imhdubai - Best Private Hospital in Dubai Al Mankhool | IMH Dubai

Gestational Diabetes

Gestational diabetes is a condition in which your blood sugar level becomes high during pregnancy, affecting up to 10% of pregnant women, diagnosed by a blood test done at 24 to 28 weeks of pregnancy. Women with gestational diabetes don’t have diabetes before their pregnancy – and it usually goes away after giving birth.

What causes gestational diabetes?

Hormones produced by the placenta cause a build-up of glucose in the blood. Usually, enough insulin is produced to control blood sugar levels. However, if the body is unable to produce insulin or stops using it, then the blood sugar levels rise, causing gestational diabetes.

Who’s at risk of gestational diabetes?

At your first antenatal appointment, a healthcare professional should check if you’re at risk of gestational diabetes.
The likelihood of getting gestational diabetes increases if you:
• were overweight before you got pregnant.
• have had gestational diabetes in the previous pregnancy.
• have had a large baby in earlier pregnancy (4.5kg/10lb or more)
• have a family history of diabetes – parent or sibling.
• come from a South Asian, Black or African Caribbean or Middle Eastern background.
• have high blood pressure .
• have given birth to a stillborn baby.
• are older than 30 years.
Having gestational diabetes increases your risk of developing it again in future pregnancies. It also increases your risk of developing Type 2 diabetes later in life. You can reduce the risk of developing gestational diabetes by managing your weight, eating healthily and keeping active before pregnancy.

Gestational diabetes symptoms.

Women with gestational diabetes don’t usually have symptoms. Most find out that have it during a routine screening.
You may notice that:
• You’re thirstier than usual
• You’re hungrier and eat more than usual
• You urinate more than usual

Gestational diabetes tests and diagnosis.

Gestational diabetes is diagnosed by routine screening, called Oral Glucose Tolerance Test, also known as an OGTT. The OGTT is done when you’re between 24-28 weeks pregnant. If you’ve had gestational diabetes before, you’ll be offered an OGTT as soon as possible, and another OGTT between 28-32 weeks if the first test result is normal.

How do you manage gestational diabetes?

The goal is to reduce blood glucose to the normal levels exhibited by a woman without gestational diabetes.

This involves:
• Measuring your blood sugar level four times a day
• Eating a healthy and balanced diet
• Performing moderate physical activity for about 150 minutes per week (Running, walking and swimming are good options)
• Reducing stress as much as possible.

These measures must be taken while continuing regular checkup with your doctor and adjusting them as needed. Changes in habits will sometimes not be enough; in such cases, metformin or insulin injections should be used during the pregnancy.

Target blood sugar levels in pregnancy:
• Before a meal: 95mg/dl or less
• An hour after a meal: 140mg/dl or less
• Two hours after a meal: 120mg/dl or less

Tips for eating well with gestational diabetes:
• Eat regular meals.
• There’s no need to ‘eat for two’. Portion size will have the most significant effect on your blood glucose level.
• Include carbohydrates but look for low GI (glycemic index) options and keep the consumption to the optimum level
• Get your five vegetables a day for vitamins, minerals and fibre.
• Cut back on salt, too much salt is associated with high blood pressure, which increases the risk of diabetes complications.
• Stick to water or sugar-free drinks.

What are the potential complications?

In the child:
• Macrosomia (above-average weight)
• Risk of being born with low blood sugar levels and respiratory problems
• Risk of obesity and type 2 diabetes later in life

In the mother:
• Risk of a difficult delivery, possibly by C-section, depending on the baby’s weight
• Surplus of amniotic fluid, which could trigger premature delivery
• Gestational hypertension & Preeclampsia
• Risk of developing type 2 diabetes later
• Risk of suffering from gestational diabetes again in a future pregnancy

Most of the complications can be prevented with appropriate treatment.
In conclusion, in the vast majority of cases, gestational diabetes is easy to control, with your blood sugar levels likely to normal in about six weeks after childbirth. However, the risk of developing gestational diabetes in the next pregnancy increases, with the women also likely to develop type 2 diabetes in the future. It would help if you got follow-up tests every year. Many problems can be avoided through healthy lifestyle habits. Don’t panic and talk to your doctor to see how you can put the odds in your favour.

Be Smart. Don’t Start.

31st May of every year is observed as No Tobacco Day. In present world where everyone talks about COVID, let’s look in to some of the aspects related to smoking which is connected to COVID-19.

Tobacco smokers (cigarettes, waterpipes, bidis, cigars, heated tobacco products) may be more vulnerable to contracting COVID-19, as the act of smoking involves contact of fingers (and possibly contaminated cigarettes) with the lips, which increases the possibility of transmission of viruses from hand to mouth. Smoking waterpipes, also known as shisha or hookah, often involves the sharing of mouth pieces and hoses, which could facilitate the transmission of the COVID-19 virus in communal and social settings.

Smoking any kind of tobacco reduces lung capacity and increases the risk of many respiratory infections and can increase the severity of respiratory diseases. COVID-19 is an infectious disease that primarily attacks the lungs. Smoking impairs lung function making it harder for the body to fight off coronaviruses and other respiratory diseases. Available research suggests that smokers are at higher risk of developing severe COVID-19 outcomes.

Using smokeless tobacco often involves some hand to mouth contact. Another risk associated with using smokeless tobacco products, like chewing tobacco, is that the virus can be spread when the user spits out the excess saliva produced during the chewing process.

Given the risks to health that tobacco use causes, WHO recommends quitting tobacco use. Quitting will help your lungs and heart to work better from the moment you stop. Within 20 minutes of quitting, elevated heart rate and blood pressure drop. After 12 hours, the carbon monoxide level in the bloodstream drops to normal. Within 2-12 weeks, circulation improves and lung function increases. After 1-9 months, coughing and shortness of breath decrease. Quitting will help to protect your loved ones, especially children, from exposure to second-hand smoke.

Precautions

• Do not share devices like waterpipes and e-cigarettes.
• Spread the word about the risks of smoking, using e-cigarettes and using smokeless tobacco.
• Protect others from the harms of second-hand smoke.
• Know the importance of washing your hands, physical distancing, and not sharing any smoking or e -cigarette products.
• Do not spit in public places

#TobaccoExposed

• Tobacco products kill more than 8 million people every year. Tobacco and related industries must continuously find new consumers to replace the ones that their products are killing to maintain revenue.
• Tobacco companies spent over USD 9 billion in marketing and advertising and the world lost 8 million lives from causes related to tobacco use and exposure to second-hand smoke.
• We want to create a generation that is free from tobacco and second-hand smoke and the death and disease that they cause.
• Break free from the tobacco and related industries’ manipulation by becoming educated on their tactics and the harm caused by their products.
• Tobacco use is responsible for 25% of all cancer deaths globally. Use of nicotine and tobacco products increases the risk of cancer, cardiovascular and pulmonary disease.
• Over 1 million people die from second-hand smoke exposure every year.
• Children and adolescents who use e-cigarettes at least double their chance of smoking cigarettes later in life.
• E-cigarette use increases your risk of heart disease and lung disorders.
• Nicotine in e-cigarettes is a highly addictive drug and can damage children’s developing brains.
• Smoking shisha is just as harmful as other forms of tobacco use.

What should I use after injury ? Cold or Heat?

Orthopedic Care DubaiInjury to the extremities and   trunk is quite common  which  almost everybody gets by normal activities or  by an accident like playing football, lifting heavy weight etc.. There seems to be the confusion about application of ice or hot pack  and how long one should use after the injury.

It is advised to  use ice in the acute stage of an injury (within the first 24-48 hours), or whenever swelling is develops. Ice helps to reduce inflammation and swelling by decreasing

Orthopedic Care in Dubai

blood flow to the area that is injured. One should  apply ice indirectly (not directly on the skin) for 10 to 20 minutes, remove the ice for at least 20 minutes, and repeat as necessary. Heat increases blood flow, which helps promote pain relief after inflammation and swelling subside. Heat is also used to assist in warming muscles up prior to exercise, any physical activity, or physical therapy.

Morning Stiffness & Back Pain

Waking up with back pain is rarely a serious problem. Even many people who are more or less pain free during the day still experience pain in the nights and while getting up.
morning stiffness & back painRecent research reveals that nearly one in three people experience back pain after a night’s sleep, No one really understands the reason for morning stiffness. Presumably, while the body is inactive, fluid leaks out from the small blood vessels and capillaries and the tissues become “waterlogged.” Then, if you try to move the part, the swollen tissues feel stiff until the motion pumps the fluid out through the lymph channels and the veins while most feel stiff or ache.

The average episode of morning stiffness lasts only about 10 to 15 minutes. The stiffness goes away as you move and warm up the joints and muscles. However, stiffness from rheumatoid arthritis may last more than an hour.
People often say, “I’m just getting old,” but old age alone does not cause morning joint stiffness. It is usually an indication of worn joints, muscle tightness, or inflammation from arthritis.When your lower back is stiff in the morning, muscles such as psoas, gluteus and hamstrings become tight overnight. This generates pressure on the joints resulting in pain. Weak abdominals also contribute to this pain as they do not allow adequate support for the lumbar spine

As your joints get older, the spongy cushion of cartilage begins to dry out and stiffen. The joint lining also produces less synovial fluid, which lubricates the joint. Weak muscles and stiff tendons also tend to tighten during sleep. Osteoarthritis, (the “wear and tear” kind), and rheumatoid arthritis, (which involves swelling and inflammation), both can trigger morning stiffness.

In some of the case, spinal morning stiffness is associated with lumbar disc disorder . The associations increases when we combined spinal morning stiffness with low back pain.

There are various causes and contributing factors for morning stiffness, and some of them are –
• Overweight and poor diet
• Too much exposure in a cold environment
• Poor posture while sleeping .

No question that the sleep surface can influence force into the soft tissues. If you don’t believe , try sleeping one night on the kitchen floor and you’ll realize it.

Remedies of morning stiffness

• Regular exercise
• Avoid stomach sleeping.
•Sleep position- Place a plush, supportive pillow underneath your knees, if you sleep on your back. This action flattens your back, removing a large arch from your lower back region. It can relieve pain in just a few minutes. If you are a back and side sleeper, you can use a supportive pillow and pull it under your knees or between your legs as you switch positions.Remedies of morning stiffness

•You can also place a small, rolled-up towel under the small of your back for extra support. You need a firm mattress (not too soft / not too hard). Your bed should form to the shape of your body

• Stretching and sitting up while in bed.- Think of stretching in the morning as you warm up for the entire day. These stretches are meant to lightly ease the body into movement, and upon completion, leave you feeling more awake and ready to get on with your day.

