Sunday, 16 February 2014

Article Glaucoma (Kala-Motia)

Glaucoma is called’s “Silent Thif” as it steals the patient’s vision without his her awareness.
Glaucoma is an eye disease in which intraocular pressure (IOP) of the eye in either raised or normal with optic nerve head damage and visual field loss.
Glaucoma is the second most common case of blindness in elderly age group, second only to cataract which of course when operated leads to total recovery of vision whereas glaucoma can cause permanent visual loss if not diagnosed and treated early.
Glaucoma is mainly of two types Primary open angle (POAG) and primary angle closure glaucoma (PACG).
POAG is more common in older age group, unlikely before 40 year of age. It’s more severe in black race than white. First degree relatives of patient’s with POAG are at increased risk of developing the disease. Diabetes mellitus and Myopia are also the risk factors in developing POAG.
Primary angle closure glaucoma (PACG) occurs more in middle aged woman than men (4:1ratio) particularly those with farsightedness (Hypermetropia) south-east Asians and Chinese population are at increased risk of developing PACG. Indians have 50% incidence of developing both POAG and PACG.
Treatment of glaucoma is with medical therapy, Laser therapy and if needed surgical intervention.
As it’s rightly said “Prevention is better than cure” awareness of this blinding disease in essential. Everyone above the age of 40 years should get a thorough eye check up from a glaucoma specialist. First degree relatives of glaucoma patient and those with refractive errors like myopia and hypermetropia and diesses like diabetes mellitus and heart disease should be more particular.
All optometrists who prescribe glasses to the patients should make it a point to advice those above 40 years age to get their IOP checked at regular intervals.

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Knee arthritis – What to do ?

Wednesday, 12 February 2014

 Osteoarthritis is a crippling disease which involves degeneration of the cartilage and usually affects the knee and the hip joints. With advancing disease, the functional limitations start to set in with increasing difficulty in day to day activities.
A few decades ago, this was tackled mainly by pain medications and non-surgical intervention was the accepted treatment modality in major parts of the world leading to pain and suffering for millions of elderly throughout the world. However With the advent of total knee arthroplasty and the ever improving design and technical improvements, a sigh of relief has been provided to those who were unable to cope up with their daily activities due to pain and deformity of their knee joints.
Knee replacement surgery, also known as knee arthroplasty, is regarded as a modern surgical procedure that can accurately be described as "knee resurfacing". This procedure entails restoring the weight bearing portion of the knee joint that is damaged, worn out, or diseased to relieve pain and movement disability. It is performed through the implant of an orthopedic metal and polyethylene component shaped as a joint so that the knee can move properly.
Arthroplasty is a field of medicine which deals with the surgical reconstruction and total replacement of degenerated joints. Arthroplasty uses artificial body parts (prosthetics). Arthroplasty literally means "the surgical repair of a joint".
When the articular cartilage of the knee becomes damaged or worn out, it becomes painful - the patient finds it extremely hard to move the knee. The bones, rather than sliding over each other with the minimum of friction, rub and crush together.If an artificial prosthesis is surgically implanted, the patient will feel much less pain, possibly none, and his knee will move properly.
Replacement surgery in a damaged knee joint by placing an artificial prosthesis will alleviate pain and help better movement of the knee.Today, every year, millions of knee replacement surgeries are carried out throughout the world. Most patients are seniors - aged over 55 years.
For most patients, a replacement knee surgical procedure will last for at least 15 to 20 years, especially if cared for properly and not put under too much strain. More than 90% of people who have total knee replacement surgery experience a dramatic decrease in knee pain and a significant improvement in their ability to perform common activities of daily living.

Reasons to perform knee replacement surgery

Today, a knee replacement surgery is considered a routine operation. Below are the three most common reasons for the procedure:
  • Osteoarthritis- This type of arthritis is age related - caused by the normal long wear and tear of the knee joint.
  • Rheumatoid arthritis- also called inflammatory arthritis, occurs when the membrane surrounding the knee joint is inflamed and thick.
  • Post-traumatic arthritis- this type of arthritis is due to a severe knee injury. When the bones around the knee break or the ligaments tear, this will affect the knee cartilage
  • When is knee replacement surgery recommended?

