Medgate today July-Aug, 2010 by Medgate Today Magazine

www.medgatetoday.com

Volume 1 Issue 2

July-August 2010

Medgate Today Survey on Gastroesophageal ReďŹ&#x201A;ux Disease in India Look Younger Lively Dr S G Parasramani Lilavati Hospital, Mumbai

ISO 9001:2008

A complete product range of privacy rail systems G-Rail privacy rail system is a strong, functional and fully reversible profile. Comprehensive range of accessories, rotating gliders with SS-hook.IV Hanger (telescopic), curtain holdback etc Synthetic wall and ceiling fittings allow privacy rail to comply with the European NEN-314 standard for special care rooms requiring anti-static facility.

A complete range of privacy curtains: Economical curtains range: WINDOW TECHS offer you the economical range of hospital cubical curtains that are safe, durable and last through out the lifetime. Trevira CS bioactive curtains range: Trevira CS curtains are so effective in resisting fire and bacteria that they can actually help to prevent fire and bacteria from spreading. This flame-resistance is inherent in the specially designed fibers and is therefore permanently effective. Shower curtains range: Shower curtain fabrics are self sanitizing and have fluid proof, flame resistant and non reactive properties that make it more durable and life long. Poly vinyl chloride & its substitutes are the most common methods used in manufacturing of shower curtain fabrics.

Manufactured in India by: WINDOW TECHS RZ-483 / 13A Tuglakabad Extn. New Delhi - 19 (INDIA) Phone No. +91-11-29992146, Telefax +91-11-29992147 E-mail: window_techs@yahoo.co.in, visit us at www.hospitalcurtains.in

Our Specialized state of the art centre is dedicated to the safe, effective and advanced treatment * An ISO 9001:2008 Certified Hospital * 24 Hours Emergency Facilities * ICU, ICCU with Ultra Modern Equipment

Department of Radiology Cardiology Gastroenterology

* Non Invasive Cardiac Lab For 24 Hours including Echocardiography TMT, PFT, HOLTER, AMBULATORY BP Monitoring E.C.G. * X-Ray, USG, Pathological Lab * 24 Hours Ready O.T With Ultra Modern Equipment * Free Ambulance with Ultra Modern Emergency Equipment * Heamo - Dialysis etc. * Round the clock medicine counter

Muzaffarpur Heart Hospital & Research Centre Pvt. Ltd. Bank Road, Muzaffarpur (Bihar)

Tel. 0621 - 2245478 (O), 0621 - 2243860 (H) Email: drajay111@yahoo.com

E D ITO R S P E A K

In this fast and modern life style, every body is busy with his own. They don’t have enough time to take proper food on time they eat burger, pizza or junk food to save time and less sleeping may causes acidity, heart burn & gastritis. If they make some changes to their diet like eating green chili in place of red chili, nonspicy and non oily food surely it will reduce gastritis. It would be easy to say that there is a reflux diet.Unfortunately; we all react differently to different foods. Following foods/drinks that commonly cause Acid reflux or heart burn. • • • • • •

Alcohol Smoking Red chili powder Tea Spicy food Beans

• • • •

Some pulses Cabbage Cauliﬂower Tomato in any form like ketchup, sauce or soup

Early to sleep and early to rise makes a man healthy wealthy and wise. Early rising will gives less gap between dinner and breakfast that will help to reduce acidity. Eat something on every 4 hours, avoid long sitting, walk bare footed on green grass in the morning and drink plenty of water that will help you to reduce acidity or heart burn. Any thoughts or question you may have mail us: info@medgatetoday.com

Dr. M A KAMAL Editor-in-chief

July – Aug 2010

C-278/3, A. F. Enclave Part IEnclave I , New Delhi +91-11-64562268 C-278/3, Ab AAbul bul Fazal Fazal Enclave Part Part-rIrI110025, ttII,II,New NewTel: Delhi-110025 Delhi-110025 25 25Ph: Ph:Mob: 011011-+91-9717085785 64562268 64562268

Contents

H E A LT H &

FITNESS

32 Fruit is the Most Important Food Drinking Milk May Boost Bene ts of a Workout kou ou ut

34 BEAUTY &

DOCTO R

COSMETIC

SPEAK

20 Q-switched Nd-Yag Laser to treat Dermatological conditions

28 All Femtosecond Refractive Surgery

Microfollicular hair transplant ant

Lasers in Benigh h Hypertrophy of Prostate

Volume 1പIssue 2

EDITOR Dr. M A Kamal EDITORIAL ADVISOR Dr. Ajay Kumar Dr. S L Shah Dr. Shakilur Rahman Dr. Piyush Pankaj

N EWS

U P D AT E At 60 – Vilas Panchal makes a new start – nds a permanent cure for his severe cervical spondylosis

CHIEF CORRESPONDENT S A Rizvi Dr. H N Sharma DESIGN & LAYOUT SPRING Design

Plastic lens may soon replace laser eye surgery

FDA Warns of Fracture Risk with Popular Heartburn Drugs

SALES & MARKETING Amjad Kamal Kashif Saigal Nitu Sinha Rahul Ranjan S Firoz SUBSCRIPTION & CIRCULATION Pallavi Gupta

D E N TA L

HYG I E N E Expert Orthodontic and Cosmetic Dentistry about Dental Disease and its Treatment Dental Pain

INDEX TO ADVERTISER Acuron ................................... 11

Care & Cure .......................... 47

Regd. Office: B 105, DDA FLATS, POCKET 11, JASOLA VIHAR, NEW DELHI-110025 Mob: +91 9289336800 E-mail: info@medgatetoday.com medgatetoday@gmail.com Visit us: www.medgatetoday.com

Corporate Gift ....................... 48

Circulation Office

Advance Health Care ............... 9 Apollo Dental ........................ 43

Mazaffarpur Dairy ................. 35

92/17, Zakir Nagar, Opp. New Friends Colony Okhla, New Delhi - 110025 Tel.: +91 11 26989438 Fax: +91 11 26982464 Mobile: +91 9289336800

Muzaffarpur Dental ............... 45

Kolkata Ofiice

Muzaffarpur Heart................... 1

74, 2nd Floor. Bentinck Street, Kolkata 700001 Mobile: +91 9088848636

Ranbaxy ................................. 17

Mumbai Ofiice

Suncie .................................... 54

7, Ground Floor, Aradhana CHS Ltd, Bal Samant Marg, Bandra (W), Mumbai 400050 Tel: +91 22 26452920

Edress Medical ....................... 53

I NTE RVI EW

38 How to maintain your heart healthy

PUBLISHED BY ADVANCE MEDIA GROUP

Technocare ............................. 49 Printed by B.B.Graphic Printer, E-49/8 (2nd. Floor), Okhla Industrial Area Phase-II, New Delhi-110020

N EWS

U P D AT E

IVF PREGNANCIES threatened by POLLUTANTS Rising pollution has become a huge concern for mankind. Fruitfulness remedial success rates are declined day by day in contaminated zones, according to the physician. The finding appeared from the main environmental study of its class. And it can help drugs enhance women's prospect to be pregnant. The most injurious pollutants are contributed by energy stations burning fossil-fuel and from diesel engine. This contamination of a gas called nitrogen dioxide, which has harmful to the female reproduction organ. It causes difficulty which stops an egg from fertilizing inside the mother womb. Approximately 7,000

Paracetamol can cause asthma Paracetamol is very common drug used in every household for many years. It is mainly used to control high fever. But now the scenario has changed. It is found from a study that the medicine Paracetamol can be a cause of asthma later. It may decrease tenderness and body heat within few minutes. But the unfavorable effect may be elevated day by day. A study done by Chest research foundation has stated the assumption. This experiment is about to be revealed at European Respiratory Society Congress. Whole effort of Dr. Rahul Kodgule and Dr Bill Brashier did an experiment called impulse oscillometry. The experiment shows that paracetamol amplifies congestion in trachea and causing gentle asthma in lungs. The experiment was done on 20 people and after the treatment of paracetamol drug 15 out of 20 test patients developed gentle asthma. It is a key factor to worry that every other home is giving their children a dosage of paracetamol when they suffer from fever worldwide. This is the reason why asthma is developed from babyhood. 6

women of child-bearing age joined in a long project of seven-year headed by physicians from Penn State College of Medicine. They gathered pollution figures from the US Environmental Protection Agency. They expected the amount of contact of each woman with pollutant during IVF and fertility on a day by day. IVF occupies thorough observation of the patient. It can calculate precisely the consequence of contact to pollutants on treatment and subsequent pregnancies. However, now the physicians have to understand that technology is liable for the contamination and the entire motherhood is suffering.

At 60 – Vilas Panchal makes a new start – ﬁnds a permanent cure for his severe cervical spondylosis A team of neurosurgeons at Fortis Hospitals Mulund led by Dr. Deepu Banerji, Consultant Chief Neurosurgeon brings back 60 year old on his feet by treating severe cervical spondylosis myelopathy and offering him a permanent cure for life long. Mr. Vilas Panchal, 60, was suffering from neck pain for the last two years. Amidst his routine professional life and personal commitments Mr. Panchal kept ignoring his pain and eventually the pain spread from his spine to his upper extremities. Since December 2009, his symptoms progressed rapidly and he subsequently experienced difficulty in walking. By January 2010 end he was practically bed ridden, requiring two people to support him and help him do his daily chores. As his condition worsened day by day and was affecting his daily life his family decided to take a second opinion and that’s when they consulted Dr. Deepu Banerji at Fortis Hospitals. Upon consultation it was revealed that Mr. Panchal was suffering from an acute case of Cervical Spondylosis Myelopathy affecting cervical spinal cord level (vertebra). Doctor advised him to go for surgery in order to avoid further deterioration of his condition. July – Aug 2010

N EWS

U P D AT E

PLASTIC LENS may soon replace

LASER EYE SURGERY Scientists from Moorfields Eye Hospital in London have come up with a novel treatment to correct shortsightedness in people. According to the researchers, the new treatment changes the path of light entering the eye by using a synthetic lens inserted in front of the natural lens. Myopia or short-sightedness is a condition where the eye focuses images in front of the retina instead of directly on it. This means objects further away appear blurred. Experts have carried out a review to compare these phakic intraocular lenses with laser surgery. "Our findings suggest phakic IOLs are safer than excimer laser surgery for correcting moderate to high levels

July â&#x20AC;&#x201C; Aug 2010

of short-sightedness," dailymail. co. uk quoted lead author Allon Barsam as saying. "Although it's not currently standard clinical practice, it could be worth considering phakic IOL treatment over the more common laser surgery for patients with moderate short-sightedness," Barsam added. A year after surgery, the percentage of eyes with 20/20 vision without spectacles was the same for both procedures, but patients undergoing phakic IOL treatment had clearer spectacle corrected vision and better contrast sensitivity. (IANS)

N EWS

U P D AT E

FDA Warns of Fracture Risk with

POPULAR HEARTBURN DRUGS Blockbuster heartburn medications such as Prevacid, Prilosec and Nexium will now carry a warning on their labels linking the drugs to a heightened risk for fractures, the U.S. Food and Drug Administration announced. The label will advise consumers to use this class of medicines, called proton pump inhibitors (PPIs), carefully, because high doses have been associated with an increased risk of fractures of the hip, wrist and spine, the agency said. PPIs, which include prescription and over-the-counter drugs, work by blocking stomach acid from being produced. However, as with any drug, this benefit comes with some risk, the FDA said. "Epidemiology studies suggest a possible increased risk of bone fractures with the use of proton pump inhibitors for one year or longer, or at high doses," Dr. Joyce Korvick, deputy director for safety in FDA's Division of Gastroenterology Products, said in an agency statement. "Because these products are used by a great number of people, it's important for the public to be aware of this possible increased risk and, when prescribing proton pump inhibitors, health care professionals should consider whether a lower dose or shorter duration of therapy would adequately treat the patient's condition," she said.