• Stretching in the morning will ease stiffness, soreness, and can help diminish chronic aches and pains in the body. Take time for yourself in the morning with yoga poses if you know, so you can be sure to enjoy the rest of the day!

•Drink enough water -. Make sure you’re well hydrated. This might seem obvious as soft tissues need water to remain as pliable as possible.

• Healthy diet
• Hot shower
•Learn techniques for stress management – Learning stress management techniques can assist you to sleep comfortably

•Supplements : You cannot reverse the effects of joint aging, and while certain medications can help manage arthritis pain and inflammation, stiffness can still occur.. Maintaining a healthy weight also can help. Finally, don’t be swayed by joint health supplements, such as glucosamine or chondroitin.. This is controversial because there have been studies that suggest Glucosamine and Chondroitin Sulfate don’t work for arthritic joints even though is chondroitin Sulfate is a disease modifying agent for osteoarthritis. It slows the progression of the disease and deterioration of the joint cartilage.

• Avoid painkillers, they don’t help morning stiffness.

Reconstructive Plastic Surgery

The incidence of Cancer both benign and malignant is on the rise worldwide. Cancer treatment especially for malignancy can damage or disfigure the body parts function and or appearance. Reconstructive Plastic Surgery helps to repair the damage and restore near normal appearance.

Plastic Surgery Dubai
Anti aging treatment and plastic surgery concept. Beautiful faces of young woman with arrows isolated on white

Unlike Cosmetic Surgery, most insurance companies cover Reconstructive Plastic surgery.

Reconstructive surgery is usually needed after a tumour is removed and there is a defect which needs to be covered. E.g. after Mastectomy ( surgical removal of breast) for cancer- the patient may choose to have the breast volume restored . Or after a jaw tumour when the onco-surgeon has removed one side of the jaw bone and cheek completely and there is a huge open defect.

Plastic Surgery In Dubai
Portrait collage of young, healthy and beautiful woman

Reconstructive Surgery can be performed immediately after removal of the tumour (Immediate reconstruction) or can be performed after completion of other cancer treatments like chemotherapy and radiation therapy (Delayed Reconstruction).

Reconstructive surgery can make use of several body parts solely or in combination to facilitate good reconstruction. Options of reconstruction may include use of only skin (skin graft) or flap surgery ( combination of skin, fat , muscle or bone).

With the advancement in Microsurgery and techniques, single stage reconstruction with good cosmesis is possible.  It works by taking tissue and blood vessels from one part of the patient’s body and placing it over the damaged part and joining the vessels under the operating microscope.

All options of reconstruction are to be discussed with the reconstructive plastic surgeon before surgery.

Reconstructive Surgery is no longer a social taboo, but a way forward to a better quality of life and better future.

How to help my toddler (between 3-4 years of age)?

What does (s) he understand?help my toddler

  • His or her complexity of understanding keeps extending. He / She now understands simple WHO? WHAT? And WHERE? Questions and hears you when you call from another room.
  • This is the crucial age where hearing difficulties may become evident. If you are in a doubt of his/her hearing, it’s wise to consult an audiologist.

how to help my toddlerWhat does (s) he speak?

  • (S)he talks about many things to you, what happened in preschools, what type of play they did, how is teacher to him/her, what are his/her friends, what funny, and new (s)he experiences, and also his imaginations.
  • His/her sentences are becoming longer and longer as (s) he combines four, five or more words. His /her speech is usually clear and fluent and easily understood by the strangers most of the time.
  • They become very loud and unstoppable.

How can I help my child?

  • Mix categories e.g. mix animals with picture of baby, cookies, ice cream. And make the child to sort them out and show what doesn’t belong to the category. Tell him/her that he is correct baby doesn’t belong to cat, dog, category because baby is not an animal.
  • Draw, glue a car without wheels, favorite cartoon with a mistake, glue a dog in driving seat and talk about how silly the pictures and encourage him/her to talk about what is missing, and what is correct.
  • Act out typical scenarios with the child like going to doctor with the pet, teacher and student, acting like the mother at home, cooking food, making baby dress up, superman. Allow her/him to guide you in acting. Be the student and let your child teach a lesson. Ask the child questions; make him repeat if you have not understood completely.
  • Expand the child’s vocabulary by acting, storytelling, singing, filling the blanks. Talk about new games, new ideas you and your child can do and have fun.How can I help my child?
  • Find out a simple and interesting story book read line by line, ask simple WH questions (what, Where, Who, Why).Talk about favorite part in the story, in the cartoon. This is the best time to talk about favorite things with the child talk about his/her favorite game, food, rhymes and tell him/her also your choices.
  • Bring your family album to the bed. Talk about the photo and ask the child can you remember this photo. Help him to explain what happened.
  • Do silly mistakes in game, apologize for your mistakes, and ask his/her help to play correctly.

Leave interesting books and materials lying around for your child to explore.

How to help my toddler (between 2-3 years of age)?

What does the toddler understand?

  • By now (s)he will understand two steps commands take your shoe off and keep on rack.how to help toddler
  • And also understand opposites like hot/cold, stop/go, nice/ugly.(s)he hears ringing of the telephone , door bell and may become excited, get you to answer or tries to answer themselves

What does (s)he speak?

  • Your toddler’s vocabulary is going to explode. They seem to have a word for almost everything. Their sentence contains of one, two or three words.
  • Speech is probably not very clear, but family members can easily understand them.
  • Your toddler loves to hold your attention of what they hear and see.
  • They may draw your attention to something by naming it, for an example, Bus, Candy, Big, Hot, Wow, see.

How can I help my child?

  • Children learn by imitating adults. Use clear, simple words & sentences what is easy to imitate .Show your interest to their speech. When the child says doggie!!! ; Expand his/her word, Oh yes it’s a doggie, Doggie is running. Doggie says bow bow. It is black. Does Anny love doggie?
  • Have his/her help to arrange cloths, toys, food at home. These are what Anny eats put all into this bucket. Foods are here. We will put Anny cloths in this bucket. Teach the child basic function, features and class of objects with examples.Help toddler
  • Encourage the child to increase the length of speech. Which puzzle do you want? Try to give him/her open ended questions than close ended. For e.g. rather than asking Do you want rice? Do you want bread? Ask would you like to eat rice or bread? This will simply limit Yes & No answers.
  • Reinforce the child effectively .Positive reinforcement is the key for the successful communication. How good Anny speaks, Thank you Anny, mommy understood.
  • Introduce books, picture books, games & activities to expand your child’s vocabulary. Use colorful picture books and name object with the child. And describe the object using a simple sentence. Create the situation to use newly learned words in context. E.g. his is an Apple. Anny eats apple./ Apple is red
  • Have the child have the habit of collecting pictures from magazines, books. Help him/her to glue then paste or write the name under each object.

 

Attention Deficit Hyperactivity Disorder

Attention deficit / hyperactivity disorder (ADHD) is a highly prevalent condition in children that has generated considerable public interest and debate. It is a chronic, pervasive childhood disorder characterized by developmentally inappropriate activity level, low frustration tolerance, impulsivity, poor organization of behavior, distractibility, and inability to sustain attention and concentration (American Psychiatric Association, 2000)which occurs in 3% to 7% of school-age children (Egger et al., 2000).

Boys are at least four times as likely as girls to develop the disorder (4:1); indeed some studies have found that boys with ADHD outnumber girls with the condition by nine to one (9:1), possibly because boys are genetically more prone to disorders of the nervous system. In children between ages 5 and 15 years it was found that 3.62% of boys and 0.85% of girls have ADHD (Ford et al., 2003). In adults 3.4 % (1.2 to 7.3 %) are presented with ADHD, in individuals aged 18 – 44 years in low-income countries (1.9%) and in high-income countries (4.2%). (Fayyad et al., 2007; Barkley R et al., 2006). 0.6 –1.2% of adults retains the childhood diagnosis ADHD by the age of 25 years.

The causes of attention deficit hyperactivity disorder still remain unknown. It is transmitted in families and most likely is due to the influence of multimodal factors, e.g., the result of a complex set of factors including genetic inheritance, environmental factors, function in several brain regions and level of neurotransmitter activity. It is believed that mutations in several genes that are normally very active in the prefrontal cortex and basal ganglia, tends to play role in the genesis of ADHD. The right prefrontal cortex, vermis region of the cerebellum, caudate nucleus, and the globus pallidus are significantly smaller in children with ADHD than the normal children. Parents of children with ADHD are often noted to be experiencing mental difficulties, high levels of stress, and conflict- laden parent – child interactions. Non-genetic factors that are known to be linked to ADHD include premature birth, maternal alcohol and tobacco use, complications during pregnancy or birth and illnesses of early infancy, exposure to high levels of lead in early childhood, brain injuries that involve prefrontal cortex, overstimulation hypothesis, and metabolic dysfunction of the central nervous system.

The essential features of ADHD continue to include the triad of inattention, impulsivity, and hyperactivity. There are three subtypes: predominantly hyperactive –impulsive type, the predominantly inattentive type (PI), and the combined type. The DSM IV criteria indicate that symptoms must be present for at least 6 months, with onset before age 7. Attention span and sitting tolerance increases with the age of child. Inattention appears to be more evident in girls. The symptoms of the disorder can cause problems in learning; socialization and behavior for those individuals afflicted with it and put them at high risk for serious psychopathology in adulthood. There is growing literature on the ADHD- PI subtype with even later age of onset. These children have lower comorbidity with disruptive disorders, and higher levels of substance abuse, anxiety and mood disorders.

There are developmental differences in the presentation of symptoms. Given below are some of them:

Preschoolers:

  • Gross motor hyperactivity- running, climbing
  • Difficulty remaining quiet
  • Non-compliant
  • 3-5 years onset – 50% of them continue to have ADHD

 

School age:

  • Difficulty focusing
  • Losing things
  • Forgetfulness
  • Poor Organizing
  • Adolescents
  • Incomplete assignments and projects
  • Academic under-performance
  • Conflicts with peers, teachers and parents
  • Poor planning, organizing skills

Management involves two phases: Assessment and Treatment

Assessments are usually multimodal: Interview: Parent and Child, Observation, School workbook, Individual testing: cognitive functions, Rating Scale- Parent, Teacher, Self-report (e.g., Conners rating scale; Vanderbilt scale)
Treatment: Psychological and pharmacological Intervention of child ADHD

Evidence based treatments for ADHD include behavioral interventions such as parent behavior management training, contingency management, and cognitive- behavior therapies, administered individually or in group settings, or pharmacologic treatment, with a variety of stimulant formulations and the non-stimulant atomoxetine approved for this indication. For many patients, the optimal treatment is multimodal, meaning the combination of medication and psychosocial treatments addressing all the impaired areas of life.

