb.This internal bleeding into the pelvis,unlike a period, has no way of leaving thebody. This causes inflammation, pain anddamage to the reproductive organs.

Endometriosis commonly occurs in the pelvis. It can be found:

• on the ovaries where it can form cysts (often referred to as ‘chocolate cysts’)
• in or on the fallopian tubes
• almost anywhere on, behind or around the womb
• in the peritoneum (the tissue that lines the abdominal wall and covers most ofthe organs in the abdomen).
Less commonly, endometriosis may occur on the bowel and bladder, or deep within themuscle wall of the uterus (adenomyosis). It can also rarely be found in other parts ofthe body.It is not yet known why endometriosis occurs.

Ultrasoundcan identify whether there is an endometriosis cystin the ovaries. A normal scan does not rule out endometriosis.For most women, having a laparoscopy is the only way to get a definite diagnosis;because of this, it is often referred to as the ‘gold standard’ test. A laparoscopy is asmall operation which is carried out under general anaesthesia.

The options for treatment may be:

• Pain-relieving drugs reduce inflammation and help to ease the pain.
• Hormone treatments. There is a range of hormone treatments to stop or reduce ovulation (the release of anegg) to allow the endometriosis to shrink or disappear.
• Laparoscopic surgery can be used to remove areas of endometriosis by destroying them or cutting them out.
Not all cases of endometriosis can be cured and for some women there is no long-termtreatment that helps. With support many women find ways to live with and managethis condition.

Dr. Sagimole Tojichen
Specialist Obstetrics / Gynecology
International Modern Hospital Dubai
For Appointments : 971 4 406 3000

Iron deficiency anemia

Anemia is one of the commonest illness found in both adult and children .
Most common anemia in children is Iron deficiency anemia and more than 1/3rd of world population is affected by Iron deficiency anemia.

Iron Deficiency Anemia

What is Anemia?
Anemia is defined by reduction in Hb Concentration, Hct Concentration or RBC count
• WHO criteria is Hb < 13 g/dl in men and Hb < 12 g/dl in women

• UK : Hb<13.5 g/dl or Hct<41% (M)
Hb<12 g/dl or Hct<37% (F)

• Pregnancy
11/10.5/10g/dl

Iron rich foods

High iron sources
• Iron fortified cereals and other foods
• Organ meat like liver and kidney
• Shell fish
• Prune juice

Moderate iron sources
• All bran cereal
• Dried beans and peas
• Beef, lamb, chicken
• Dried peaches, prunes
• Peanuts, nuts, sun flower seeds (not recommended <3 yrs because of risk of choking)
• Raisins
• Green leafy vegetables

Preventive Measures
• Ensure iron rich food in the diet
• Mixing heme and nonheme source – increases absorption of non heme iron
• Give vitamin C rich foods along with iron rich food
• Try to avoid iron inhibitors along with iron rich foods
• The phytates can be significantly reduced in beans by soaking them overnight in warm water and discarding the water before cooking them.
• Avoid drinking tea within 2 hours of a meal
• Avoid taking iron rich food along with milk or calcium supplements
• Avoid cow’s milk before 1 year of age
• Restrict unmodified cow’s milk to less than 600ml/day for children above one year
• Follow the guidelines

CDC Guidelines for Prevention
• For girls ages 12-18 years and non pregnant women of childbearing age : Screen every 5 years Screen every 1 year if risk factors

• Pregnancy : Low dose (30 mg/d)at first prenatal visit
Screening for ID at first visit

• Men and postmenopausal women: No routine screening IDA : complete evaluation

Dr. Anil Grover
Dr. Anil Grover,
MBBS,MD
Specialist Internal Medicine
Appointments Call : 971 4 406 3000

Often neglected cause of numbness of hands -Carpal tunnel syndrome

Carpal tunnel syndrome is a very common,easily treatable condition affecting middle aged people commonly.The condition is characterized by feeling of tingling and numbness in the hand.Sometimes there will be pain instead of the typical numbness.
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THE PROBLEM

Compression of MEDIAN NERVE in the carpal tunnel
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carpal tunnel syndrome more commonly affects FEMALES in the age group 30 to 60 years .
men involved in HEAVY DRILLING ACTIVITIES and using VIBRATING MACHINERY are also susceptible.
obesity,smoking,alchoholism,rhuematoid arthritis and other inflammatory arthritis,hypothyroidism,diabetes mellitus
amyloidosis rarely affects children

CLINICAL SYMPTOMS
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NUMBNESS in the outer three and a half fingers
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weakness of the thumb
decreased grip strength
wasting of thenar muscles
phalens test positive
durcums test positive
tinels sign

INVESTIGATIONS
Nerve conduction study
MRI
CT

TREATMENT
STEROID INJECTION AND NIGHT SPLINT – very early cases

CARPAL TUNNEL RELEASE SURGERY – later stages

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