Based on a review of the scientific evidence, the agency is instructing the makers of the drugs to change the labels for both the prescription and the over-the-counter versions of the proton pump inhibitors. The FDA based its decision on the results of seven studies, six of which noted a link between PPIs and fracture, primarily among users aged 50 and over. Proton pump inhibitors include the drugs Nexium (esomeprazole), dexlansoprazole (Dexilant), Prilosec/Zegerid (omeprazole), Prevacid (lansoprazole), Protonix (pantoprazole), and Aciphex (rabeprazole). These medicines are used to treat gastroesophageal reflux disease (GERD), stomach and small intestine ulcers, and inflammation of the esophagus. Over-the-counter versions of Prevacid, Prilosec and Zegerid also fall into this class of drugs. The FDA is advising consumers to not stop taking PPIs until you have consulted with your doctor. However, patients should be aware of the increased risk for fractures. The highest risk was seen in people taking higher doses of PPIs, or among those who took them for a year or more, the agency said. For people taking over-the-counter proton pump inhibitors, the FDA said they should only be taken for 14 days to help ease frequent heartburn. If heartburn continues, people should see their doctor. Under no circumstances should

over-the-counter PPIs be taken for more than three 14-day periods in a year, the agency said. Dr. Amar R. Deshpande, an assistant professor of gastroenterology at the University of Miami Miller School of Medicine, said the data behind the FDA decision "is not new." PPIs may disrupt the body's ability to absorb calcium, which, in turn, can increase the risk for fractures, Deshpande explained. He also believes that this class of drugs is overused and often taken by patients for too long. There's a need to "be judicious in general, irrespective of this data," Deshpande said. "With PPIs we should really have a targeted endpoint to come off these medications. There is more reason to do that now that we are seeing data that they can have potential side effects." It is probably also a good idea to shy away from high doses of the heartburn medications, unless absolutely necessary, he said. "Everything in medicine is a risk/benefit ratio," Deshpande said. "Patients need to talk to their doctor about what they are on the PPI for and look at the risk/benefit ratio and see if they should be on it indefinably or should be able to come off the PPI."

July â&#x20AC;&#x201C; Aug 2010

KNEE SUPPORT ANKLE SUPPORT VERICASE VEIN SUPPORT ADVANCE HEALTH CARE

Manufacturer of or tho and Rehabilitation Aids

C-162, Prem Nagar - II, Nangloi, Delhi - 110 041 Phone: 011-25180014 Mobile: 09968139239, 9310039239 Email: info@advancehealthcare.in Website: www.advancehealthcare.in

N EWS

U P D AT E

New Birth Control Pill Natazia Gets FDA Approval

The FDA says it has approved a new birth control pill called Natazia that is the first four-phase oral contraceptive to be marketed in the United States.

contraceptive as their method of contraception."

The pill, manufactured by Bayer HealthCare Pharmaceuticals of Wayne, N.J., contains two female hormones -- an estrogen called estradiol valerate and a progestin called dienogest.

Irregular bleeding is one of the most common side effects of Natazia.

Natazia already has been licensed in Europe under the brand name Qlaira.

The FDA says women older than 35 who smoke should not use Natazia, and cautioned that smoking cigarettes increases the risk of serious cardiovascular events for women using oral contraceptives. Birth control pills do not protect against sexually transmitted diseases, including HIV (the virus that causes AIDS).

The FDA says "four-phasic" means the pill delivers varying doses of the progestin and estrogen at four times throughout each 28-day treatment cycle.

The FDA says two studies of 1,867 women found Natazia effective.

Others include breast tenderness, headaches, nausea and vomiting, increased weight, and acne.

Birth control pills have been available for 50 years, but Bayer says Natazia is the first in a new class of oral contraceptives to deliver estradiol valerate, a synthetic estrogen. "We are very pleased that now women in the U.S. have the option to choose our new oral contraceptive Natazia as an effective option for the prevention of pregnancy," said Bayer's Phil Smits, MD, in Berlin. "We are also working with the FDA on an indication for menstrual bleeding disorders to offer women a tailored therapy for this debilitating condition." Natazia is expected to be available in the U.S. this summer, Bayer said in a news release issued at the parent company's main office in Berlin.

"Nearly 12 million women in the United States and more than 100 million women worldwide currently use oral contraceptives," Scott Monroe, MD, director of FDA's Division of Reproductive and Urologic Products, says in a news release. "The approval of Natazia provides another option for women who choose to use an oral

July â&#x20AC;&#x201C; Aug 2010

N EWS

U P D AT E

Lap band more effective than lifestyle measures in adolescents In teenagers with a BMI over 35, gastric lap banding helped almost all shed at least 50% of their excess weight, or an average of 35kg, an Australian trial shows.

with no perioperative adverse events than those in the intervention group, however; 8 reoperations were required among 7 of 24 patients who received surgery.

Led by Paul O'Brien, director of the Centre for Obesity Research and Education at Monash University, the study randomised 50 obese adolescents (14-18 years) to receive a laparoscopic banding device or enrol in a 6-week medically supervised weight loss program. Patients were then monitored at two years of follow-up.

The study authors noted in JAMA that although weight measures and health status did improve in both study groups, gastric banding was more effective in reducing obesity, the metabolic syndrome and improving insulin resistance.

Those who had laparoscopic banding achieved a mean weight loss of 34.6kg compared to 3kg in the intervention group. Patients who underwent surgery also had significantly improved hypertension, hyperlipidemia and insulin

resistance than those who did not have surgery. Of nine participants in the banding group and ten in the intervention group who had metabolic syndrome at baseline, no participants who underwent surgery had the disorder at 24 months compared with 22% in the intervention group. Patients who had gastric banding also had improved quality of life

However, an accompanying editorial noted that the adverse events in patients who received laparoscopic banding are “likely to be higher in actual community practice” because the researchers who led the study are “the most experienced group in the world with these operations”.

Norovirus testing may prevent cases of viral Gastroenteritis in infants and children Specialists are urging hospitals to use norovirus testing to prevent cases of viral gastroenteritis in infants and children. In their letter published in the MJA, researchers from Westmead’s Children’s Hospital in Sydney said rotavirus is recognised as the most important viral cause of gastroenteritis in young children. “But one difficulty in accurately documenting the role of norovirus in childhood acute diarrhoeal illness

has been the limited availability of routine diagnostic testing,” they said. Reviewing the frequency of norovirus detection, they followed 3,962 children with acute gastroenteritis for 12 months and found 122 patients had norovirus infection. Ninety-one children were admitted to hospital, of which 33% of cases were hospital-acquired. The researchers noted that their findings agreed with several other

studies which found norovirus caused 20-88% of viral gastroenteritis in children and is responsible for a “significant proportion of hospital admissions of children with gastroenteritis”. In conclusion, they recommended hospitals should use testing such as the enzyme-linked immunosorbent assay (ELISA) to “establish the incidence and prevalence of disease and to inform public health authorities responsible for infection control policy and practices”.

July – Aug 2010

Acidity? Relieving acidity was never so effective and complete... Incidence of acidity is on the rise these days due to changing lifestyles. With increased intake of fast food and other fatty or oily products, coupled with irregular eating routines and sleeping patterns, it is no wonder that almost all of us have experienced heartburn, gas, acid indigestion and other symptoms related with acidity. Also many of us suffer from acidity on a more regular basis which has become a constant nuisance in our lives. All this can even lead to more serious symptoms of GERD. GERD is Gastroesophageal Reflux Disease, a disorder in which there is recurrent return of stomach contents (Reflux) back into the esophagus, frequently causing heartburn, a symptom of irritation of the esophagus by stomach acid. This can lead to scarring and stricture of the esophagus, which can require

acidity once he stops taking these drugs. Therefore OTC antacids are preferable for people with mild to moderate symptoms of acidity, gas and reflux problems. Several OTC antacids available in the markets do have ingredients that counter acidity by neutralizing the extra acid but fail to target all other symptoms of acidity. The top selling antacid gels in India do not even address the issue of acid reflux. This results in incomplete relief and one is left with no choice but to go for drugs which can only be taken for short duration. But now Ranbaxy has introduced a complete antacid solution-Pepflux. RANBAXY'S PEPFLUX with a powerful 5-in-1 formula offers a safe alternative for a faster and longer relief from Acidity and all its symptoms like Acid Reflux, Gas, Acid Indigestion, Heartburn and Dyspepsia.

stretching. 10% of patients with GERD develop Barrett's esophagus which increases the risk of cancer of the esophagus. 80% of patients with GERD also develop a hiatal hernia. Acid reflux makes it difficult for us to concentrate on the job at hand and sleeping with this condition is nearly impossible. This is why acidity has emerged as one of the biggest daily health problems and needs effective and safe remedies to counter it. Increasingly people are using prescription drugs to counter acidity particularly for cases of acid reflux. Regular usage of these drugs is known to cause dependency which means that one suffers with increased frequency and intensity of

1. Pepflux has a unique ingredient (Alginic acid) that forms a raft or foam on top of stomach contents 5$)7 which prevents acid from moving up into food pipe as the foam forms a physical barrier against reflux. 2. At the same time, two fast and two long acting antacids neutralize the extra acid in the stomach and ensure that the relief is not just felt immediately but even lasts long. 3. Another ingredient is Simethicone which helps in removing gas to provide relief from stomach bloating and heaviness. With all these benefits Pepflux can be truly called India's only complete antacid and gas relief formula.

COVE R

STORY

July – Aug 2010

COVE R

STORY

July – Aug 2010

COVE R

STORY

Gastroenterology: Medgate Today Survey on Gastric/Heart burn/Acidity, peptic ulcer in India.

Common survey done by Medgate Today, online poll through website and survey conducted in various Hospitals. It is found that 60% people are suffering from heart burn, Gastric, peptic ulcer, gas, acidityand indigestion. Peptic ulcer is common among adults in modern society. The physical morbidity and economic in capacity associated with this disease justify continued interest in its epidemiology.