Conclusion: Despite considerable progress over the past three decades, much is to be learned regarding the neurophysiological basis and genetics of ADHD. Psychological Assessment can serve to essentially validate the diagnosis of ADHD in children and Adults. There have been considerable advances in psychosocial, pharmacological and multimodal treatment of ADHD.

How to help my toddler (between 1-2 years of age)?

What does the toddler understand?

  • Her his receptive vocabulary is increasing day by day
  • The child points to pictures in a book when you name them, and also (s)he points to a few body parts when asked(nose, eyes, tummy, head).
  • She or He follows simple commands like push the chair, don’t touch, it’s hot, wash hands and understand simple questions (where is daddy, what is your frock, who is bunny).
  • Their interest shift from singing songs or say rhymes to simple story telling.
  • Your toddler now likes to listen to simple stories over songs.
  • This is the stage where you become exhausted with repeating the same story, game, rhymes many many times. But (s)he wants to listen the same again & again.

What does the toddler speak?

  • His/her expressive vocabulary keep increasing.,(s)he accumulating more and more words as each month passes.

  • (S)he can even combine 2 words and questions like mama ball, what is that, give me chocos, more chips, all gone, doggie ,daddy poo(car).

How to help my toddler?

Talk to the child while doing household things, going out or performing any activity. For an example Baby is going to bathe, run the tap. Water is coming ( put toys in the tub)Duckie is swimming, push push dickiee. Second example. I see a doggie, Doggie is running. It’s a big dog, Doggie says bow wow .Keep your language grammatically correct and easy to imitate. Talk about present activities what the child What does the toddler understand?sees around him/her. Use rhymes such as jonny jonny yes papa. Encourage the child to say hahahahaa/aaaaaa with you. Associate the object with sound e,g introduce the clock to the child, t-t-t-t-t clock, ding- dong- ding-dong .pi pi pi pi daddy car. Make him listen to the sounds of objects and create a sound associated with the object. mow mow mow mow cow. Use the sound like p-p-p-p-, m-m-m-m-, b-b-b-b-b, brooo-brooo, grrrr- ggrr while bathing, playing with toys, pampering him/her. These sounds will help him to learn better in preschool and kindergarten. Expand on words what the child says, for an example, if (s)he says car or sound likes car. Expand on words saying oh! yes it is a CAR, Biiig CAR, Big red CAR! Show the child big colorful picture book with large pictures. Name them, read aloud and talk about the picture. Wait your child to explore the picture, Ask him/her what is this and you answer. Make him/her point to picture Repeat the same several days. You would be surprised one day hearing(s)he names the picture.

Depression in children and adolescents: an overview

Depression – Let’s talk”, the World Health Day theme 2017 ring an alarm bell in our heart about the presence of this disorder amid our dear n’ near ones. Depression was once thought to be a disease of adults. It is no more considered rare among the children and adolescents, with an incidence of 2 – 4% and 4 – 8 % respectively. A youngster who appears withdrawn and lonely is most likely going through a period of “intense internal emotional turmoil”. They often feel sad and may consistently understand their plight as hopeless. They may frequently show poor concentration, lack of initiation; poor sleep and eating habits, negativity, get tired easily, feel guilty or worthless etc. Depression In ChildrenSubsequently, this often results in chronic depression, poor scholastic performance, psycho-social problems, substance abuse and even suicide. It’s equally prevalent in both sexes during pre-puberty stage whereas more in females with a ratio of 2:1 post-puberty. Mean duration of an episode of depression is 7 to 9 months. 70 to 80 % recover at the end of one year. Increased chance of recurrence is seen in children with early onset and those with the history of previous episodes, co-morbid psychotic symptoms, poor drug compliance, negative life events and positive family history in parents. 20 to 30 % of depressive children develop manic episodes (Bipolar Disorder) on follow up.
Majority of them may reach the general practitioner or the pediatrician with vague so called ‘functional symptoms’. A recent change in behavior with sad or irritable mood lasting for more than 2 weeks indicates a depression. Unfortunately, these disorders often go unrecognized by families and physicians alike. Early diagnosis and treatment of depressive disorders are critical to healthy emotional, social and behavioral development.
Clinical presentation varies according to the developmental stage of the child. They can be seen as given below:
Preschool child: apathetic, refuses food, unhappy and irritable, looks miserable, frequent crying spells, ‘failure to thrive’, insecure and unhappy child without any physical abnormality.
Middle childhood (Pre-adolescence): Apathy, verbal and motor retardation, and loss of appetite are the classic features of depression in this age group. Other features are: psychosomatic symptoms (e.g., head ache or pain abdomen); decline in academic performance with poor attention and concentration, irritability and social withdrawal, low self-esteem (I am not good enough compared to others), feeling bored and lack of interest in usual activities, sleep and appetite disturbances may be present though less common.
Adolescence: Clinical features are more similar to those of adult depression. Feeling sad, apathetic, lack of energy; sleep and appetite disturbances are more common. Bodily preoccupation, worries over his/her appearance or minor health problems (e.g., acne); suicidal thoughts are relatively common.
Etiology: There are multiple factors which individually or in combination with other factors, could contribute to depression. Depression In Children and adolescentsFew predisposing factors/ vulnerability factors are: Genetic; biological factors (neurotransmitters -monoamine metabolism and endocrine abnormalities); and temperament (e.g. quiet children with regular habits and slow to adapt to new experiences). Chronic life adversities are also likely to contribute to develop depression – broken homes, parental alcoholism, abuse, rejection etc. Undesirable life events in previous 12 months are important e.g., an event at home, or school and experience of loss.
Some points to be considered by a parent or caregivers to alleviate emotional disturbances:

  • Use positive reinforcement while disciplining them; avoid overprotecting and over directing.
  • Don’t expect absolute compliance. Don’t use your child to fulfill your own unachieved goals.
  • Take the problem seriously. It will be important to them and give them a feel of being understood.
  • Encourage them to talk to other people (may be a trusted adult friend or grandparents) as well as to you.
  • Treatment strategies for Depression – right time; right way; right people

A proper assessment is needed to establish depression – understand the nature, extent and Depression in Children: Symptoms, Causes, Treatmentsdisability by obtaining the history from all available sources; to explore into the stressors in the school/home; to consider differential diagnosis – Physical conditions like hypothyroidism; psychosis; normal reactive feelings of sadness and unhappiness; look for co morbid condition.
Treatment can include a combination of pharmacological management and various psychotherapeutic approaches – Supportive counseling and ways to relieve stress; Cognitive behavior therapy; Interpersonal therapy.
To conclude, Depression is a treatable emotional/behavioral condition. What is needed is treatment by “right technique at right time by right people” (trained mental health professionals).

Minimally Invasive Therapy (Lasers) in Treatment of Anorectal Disorders

Anorectal disorders are a group of medical disorders that occur at the junction of the anal canal and rectum. These disorders are very common in the UAE population due to the local climatic changes and lifestyle choices. Almost 50% of  all people experience this problem at least once in their lives by the age of 50. 75% of these disorders will worsen and progress if not treated at the right time.

The 4 most common problems encountered by people are hemorrhoids,anal fistula,anal fissure and pilonidal sinus.Almost 50% or more of patients seen by a Surgeon in his daily practice constitute these problems.Most of these disorders occur due to wrong diet ( lack of fibre and fluids), wrong lifestyle( less physical activity),constipation,laxative misuse, weak connective tissues and other causes. Of these, hemorrhoids are the most common and constitute around 60 to 65% of cases.

People who suffer from these problems present with bleeding while passing stools,painful stools,discharge,itching,swelling and at times fever.

Minimally Invasive Therapy (Lasers)It is important for these people to see a Surgeon at the earliest to enable an accurate diagnosis and initiate early treatment to prevent further complications. Over the counter medications  and creams are of limited use as almost all of these conditions present with more or less the same complaints, however the treatment is completely different for each one of them.

A proper history,physical examination by a Surgeon and relevant lab and other radiological tests may be required for a proper diagnosis and treatment of these conditions.

Till now, only traditional methods of surgery were available to treat these conditions causing a lot of pain, bleeding,large wounds and prolonged healing times for the patient. This prevented a lot of patients from seeking medical advice and undergoing treatment at the right stage.

However, with new developments in the field of surgery and  rapid advances in technology, new minimally invasive modalities are now available for treating these conditions. Of these, Lasers offer the most effective, safe and reliable method for treatment.Lasers have a tremendous benefit over an open operation in that they are painless, almost bloodless, have a short operative time of 15 to 20 minutes, cause no anal narrowing or loss of stool control,have no muscle or skin damage, no need for insertion of stitches or other foreign bodies and subsequently have much faster healing time. Patients can return to their normal work and activities in 4 to 5 days time.

Treatment Of Anorectal DisordersThese however, need to be performed by experienced Surgeons who have undergone extensive training in this specialty and have the know how and technical expertise.

Patients who suffer from these disorders should take full advantage of this new option available  to them with the host of benefits it offers. So, my advice to those with these problems is “ Act now ,don’t suffer in silence!”

How To Prevent Common ENT Disorders

There are many ways to prevent ENT disorders, though it is not always possible, as in the case of congenital conditions. However, multiple ENT disorders can be prevented. Here are some things you can do to prevent ENT disorders. Frequent hand washing is the single most important thing you can do to prevent infection. Avoid exposure to illness, and practice good hygiene, such as covering your mouth when you cough and staying at home when you are sick.
Since it is difficult to teach good hygiene to small children, toddlers who attend daycare or preschool are at a higher risk of developing chronic ENT disorders.

Preventing Ear Infections

Preventing Ear Infections

 

Ear infections are a common ENT disorder. They occur when germs enter the ear and become trapped there. Due to their infectious nature, there are many things you can do to prevent ear infections. Certain inherited traits, though, make some people, especially children, more prone to ear infections.

Here are a list of ways to prevent ear infections:
• Avoid exposure to cigarette smoke.
• Identify and treat allergies.
• Keep your child’s immunizations up to date.
• Do not remove earwax unless your physician tells you to.

Preventing Sinus Infections
Preventing Sinus InfectionsSinus infections occur when germs enter one of the hollow cavities in the skull surrounding the eyes and nose. A sinus infection may feel like a very bad cold that doesn’t go away after the usual 2 to 3 weeks.

Here are some ways you can protect yourself.
• If you have a cold, use a saline nasal spray (available over the counter) to keep your nasal passages from becoming blocked.
• Do not fly if you have a cold. If you must fly, consider use of a decongestant and nasal spray 30 minutes before take-off.
• Identify and treat allergies; long-term sinusitis is usually caused by allergies, while acute sinusitis is usually caused by bacteria.
• Try using saline nasal spray daily for chronic sinusitis.