    Knee surgery is recommended for older people, although adults or teenagers of any age can be candidates for the procedure, since they are physically active and will more rapidly wear the joint out. The weight, gender, or age of the person is never a factor when considering knee replacement surgery. Whether or not to perform surgery is nearly always based on the severity of pain and degree of disability of the patient.
    If should be noted that knee replacement surgery that occurs earlier in life usually means further surgery later on. However, several studies have proven that knee replacement surgery performed before severe stiffness and pain set in is associated with better outcomes.
    When considering the option of knee replacement surgery, doctors take into account a number of symptoms:
    • Severe knee pain or stiffness.
    • Moderate but continuous knee pain.
    • Chronic knee inflammation and swelling.
    • Knee deformity.
    • Nothing else worked.
    • Preparing for a knee replacement surgery procedure

      The preparations for a knee replacement surgery are started way before the actual day of surgery. The blood investigations and urine examination is done to rule out any possible source of infection, which if present is a contraindication to surgery. The patient is kept fasting overnight before the day of surgery and the procedure is carried out under spinal anesthesia. The procedure lasts for about 30 to 45 minutes.
      The patient is mobilized the same day and weightbearing is started by next day. The patient is made to walk with support by next day and after stitch removal at 10-12 days weight bearing without supports can be done. The patient is usually discharged in 3 to 4 days.

      What are the risks of surgery?

      Experts say that total knee replacements have extremely low complication rates - and occur in fewer than 2% of patients. Complications may include stroke, DVT (deep vein thrombosis), infection in the knee joint, or heart attack. Nerve damage occurs in 1 to 2% of patients.
      Persistent pain or stiffness occurs in 8-23% of patients.About 1 in every 50 patients will experience prosthesis failure within five years of their operation.

      Recent Advances in Total Knee Replacement -

      • Mini-incision surgery (MIS) - Still considered a new surgical technique, the difference is that the orthopedic surgeon performs a very small cut in front of the knee rather than the standard large opening. New specialized instruments are inserted in the small opening to maneuver around the tissue rather than cutting through it. Since the procedure is less harmful to the joint, the recovery time is much quicker and less painful.
      • Image-guided surgery - Although considered as a very accurate alternative in positioning the new knee joint, it is still not a common surgery. As a matter of fact, only 1% of all operations are done through image-guided surgery.
      • Autologous chondrocyte implantation (ACI) - This procedure is when new cartilage from the patient´s own cells matures artificially in a test tube and is later introduced into the damaged area. It is a common procedure used when the patient has injured his knee in an accident. A more common procedure for patients with accidental injuries, rather than those with arthritis.
      • Custom knee Replacement Surgery -

        It is the most recent development in this fiend where CT Scan of the patient’s knee is taken and custom pre-operative alignment blocks are made , as shown in below diagram.
        Since the knee is accustomed to the patient’s knee , it provides an exact fit for each patient undergoing surgery . It also lowers the operative time and number of steps involved in the surgery.
        Pre – Operative Post Operative
        Steps involvedin a custom Total Knee Replacement Surgery
        Thus this technique allows improvements in speed, cost,access, reach and flexibility which benefits both the surgeon and the patient.

        Summary and Conclusion: -

        Pain and suffering from osteoarthritis are soon going to be a thing of the past and elderly can achieve a near normal life, made possible with increasingly affordable surgery and improving designs and new innovations.

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Knee Osteoarthritis

Osteoarthritis (OA) of knee is one of the most common forms of arthritis. It is a chronic condition in which the material that cushions the joints, called cartilage, breaks down. Osteoarthritis may be initiated by multiple factors, including genetic, metabolic and traumatic, they involve all of the tissues of the joint.