Studies from the west reveal that 5-10% of the adult population can expect to develop a peptic ulcer during their life time. Survey conducted in various hospital of Mumbai, Delhi, Kolkata, Bihar and Jharkhand. According to Medgate survey gastric or gastro-esophageal reflux disease depend upon life style, nature of work, not taking food on time and taking junk & oily food.

Regional Survey on Gastric, Peptic ulcer and Heart burn

Due to busy life style in Metro's and eating junk foods like vada pao,Burger etc are main cause of acidity and heart burn. Our survey shows in Bihar specially in north there is much gastroesophageal Reflux diseases.

July â&#x20AC;&#x201C; Aug 2010

3LQN LV LQFRPSOHWH

*UHHQ LV FRPSOHWH Presenting Ranbaxy Pepflux to provide complete relief from all acidity symptoms. Treating acidity won't be the same again anymore. Thanks to Pepflux, India's only complete antacid and gas relief formula. Its unique property of forming a raft on top of stomach contents prevents acid to enter food pipe, giving instant and complete relief from heartburn and acidity. The powerful combination of ingredients in its 5-in-1 formula provides you faster and longer relief from acidity and all its symptoms. So, next time acidity strikes.. choose Pepflux.

ACTION Aluminium hydroxide Slow acting antacid Magnesium hydroxide/ Fast acting antacid trisilicate Calcium carbonate Fast acting-longer duration antacid Sodium bicarbonate Fast acting antacid Activated dimethicone Anti-flatulent Alginic acid Anti-Reflux

Brand A Brand B PEPFLUX

l y India 's on

Completceid Anietfaf or mula &

Gas r el

t upaay

Acidity ka bes

For feedback and queries on PEPFLUX call: Dr. Deepti: 0124-4185828 email: deepti.dhodi@ranbaxy.com

COVE R

STORY Addiction of Alcohol, NSAIDS, Smoking and HP effects peptic ulcer

Profession nal sta atu tuss th hat at aff ffec ffec ects ctss Gasstrric and peptic ulce ulce ul cerr: r:

Hp pylori is one of the most common pathogens worldwide. Approximately 60% of the world population is infected by these bacteria which causes gastritis and peptic ulcer. Smoking, pain killer (NSAIDS)and consuming alcohol can also causes gastric and peptic ulcer.

July â&#x20AC;&#x201C; Aug 2010

92/17, Zakir Nagar, Opp. New Friends Colony, Okhla, New Delhi - 110025 Tel.: +91 11 26989438 Fax: +91 11 26982464 Mobile: +91 9289336800 Email: info@medgatetoday.com medgatetoday@gmail.com Website: www.medgatetoday.com

BEAUTY &

COSMETIC

July – Aug 2010

BEAUTY &

COSMETIC

Q-switched Nd-Yag

Laser to treat

Dermatological conditions Q -switched Nd-Yag laser is a versatile tool to treat hitherto untreatable skin conditions. We have been using this laser for last more than three years. It requires no consumables and is operator friendly. Laser details are as follows: 1064nm, Repetition rate 2Hz, 5 Hz or 10Hz, Spot sizes vary from 8mm, 6mm, 4mm and 3mm. The fluence can be adjusted from 1 joule/cm2 to 13 joule/ cm2. This machine also has a frequency doubled 532 nm laser.

Dr S G Parasramani Consultant Dermatologist Lilavati Hospital, Mumbai

A wide variety of benign pigmented conditions can be treated with laser. Birth marks such as Becker’s Nevus and Nevus of Ota which were difficult to treat can be treated with ease without surgery. Almost 80% clearance of pigment occurs. However Becker’s Nevus may sometimes recur but these can be retreated.. Nevomelanocytic Nevus (moles) both acquired and congenital ones can be very well treated with laser. Melasma a very difficult and recurrent hyperpigmented macular lesion occurring on face can be reduced with laser and its further progress can be reduced with use of sunscreens and pigment lightening agents. Hori’s nevus, Café au lait macules (CALM), Nevus Spilus Seborrheic Keratosis are also treated successfully with laser. Multiple freckles on face or elsewhere are managed

July – Aug 2010

well with laser. Post inflammatory hyperpigmentation following insect bites, drug reactions, superficial burns and any form of injury to skin can be reduced markedly with laser.

Different coloured Tattoos varying from green-black, red, yellow and blue can be treated with laser. Sometimes mild ghost image of tattoos following laser may remain and may a long time to disappear. Professional tattoos and fresh tattoos are difficult to treat. Tattoos having white pigment mixed with primary greenblack colour may become darker after laser. Tattoos used for cosmetic purposes contain brown pigment and these become darker or black after laser hence this must

According to oxford dictionary Rejuvenation means- To make someone look younger and or lively. We can strive to make a person look better than what he or she looks now by trying to reduce the blemishes on their face/ body. Age spots, melasma, seborrheic keratosis, dermatosis papulosa nigra, actinic keratosis, open pores, acne scars, freckles, fine lines, wrinkles,PIH, peri-orbital hyper pigmentation are skin conditions which make a person look older 21

BEAUTY &

COSMETIC

Medlite laser has offered a new possibility in treatment of facial pigmentation and toning of the skin. Long term maintenance and prevention of UV light exposure is the key to successful long term treatment be explained to the person seeking laser treatment. According to oxford dictionary Rejuvenation means- To make someone look younger and or lively. We can strive to make a person look better than what he or she looks now by trying to reduce the blemishes on their face/body. Age spots, melasma, seborrheic keratosis, dermatosis papulosa nigra, actinic keratosis, open pores, acne scars, freckles, fine lines, wrinkles,PIH, peri-orbital hyper pigmentation are skin conditions which make a person look older. The skin conditions in italic can be treated with laser. Skin resurfacing and rejuvenation can be done with Q-switched Nd-Yag laser. Nonablative laser toning wherein pore size is reduced, fine facial hairs removed, tightening of skin leading to

reduction of fine wrinkles and reduction of superficial pigmentation adding to glow on the skin is noticed following use of this laser. Laser light works by targeting certain chromophores in the skin these are melanin, haemoglobin, water and tattoo ink. When sufficient amount of laser light penetrates adequately into the skin it is converted into thermal energy and absorbed by the above mentioned chromophores. The target tissue containing these chromophores are destroyed. 1064 nm Q-Switched Nd-Yag laser is useful for treating Indian skin types as risk of epidermal injury and subsequent post inflammatory hyperpigmentation is minimized.

Laser therapy should be avoided in persons with keloidal tendency, those who have History of Koebners phenomenon having underlying skin disorders such as psoriasis, vitiligo or lichen planus. It should be deferred in presence of Infections both bacterial and viral. (ie. Impetigo, Herpes simplex). People who are on oral retinioids, anticoagulants and aspirin these drugs should be stopped before treatment with laser. Laser is contraindicated in pregnancy. Medlite laser has offered a new possibility in treatment of facial pigmentation and toning of the skin. Long term maintenance and prevention of UV light exposure is the key to successful long term treatment.

July â&#x20AC;&#x201C; Aug 2010

laser were never so effective Introducing cutis carâ&#x20AC;&#x2122;s state of the art Laser Unit

laser orks f or a better f eel

Acne Treatment Removal of moles, warts & skin tags Scar reduction Under eye dark circle treatment Stretch Marks Palmoplantar hyperhidrosis Phototherapy for vitiligo & psoriasis Hair removal Skin Pigmentation Facial Telenglectasia Wrinkle Reduction Skin Photorejucenation Leg Spider Veins Wrinkle and Age Sport

All treatments are availabe for men and women

CUTIS - CARE Dr. PI YUS H, M B B S, MD (SKIN) Jur an Chapra, Main R oad (Opposit Road No.3) Muzaff arpur (Bihar ) Contact: +91 97717649 19 (Dr.) +91 93088011 99 (Clinic)

BEAUTY &

COSMETIC

Microfollicular hair transplant H

air restoration has become one of the most popular techniques in male plastic surgery. The use of punch grafts was reported by Orentreich in the 1950s. However punch grafts were associated with a lot of unsatisfactory results because of the poor aesthetic results with the punches, which gave a " corn in a field" appearance. A new era began in 1986, when Dr Carlos Uebel in the state of Rio Grande do Sul (Brazil) started the use of microand minigraft "megasessions." It is considered a safe

July â&#x20AC;&#x201C; Aug 2010

BEAUTY &

COSMETIC procedure which, allied to a natural hairline, is today a much valued option for surgeons and patients. Unfortunately in India, we were late to embrace the technique of Microfollicular Hair Transplant. A number of Plastic Surgeon in India felt that Hair Transplant was a procedure not worthy of their interest; this led to a large number of unsatisfactory procedures by professionals of other medical specialities, and a bad image of Hair transplant in the mind of the Indian public. However we must remember that revisions to correct the poor results of previous surgery are possible.

Male pattern baldness (MPB) can start at the age of 16 years, caused by a coincidence of three main factors: hereditary, androgenic

July â&#x20AC;&#x201C; Aug 2010

hormone and age. In today's times, stress in the forms of smoking, late night jobs, long hours of work, irregular sleep cycles are contributing to the increased incidence in young men and women. Women are not immune from baldness, and indeed hair transplant is very successful in them also. In female patients hair fall appears more in the menopause period, but we also see androgenetic female baldness and thinning at earlier ages.

What is the Microfollicular Hair Transplant technique In this technique, a strip of hair bearing skin is taken from the back of the head (which is relatively unaffected by the male hormones which are responsible for hair loss). This strip is then processed in a way that single hair bearing units are taken out. These are known as micro-grafts. These micro-grafts are required to make the anterior hair line. Further 2-3 hair bearing units are isolated. Each such unit is known as mini-graft. This procedure can take 5-6 hours. When sufficient numbers of grafts are isolated, they are then implanted one by one into the area of baldness. The stick and place procedure is performed with a microsurgical blade, while the follicular unit insertion is done at the same time. This procedure can take 3-4 hours. Usually these two procedures run side by side, so the whole process can be expected to last 4-6 hours. Usually for the front of the head about 1000 hair follicle units are required. For a complete coverage, about 3000 units may be required. It is

preferable to make a second replacement after 8 months, when we can implant another quantity of grafts with success. Hair is like a plant - we need to keep a distance between each graft to enable each one to grow with better vitality. In the frontal hairline we insert only single hair irregularly. To achieve a greater density, repeat sessions may be required. The entire procedure is done under local anesthesia using a mixture of agents which are fast acting as well as have a prolonged duration of action. This allows a comfortable procedure, even while the patient is awake, and actively participates in the planning of the hair line. We have had patients driving back themselves to their homes after the procedure, of course with an attendant.

Hairline Design In young patients it is important to project the definitive frontal hairline.The frontal hairline is projected irregularly, maintaining the temporal recesses, and a non-straight line is important to achieve a natural and non-detectable result. The forehead middle point is normally 8 cm distant from the root of the nose varying from 7 to 9 cm depending on the facial structure.