Preventing Sore Throat
Preventing Sore ThroatThere are many causes of sore throat, including infections, acid reflux, sleep apnea or more severe and rare disorders, such as cancer. A very common cause of sore throat is a bacterial or viral infection, so practicing good hygiene, such as frequent hand washing, is a good way to prevent sore throat. Here are some other suggestions:
• Get plenty of rest and exercise to bolster your immune system.
• Avoid exposure to cigarette smoke.
• Do not spend long periods of time outside when the air quality in your area is poor.
• Treat esophageal reflux.

Preventing Snoring and Sleep Apnea

Preventing Snoring and Sleep ApneaSleep apnea is a condition where a person stops breathing for brief periods of time while asleep. It is very common in the United Arab Emirates and can be harmful if left untreated. Fortunately, there are many treatments available, and sleep apnea can often be cured. Here are some good ideas to prevent or keep sleep apnea at bay.
• Maintain a healthy body weight.
• Avoid alcohol or sedatives at bedtime.
• Identify and treat tonsillitis, nasal polyps or other disorders that can cause airway obstruction.
• Quit smoking.

Not all ENT disorders can be prevented. Many depend on inherited traits; however, following these suggestions may serve to keep you healthier in the future. Hand washing remains at the forefront of disease prevention, along with other isolation practices, including coughing in to your sleeve and staying at home while you are sick. These guidelines can also help strengthen your immune system, decreasing the likelihood of catching an illness and limiting the amount of time you spend sick.

Not paying attention to your nasal symptoms may turn your sinusitis chronic

Headache disorders Info Graphics in circle.Vector illustrationsApproximately 20% of the UAE population suffers from Chronic Sinusitis. Symptoms range from stuffy nose, nasal blockage, headache, facial pain, postnasal discharge, cough and bad breath. These are all symptoms of chronic sinusitis. The weather in UAE plays a significant role in the development of these symptoms. Fine sand in the air, humidity, allergies, sudden temperature changes too trigger it. Deviation of the nasal septum and nasal polyps too can lead to chronic sinusitis.

KNOW YOUR SYMPTOMS

When you have chronic sinusitis, the mucous membrane of the nose, sinuses and throat get inflamed, possibly from a pre-existing upper respiratory tract infection or allergies. Swelling obstructs the sinus opening and prevents normal mucous drainage, causes mucous and pressure to buildup.

Symptoms include – thick greenish post nasal discharge, nasal stuffiness, and pain around the eyes, cheeks, nose and forehead. There could be an associated reduced sense of smell and or taste.This condition if not treated on time can lead to Bronchitis, asthma or other respiratory diseases,

Many people with sinusitis either silently suffer or opt for self medication, making the problem worse leading to a chronic ailment. A common cold is usually caused by a viral infection and it gets better in approximately a week’s time. If it lasts for more than that, you need to see a Doctor.

HOW TO GET WELL

sinus-1Visual inspection, nasal endoscopy and CT scan, paranasal sinuses can help screen for chronic sinusitis. A CT scan can accurately diagnose chronic sinusitis. Once diagnosed, it is treated with nasal decongestants, steroid nasal sprays, antihistamines, antibiotics etc.
Sinus surgery may be required when conservative treatment fails. Endoscopic sinus surgery is done under local or general anesthesia. The main aim of the surgery is to enlarge the natural opening of the sinuses and to restore the normal sino-nasal ventilation and drainage.

HOME REMEDIES THAT CAN HELP

  • Steam inhalation
  • Saline spray
  • Pain in the nose and sinuses can be relieved by warm compress.

TIPS TO AVOID SINUSITIS

  • Keep yourself hydrated – Drinking water prevents mucus from thickening and blocking the sinuses.
  • Avoid smoking – Smokers are more prone to suffer from sinusitis.
  • Consult a Doctor if a cold persists for more than 10 days.
  • Complete prescribed course of antibiotics. When indicatedHeadache disorders Info Graphics in circle.Vector illustrations

Pain Management Clinic

Pain is defined by International Association for study of Pain as an unpleasant sensory and emotional experience with actual or potential tissue damage.

Conquering pain has been a major limitation for the more evolved human race. Pain imposes a burden on those who suffer from it and impairs quality of life. Most often, it is the common symptom that brings the patient to see a Physician. Pain most commonly presents as a warning sign for any pathological process in the body nevertheless may also cause agony without a specific purpose. The most common forms of pain encountered in daily medical practice are musculoskeletal pain 30-40 %, neck and back pain 30%, headaches less than 10%, and cancer pain 1-2 %.

            Pain Clinic at International Modern HospitalPain may be classified into different types based on the origin, duration, periodicity and nature of pain. Accordingly, Pain management can broadly be classified as acute and chronic pain management. While acute pain deals with perioperative pain, pain in labour, trauma, burns etc., and the latter includes a diverse group of patients in the outpatient setting. The management of acute pain is primarily therapeutic. Chronic pain management requires various pharmacological and non pharmacological approaches to tackle the multidimensional components of pain. At International Modern Hospital we take a holistic approach so as to not only treat the underlying cause but also provide psychological support and rehabilitation to ailing patient.

Pain Clinic at International Modern HospitalPain management largely comprises of pharmacological and non-pharmacological modalities, commonly being medication, counselling, relaxation techniques, electrical stimulation and local anaesthetics. Few Prescribed medications include anti-depressants and systemic local anaesthetics.

Pain Clinic at International Modern HospitalAt International Modern Hospital we undertake Interventional modalities which include diagnostic and therapeutic nerve blocks, facet blocks, epidural steroids, intra articular injections, trigger point injections for myofacial syndromesetc. Therapeutic adjuvants include Psychiatric counselling, physiotherapy and electrical stimulation. Unrelieved and inadequate relief of pain is continuing to be a global health problem and serious efforts have to be taken to provide pain treatment as it is definitely a basic human right.

It may be real or unreal , but their distress is real!!!

 “ Real beauty isn’t about symmetry or weight or makeup; it’s about looking life right in the face and seeing all its magnificence reflected in your own.”

(Valerie Monroe)

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“15 yr old 10th grade girl, not attending school, saying that she was not good looking and her face has some asymmetry. She doesn’t want to go out, and if at all she goes out, she covers her most of her face with scarf. She expresses severe suicidal ideas and was very much depressed.”

Most of us have something we don’t like about our appearance — a crooked nose, an uneven smile, or eyes that are too large or too small, but they don’t interfere with our daily lives.

Body Dysmorphophobic Disorder (BDD) people think about their real or perceived flaws for hours each day.

bdd-1They can’t control their negative thoughts and don’t believe people who tell them that they look fine. Their thoughts may cause severe emotional distress and interfere with their daily functioning. They may miss work or school, avoid social situations and isolate themselves, even from family and friends, because they fear others will notice their flaws.

They may even undergo unnecessary plastic surgeries to correct perceived imperfections, never finding satisfaction with the results.

Who they are? & what they do?

BDD is a body-image disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one’s appearance.

They can dislike any part of their body, but most commonly find fault with their hair, skin, nose, chest, or stomach. In real sense, a perceived defect may be only a slight imperfection or nonexistent, but for people with BDD, the flaw is significant and prominent, often causing severe emotional distress and difficulties in daily functioning.bdd-1

Most often it develops in adolescents and teens, and research shows that it affects men and women almost equally.

They suffer from obsessions about their appearance that can last for hours or up to an entire day. This can lead to low self-esteem, avoidance of social situations, and problems at work or school.

They may avoid leaving their homes altogether and may even have thoughts of suicide or make a suicide attempt.

They may perform some type of compulsive or repetitive behavior to try to hide or improve their flaws.

 Examples are:

  • Camouflaging (with body position, clothing, makeup, hair, hats, etc.)
  • comparing body part to others’ appearance
  • seeking surgery
  • checking in a mirror
  • avoiding mirrors
  • skin picking
  • excessive grooming
  • excessive exercise
  • changing clothes excessively

Treatment

CBT & Antidepressants

“The human body is the best work of art.” 

(Jess C. Scott)

It’s Ability and not Disability

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“Let us work together for the full and equal participation of persons with disabilities in an inclusive and sustainable world that embraces humanity in all its diversity.” 

(UN-Secretary-General Ban Ki-moon)

According to the 2011 World Report on Disability by the World Health Organisation, there are an estimated 1 billion persons with disabilities worldwide. It also states that 1 in 5 of the world’s poorest people has disabilities

Numbers

  • 7 billion people: world population.
  • Over 1 billion people in the world have some form of disability, that’s 1 in 7.
  • More than 100 million disabled persons are children.
  • Children with disabilities are almost four times more likely to experience violence than non-disabled children.
  • 80% of all people with disabilities live in a developing country.
  • 50% of disabled persons cannot afford health care.

Disability

A condition or function judged to be significantly impaired relative to the usual standard of an individual of their group. It used to refer to individual functioning, including physical impairment, sensory impairment, cognitive impairment, intellectual impairment, mental illness, and various types of chronic disease.disability-5

Persons with disabilities

“The world’s largest minority”, has generally poorer health, lower education achievements, fewer economic opportunities and higher rates of poverty than people without disabilities. This is largely due to the lack of services available to them (like information and communications technology (ICT), justice or transportation) and the many obstacles they face in their everyday lives. These obstacles can take a variety of forms, including those relating to the physical environment, or those resulting from legislation or policy, or from societal attitudes or discrimination.

International Day of Persons with Disabilities, 3 December 2016- “Achieving 17 Goals for the Future We Want”.

The 2030 Agenda has 17 goals for sustainable development. disability-7

Disability is referenced specifically in parts related to education, growth and employment, inequality, accessibility of human settlements.

Goal 4 on inclusive and equitable quality education and promotion of life-long learning opportunities for all focuses on eliminating gender disparities in education and ensuring equal access to all levels of education and vocational training for the vulnerable, including persons with disabilities.

Goal 8: to promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all, the international community aims to achieve full and productive employment and decent work for all women and men, including for persons with disabilities, and equal pay for work of equal value.

Goal 10, which strives to reduce inequality within and among countries by empowering and promoting the social, economic and political inclusion of all, including persons with disabilities.

Goal 11 would work to make cities and human settlements inclusive, safe and sustainable. To realise this goal, Member States are called upon to provide access to safe, affordable, accessible and sustainable transport systems for all, improving road safety, notably by expanding public transport, with special attention to the needs of those in vulnerable situations, such as persons with disabilities. In addition, the proposal calls for providing universal access to safe, inclusive and accessible, green and public spaces, particularly for persons with disabilities.