Clinical osteoarthritis is characterized by joint pain, tenderness, limitation of movement, crepitus, occasional effusion and variable degrees of inflammation. Most physicians diagnose knee osteoarthritis not only by the symptoms, but by the radiological findings.

Although osteoarthritis (or OA) is more common as we age, it is not an inevitable part of aging. As we work to understand causes of osteoarthritis, we are able to offer advice to help prevent the disease or its progression and lessen its impact on your life. Here are four steps you can take now to prevent osteoarthritis or its progression.

First step is to control weight-If you are at a healthy weight, maintaining that weight may be the most important thing you can do to prevent osteoarthritis. If you are overweight, losing weight may be your best hedge against the disease. Being overweight strains the joints, particularly those that bear the body's weight such as the knees, hips, and joints of the feet, causing the cartilage to wear away. Continue reading below... Weight loss of at least 5% of body weight may decrease stress on the knees, hips, and lower back If you already have osteoarthritis, losing weight may help improve symptoms.

Second Step is Exercise- If the muscles that run along the front of the thigh are weak than you have an increased risk of painful knee osteoarthritis. Fortunately, even relatively minor increases in the strength of these muscles, the quadriceps, can reduce the risk.

If fear of joint pain after exercise keeps you from exercising, try using heat and cold on painful joints or take pain relievers, which may make it easier to exercise and stay active. The safest exercises are those that place the least body weight on the joints, such as bicycling, swimming, and other water exercise.

Third step is Avoid injury to joint or get treated - Suffering a joint injury when you are young predisposes you to osteoarthritis in the same joint when you are older. Injuring a joint as an adult may put the joint at even greater risk. People who injured their knee as an adult had a five times greater risk of osteoarthritis in the joint.

Fourth Step is to Eat Right- Although no specific diet has been shown to prevent osteoarthritis, certain nutrients have been associated with a reduced risk of the disease or its severity. They include:

Omega-3 fatty acids. These healthy fats reduce joint inflammation, while unhealthy fats can increase it. Good sources of omega-3 fatty acids include fish oil and certain plant/nut oils, including walnut, canola, soybean, flaxseed/linseed, and olive.

Vitamin C. Good source of vitamin C in your diet by eating green peppers, citrus fruits and juices, strawberries, tomatoes, broccoli, turnip greens and other leafy greens, sweet and white potatoes, and cantaloupe.

Vitamin D. Sunlight is the good source of Vitamin D. You can also get more vitamin D in your diet by eating fatty fish such as salmon, mackerel, tuna, sardines, and herring; vitamin D-fortified milk and cereal; and eggs.

If you already have osteoarthritis, these same steps can be useful for reducing pain and other symptoms. In addition, there are many treatments. They range from over-the-counter pain relievers to injections of corticosteroids or Hyaluronic acid and, eventually, surgery to replace the painful, damaged joint.

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Allergic Rhinitis What is allergic rhinitis?

What is allergic rhinitis?

Allergic rhinitis is a reaction of the lining of the nose to particles in the air.

How does it occur?

Allergic rhinitis occurs when the nose and usually also the ears, eyes, sinuses, and throat come into contact with allergy causing substances. The allergy-causing substances are called allergens. The most common allergens are pollens, molds, dust, and animal dander. Some allergens are present only during certain seasons, for example, ragweed (genus Ambrosia) in the fall. The allergic reaction they cause is called seasonal allergic rhinitis or hay fever. Other allergens are present year-round, such as the mite’s in house dust. These allergens cause a type of rhinitis called perennial allergic rhinitis.
When the lining tissues of the nose and sinuses come into contact with allergens, chemical
called histamine is released from cells in the nose. Histamine causes the nose lining to swell,
itch, and make too much mucus.

What are the symptoms?

Common symptoms of allergic rhinitis are

  • Itchy, runny nose
  • Sneezing
  • Nasal and head congestion
  • Other possible symptoms include

  • Fatigue and lethargy
  • Itchy throat
  • Postnasal drainage
  • Itchy, watery eyes.
  • How is it diagnosed?