Results The tiny hair that is transplanted in the graft normally falls out within the first few weeks. This is normal. The hair will then grow normally from the hair root and will be noticeable by approximately 3 months and carry on growing as fast and as long as your normal hair, usually about

BEAUTY &

COSMETIC

1cm a month. Some crusting will occur around the grafts. These must not be scratched as the grafts may be pulled out. These crusts will quickly dissolve once hair wetting is started.

Complications and how to avoid them Possible situations Prolonged pain in the back of the head and headaches This situation is easily avoidable. It occurs

commonly in procedures that are done by untrained surgeons and other surgeons who perform hair transplant, assuming that it is a simple procedure. The reason for this is that these surgeons raise the hair bearing strip in the sub galeal plane, since it is faster and blood less. What they forget is that this plane also damages the nerves and the vessels permanently. A nerve that is avulsed, never recovers, and develops a swollen end known as neuroma that is responsible for the jarring pain and irritable sensation that occurs chronically. It is advised that the strip be raised in the plane above galea, just 1 mm deep to the follicle roots. This clearly prevents damage to the nerves, and if done patiently, does not cause any bleeding and is reasonably fast. The surgeon only needs to be patient and know tissue handling.

each other Monocryl may be preferred to Vicryl for better tension control and less reaction

Scar on the back of the head

This situation is something that needs better surgical technique. The viability of hair follicles has to be maintained, cold saline should be used to maintain the hair follicles. The assistants should be carefully taught the procedures so that inadvertent hair root damage does not occur. It is important to not keep the hair roots exposed for too long outside the body. Use of fine instruments to make slits allows better density.

Usually the scar on the back of the head should be a pencil line thickness and well settled, and not red in colour. In some individuals there is a naturally tight scalp. Slight scar spreading does occur in them. But this should not be common. In most of the clients, the scar should be imperceptible. The trick is simply to do a 2 layered closure and the 2 edges should not be in tension. It is advisable to dissect the layers a bit so that they come closer to

Bleeding This should never be a problem. It is essential to use a tumescent anesthesia for infiltation. Inject Adrenaline in a concentration of 1:200,000, and wait for at least 7 minutes. Apply pressure on both sides of the strip and raise the strip in the proper plane. It hardly bleeds at all.

Infection This should be the rarest of clinical situations. If it does occur, it is prudent to question the sterilisation techniques used.

No hair growth or poor density

July â&#x20AC;&#x201C; Aug 2010

DOCTO R

SPEAK

All Femtosecond

Refractive Surgery F

emtosecond is an ultrafast laser generating pulses as short as one quadrillionth of a second (10-15). The world Femto came from Danish word for number 15. It uses infrared beam to separate tissues by photo disruption.

All Femtosecond Refractive Correction

Dr. Sharad Lakhotia President of Delhi Ophthalmological Society Lakhotia Eye Centre & laser Institute New Delhi

Femtosecond lenticule extraction or FLEx using Visumax (Carl Zeiss meditec, Jena Germany) have reported excellent results for total refractive correction. INTRACOR procedure also uses Femtosecond laser to interact with stroma to give vision correction.

Lenticular Extraction with Visu Max Femtosecond laser Dr. Walter Sekundo & Dr. Marcus Blum were first surgeon to perform this procedure in

August 2008. Over 1000 eyes have been operated till now at all centres including one at Baroda run by Dr. Rupal Shah besides 3 other international sites. In FILEx treatment, Femtosecond laser creates two cuts, a refractive and a nonrefractive as a single step. The first cut is made at the bottom of the refractive lenticle while the second one at its roof. Once the cuts are made, flap is lifted and refractive lenticule is removed. The flap is reposited in usual manner. It is important to make manipulation at correct plane between flap & lenticule and separate lenticule edge. The lenticule can be of different diameters from 6mm to 7.3 mm equivalent to optical zone of Eximer laser. The remaining stromal zone is usually 300 micron or more. Walter Sekundo reported good results in 6 months follow up. 9% gained 2 lines of visual acuity, 43% gained one line 39% remain unchanged and 7% lost one line visual acuity. 74% patients were 6/6 or better. Dr. Rupal Shah reported slow visual recovery at 1 week but changing

scanning pattern produced good results. While scanning in spirals, they used to cleave

July â&#x20AC;&#x201C; Aug 2010

DOCTO R

SPEAK

Journey from Flex to smile is easy and has advantage of small incision thus providing all Femtosecond laser solution to refractive problems. Initial results with hyperopia suggest FLEx can be a good option. There was some regression as with Eximer laser but data at 1 month interval was great. In hyperopia, the flap is just 0.5mm larger in diameter then the lenticule. The main point for consideration is that lenticule should not have sharp edge otherwise it will result in regression. So the main challenge is to find an optimal form for lenticule edge. posterior surface of the lenticule from centre to periphery. The flap was then cleaved from periphery to centre. The changed direction i.e. posterior surface of lenticule was separated by scanning from periphery to centre and anterior surface from centre to per ipher y. This led to dramatic improvement in visual recovery. 89% reached to pre operative BCVA after 1 week. With upgraded 500 Hz Visumax, 95% reached or improved to pre- operation BCVA level at 1 week. Some of the investigators are doing a modified version called small incision lenticular extraction or Smile. This technique makes the procedure less invasive where by the entire lenticule can be extracted through a small incision without lifting up the flap. Osama Ibrahim reported 90% of patients having better than 20/25 visual acuity after one month. He is of the opinion that results with this procedure are more stable than Lasik including high myopia patients. If the lenticule is dissected above than it is very easy to identify inferior surface by having enough resistance and empty spaces. Once dissected, it is very easy to lift flap by simple pull with forceps or spatula.

July – Aug 2010

Complication They were minimal. Mild transient haze like reaction and microstria were reported which cleared. There were some problems in separating the refractive lenticule in 2 cases of which one resolved after 6 months. However no patient showed signs of diffuse lamellar keratitis or transient light sensitivity syndrome.

Bene ts of Visumax System While designing Femtosecond laser a balance has to be kept between increasing pulse rate and focusing power & decreasing spot size & energy. The optics of Visu Max produce tightly focused beam with following effects. • The accuracy of pulse placement is optimized. • Tissue dissection is carried out with low energy. • Energy drop off from point of impact is steep thus causing less collateral tissue damage & hence faster recovery. Some Femtosecond lasers require scleral suction & flat applanation. High suction in such cases can cause discomfort & subconjunctival hemorrhages. In Visumax the rise is intraocular pressure is low enough for patients to see & does not discomfort the patient. A curved contact glass and corneal suction allows IOP below 90 or 100mg. In one study rise in IOP during flap creation was 84.9 ± 7.3mmHg for Visumax, 180.6 ± 21.6

mmHg for intralase and 150.9 ± 17.2 mmHg for LDV. Thus anxiety level of patient is less, patient can visualize fixation light and so better fixation is achieved during treatment. Flap centration on corneal vertex is well achieved as it was intended for FLEx procedure. The vertex of cornea fit well in to vertex of contact glass of Visu Max Femtosecond laser. The problem of opaque bubble layer is very thin as it dissipates very rapidly. Walter Sekundo considers this to be standard procedure with potential to revolutionize the course of refractive surgery.

INTRACOR procedure:- is an intrastromal procedure done on TECHNOLAS Femtosecond work station. It applies energy inside the cornea without bringing it to the surface. There is no incision of epi thelium, endothelium or Bowman’s or Descemet’s membrane and thus ensure better healing with minimal risk of infection. The pulses are placed on concentric intrastromal circles centered about visual axis and extended at least up to 100 microns from the surface. The concentric patterns of cut fibers shift the centre of cornea slightly anteriorly and create a hyperprolate shape. At present myopia up -3D and astigmatism up to 2D have been tried. However the results are not very accurate. Also its role in presbyopia has been emphasized as it causes a biomechanical change in cornea that shifts centre slightly forward creating a pattern of hypersphericity thus allowing some near vision while retaining distance vision. The surgeon can expand circle diameter or add radial intrastromal incision similar to those created in radial Keratotomy and is effective in biomechanically correcting small degree of myopia. INTRACOR brings hope for correcting presbyopia with low refractive errors by biomechanical methods. Thus Visumax Femtosecond has shown a great stride as an alternative as all Femtosecond laser option for all refractive errors with small incision lenticular extraction. 29

DOCTO R

SPEAK

Lasers in Benigh Hypertrophy of Prostate Dr. H S Bhatyal Dr. G S Kochhar Dr. S K Pal Lions Kidney Hospital & Urology Research Institure New Delhi

enign enlargement of the prostate gland is extremely common with increasing age and is responsible for urinary problems in the elderly. The incidence of BPH is at least 50 percent for all men at his age of 50 and rises to at least 80 percent of all men in their eighth decade of life. Of the approximately 100,000 surgical procedures performed each year for BPH, 90 percent are transurethral resection of the prostate gland, or TURP. For several decades now TURP has been the standard treatment for men with lower urinary tract symptoms secondary to BPH . TURP produces durable and reliable improvements in flow rates and subjective symptom. Despite its efficacy however, it is associated with a significant side-effect profile, including the need for blood transfusion, infections, strictures, sexual problems and incontinence. In

addition, men who undergo a TURP require on average two to three days of catheterizations and hospitalizations before undergoing a trial of void and discharge and remain at risk for further bleeding episodes for another 3 wks to 3 months. From the simple options of either a transurethral resection of prostate (TURP) or conservative management available some year ago we now have a plethora of modes of management of BPH including medical options. Laser (light amplification by stimulated emission of radiation) is one of the modalities being put to an extensive use nowadays for the management of BPH. The first visible light laser was produced from a synthetic ruby crystal in 1960 by T.H. Maimen. Persons

first used laser light in canine bladders in 1966. Laser for BPH was first used in 1990. Laser nowadays form an important part of the armamentarium of modern medical management. Advances in fiber optics and the development of thinner endoscopes have facilitated the use of lasers in narrow tubes of the urinary system.

Lasers in the management of BPH The inherent properties of Laser light and the ability to minimize bleeding during surgery prompted investigators to use lasers for treatment of BPH. The Neodymium : YAG (Nd : YAG) laser and the potassium titanyl phosphate (KTP) laser allowed for safe removal of small amount of prostatic tissue with little or no bleeding. Other complications are also minimized. The main tissue effects of laser on prostate are coagulation and vaporization. In coagulation the temperature reaches 100 degree C and the proteins are denatured with consequent necrosis. The necrotic tissue progressively sloughs resulting in debulking of the prostate. In vaporization the temperature reaches 300 degree C and tissue water vaporizes resulting in instantaneous debuling of the irradiated area.