Goal 17 stresses that in order to strengthen the means of implementation and revitalise the global partnership for sustainable development, the collection of data and monitoring and accountability of the SDGs are crucial.

 Inclusive society

Evidence and experience shows that when barriers to their inclusion are removed and persons with disabilities are empowered to participate fully in societal life, their entire community benefits.

disability-2The Convention on the Rights of Persons with Disabilities (CRPD) recognises that the existence of barriers constitutes a central component of disability.

Accessibility and inclusion of persons with disabilities are fundamental rights recognised by the Convention on the Rights of Persons with Disabilities.

“Science may have found a cure for most evils; but it has found no remedy for the worst of them all – the apathy of human beings.”

(Helen Keller)

Language Problem or Late Talking?

 Our parents are smart. They are really concern about their child talk and how he / she communicate. They also listen to his or her peers who are at same age and may compare what older brothers and sisters did at the same age. This is how our parents mentally compare their child’s performance with other children. They immediately create an impression of whether the child is developing speech & language at normal rate or not.

st3If parents feel that development is slow, they check their impression with the other parents, relatives, and their pediatrician. You probably get an answer such as Oh!! Don’t worry, he / she will outgrow it. Look at my child she was so quiet and now she is a chatter box, give him/her time.

But…… suppose he / she doesn’t? Even after giving adequate time. 

st2You would feel guilty waiting and then finding out that I should have acted earlier. Waiting is so hard, why we have to be frustrated at last . We want the best for our child. What’s a parent to do?

But……. You’re not sure of what to do.

st1It’s hard to say the exact age when they hit speech and language milestones. It varies a lot on factors such as the child’s inborn ability to learn language, other skills the child is learning, the amount speech and language input he/she gets. and how others respond to his/her communication attempts .

Do you praise him/her? Listen to him/her carefully?

These factors can slow down or accelerate the speed of speech and language development of our children. Be aware of the certain factors that may increase the risk of late-talking child in the 18 to 30 month old age range even with normal intelligence.

The sooner The Better

If you are concerned about your child’s speech and language development, you should see a speech-language pathologist. The speech-language pathologist may suggest on early intervention program with follow up sessions. It’s important to have formal therapy sessions in case of severe problems.

Do you really want to wait for him/her to outgrow???Don’t leave a chance which leads you to feel guilty that I would have done with everything I could

To undergo treatment, you have to be very healthy !!!

Drug Safety (Rational and Safe use of Medicines)

“To undergo treatment you have to be very healthy, because apart from your sickness you have to withstand the medicine” (Molière)

pharmacovigilanceDrug safety ( Pharmacovigilance) – The science and activities relating to the detection, evaluation, understanding and prevention of adverse drug reactions or any other drug-related problems.

Why drug safety? – Adverse Drug Reactions are among the top ten causes of mortality. The percentage of hospital admissions due to drug related events in some countries is about or more than 10%. Economic impact Drug related morbidity and mortality expenses exceeded US$ 177.4 billion in the USA in 2000.ADR database shows- No of reports: more than 3.5 million, each year increase ~160,000 / year.safe

Drug safety heavily focuses on Adverse Drug Reactions (ADR), which are defined as any response to a drug which is noxious and unintended. ADR is considered serious if it meets one or more of the following criteria:

  1. Results in death or is life-threatening;
  2. Requires inpatient hospitalization or prolongation of existing hospitalization;
  3. Results in persistent or significant disability or incapacity;
  4. Results in a congenital anomaly (birth defect)

FDA drug categories – A, B, C, D or X

Category A

Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy

Category B

Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.

Category C

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Category D

There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Category X

Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

Eg: atorvastatin, warfarin, methotrexate,

Pharmaceutical companies perform clinical trials, testing new drugs on people before they are made generally available to see their risk / benefit profile

Specific Patient Populations

Senior man and daughter at homePregnant woman with daughter

Pregnant and lactating women

A pregnant woman must not take any medication without consulting a specialist about the safety of the medication as it may affect the formation of the fetus. During the period of lactation, mothers should consult professionals before use of any medication because some medications can be excreted in breast milk, which may have a negative impact on the infant.

Children

We should take extreme caution when using any medications for children. The reasons are- the lack of scientific studies and clinical trials needed to evaluate the safety of these medications in this age group and also their vital organs are not mature, and thus exposure to certain medications may lead to toxic side effects as the body is mostly unable to fully metabolize or excrete the drugs.

Old people

This group is considered to be most vulnerable to the effect of medications and so it is very important to consider their health status before prescribing any medication, for several reasons. The physiological functions of many body organs decline with age, especially important organs such as the liver and kidneys. Older people can suffer from many chronic illnesses, such as high blood pressure, diabetes, and high blood cholesterol and lipids, possibly necessitating the chronic use of multiple medications, which may conflict with each other.

Drug interactions

Every patient must ensure they are aware of all necessary information regarding those drugs, as well as the possibility of interactions with other drugs or certain food types, through consulting the pharmacist or physician. Groups that are at extreme risk and exposure to those drug interactions include: Patients who use multiple medications, Elderly patients, Patients with multiple chronic diseases and illnesses

Ensuring drug safety

Drug safety is the main aspect of medical therapy that can play a major role in deciding which drug should be given to a patient. Considering the concept of benefit–risk balance drugs with a high risk profile should be avoided unless needed. Personalized medicine should be considered when medications are given to patients.

It is possible to avoid these side effects by using the drug in the proper way, and by following the instructions included in the drug leaflet or provided by the pharmacist or the physician. Knowing the necessary information about a medicine is considered the first step in avoiding side effects.

The risks from medications could be minimized through patient education about drug safety and openness with the patient, allowing him/her to ask questions related to their disease or medications. A good relationship between the medical team and the patient is one of the most important determinants for drug safety.

“Dying from a disease is sometimes unavoidable. But, dying from an adverse drug reaction is unacceptable”(Dr. Vladimir Lepakhin)

Mammography

What is mammography?

Mammography is pro-bably the most important tool doctors have to help them diagnose, evaluate, and follow women who’ve had breast cancer and also for screening women for breast cancer.

Safe and highly accurate, a mammogram is an X-ray photograph of the breast. The technique has been in use for about thirty years. It can detect most breast cancers at an early stage, before symptoms develop. Routine mammography is not available to women under 30 unless you have a first degree relative (mother or sister) who has had breast cancer at a young age.

Why is mammography important?

digital-mammographyMammography saves lives. About 1 in 12 women develop breast cancer at some stage in life, mostly over the age of 50. The earlier breast cancer is detected, the better the chance of a cure.

Finding breast cancers early with mammography has also meant that many more women being treated for breast cancer are able to keep their breasts. When caught early, localized cancers can be removed without resorting to breast removal. Research studies have shown that mammography screening has significantly reduced the number of deaths from breast cancer.

When to get a mammogram?

There’s a lot of confusion about when and how often to get a mammogram. For now, the recommendation is that women get a mammogram once a year, beginning at age 40. If you’re at high risk for breast cancer, with a strong family history of breast or ovarian cancer, or have had radiation treatment to the chest in the past, it’s recommended that you start having annual mammograms at a younger age (often beginning around age 30).

What if there is an abnormality?

Most women have a normal mammogram. Some women are asked to attend again if the X-ray picture is not clear, or to look more closely at a special area of the breast which needs a further detailed check. A small number are found to have early breast cancer and are offered referral to a surgeon for treatment. If any abnormality is detected, the patients would be advised to have an ultrasound of the breast with FNAC (A small needle would be put through the area of abnormality with or without ultrasound guidance, where cells would be taken from that site and sent for microscopic evaluation for cancer cells.)

Three important things to know about mammograms

1. They can save your life. Finding breast cancer early reduces your risk of dying from the disease by 25-30% or more. Women should begin having mammograms yearly at age 40, or earlier if they’re at high risk.

2. Don’t be afraid. It’s a fast procedure (about 5-10 minutes), and discomfort is minimal. The procedure is safe: there’s only a very tiny amount of radiation exposure from a mammogram. To relieve the anxiety of waiting for results, go to a centre that will give you results before you leave.

3. It is our most powerful breast cancer detection tool. However, mammograms can still miss 15-20% of breast cancers that are simply not visible using this technique. Other important tools-such as breast self-exam, clinical breast examination, ultrasound, and MRI can and should be used as complementary tools, but there are no substitutes or replacements for a mammogram.

Alzheimer’s Disease

anigif_sub-buzz-22090-1465935906-25Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks. Alzheimer’s is a type of dementia that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.

Symptoms

The most common early symptom of Alzheimer’s is difficulty remembering newly learned information.

Just like the rest of our bodies, our brains change as we age . Most of us eventually notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work may be a sign that brain cells are failing.

The most common early symptom of Alzheimer’s is difficulty remembering newly learned information because Alzheimer’s changes typically begin in the part of the brain that affects learning. As Alzheimer’s advances through the brain it leads to increasingly severe symptoms, including disorientation, mood and behavior changes; deepening confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more serious memory loss and behavior changes; and difficulty speaking, swallowing and walking.

imagesPeople with memory loss or other possible signs of Alzheimer’s may find it hard to recognize they have a problem. Signs of dementia may be more obvious to family members or friends. Anyone experiencing dementia-like symptoms should see a doctor as soon as possible. At International Modern Hospital, we offer specialised care for such patients under the guidance of our psychiatrist, Dr. Shaju George

 alzprogress

Alzheimer’s is not the only cause of memory loss.

Many people have trouble with memory — this does NOT mean they have Alzheimer’s. There are many different causes of memory loss. If you or a loved one is experiencing symptoms of dementia, it is best to visit a doctor so the cause can be determined.

The role of plaques and tangles

 Plaques and tangles tend to spread through the cortex as Alzheimer’s progresses.

Two abnormal structures called plaques and tangles are prime suspects in damaging and killing nerve cells.

healthyvsadPlaques are deposits of a protein fragment called beta-amyloid (BAY-tuh AM-uh-loyd) that build up in the spaces between nerve cells.

Tangles are twisted fibers of another protein called tau (rhymes with “wow”) that build up inside cells.

Though most people develop some plaques and tangles as they age, those with Alzheimer’s tend to develop far more. They also tend to develop them in a predictable pattern, beginning in areas important for memory before spreading to other regions.

Scientists do not know exactly what role plaques and tangles play in Alzheimer’s disease. Most experts believe they somehow play a critical role in blocking communication among nerve cells and disrupting processes that cells need to survive.