    Your health care provider will ask about your symptoms, medical history, and family history. He may swab the lining of your nose to obtain a sample of mucus. About 50% of people with allergies have cells in their mucus that indicate allergy. It may take some detective work to figure out exactly what you are allergic to. You may have tests for specific allergies. For most people the best tests are skin scratch or prick tests. For these tests your health care provider or an allergy specialist places tiny amounts of suspected allergens under your skin and looks for reactions. These allergy tests will identify which of many possible allergens are causing your symptoms. In some cases you may have blood tests to look for antibodies to suspected allergens. Allergy tests are expensive. Your health care provider will probably recommend that you try treating your symptoms with medicine first. If medicines do not control your symptoms, you may need allergy tests.

    How is it treated?

    • The first step is to try to avoid contact with the things you are allergic to. For example, using an air conditioner and special filters rather than an attic fan lessens the amount of pollen that gets into your home. Putting plastic covers on mattresses may help you avoid dust and mold. You may also cover pillows with plastic.
    • The second step is treatment with medicine.
    • Medications
      Antihistamines-stop the interaction between histamine and the receptors; block the action of histamine; usually taken as pills or syrup
      Decongestants-decrease congestion by constricting blood vessels, taken as pills or as a nasal spray; use of the nasal spray may lead to rebound congestion
      Mast cell inhibitors-nasal sprays that interfere with the chemical reactions leading to histamine release
      Topical corticosteroids-nasal sprays that decrease swelling in the nasal passages. There are several steroid nose sprays that can be used daily to treat or prevent symptoms. Depending on your other allergy symptoms, a nose spray may be the first and only medicine you need.
      Immunotherapy (Allergy Shots) and Sublingual Therapy
      If your symptoms are severe in spite of medicines, your health care provider may suggest allergy shots. With immunotherapy, very small amounts of allergens are injected over weeks, months, or even years. The goal is to make your body's immune system less sensitive to those allergens.
      There's another, similar type of treatment called sublingual immunotherapy. It involves placing small amounts of allergens under the tongue. This treatment is more popular in Europe. While it has shown to reduce symptoms in some studies, more research is needed.

How long will the effects last?

If you have had allergies since you were a child, you will probably have them the rest of your life. New allergies can develop any time, even if you have not had allergies before. Allergy symptoms depend not only on the season and weather but also on location. This means your allergies may wax and wane, depending on where you are living.

How can I help prevent allergic rhinitis?

There are no known ways to prevent the development of allergic rhinitis. Once allergies have developed, you can try to limit exposure to the things that cause them, for example, pollens or animals. In severe cases, you may need to move to another area, but you may develop allergies there as well. The following strategies may help prevent allergic rhinitis :

  • Stay inside during the morning hours when pollen counts are highest.
  • Avoid outside activities during the time of year when the trees, grasses, weeds, or molds are blooming.
  • Keep the windows of your house and car closed to keep pollen out.
  • Use an air conditioner to reduce indoor humidity and to prevent mold and mildew growth.
  • Clean your air conditioner's filters regularly.
  • Consider running an air purifier in your home, especially in your bedroom.
  • Use vacuum cleaners and air conditioners with high efficiency particulate air (HEPA) filter to trap allergens.
  • Decrease or avoid outdoor activities on hot summer days, when ozone levels may make your symptoms worse.
  • Cover pillows and mattresses with vinyl covers to reduce your exposure to dust mites.
  • Wash bedding weekly in very hot water.
  • Use fewer dust-collecting items, such as curtains, bed skirts, carpeting, and stuffed animals, especially in your bedroom.
  • If you can't avoid having a furry pet, vacuum frequently and keep your pet out of bedrooms and other rooms with carpets.
Proper treatment of allergy symptoms is the best way to prevent complications of allergic rhinitis, such as ear and sinus infections. If you are diagnosed with allergic rhinitis, follow your doctor's instructions.

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