July â&#x20AC;&#x201C; Aug 2010

DOCTO R

SPEAK

Nd : YAG laser was used most commonly for its coagulative effect. Segmental coagulation is achieved by aiming for the 12,3,6 and 9 Oâ&#x20AC;&#x2122;Clock position for varying periods of time. The post operative course may be complicated by irritative voiding symptoms. The Holmium : YAG (Ho : YAG) laser has been used to incise or enuleate prostate adenomas down to the capsule. It creates precise incisions, cuts by vaporizing tissue with adequate hemostasis and leaves minimal collateral damage. The advantages are minimal bleeding availability of a specimen for histologic examination, less post operative catheter time and ability to excise large adenomas. The disadvantages are greater training time and the need to morcellate or resect the prostate pieces in the bladder prior to removal. The KTP (Greenlight) laser is commonly used for its vaporizing effect on prostatic tissue. This procedure is associated with significantly less bleeding, markedly reduced fluid absorption and minimal catheterization time than standard TURP. This is a safe and effective treatment

July â&#x20AC;&#x201C; Aug 2010

option in seriously ill patients or for those receving anticoagulants. The drawbacks are the lack of tissue obtained for post operative pathological analysis.

Diode Laser There has been a recent upgrade of the technology allowing higher energy to

be delivered in a more focused fashion. The new 150 watt Diode laser, from Biolitec Company in Germany, has been recently acquired by Lions Kidney Hospital & Urology Research Institure in New Friends Colony, allows laser prostatectomy to be more precise with reduced treatment times. Its unique wave length of 980 nm is equally well absorbed in water and blood. It also allows cutting as well as vaporization of prostate tissue and simultaneously seals the blood vessels, resulting in a completely bloodless field. The net result is that even patients who are on blood thinners such as warfarin, aspirin, and clopidrogel can be safely treated whilst remaining on these medications. The long term efficacy of Diode laser prostatectomy in ameliorating the urinary symptoms and improving the flow rate is far superior to that of TURP. A technique of transurethral enucleation of prostate has been developed at the Lions Kidney Hospital. 31

H E A LT H &

FITNESS

FRUIT is the Most Important FOOD We all think eating fruits means just buying fruits, cutting it and just popping it into our mouths. It's not as easy as you think It's important to know how and when to eat. What is the correct way of eating fruits? It means not eating fruits after your meals! Fruits should be eaten on an empty stomach. If you eat fruit on an empty stomach, it will play a major role to detoxify your system, supplying you with a great deal of energy for weight loss and other life activities. 32

July â&#x20AC;&#x201C; Aug 2010

H E A LT H &

FITNESS

Let's say you eat two slices of bread and then a slice of fruit.. The slice of fruit is ready to go straight through the stomach into the intestines, but it is prevented from doing so. In the meantime the whole meal rots and ferments and turns to acid. The minute the fruit comes into contact with the food in the stomach and digestive juices, the entire mass of food begins to spoil. So please eat your fruits on an empty stomach or before your meals! You have heard people complaining - every time I eat water-melon I burp, when I eat durian (fruit from Asia with a foul smell yet delicious flavor) my stomach bloats up, when I eat a banana I feel like running to the toilet etc. - actually all this will not arise if you eat the fruit on an empty stomach. The fruit mixes with the putrefying other food and produces gas and hence you will bloat! Graying hair, balding, nervous outburst, and dark circles under the eyes - all these will not happen if you take fruits on an empty stomach. There is no such thing as some fruits, like orange and lemon are acidic, because all fruits become alkaline in our body, according to Dr. Herbert Shelton who did research on this matter. If you have mastered the correct way of eating fruits, you have the Secret of beauty, longevity, health, energy, happiness and normal weight. When you need to drink fruit juice - drink only fresh fruit juice, NOT from the cans.. Don't even drink juice that has been heated up. Don't eat cooked fruits because you don't get the nutrients at all. You only get to taste.

Cooking destroys all the vitamins. But eating a whole fruit is better than drinking the juice. If you should drink the juice, drink it mouthful by mouthful slowly, because you must let it mix with your saliva before swallowing it. You can go on a 3-day fruit fast to cleanse your body. Just eat fruits and drink fruit juice throughout the 3 days and you will be surprised when your friends tell you how radiant you look! July â&#x20AC;&#x201C; Aug 2010

Kiwi Tiny but mighty. This is a good source of potassium, magnesium, vitamin E & fiber. Its vitamin C content is twice that of an orange.

Apple An apple a day keeps the doctor away? Although an apple has a low vitamin C content, it has antioxidants & flavonoid which enhances the activity of vitamin C thereby helping to lower the risks of colon cancer, heart attack & stroke.

Strawberry Protective Fruit. Strawberries have the highest total antioxidant power among major fruits & protect the body from cancer-causing, blood vessel-clogging free radicals.

Orange Sweetest medicine, eating 2 to 4 oranges a day may help keep colds away, lower cholesterol, prevent & dissolve kidney stones as well as lessens the risk of colon cancer.

Watermelon Coolest thirst quencher. Composed of 92% water, it is also packed with a giant dose of glutathione, which helps boost our immune system. They are also a key source of lycopene - the cancer fighting oxidant. Other nutrients found in watermelon are vitamin C & Potassium.

Guava & Papaya Top awards for vitamin C. They are the clear winners for their high vitamin C content. Guava is also rich in fiber, which helps prevent constipation. Papaya is rich in carotene; this is good for your eyes. 33

H E A LT H &

FITNESS

Ginger eases Aches & Pains E

ating ginger can help ease muscle pain caused by heavy exercise, says a latest research.

Ginger root has been used as a household remedy since centuries for a variety of ailments, such as cough and colds and upset stomach, but now the study has revealed that ginger is particularly good for staving off muscle pain, reports dailymail. co. uk. Professor Patrick O'Connor, of the University of Georgia, who led the

research believes this remedy can be better than consuming painkiller drugs. "Anything that can truly relieve this type of pain will be greatly welcomed by the many people who are experiencing it," he said. The study showed daily ginger intake reduced the exercise-induced pain by 25 percent. It is known to contain chemicals that work in a similar way to nonsteroidal anti-inflammatory drugs, such as ibuprofen and aspirin. (IANS)

Drinking Milk May Boost Bene ts of a Workout W omen who do weight-lifting exercise routines may be better off drinking two large glasses of milk than sugar-based energy drinks after workout regimens, a new study shows.

McMaster University researchers in Canada report they found that women who drank two large glasses of milk after weight-lifting exercises gained more muscle and lost more fat than women who drank sugar-based energy drinks. The finding is published in the June issue of Medicine and Science in Sport and Exercise.

July â&#x20AC;&#x201C; Aug 2010

H E A LT H &

FITNESS

"Resistance training is not a typical choice of exercise for women, but the health benefits of resistance training are enormous," says Stuart M. Phillips, PhD, professor of kinesiology at McMaster University in Hamilton, Canada, in a news release. "It boosts strength, bone, muscular and metabolic health in a way that other types of exercise cannot." A previous study involving men showed that they gained muscle mass and lost fat after exercising and drinking milk. Phillips says he and his research team aren't sure what causes the result, but more study is being done. In a three-month period, researchers monitored young women who did not previously perform resistance-training exercises. Two hours before exercising each day, the women weren't allowed to eat and were only allowed to drink water.

push-downs; and leg exercises such as leg presses and hamstring curls. "We expected the gains in muscle mass to be greater, but the size of the fat loss surprised us," Phillips says in the news release. "We're still not sure what causes this but we're investigating that now. It could be the combination of calcium, high-quality protein, and vitamin D may be the key. And conveniently, all of these nutrients are in milk."

But after their routines, one group drank 500 milliliters, or about 17 ounces, of fatfree white milk. The comparison group drank a substance that looked similar, but was actually a sugar-based energy drink. An hour after exercising, the same drinks were drunk. Exercises included three different types: pushing exercises such as bench presses, pulling-down routines such as triceps

July â&#x20AC;&#x201C; Aug 2010

H E A LT H &

FITNESS

Drinking Milk and Exercise P

hillips says the women who drank milk barely gained any weight, because what they gained in lean muscle balanced out with the loss of fat. Thus, it seems that "simple things like regular weightlifting exercise and milk consumption work to substantially improve women's body composition and health." The participants were not accepted for the study if they had participated in any resistance training for the eight-month period prior to the study. However, the women were aerobically active. The researchers also excluded women who had consumed any dietary supplements, such as vitamins or minerals, in the previous eight months. Five women in each group were taking oral contraceptives.

Women drinking milk and exercising lost fat mass, while gaining lean mass and strength. Body mass increased in the control group, however. Upper-body strength gains were particularly noted. The researchers speculate a reason for greater strength gains may reflect "a greater potential for change in women because of their lower initial upper-body strength." Vitamin D consumption also appeared to be a factor, according to the researchers. While more research is needed, the researchers write that drinking milk seems to be good for women undergoing resistance-strength training, possibly strengthening their bones.

All of them were told to maintain their usual dietary patterns. Twice during the 12 weeks the women were summoned to the laboratory for a routine fasting blood sample, all of which were analyzed. All the young women were of similar height, age, and weight; compliance with the regimen was deemed excellent -- as were the results.

July â&#x20AC;&#x201C; Aug 2010

I NTE RVI EW

spoke to Dr.Ajay Kumar

How to maintain your

HEART HEALTHY

Dr. Ajay Kumar Consultant Cardiology and Cardio Thoracic Surgeon (Preventive Cardiology & Rehabilitation)

July â&#x20AC;&#x201C; Aug 2010

I NTE RVI EW

Dr Ajay please tell us about some simple steps to prevents heart disease and get away from cardiac arrest. There are many steps people can take to try to prevent heart disease. You can start by concentrating on key lifestyle areas such as eating, exercise, smoking and drinking, and considering other factors like family history, diabetes and stress. Here are few tips for a healthy heart Stop smoking. Quitting smoking is the single most important thing a person can do to live longer. If you are a smoker, you are twice more likely to have a heart attack than a non-smoker. But from the moment you stop smoking, the risk of heart attack starts to reduce. With public smoking bans recently introduced, there has never been a better time to give up. Cut down on salt. Too much salt can cause high blood pressure, which increases the risk of developing coronary heart disease. Avoid foods like crisps, salted nuts, canned and packet soups and sauces, baked beans and canned vegetables, pork pies, pizzas and ready meals. Many breakfast cereals and breads that appear healthy also contain high levels of salt, so o. keep your eye on these too. hy diet can help Watch your diet. A healthy oping heart to reduce the risk of developing disease, and can also help increase the chances of survival after a heart attack. You should try to have a balanced diet, containing plenty of fresh fruit and hy foods such vegetables, oily fish, starchy as wholegrain bread, pastaa and rice. Avoid foods like biscuits, cakes, ts that pastries and dairy products are high in saturated fats and sugar.

having a heart attack, so you should aim to limit your intake to one to two units a day. Get active.The heart is a muscle and it needs exercise to keep fit so that it can pump blood efficiently round your body with each heart beat. You should aim for 30 minutes of moderate intensity exercise a day. If this seems too daunting, start off gently and build up gradually. Keeping fit not only benefits your physical health - it improves your mental health and wellbeing too. Manage your weight. The number of people who are overweight in Britain is rising fast - already more than half of the adult population is overweight or obese. Carrying a lot of extra weight as fat can greatly affect your health and increases the risk of life-threatening conditions such as coronary heart disease and diabetes. If you are overweight or obese, start by making small, but healthy changes to what you eat, and try to become more active.