It’s the destruction and death of nerve cells that causes memory failure, personality changes, problems carrying out daily activities and other symptoms of Alzheimer’s disease.

 Diagnosis of Alzheimer’s Disease

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Doctors use several methods and tools to help determine whether a person who is having memory problems has “possible Alzheimer’s dementia” (dementia may be due to another cause) or “probable Alzheimer’s dementia” (no other cause for dementia can be found).

To diagnose Alzheimer’s, doctors may:

  • Ask the person and a family member or friend questions about overall health, past medical problems, ability to carry out daily activities, and changes in behavior and personality
  • Conduct tests of memory, problem solving, attention, counting, and language
  • Carry out standard medical tests, such as blood and urine tests, to identify other possible causes of the problem
  • Perform brain scans, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), to rule out other possible causes for symptoms.

These tests may be repeated to give doctors information about how the person’s memory and other cognitive functions are changing over time.

Alzheimer’s disease can be definitely diagnosed only after death, by linking clinical measures with an examination of brain tissue in an autopsy.

Treatment of Alzheimer’s Disease

Alzheimer’s disease is complex, and it is unlikely that any one drug or other intervention can successfully treat it. Current approaches focus on helping people maintain mental function, manage behavioral symptoms, and slow or delay the symptoms of disease. Researchers hope to develop therapies targeting specific genetic, molecular, and cellular mechanisms so that the actual underlying cause of the disease can be stopped or prevented.blog-alz

CONNECT, COMMUNICATE, CARE – World Suicide Prevention Day

14231876_1060620760658541_7316520330448059815_oThe World Health Organization estimates that over 800,000 people die by suicide each year – that’s one person every 40 seconds. Up to 25 times as many again make a suicide attempt. There are many, many more people who have been bereaved by suicide or have been close to someone who has tried to take his or her own life. ‘Connect, communicate, care’ is the theme of the 2016 World Suicide Prevention Day. These three words are at the heart of suicide prevention.

CONNECT

14317628_1060620923991858_7388485385653221106_nSocial connectedness reduces the risk of suicide, so being there for someone who has become disconnected can be a life-saving act. Connecting them with formal and informal supports may also help to prevent suicide. Individuals, organisations and communities all have a responsibility here.

COMMUNICATE

14317602_1060620803991870_7393260786696702560_nOpen communication is vital if we are to combat suicide. We need to discuss suicide as we would any other public health issue if we are to dispel myths about it and reduce the stigma surrounding it. Equipping people to communicate effectively with those who might be vulnerable to suicide is an important part of any suicide prevention strategy. Showing compassion and empathy, and listening in a non-judgemental way is very important.

CARE

14212830_1060620883991862_138179977086114850_nAll the connecting and communicating in the world will have no effect without care. We need to ensure that we are caring ourselves. We need to look out for others who may be struggling, and let them tell their story in their own way and at their own pace.

mind-wellness-dept_dr-shaju-george

Know the noise around you !!!

You can lose some hearing after being exposed to loud noises for too long, for example by standing close to speakers at a nightclub. Or hearing can be damaged after a short burst of explosive noise, such as gunshots or fireworks.

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If you work or frequently spend time in a noisy place or listen to loud music a lot, you could be losing your hearing without even realising it.

The best way to avoid developing noise-induced hearing loss is to keep away from loud noise as much as you can.

Here’s a guide to some typical noise levels, measured in decibels (dB). The higher the number, the louder the noise. The Health and Safety Executive (HSE) says noise levels above 105dB can damage your hearing if endured for more than 15 minutes each week. But lower levels, such as between 80dB and 90dB can also cause permanent damage if you’re exposed to them for hours every day. Find out some of the common noise levels around you which you may come across daily

  • normal conversation: 60-65dB
  • a busy street: 75-85dB
  • lawn mower/heavy traffic: 85dB
  • forklift truck: 90dB
  • hand drill: 98dB
  • heavy lorry about seven metres away: 95-100dB
  • motorbikes: 100dB
  • cinema: some films regularly top 100dB during big action scenes
  • disco/nightclub/car horn: 110dB
  • MP3 player on loud: 112dB
  • chainsaw: 115-120dB
  • rock concert/ambulance siren: 120dB

Ways to Protect Your Ears and Hearing Health

  1. Use earplugs around loud noises – Clubs, concerts, lawnmowers, chainsaws, and any other noises that force you to shout so the person next to you can hear your voice all create dangerous levels of sound. Earplugs are convenient and easy to obtain. You can even have a pair custom fitted for your ears by your local hearing healthcare provider.
  2. Turn the volume down – According to the World Health Organization, 1.1 billion teenagers and young adults worldwide are at risk for noise-induced hearing loss from unsafe use of audio devices.If you like to enjoy music through headphones or earbuds, you can protect your ears by following the 60/60 rule. The suggestion is to listen with headphones at no more than 60% volume for no more than 60 minutes a day. Earbuds are especially dangerous, as they fit directly next to the eardrum. If possible, opt for over-the-ear headphones.Don’t forget that any loud music, not just music played through headphones, presents a risk for noise-induced hearing loss. If you’re hosting a social event, keep the music at a volume which won’t force people to shout in order to hold a conversation
  3. Give your ears time to recover – If you are exposed to loud noises for a prolonged period of time, like at a concert or a bar, your ears need time to recover. If you can, step outside for five minutes every so often in order to let them rest.
  4. Stop using cotton swabs in your ears – It’s common for people to use cotton swabs to clean wax out of their ear canal, but this is definitely not advisable. A little bit of wax in your ears is not only normal, but it’s also important. The ears are self-cleaning organs, and wax stops dust and other harmful particles from entering the canal. Plus, inserting anything inside your ear canals risks damaging sensitive organs like your ear drum.
  5. Take medications only as directed – Certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDS) like aspirin, ibuprofen and naproxen, can sometimes contribute to hearing loss. Discuss medications with your doctor if you’re concerned that they’ll impact your hearing ability and take them only as directed.
  6. Keep your ears dry – Excess moisture can allow bacteria to enter and attack the ear canal. This can cause swimmer’s ear or other types of ear infections, which can be dangerous for your hearing ability. Be sure you gently towel-dry your ears after bathing or swimming. If you can feel water in the ear, tilt your head to the side and tug lightly on the ear lobe to coax the water out.
  7. Get regular checkups – Ask your primary care physician to incorporate hearing screenings into your regular checkups. Because hearing loss develops gradually, it’s also recommended that you have annual hearing consultations with a hearing healthcare professional. That way, you’ll be more likely to recognize signs of hearing loss and take action as soon as you do.

Taking action is important because untreated hearing loss, besides detracting from quality of life and the strength of relationships, has been linked to other health concerns like depression, dementia, and heart disease.

Make Sure Kids’ Eyes and Vision Are Perfect This School Year

11325859 - eyeglasses over a blurry eye chart

With schools back in progress, parents may think they have crossed everything off on their checklist, but our eye specialist want to remind parents on their children’s eye health. Good vision and overall eye health are vital to learning and academic success. Because children are still growing, being vigilant about eye health is important. The earlier problems are identified; the sooner they can be addressed to the ophthalmologist. Dr.Tarek Makhlof, Ophthalmologist @ International Modern Hospital, recommends the following tips to for healthy eyes and vision:

  1. rubWatch for signals of eye problems– Parents should be alert to symptoms that could indicate an eye or vision problem, such as complaints of eyestrain, headaches and squinting when reading or performing other common activities like regular rubbing of the eye etc. Other symptoms to look for include a white or grayish-white coloring in the pupil, one eye that turns in or out, or eyes that do not track in sync together.
  2. Wear protective eyewear when playing sports– Eye injuries while playing sports can cause serious damage. Hence wear protective eye wears as a protective measure.
  3. Get regular childhood vision screenings 
    Children’s eyes change rapidly, making regular vision screenings an important step in detecting and correcting eye problems in early stages. eyetestFor school-age children, a vision screening, which is less comprehensive than a dilated eye examination by an ophthalmologist,can be performed by a pediatrician, family physician, nurse or trained technician during regular checkups. If the screening detects a problem, the child may need to see an ophthalmologist — an eye physician and surgeon.
  4. Know and share your family eye health history– Everyone should find out whether eye conditions or diseases run in their family. Parents should share that information with the person performing the screening when possible. Examples of common eye conditions include refractive errors (nearsightedness, farsightedness, astigmatism) crossed eye, known as strabismus, and lazy eye, known as amblyopia. If crossed eye and lazy eye are not treated in childhood, they can sometimes cause permanent vision loss in one or both eyes.
  5. kid-with-tablet_opt-100623783-primary.idgeBeware of television on hand held devices– It is now becoming more and more common for children to suffer from eye strain after staring at screens for hours and hours. This is sometimes known as computer vision syndrome. Watch out for dry, red and sore eyes. Sometimes, children may experience blurry vision and have problems with words moving on the screen because their eyes are not properly aligned. You can avoid eye problems setting in at an early age by making sure that sessions involving near screen work are limited to 30 minutes a time. Make sure that there are plenty of breaks and that outdoor activity is not neglected.

Weaning foods for children

babyIntroducing your baby to solid foods – sometimes called weaning or complementary feeding – should start when your baby is around six months old.It’s a really important step in their development, and it can be great fun to explore new flavours and textures together.

Three signs your baby is ready for thir first food

There are three clear signs that, together, show your baby is ready for solid foods alongside breast milk or formula. It’s very rare for these signs to appear together before your baby is six months old.

  1. They can stay in a sitting position and hold their head steady.
  2. They can co-ordinate their eyes, hands and mouth so they can look at the food, pick it up and put it in their mouth, all by themselves.
  3. They can swallow food. Babies who are not ready will push their food back out with their tongue, so they get more round their face than they do in their mouths.

Some signs that can be mistaken for a baby being ready for solid foods:

  • chewing fists
  • waking in the night when they have previously slept through
  • wanting extra milk feeds

These are normal behaviours and not necessarily a sign of hunger or being ready to start solid food. Starting solid foods won’t make them any more likely to sleep through the night. Extra feeds are usually enough until they’re ready for other food.

When can I introduce weaning foods to my baby?

The World Health Organization (WHO) recommends exclusive breast feeding alone up to the age of 6 months. After 6 months babies need complementary feeding to provide adequate supply of nutrients.

Step 1: Your baby is now 6 months old (completed 6 months)

  • Purées of vegetables such as carrots, pumpkin , potato, sweet potato
  • Purées of fruits, such as ripe cooked apple, pear , or mashed banana
  • Gluten-free baby cereals, such as rice cereal mixed with baby’s usual milk

Milk is still a major part of the baby’s diet. If you are breastfeeding, you can continue breastfeeding till baby is two years old.