Get your blood pressure and cholesterol levels checked by your GP. The higher your blood pressure, the shorter your life expectancy. People with high blood pressure run a higher risk of having a stroke or a heart attack. High levels of cholesterol in the blood - produced by the liver from saturated fats - can lead to fatty deposits in your coronary arteries that increase your risk of coronary heart disease, stroke, and diseases that affect the circulation. You can help lower your cholesterol level by exercising and eating high-fibre foods such as porridge, beans, pulses, lentils, nuts, fruits and vegetables. Learn to manage your stress levels. If you find things are getting on top of you, you may fail to eat properly, smoke and drink too much and this may increase your risk of a heart attack. Check your family history . If a close relative is at risk of developing coronary heart disease from smoking, high blood pressure, high cholesterol, lack of physical activity, obesity and diabetes, then you could be at risk too. . Make sure you can recognise the early signs of coronary heart disease . Tightness or discomfort in the chest, neck, arm or stomach which comes on when you exert yourself but goes away with rest may be the first sign of angina, which can lead to a heart attack if left untreated.

Monitor your alcohol. Too much alcohol can damage the heart muscle, increase blood pressure and also lead to ng weight gain. Binge drinking will increase your risk of July â&#x20AC;&#x201C; Aug 2010

I NTE RVI EW

Heart attack What are the symptoms?

eeling a bad pain in your chest is the most common sign that you’re having a heart attack.

If you have severe chest pain and you’re not sure what is causing it, don’t waste time. Call your cardiac consultant. Acting quickly might save your life. Once you get to hospital, doctors can run tests and treat you straight away.

Warning signs of a heart attack Pain The pain of a heart attack can stop you in your tracks. It can feel as if someone has

tied a belt around your chest and is pulling it tighter and tighter until your breath is gone. People have described the pain as crushing, tightening, constricting and pressing. Your heart is a muscle and needs oxygen to keep working properly. During a heart attack, blood and oxygen can’t get through to your heart. This causes pain around it. You may have warning signs a few days before you have a heart attack. You may have chest pain that is uncomfortable but not severe. You may have a pain that feels like your chest is being crushed and you can’t get enough air. If you have a type of chest pain called angina, the pain might keep getting worse. Angina is usually caused by hardening of the arteries (atherosclerosis). It happens because your heart isn’t getting enough blood.

if you rest. It doesn’t disappear if you take painkillers or medicine prescribed for a type of chest pain called angina. The pain usually lasts half an hour or more.

If you think you’re having a heart attack, get help straight away . Don’t delay. Doctors call this kind of chest pain typical or classic. But for many people, heart attack pain is mild. Some people have no pain at all. If you’re a woman, are older or have diabetes, you’re less likely to have typical chest pain.

During a heart attack, you’ll usually have pain in the centre of your chest. It often spreads down one arm, usually the left. Sometimes the pain is in both arms. Sometimes it spreads up into your jaw. The pain doesn’t go away 40

July – Aug 2010

I NTE RVI EW

Heart attack What treatments work? A heart attack is serious. But if you get treatment quickly, you have a good chance of living through it. The first treatments you’re likely to have will help clear the blockage that is stopping blood getting through to your heart. They will also stop the pain and limit the damage caused by your heart attack. There are other treatments that can help with the pain and help your heart pump blood more easily. And there are treatments that can lower your chances of having another heart attack.

You can do a lot to help your heart recover By keeping healthy you can make it less likely that you’ll have another heart attack. You can ask your doctor about joining a cardiac rehabilitation programme to learn how to care for your heart and your health. Y You may have to take medicine for a long time after your heart attack. Don’t stop taking your medicine without talking to your doctor first. If side effects bother you, see your doctor as soon as you can. You may be able to take a different medicine or a different dose.

Key points about treating heart attacks

In hospital, two treatments can increase your chances of a good recovery. They are clot-busting (thrombolytic) drugs and an operation to open up blocked arteries. Both work well. Drugs called beta-blockers can reduce your risk of dying after a heart attack. They may also lower your chances of having another heart attack. After a heart attack, drugs called ACE inhibitors can help you live longer and may prevent another heart attack. You and your doctor can take steps to prevent another heart attack. For example, you will probably be given a drug called a statin before you leave hospital. Statins are drugs that are used to treat high cholesterol, but they can also help people who have had a heart attack.

Treatments for heart attacks We’ve weighed up the evidence about treating heart attacks and divided the treatments into categories. You can find out more about each treatment by clicking on the links.

Dr. Ajay Kumar Consultant Cardiology and Cardio Thoracic Surgeon (Preventive Cardiology & Rehabilitation)

• Aspirin: This is a drug that makes your blood less likely to clot. • Clot-busting (thrombolytic) drugs: These break up the blood clot that is stopping blood reaching your heart. Common clot-busting drugs (and their brand names) include alteplase (Actilyse), reteplase (Rapilysin), streptokinase (Streptase), and tenecteplase (Metalyse). • Beta-blockers: These are drugs that slow down your heartbeat. Common beta-blockers (and their brand names) include atenolol (Tenormin), metoprolol (Lopresor), propranolol (Inderal), and timolol (Betim). • ACE inhibitors: These are drugs that relieve the strain on your heart after a heart attack. Common ACE inhibitors (and their brand names) include captopril (Capoten), enalapril (Innovace), lisinopril (Zestril), and ramipril (Tritace). • An operation to widen blocked arteries: This is called coronary angioplasty. It widens a blocked artery in your heart.

For help in deciding which treatment is best for you, see .

Treatments that work

Treatments work best if you get them quickly. If you think you may be having a heart attack, call your doctor. W While you’re waiting for help, chew an aspirin. Aspirin can help you make it through your heart attack. But always call for help first, before looking for an aspirin. July – Aug 2010

D E N TA L

HYG I E N E

spoke to Dr.N K Singh

Expert Orthodontic and Cosmetic Dentistry about Dent Dental al Disease Disease and its Treatment Dr. N K Singh Director Apollo Dental clinic

What is root canal treatment? Root canal treatment (also called endodontics) is needed when the blood or nerve supply of the tooth (known as the pulp) is infected through decay or injury. You may not feel any pain in the early stages of the infection. In some cases, your tooth could darken in colour which may mean that the nerve of the tooth has died (or is dying). This would need root canal treatment.

No. A local anaesthetic is used and it should feel no different to having an ordinary filling done.

Why is root canal treatment needed?

Root canal treatment is a skilled and time-consuming procedure. Most courses of treatment will involve two or more visits to your dentist.

If the pulp becomes infected, the infection may spread through the root canal system of the tooth. This may eventually lead to an abscess. An abscess is an inflamed area in which pus collects and can cause swelling of the tissues around the tooth. The symptoms of an abscess can range from dull ache to severe pain and the tooth may be tender when you bite. If root canal treatment (RCT) is not carried out, the infection will spread and the tooth may need to be taken out. 42

Does it hurt?

What does it involve? The aim of the treatment is to remove all infection from the root canal. The root is then cleaned and filled to prevent any further infection.

At the first appointment, the infected pulp is removed. Any abscesses, which may be present, can also be drained at this time. The root canal is then cleaned and shaped ready for the filling. A temporary filling is put in and the tooth is left to settle. The tooth is checked at a later visit and when all the infection has cleared, the tooth is permanently filled. July â&#x20AC;&#x201C; Aug 2010

D E N TA L

HYG I E N E

What if it happens again?

the tooth with a crown to provide extra support and strength to the tooth.

Root canal treatment is usually very successful. However, if the infection comes back the treatment can be repeated.

Where can this treatment be carried out?

What if I don’t have the treatment?

What will my tooth look like after treatment? In the past, a root filled tooth would often darken after treatment. However, with modern techniques this does not usually happen. If there is any discolouration, there are several treatments available to restore the natural appearance.

The alternative is to have the tooth out. Once the pulp is destroyed, it can’t heal and it is not recommended to leave an infected tooth in the mouth. Although some people would prefer an extraction, it is usually best to keep as many natural teeth as possible.

Will the tooth be safe after treatment? Yes. However, as a dead tooth is more brittle, it may be necessary to restore

Root canal treatment is a routine dental procedure, which your dentist will be happy to do for you. However, sometimes your dentist may refer you to an Endodontist who is a specialist in this type of treatment.

What about aftercare? Root-treated teeth should be treated just the same as any other tooth. Remember to clean your teeth at least twice a day, preferably with a fluoride toothpaste. Cut down on sugary snacks, and keep them only to mealtimes if possible. See your dentist as often as they recommend for regular check-ups.

APOLLO DENTAL

Zila Parishad Market, Juran Chapra, Muzaffarpur (Bihar) Mobile: +91 9835049105

FAMOUS FOR WORLD CLASS TREATMENT Dr. N K Singh, BDS (Hons), MIDA Consultant Oral & Dental Surgeon

FACILITIES * RCT * Cleaning of teeth by ultra sonic scaller and gum treatment * Cosmetic filling * Removable & fix denture * Crown & bridge surgery * Treatment of discoloured & broken tooth * Surgical extraction of impected tooth, apicoectomy & other minor & major procedures * Mal position teeth treatment by fix orthodontic * Tooth implantation & transplantation * Vaneer & bleaching PATNA BRANCH Pushpanjali Complex, Boring Road, Patna (Bihar) Mobile: +91 9835490205 July – Aug 2010

D E N TA L

HYG I E N E

Dental Pain W

hen a patient complains of toothache, pain may be arising from a variety of different structures & may be classified as follows: • Pulpal pain • Perespical/pereradicular pain • Non-dental pain Dental pain can be very difficult to diagnose, & the clinician must first gather as much information a possible from the history, clinical & radiographic examinations & other special tests.

Although numerous classification of pulpal disease exist only a limited no. of clinical diagnostic situation require identification before effective treatment can be given.

Pulpal Pain:

Reversible Pulpitis:

The pulp may be subject to a wide variety of irrsults eg: bacterial, thermal, chemical, traumatic, the effects of which are cumulative and can ultimately lead to inflammation in the pulp (pulpitis) & pain. The dental pulp does not contain any proprioceptive nerve endings, :: a characteristic of pulpal pain is that the patient is unable to localize the affected tooth. The ability of pulp to recover from injury depends upon its blood supply not

Symptoms: Fleeting sensitivity/pain to hot, cold or sweet with immediate onset.Pain is usually sharp & may be difficult to locate .Quickly subsides after removal of stimulus.

the nerve supply, which must be borne in when vitality (Sensibility) testing is carried out. It is impossible to reliably achieve an accurate of the state of pulp on clinical grounds alone, the only 100% accurate method is histological section.