Purées may be easiest for your baby at first. However, babies can quickly learn to chew soft, lumpy food even if they have no teeth. Ensure the food is well mashed and gradually make the food a thicker consistency.

Try to limit the number of sweet or cereal purées to one a day, and always include a vegetable purée. 

Don’t add salt or sugar, honey or other sweeteners to your baby’s food. 

Step 2: Baby is taking puréed food well

If baby is taking puréed food well, time to increase the variety in their food.

  • Purées of lean meat or poultry
  • Purées of lentils or split peas 
  • Purées of mixed vegetables with potatoes or rice
  • Purées which include green vegetables, such as peas, cabbage , spinach or broccoli
  • Full cream milk, yoghurt, cream cheese, paneeror custard.

Do not give cow’s (or goat or sheep’ milk) as baby’s main milk till they are atleast one year old. 

Make changes in child’s diet when they are well. This is to avoid attributing the symptoms of illness to change in diet.

Some foods are more likely to cause allergies than others. These should be introduced one at a time. These foods are:

  • Milk products such as cheese, yoghurt, fromage frais, paneer etc (Use full fat variety)
  • Fish and shell fish
  • Soya beans
  • Citrus fruit (including orange juice)
  • Wheat, rye and barley based foods such as bread, flour, pasta, some breakfast cereals and rusks.
  • Nuts, especially if your family has a history of allergies.

Step 3: Baby food from seven to nine months

Now is the time to introduce more variety in baby’s food.

Remember that most baby food can be easily made at home. 

  • Mashed or minced food, not purées. Be sure to include some lumps.
  • A wider range of starchy foods such as khichdi suji upmasuji kheersabudaana kheerdalia, bread. Baby breadsticks, breakfast cereals, oats, in addition to cornmeal, potatoes, rice and millet are also good options. Give two to three servings a day of starchy foods.
  • Cooled, filtered and boiled waterfrom a sipper with a soft spout, when she is thirsty. This is in addition to her daily breastmilk or 500-600 mls of formula.
  • Keeping juice to meal times helps with iron absorption and reduces the risk of damage to emerging teeth.
  • Citrus fruits, such as oranges (santara), kinnow (keenu) and sweetlime (mosambi).
  • Fish, lean red meat, poultry and lentils. Aim for one serving of protein-rich food a day.
  • Nut butters as long as there is no family history of allergic diseases. Use unsalted smooth versions, or make your own.
  • Dairy products, such as paneer, yoghurt and cheese. You should wait until one year to introduce cow’s milk as a drink. However, it can be used in small amounts for cooking foods.
  • Follow-on formula, if you wish.
  • Finger foods such as cooked green beans (frans been) or carrots (gajar), cubes of cheese, slices of banana (kela) or soft pear (nashpati).

If you are buying canned food, do ensure they do not contain excess salt or sugar. Adult canned food is not recommended for babies as it contains excess salt or sugar.

Step 4: Meals from 10 months

Meals should be more adult-like now. They should be chopped or minced. You may like to follow a two to three meal a day pattern along with one or two snacks. Continue to offer breastmilk or 500-600mls of formula milk. 

At this stage your baby should be having:

  • three or four servings of starchy foods, such as khichdi, rice, daldalia, or potatoes, a day
  • one serving of meat, fish, well-cooked eggs, or two of pulses (lentils, peas, beans) or nut butters
  • one to two servings of cheese, paneeror yoghurt as well as breastmilk or formula milk.

What foods should I not give my baby if she is under a year?

  • Salt: Adding salt to baby food is neither needed nor recommended in the  first year of life
  • Honey. Even if she has a cough, your baby shouldn’t have honey until she’s one.
  • Sugar. Try sweetening desserts with mashed banana or a purée of stewed dried fruit. Or you could use expressed breast milk or formula milk.
  • Artificial sweeteners. Diet drinks or squashes containing artificial sweeteners are not suitable for your baby. They are not nutritious and can encourage a<style=”color: #000000;”>sweet tooth.
  • Whole nuts.These are a choking hazard.
  • Tea or coffee. The tannin in tea may prevent her from absorbing the iron in her food properly. Any caffeinated drink is unsuitable for your baby.
  • Low-fat foods. Single or double toned milk, yoghurts and reduced-fat cheeses aren’t right for your baby. Always offer your baby the full-fat versions. She needs the calories.
  • Foods which may carry a risk of food poisoning; such as soft mould-ripened cheeses (brie, camembert), liver pâté, and soft-boiled or raw eggs.
  • Cow’s (or goat’s or sheep’s) milkas a main drink under one year. 

Varicose Vein

19705Varicose veins are swollen, twisted, and enlarged veins that you can see under the skin. They are often red or blue in color. They usually appear in the legs, but can occur in other parts of the body.

Causes

Normally, one-way valves in your leg veins keep blood moving up toward the heart. When the valves do not work properly, they allow blood to back up into the vein. The vein swells from the blood that collects there, which causes varicose veins. Smaller varicose veins that you can see on the surface of the skin are called spider veins.
Varicose veins are common, and affect more women than men. They don’t cause problems for most people. However, in some people, they can lead to serious conditions, such as leg swelling and pain, blood clots, and skin changes.
Risk factors include:
• Older age
• Being female (hormonal changes from puberty, pregnancy, and menopause can lead to varicose veins, and taking birth control pills or hormone replacement can increase your risk)
• Being born with defective valves
• Obesity
• Pregnancy
• History of blood clots in your legs
• Standing or sitting for long periods of time
• Family history of varicose veins

Symptoms

• Fullness, heaviness, aching, and sometimes pain in the legs
• Visible, swollen veins
• Mild swelling of feet or ankles
• Itching
Severe symptoms include:
• Leg swelling
• Leg or calf pain after sitting or standing for long periods
• Skin color changes of the legs or ankles
• Dry, irritated, scaly skin that can crack easily
• Skin sores (ulcers) that don’t heal easily
• Thickening and hardening of the skin in the legs and ankles
• Bleeding from ruptured veins

Diagnosis

Your doctor will examine your legs to look for swelling, changes in skin color, or sores. Your doctor also may:
• Check blood flow in the veins
• Rule out other problems with the legs (such as a blood clot)
• Do a colour scan for the leg veins

Treatment

Your doctor may suggest that you take the following self-care steps to help manage varicose veins:
• Wear compression stockings to decrease swelling. These stockings gently squeeze your legs to move blood up towards your heart.
• Do not sit or stand for long periods. Even moving your legs slightly helps keep the blood flowing.
• Raise your legs above your heart three or four times a day for 15 minutes at a time.
• Care for wounds in you have any open sores or infections. Your health care provider can show you how.
• Lose weight if you are overweight.
• Get more exercise. This can help you keep off weight and help move blood up your legs. Walking or swimming are good options.
• If you have dry or cracked skin on your legs, moisturizing may help. However, some skin care treatments can make the problem worse. Talk to your health care provider before using any lotions, creams, or antibiotic ointments. Your provider can recommend lotions that can help.
If your condition is severe, your doctor may recommend the following treatments:
• Laser therapy. Strong bursts of light are projected on smaller varicose veins, making them disappear.
• Sclerotherapy. Salt water or a chemical solution is injected into the vein. The vein hardens and disappears.
• Ablation. Heat is used to close off and destroy the vein. The vein disappears over time.
• Microphlebectomy. Small surgical cuts are made in the leg near the damaged vein. The vein is removed through one of the cuts.
• Bypass. Surgery reroutes blood flow around the blocked vein. A tube or blood vessel taken from your body is used to make a detour around, or bypass the damaged vein.
• Angioplasty and stenting. A procedure opens a narrowed or blocked vein. Angioplasty uses a tiny medical balloon to widen the blocked vein. The balloon presses against the inside wall of the vein to open it and improve blood flow. A tiny metal mesh tube called a stent is then placed inside the vein to prevent it from narrowing again.
Varicose veins tend to get worse over time. Taking self-care steps can help relieve achiness and pain, keep varicose veins from getting worse, and prevent more serious problems.

When to Contact a Medical Professional

Call your health care provider if:
• Varicose veins are painful
• They get worse or do not improve with self-care, such as by wearing compression stockings or avoiding standing or sitting for too long
• You have a sudden increase in pain or swelling, fever, redness of the leg, or leg sores
• You develop leg sores that do not heal

Gestational Diabetes

Whats is Gestational Diabetes?
Diabetes (poor tolerance to blood sugars) diagnosed for the first time during pregnancy. It usually starts in the middle or ed of pregnancy.

CAUSES
Gestational diabetes occurs when you body cannot make enough insulin during pregnancy.High levels of hormones with weight gain of pregnancy causes your body cells to use insulin less effectively. The risk of developing pregnancy diabetes is higher in the following situations.

    • If you are overweight (BMI>30)
    • You had a previous large baby weighing more than 4.5 KG
    • You had diabetes in the previous pregnancy.
    • You have a family member like parents or siblings with diabetes
    • Some nationalities like Asians, Middle Eastern, African – Caribbean

 

DIAGNOSIS
Diagnosis is by checking your blood sugar level during pregnancy. It is done in early pregnancy if you have risk factors as mentioned. Routinely its done in the 6th or 7th (24 to 28 Weeks) month of pregnancy. The test is called GTT and it is done by checking your fasting levels of glucose and bp levels 1 to 2 hours after having a glucose drink.

 

What are the risks of diabetes to my baby?
If the blood glucose levels are too high , the baby can grow bigger which increases the risk of long labour, c section, birth injuries during delivery and still birth. The baby produces more insulin and can have low glucose levels after birth. Future risk to the baby include obesity and diabetes.

TREATMENT
Once you are diagnosed diabetic during pregnancy, the treatment involves 3 steps:
1. Referral to a Dietitian : Diet should reduce your blood sugar levels and it should give you the calories required for pregnancy
2. Medications : Medications are started if diet does not lower blood sugar levels within 2 weeks. Medications safe in pregnancy are metformin and insulin.
3. Exercise : It also helps lower blood sugar level.

 

MONITORING SUGAR LEVELS
1. You will have follow up visits every 2 weeks
2. You will be instructed how to monitor your blood sugar levels at home at least twice during the week
3. Aim of treatment is to maintain blood sugar level within normal range (fasting less than 90mg and post meals more than 1 hour = 140 mg / dl)

PLAN AFTER DELIVERY
1. Your baby growth will be monitored by Ultra sound
2. Increased fluid and large baby are signs of poor sugar control
3. If sugar levels are well controlled labour will be induced between 39 – 40 weeks.
4. If sugar control is poor baby is large and water around baby is increased. Labour will be induced soon after 38 weeks.
5. Normal delivery is possible if baby weight is average.
6. Large baby is many to be delivered by c section.
7. After deliver the baby’s blood sugar will be checked as it can be low.
8. Your diabetes medications may be stopped after checking your blood sugar levels.
9. You should check your fasting blood sugar 6 weeks after delivery.
10. Life style modification in the form of diet and exercise can postpone development of overt diabetes later in life.

ANAESTHESIA – AWARENESS ABOUT “NO AWARENESS”

anaesthetist

A visit to the doctor confirms your worst fear: SURGERY. Suddenly you cease to think about the disease that is plaguing your body and it all becomes about the upcoming and seriously daunting surgery. You get anxious and scared and seek people who can answer some questions that are running through your mind. Will I be seeing the surgery? Will I wake up of the Anaesthesia? When will I wake up? What if I wake up in the middle of the surgery? Will there be pain? If yes, how much pain? What can be done to have no pain during and after surgery? What will happen if the said surgery doesn’t go well, or as predicted? Will I come out of the surgery alive? But often these questions are not directed to the right person who can give us the right information. Have you ever consulted an Anaesthetist before you go to the operation theatre for the surgery and have your queries been addressed to? After practicing Anaesthesia for close to a decade now, I have realized that most patients go into surgery scared and with many of these questions still unanswered. Let me try to solve this mystery for you by answering some of the frequent questions that plague a person’s mind before surgery:

 1. What is Anaesthesia? Anaesthesia literally means insensitivity to pain temporarily induced by drugs. It is a speciality of medicine which deals with temporary induced state with one or more of the following: Analgesia (relief from or prevention of pain), Amnesia (loss of memory), Paralysis (extreme muscle relaxation) and/or Unconsciousness. It is a temporary state where you are completely unaware of the surroundings controlled by various drugs given to you by a qualified Anaesthetist, who also take care of your vitals (heart beat, blood pressure, oxygen concentration, temperature, respiration or breathing and status of other organs like kidney, liver, etc.) while you are unaware of these experiences. Anaesthesia is science being researched and developed by medical science and is an important aspect of a successful surgery today.
2. Who is an Anaesthetist or Anaesthesiologist? An Anaesthetist (or Anaesthesiologist) is a highly trained specialist in the subject, (who has done specialisation/post graduation in Anaesthesia for 3 years, after 5 and half years of graduation i.e. M.B.B.S.), who makes all the decisions during surgery. She/he is responsible for the administration of anaesthesia and patients well being while under anesthesia and also the immediate post-operative care. Anaesthetists play a vital role in various areas of healthcare and hospitals these days. They are your perioperative physicians who take care of your illnesses prior to the surgery and also after the surgery. Anaesthetists are a vital team member of the Intensive care units or the critical care units. Some Anaesthetists also run pain clinics to take care of your long standing pain. Anaesthetists also take up the role of emergency physicians in trauma care and acute pain management. Anaesthetists are also key member of the hospital administration and management who can connect all the departments with ease.
3. What are the side effects of the anaesthesia that will be given to me? The medications given to you during anaesthesia are chosen as per your physical condition, and your pre-existing ailments. These medications are used in combination and the dosages are well calculated before administration and are associated with very minimal or negligible side effects. However, in some patients may experience reactions to the medications given, in the event of which the Anaesthetist will address to it immediately.
4. Does the Anaesthetist makes patients sleep during surgery and leaves the theatre? An Anaesthetist makes you sleep, takes care of your vitals throughout the surgery, awakens you, accompanies you to the recovery ward and takes care of you in the immediate postoperative period. She/he is mandatorily required to be present with the patient from the time the patient enters the operating room till the time the patient reaches the recovery room.
5. I am afraid of being in the operation theatre. Can you make me sleep before going in to the operation theatre? All patients are anaesthetised only after attachment of the standard monitoring and after securing an intravenous access. But for patients who are over anxious of the theatre they may be given some sedative or anti-anxiety medication in the preoperative ward, before going into the theatre. Usually your anaesthetist prescribes you some medications to be given in the ward which also helps you relieve anxiety and when you come to the theatre you might be in a light sleep.
6. I fear the needles. Is there any other way of making me sleep? Usually the anaesthetic medications are given to you through an intravenous cannula, secured in a vein in one of your hands which needs just one needle prick. It is mandatory for administration of anaesthesia. In children, they are either sedated with gases or an intramuscular injection and then intravenous access is secured. Same can be done for adults who have severe phobia for needle prick, as a special case.
7. Will I be seeing the surgery? Usually you will be completely unaware of the surgery; that means you will be under anaesthesia. In some cases where only part of your body is anaesthetised, either your lower half of the body or your any of your limbs, you may opt to see the surgery. Certain centres also record the surgeries to be seen later.
8. Will I wake up of the Anaesthesia? When will I wake up? Will I come out alive after the surgery? With the advancement of this medical speciality there are various medications whose combination is used for administration of safe anaesthesia and patients can be awakened within minutes of completion of the surgery. You will awaken, and very much alive, immediately after the surgery.
9. What if I wake up in the middle of the surgery? The Anaesthetised patient is closely monitored by the Anaesthetist who makes sure you don’t awaken in between surgery. The depth of anaesthesia can be well maintained safely with the advanced drugs available these days. Despite all the efforts, in certain cases where due to some genetic illnesses some patients awaken in between there is a very low chance of them knowing or remembering the said instance.
10. Will there be pain? If yes, how much pain? The patient undergoing anaesthesia is given Analgesia (pain killer) prior to the surgery and maintained throughout the surgery. You might wake up with a little burning sensation in the operated site but usually there is no pain or very minimal pain of the surgery for which your Anaesthetist will give you pain medication in the recovery ward. . Along with that, there are various techniques to block the pain mechanism of the surgery site which are done. This technique is also called Regional Anaesthesia. These injections are usually given while you are still asleep and when you awaken you are pain free.
11. What will happen if the said surgery doesn’t go well, or as predicted? Anaesthetists take all precautions for conduct of safe surgery. Despite all the efforts some patients might have complications during or after the surgery. All patients are monitored for such scenarios. Any patient who encounters such complication is taken to the intensive care units (I.C.U.) or critical care units for observation and further management.
12. What are the various Anaesthetic options I have? Anesthesia is broadly divided into General anaesthesia and Regional Anaesthesia. General anaesthesia is the one where you are completely unconscious and unaware of the surgery. Regional anaesthesia is again divided in various forms where a part of your body is anaesthetised during the surgery and can be combined with some sedation or even general anaesthesia. Spinal or epidural anaesthesia is one where lower half of your body is anaesthetised. Local anaesthesia is done in superficial surgeries where only the surgical part in anaesthetised. Nerve blocks are done, where the nerves supplying the surgical area are selectively anaesthetised and you feel no pain during the surgery and these can also be used for postoperative pain management. These are also combined in a surgery for better comfort and outcome.
13. I have heard from my relatives that Spinal anaesthesia causes backache. Is it true? Backache is predominant in mankind as a punishment for our standing posture. In pregnancy because of poor back care patients experience backache. Rather these days various types of epidural medications and treatment are given for various types of backache. In pregnancy the back pain is due to inadequate exercise, and back care. The spinal anaesthesia is safer option for you and your baby during a caesarean section (unless contraindicated for some coexisting illness). These days epidural Anaesthesia is being given for painless normal deliveries, which are also safe for you and your baby.
14. Minor surgery involves no risk. Is it true? The severity of surgery is not the only factor that determines the risk involved. Your coexisting diseases also play a major factor in risk assessment. For example – a patient with severe cardiac problem is very high risk for surgery even for a small biopsy.
15. The risk involved is due to Anaesthesia. Is this true? Some patients think that the risk involved in a surgery is only due to Anaesthesia, which is not true. The anaesthetists are well trained to administer you anaesthesia with your coexisting diseases safely, it is rather the stress of surgery (especially without anaesthesia) that is more risky than undergoing surgery under anaesthesia. The anaesthetists just want to correct the coexisting problems as much as possible and then take you for surgery so that the surgery is done more safely, medically optimise your health condition prior to surgery.

anaesthesia

Safe and successful surgery is a result of many factors involved in surgery including a good and responsible anaesthetist. It is very important to meet your Anaesthetist before any surgery, as your Anaesthetist evaluates your health status, your coexisting illness or diseases, status of your vital organs like the heart, kidneys, liver, etc and co-relates with the surgery involved and accordingly decides the Anaesthesia best for your surgery in your own health condition. This is also the best time to ask the questions you want to ask your Anaesthetist about the unawareness and postoperative care.

Autism or Autism Spectrum Disorder (ASD)

What Is Autism or Autism Spectrum Disorder (ASD)?
Autism spectrum disorder (ASD) and autism are both general terms for a group of complex disorders of brain development. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors.
ASD can be associated with intellectual disability, difficulties in motor coordination and attention and physical health issues such as sleep and gastrointestinal disturbances. Some persons with ASD excel in visual skills, music, math and art.

Autism-02
How Common Is Autism?
An estimated 1 out of 42 boys and 1 in 189 girls are diagnosed with autism in the United States.
What Causes Autism?
First and foremost, there is no one cause of autism just as there is no one type of autism. Over the last five years, scientists have identified a number of rare gene changes, or mutations, associated with autism. A small number of these are sufficient to cause autism by them. Most cases of autism, however, appear to be caused by a combination of autism risk genes and environmental factors influencing early brain development.
A growing body of research suggests that a woman can reduce her risk of having a child with autism by taking prenatal vitamins containing folic acid and/or eating a diet rich in folic acid (at least 600 mcg a day) during the months before and after conception.
What Does It Mean to Be “On the Spectrum”?
Each individual with autism is unique. Many of those on the autism spectrum have exceptional abilities in visual skills, music and academic skills. About 40 percent have average to above average intellectual abilities. Indeed, many persons on the spectrum take deserved pride in their distinctive abilities and “atypical” ways of viewing the world. Others with autism have significant disability and are unable to live independently. About 25 percent of individuals with ASD are nonverbal but can learn to communicate using other means. Autism Speaks’ mission is to improve the lives of all those on the autism spectrum. For some, this means the development and delivery of more effective treatments that can address significant challenges in communication and physical health. For others, it means increasing acceptance, respect and support.

Did you know …
• Autism now affects 1 in 68 children and 1 in 42 boys
• Autism prevalence figures are growing
• Autism is one of the fastest-growing developmental disorders in the U.S.
• Autism costs a family $60,000 a year on average
• Boys are nearly five times more likely than girls to have autism
• There is no medical detection or cure for autism

 
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