Sign: Exaggerated response to pulp testing. Carious cavity /leaking restoration. Rx: remove any carious present and place a sedative dressing eg(ZOE) or permanent restoration with suitable pulp protection.

Dr. Yunus Ansari BDS, New Delhi

Irreversible Pulpitis: Symptoms: Spontaneous pain which may last several hours, be worse at night, & is often pulsatile in nature. Pain is elicited by hot & cold at first, but in later stages heat is more significant & cold may actually ease symptoms. A characteristic feature is that the pain remains after the removal of stimulus. Localization of pain may be difficult initially, but as the inflammation spreads to the periopical tissues the tooth will become more sensitive to pressure. Signs: Application of heat (eg warm GP) elicits pain Affected tooth may give no or a reduced response to electric pulp tester. In later stages may become TTP. Rx: Extirpation of the pulp & RCT is the treatment of choice (assuming the

July – Aug 2010

D E N TA L

HYG I E N E gives rise to symptoms.) It is thought to be due to dentinal fluid movement stimulating pulpal pain receptors. Prevalence is 1:7 adults with a peak in young adults, then with age. Is by elimination of other possible causes & by evoking symptoms. Rx: Involves a etiological factors (i.e. OH1, possibly including tooth brushing technique & by permeability of dentinal tubules (e.g. by tooth paste containing strontium, formalin &/or fluoride; placement of varnishes, dentine desensitizers, dentine adhesive systems or if indicated a restoration. tooth is to be saved). If time is short or if a anesthesia proves elusive then removal of coronal pulp & a ledermix dressing can often control the symptoms until the remaining pulp can be extirpated under LA at the next appointment.

Dentine Sypersensitivity This pain arising from exposed dentine in response to a thermal, tactile, or osmotic stimulus (but not all exposed dentine

Cracked Tooth Syndrome Symptoms: Sharp pain on biting short duration. Signs: Often relatively few difficult. Tooth often has a large restoration. Crack may not be apparent at first but Tran illumination & possibly removal of the restoration may aid visualization. Positive response to vitality (Sensibility) testing &

pain can normally be elicited by getting the pt to bite with the affected tooth on a cotton wool roll or a tooth sleuth. May be associated & brushing habit. Rx: An adhesive resin composite restoration may be appropriate in teeth which are minimally restored, but some cases a cast restoration but in some cases a cast restoration with full recusal coverage will be needed. Occasionally RCT may be required.

Periapical/Periredicular Pain: Progression of irreversible pulpitis ultimately leads to death of pulp (Pulpal necrosis). At this stage the patient may experience relief from pain & thus may not seek attention. If neglected however, the bacteria & pulpal breakdown products leave the root canal system via the apical foramen or lateral canal & lead to inflammatory changes & possibly pain. Characteristically the patient can precisely identify the affected tooth as the PBL which is well supplied with proproaptve nerve endings, is inflamed.

Revolution in dental treatment by high technology equipments by muzaffarpur dental, its providing world class treatment..

WHY? Muzaffarpur Dental Hospital • All dental facilities, including comprehensive lab & X-Ray at one place. • Co-ordinated care with physician, if required. • Concern for Hygiene and Patient Safety • Strict sterilization procedures • All kinds of restorative treatment (International Quality materials)

• All kinds of treatment of pediatric/kids • Smile design by cosmetic dentistry, with dental jewellery, crown cap (labMumbai) • All kinds of orthodontic treatment • All kinds of gum treatment • All kinds of surgery • All kinds of denture fabrication (labMumbai) and many more dental treatment by latest technology

MUZAFFARPUR DENTAL HOSPITAL Established by: Dr. Priya Ranjan

July – Aug 2010

Purani Bazar, Shuka Road, Sita Market, Muzaffarpur Contact: 9973408861

E X P E RT

VIEWS

Ankylosing Spondylitis Diagnosis and treatment

Sajidur Rahman Senior Healthcare Expert

nkylosing Spondylitis is a form of chronic inflammation of the spine and the sacroiliac joints. The sacroiliac joints are located in the low back where the sacrum (the bone directly above the tail bone meets the iliac bones (bones on either side of the upper buttocks) chronic inflammation in those areas causes pain and stiffness in and around the spine .overtime chronic inflammation of the spine (spondylitis) can lead to a complete cementing together(fusion) of the vertebrae, a process referred to as ankylosis.Ankylosis leads to loss of mobility of the spine and such a fused spine is referred as bamboo spine. Ankolysing spondylitis is also a systemic disease meaning it can affect other tissues throughout the body. Accordingly it can cause inflammation in or injury to other joints away from the spine, as well as to other organs such as the eyes,heart,lungs and kidney.Ankylosing spondilitis shares many features with several other arthritis associated with crohn’s disease and ulcerative colitis. Each of these arthritis conditions can cause disease and inflammation in the spine, other joints, eyes skin mouth and various organs. In view of their similarities and tendency to cause inflammation of the spine ,these conditions are collectively referred to spondyloarthopathies.Ankylosing spondylitis is considered one of the many rhematic disease because it can cause symptoms involving muscles & njoints. Ankylosing spondylitis is two to three times more common in males than in females. In women joints away from the spine are more frequently affected than in men .Ankylosing spondylitis affects all age groups including children.The most common age group of onset symptoms is the second and third decade of life. 46

How is ankylosing spondylitis diagnosed? The diagnosis of ankylosing spondilitis is based on evaluating the patients symptoms , a physical examination ,x-ray findings and blood tests.Stiffness pain and decreased range of motion of the spine are characteristic of the inflammatory back pain of ankylosing spondylitis.

Common side effects of the NSAID’s Stomach upset,nausea,abdominal pain, diarrhea and even bleeding ulcers. These medicines are frequently taken with food in order to minimize side effects. In advance stages, NSAID’s are not found to be effective alone rather used with steroids to suppress the body immune.

Symptom includes i. Pain and morning stiffness of the spine and sacral areas. ii. Pain and stiffness in other joints side by side, tendons and organs as secondary symptom. Further clues to the diagnosis are suggested by x-ray abnormalities of the spine and the presence of the genetic marker HLA-B27 gene identified by a blood test, other blood tests such as ESR which is the marker of non specific inflammation of the body after elevated in case of ankylosing spondylitis.

Treatment option for ankylosing spondylitis The Treatment of ankylosing spondylitis involves the use of medication to reduce inflammation and or suppress immunity to stop progression of the disease, physical therapy and exercise .Medication decreases inflammation in the spine, other joint and organs. Physical therapy and exercise help to improve posture, spine mobility and lung capacity.

Recent research has shown that persistent ankylosing spondylitis with spinal movement that is unresponsive to anti inflammatory medications,both sulphasalazinen and methotraxate are ineffective. Newer effective medication for spine disease attack a messenger protein of inflammation called tumor necrosis factor. These TNF blocking medication have been shown to be extremely effective for treating ankylosing spondylitis by stopping disease activity ,decreasing inflammation and improving spinal mobility. Physical therapy of ankylosing spondylitis includes instructions and exercise to maintain proper posture. Exercise programs are customized for each individual. Swimming after is a preferred form of exercise as it avoids jarring impact of the spine. Aerobic exercise is generally encouraged as it promotes full expansion of the berating muscles and opens the airways of the lungs.

Commonly used Drugs: • NSAID (Non steroidal anti inflammatory drugs)

• • • •

Indomethacin Tolmentin Diclofenac Naproxen

July – Aug 2010

E X P E RT

VIEWS

Acupressure Therapy A blessing to human being cupressure therapy is world famous healing modality to cure all chronic and acute problems without any side effect.

pain, sciatica pain, digestive disorder, arthritis, paralysis asthma but also have trained many students all over the world.

Acupressure is made of two words acu means minute and pressure means applying pressure, so means by applying pressure on a very small point on the body according to the disease and just by stimulating that point through pressure, magnet or colour getting the healing effect is called acupressure says world renowned acupressure specialist Jagmohan Sachdeva who has not only treated many cases of cervical, back

Our body is made of five elements that are -water,air,fire,earth and space. Imbalance between these elements causes problems and diseases in our body.

person is having burning sensation in chest area then we can treat by reducing fire and increasing water in that area. it is very simple and effective therapy. Many physiotherapist, homeopath, yoga therapist, naturopath doctors are also learning acupressure therapy. Its results are so fast that even in the first session people get a lot of relief.

For example if earth element increases in uterus of a female it will cause uterus fibroids. We can treat it just by reducing earth element and increasing fire element so that fire can dissolve those fibroids. Another example if a

Acupressure have a very effective and sure shot treatment for gaining height if the children follow the instruction given by acupressure specialists then just by giving 10 min of time each day will help in gaining good height.

CARE & CURE

an international institute of alternate science

• Acupressure Therapy

• Naturopathy

• Su-Jok Therapy

• Tarot Card Reading

• Reiki Healing

• Numerology

• Hypnosis

• Vaastu

• Yoya/Pranayam

• Merlin Trinity & Other

• Meditation

Alternate Therapies

We provide World Class Training, Treatments, Consultation and Correspondence Courses Treatment of Uric Acid, Rheumatoid Arthritis, Frozen Shoulder, Cervical, Back Pain, Slip Disc, Constipation, Gas, Acidity, Pcod, Uterus Fibroid, Knee Pain, Vertigo, Paralysis, Angina, Asthma and other Chronic and Acute Diseases is available without Medicine & without any Side Effects.

Dr. Jagmohan Sachdeva Phone: +91 9899031555, 9268796845 July – Aug 2010

jagmohan2005@yahoo.com

www.caredelhi.com 47

COMPLETE GIFTS SOLUTIONS FOR PHARAMACEAUTICALS & HOSPITALS • • • • •

T-shirt Caps Bags Key Rings Pens

• • • • •

Ourprime primeproducts products are are logo printing Our logoprint onon Pen-drive • Corporate Uniforms Coffee Mugs • Hospital Uniforms Watches • Face Mask Calendar • PVC Products Diaries • Wooden Products

• Leather Products etc • Disposable Skin Blade • All Kind of Novelties Products

Corporate Gift Mart TA 64/4, 1st Floor, Main Okhla Road, Tughlakabad Extn., New Delhi - 110019 Contact us: +91 9971258804, +91 9212328518 E-mail: corporategiftmart@gmail.com www.corporategiftmart.in

E X P E RT

ORTHOTIC & PROSTHETIC

VIEWS

The Ponseti Technique The corrective process utilizing the Ponseti technique can be divided into two phases: the treatment phase, during which time the deformity is corrected completely, and the maintenance phase, during which time a brace is utilized to prevent recurrence. During each of these phases, attention to the details of the technique is essential to minimize the possibility of incomplete correction and recurrences.

The Treatment Phase The treatment phase should begin as early as possible, optimally within the first week of life. Gentle manipulation and casting is performed on a weekly basis. Each cast holds the foot in the corrected position, allowing it to gradually re-shape. Generally 5 to 6 casts are required to fully correct the alignment of the foot and ankle. At the time of the final cast, the majority of infants (70% or higher) will require a percutaneous surgical procedure (with a small incision through the skin) to gain adequate lengthening of their Achilles tendon.

for three months and then during the night-time for several years. Failure to use the orthosis correctly may result in recurrence of the clubfoot deformity. Good results have been demonstrated at multiple centers, and long-term results indicate that foot function is comparable with that of normal feet.

Manipulation and Casting - Distinct Elements of the Ponseti Method The unique manipulation and casting maneuvers used in the Ponseti technique are just two examples of several elements which make it quite distinct from other casting methods. First Cast: Prior to casting, the position of the forefoot (front of the foot) in relation to the heel creates cavus (abnormally high arch) of the foot. The first cast application addresses the foot deformity, aligning the

The Maintenance Phase

The final cast remains in place for three weeks, after which the infant's foot is placed into a removable orthotic device. The orthosis is worn 23 hours per day

Figure 2: The initial Ponseti cast. Note the positioning of the forefoot to align with the heel, with the outer edge of the foot tilted even further downward due to Achilles tendon tightness.

Figure 1: Before treatment. The marked curvature of the foot, called a cavus deformity, is characterized by a visible crease in the midsection of the foot. The foot is tilted down due to tightness of the Achilles tendon.

Figure 3: After the first cast, the foot is straight and the cavus and crease are no longer evident.

Mohammad Tahir Jamal Orthotics & Prosthetic DUBAI

forefoot with the hindfoot (back of the foot). In doing so, the cavus is corrected, typically after one cast. It is usually easiest to apply the cast in two stages: first a short-leg cast to just below the knee, which is then extended above the knee once the plaster sets. This is preferable in older children (beyond 2 to 3 months) who are stronger and less easily consoled during the casting. Ponseti emphasizes the importance of long-leg casts, which are essential to maintain adequate stretching of tendons and ligaments. Second Cast: One week later, the first cast is removed and, after a short period of manipulation, the next toe-to-groin plaster cast is applied.(Figure 4) This phase in the manipulation and casting process is focused on straightening the foot, aligning the forefoot with the heel. Care is taken to maintain the downward tilt of the foot; correction of this downward tilt - due to tightness of the ankle - will occur in subsequent casts. Before casting, the physician manipulates the forefoot according

Figure 4: The second cast is applied with the outer edge of the foot still tilted downward and the forefoot moved slightly outward. July â&#x20AC;&#x201C; Aug 2010

             

272-A Ground Floor, Okhla Main Road, Near Jaswant Apartment, Jamia Nagar, New Delhi - 110025 Tel No. +91 11 26310053 Mobile +91 9871920287 Email dr_shakil@yahoo.com

INDIA HEALTH CARE

Manufacturer, Distributer, Exporter & Service provider

Physiotherapy Equipments Dental Equipments X-Ray Machine OT Light, OT Table Hospital Furniture & Surgical Equipments

1-B, Pratapadity Road, Kolkata - 700026 Tel No. +91 33 39505914 E-mail: indiahealthcare@vsnl.net

To Advertise in To Advertise in Medgate Today Medgate Today Kolkata +91 9830517022 Mumbai +91 22 26452920

UAE +971502108378 KSA +966502922541

BO O K YOU R S PACE TO A DV E R TI S E I N T H IS SECT ION

Callll U Ca Us: s +91 9289336 8 0 0 , +91 9 0 0 6 4 92778

E X P E RT

VIEWS

Figure 5: The third cast. The Achilles tendon is stretched, bringing the outer edge of the foot into a more normal position as the forefoot is turned further outward.

to Ponseti's carefully described technique in order to stretch the foot, determining the amount of correction that can be maintained when the plaster cast is applied. Another crucial point in the Ponseti technique which is radically different than other techniques, is that the heel is never directly manipulated. The gradual correction of the hindfoot and midfoot are such that the heel will naturally move into a correct position. Further Casting: Manipulation and casting is continued on a weekly basis for the next two to three weeks in order to gradually straighten the forefoot, allowing the forefoot to move in line with the heel. (Figure 5) After four or five casts have been applied, normal position of the foot will begin to be observed.

Figure 6: The final cast is applied, and the Achilles tendon is stretched further with the forefeet pointed upward. This cast is typically applied in 2 stages, with the short leg component extended up to the groin once the lower component has hardened. 52

The Achilles tendon: The Achilles tendon is the cord behind the ankle that allows the ankle to move up and down. In children with clubfoot this tendon is shortened, preventing the ankle from bending up properly. In the majority of these children the tendon must be lengthened in order to allow sufficient ankle motion. In the Ponseti technique, this is accomplished with a percutaneous surgical release of the tendon which allows the ankle to be positioned at a right angle with the leg. This percutaneous release is a quick procedure that is typically done through a small puncture, under local anesthesia. The ďŹ nal cast: The foot and ankle are then casted in the final, corrected, position. (Figure 6) A total of five or six casts are typically needed to correct the foot and ankle. More are rarely needed in the most severe cases of club foot.

Maintenance and Recurrence Prevention Upon removal of the final cast, the infant is placed into an orthosis or brace which maintains the foot in its corrected position. The purpose of this splinting, after the casting phase in the Ponseti method, is to maintain the foot in the proper position, with the forefeet set apart and pointed upward. This is accomplished with a brace consisting of shoes mounted to a bar. (Figure 7) The brace is worn 23 hours per day for the rst 3 months following casting and then while sleeping for several years to follow, usually until around age three or four. Two recent studies have demonstrated the high risk for recurrence if the brace is not worn according to these guidelines. The reasons for recurrence in feet that appear to be fully corrected have not yet been clearly proven, but regardless of the cause, recurrence appears to be close to zero when the bracing regimen is followed accurately. In one study, researchers reported no recurrences among patients compliant with the foot abduction orthosis compared with 57% recurrence among

Figure 7: Image of the foot orthotic.

non-compliant patients when studied at short-term follow-up. (Thacker MM, Scher DM, Sala DA, et al: Use of the foot abduction orthosis following Ponseti casts: Is it essential? J Pediatric Orthop 25:225-228, 2005)

Management of Recurrence The risk of recurrence persists for several years after the casting is completed. Ponseti reported a recurrence rate of approximately 50% in his early series, but noted a decrease with greater emphasis placed on the use of the foot orthotic. Early recurrences are best treated with several long-leg plaster casts applied at two-week intervals. The rst cast may require correction of recurrent foot deformity, with subsequent casts to correct ankle tightness. An Achilles tendon lengthening may be necessary if there is insuf cient correction at the ankle, and a tendon transfer (of the tibialis anterior tendon) may be performed in older children to help maintain the correction. Following this additional surgery, the child is then placed in a long-leg cast for four weeks with the foot in neutral position. Conclusion: The Treatment of Choice for Children with Clubfeet The Ponseti technique is gaining widespread acceptance as the treatment of choice for infants with clubfeet. It is now even implemented in several third-world countries, where it is supported by their national health systems and administered by casting specialists and technicians. If a child's physician meticulously follows the details of this technique and applies all of the elements without modi cation, parents can expect optimal results in the short and long term for children with clubfeet. July â&#x20AC;&#x201C; Aug 2010

Orthopaedic Solutions Medical Shoes Custom made insole Diabetics Shoes Artificial Limbs Spinal Support Rehabilitation Aids

Edrees Medical Equipment P.O Box 123876, Dubai, U.A.E, Behind Day to day, Karama Tel. +971 43979594 Fax: +971 43979584 Mobile. +971 502108378 Email: info@edreesmedical.com Website: www.edreesmedical.com

HO: Jeddah, Kingdom of Saudi Arbia

SUNCIE TECHNOLOGY INDUSTRY HONGKONG LTD has been in medical accessories area for many years, professional supplied Medicalaccessories

ECG-Patient monitor Cable

Medical Temperature Probes

EEG Electrode and Cord

Patient Return Plate Cable

Spo2 Oximeter Probe

NIBP Cuff & Tubes

Socket Series

IBP Cable

Extension cable

Disposable series

HongKong Office: Flat/Rm T78, G/F, BangKOK Bank Building, 18 Bonham Strand West, Sheung Wan, HongKong Tel: 852-26720559 Fax: 852-39711528 ShenZhen office: 27E, Yucuige, YongCuiHuaFu, TaiBai Road, LuoHu, ShenZhen, China Tel: 86-755-25013586 Fax: 86-755-25013586 BaoAn office: 2301, Wanfuge, Xingfu Garden, Liutang Road, Xixiang, Baoan, Shenzhen, China Tel: 86-755-82948052-806 Fax: 86-755-82948052-808 Contact: Janet Law Mobile 86-13828855180 MSN online: sunciesale@hotmail.com Tel: 86755-25013586 /86-13828855180 Fax: 86755-25013586 www.suncie.com Email: sales@suncie.com

Application Form Best Doctor Award for his services and excellence.

First Name ............................... Last Name ........................... Quali cations ........................................................................... Specialization .......................................................................... Experience (No. Of Year) ......................................................... Name of Hospital or clinic ....................................................... Designation ............................................................................. Average No. of Patient/Day ..................................................... Address .................................................................................. City .......................................... State .................................... Postal code ............................. Country ................................ Phone ...................................... Mobile ................................. Email ....................................................................................... Website .................................................................................... Success Story ......................................................................... ................................................................................................. ................................................................................................. .................................................................................................

Signature Note: Please make photo copy for more than one use. Please ll the application form and send us by courier/post on below address:

Medgate Today 92/17, Zakir Nagar, Opp. New Friends Colony, Okhla, New Delhi - 110025 Mobile: +91 9289336800 Email: info@medgatetoday.com; medgatetoday@gmail.com Website: www.medgatetoday.com

I would like to subscribe for (tick as applicable) 1 year 6 bimonthly issues for Rs. 450 (Our price Rs. 350/-) & US$30 2 years 12 bimonthly issues for Rs. 900 (Our price Rs. 700/-) & US$60 First Name ......................................... Last Name .................................... Designation ....................................... Organization ................................. Address ..................................................................................................... City .................................................... State ............................................. Postal code ....................................... Country ......................................... Phone ................................................ Fax ............................................... Email ..........................................................................................................

I enclose cheque no ........................... drawn on ....................................... dated ......................... towards subscription for Medgate Today magazine in favour of Medgate Today.

Sign ......................................................Date ............................

Don’t Miss Out on the Medgate Action!!! “Subscribe Now”

Mail this form with payment to: Medgate Today 92/17, Zakir Nagar, Opp. New Friends Colony, Okhla, New Delhi - 110025 Mobile: +91 9289336800 Email: info@medgatetoday.com; medgatetoday@gmail.com Website: www.medgatetoday.com

India’s Top Health & Medical Magazine