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NEWS l DOCTOR SPEAK l SPECIAL FEATURE l BEAUTY & COSMETIC l LIFE GUARD l ACUPUNCTURE
Vol.I Issue 1 May-June 2010
Gateway to Health & Medical World
exposure ofTOOTH
Health&
fitness
ExpertVIEWS
ME
DG
AT
ET
OD
AY
RS
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MED
GATE
TODA
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AY-J
UNE
2010
VOL.
IIS
SUE
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C-278/3, Abul Fazal Enclave Part II, New Delhi-110025 Ph: 011- 64562268Abul Fazal Enclave Part II, New Delhi-110025 Ph: 011- 64562268rt II, New Delhi-110025 Ph: 011- 6456226825 Ph: 011- 64562268AAbul Fazal Enclave Part II, New Delhi-110025 Ph: 011- 64562268rt II, New Delhi-110025 Ph: 011- 6456226825 Ph: 011- 64562268C-278/3, A. F. Enclave Part II, New Delhi - 110025, Tel: +91-11-64562268 Mob: +91-9717085785
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MAY-JUNE l 2010
S P E A KE D I T O R
Hello and welcome once again to Medgate
Today Magazine. I would like to open this
issue of the Magazine by thanking all of
you. The Publication has been nothing
short of fantastic and we are grateful for the opportu-
nity to continue bringing important health advice and
information to all.
Medgate Today provides an insight into this chal-
lenging condition with an overview of the spectrum.
We also look at a luxury treatment method that is help-
ing to heal.
This issue also focuses on the other medical and
health industry to take insight of the current scenario
and future prospective, we feel passionate about the
feedback from our readers.
We hope that you find this latest addition of Maga-
zine useful and we welcome your comments and opin-
ions on the magazine.
Any thoughts or question you may have mail us:
Dr M A KAMALEditor-in-chief
Dreamingof luxury treatment
methods
2
FFOR FFRANCHISE EENQUIRY:Mr. GGautam KKarjee ((Director)Mobile ++91 99835695801, +91 99471479697
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MAY-JUNE l 20104
06 NewsJordanian organ traffickingsuspect held in Yemen
Simple eye test can detectmental disorders
12 Cover StoryDesigned to heal
18 Product LineMedical Equipment
20 Dental HygienBrushing Technique
23 Beauty & CosmeticAcne Vulgaris
How to Look Younger
29 Doctor SpeakChest pain
30 Health & fitnessHow much weight womenshousld gain during preg-nancy
Healthy Orange
CONTENTS
12
40 Expert ViewsArthritis cause & Treatment
Merging Talents with Technology
48 Special FeaturesDoctor appearance
52 Life GuardAn Emergency Oxygen Guideline
EDITORDr. M. A. Kamal
EDITORIAL ADVISORDr. N. AshrafDr. Shakilur RahmanDr. S.L. ShahDr. Firozuddin Faiz
CHIEF CORRESPONDENTS. A. RizviDr. H. N. Sharma
DESIGN BYStudio Design
CREATIVE DESIGNERNitu Sinha
GRAPHIC DESIGNERAmit Kumar
SALES & MARKETINGAmjad Kamal Abrar Ahmad JawaidDevendra Kumar YadavKashif SaigalS. FirozRahul Ranjan
SUBSCRIPTION & CIRCULATIONPallavi Gupta
All rights reserved by all everts are made to ensure that the information published is orrect,MEDGATE TODAY holds no responsibility any unlikely errors that might occur.
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Volume I Issue 1
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07
36
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MAY-JUNE l 2010
U P D A T EN E W S
SANAA - A Jordanian suspected of trafficking inhuman organs has been arrested in Yemen as he at-tempted to fly to Egypt along with seven of his “vic-tims,” the interior ministry said on its website .
“Security forces in the capital arrested a Jordan-ian organ trader named Ramzi Khalil AbdullahFarah who was trying to travel to Egypt along with
seven Yemeni victims,” the ministry said. It said Farah was wanted for allegedly recruit-
ing people to sell their kidneys. It said the sevenYemenis, aged between 20 and 45, were “on theirway to Egypt after being persuaded by the Jordan-ian trader” who advanced them money from theproposed sale of their organs.
The ministry website did not say how much wasreportedly paid to each person. Yemen is the poor-est country in the Arab world. The World HealthOrganisation considers Egypt, where hundreds ofpoor people sell kidneys or parts of their liversevery year, to be a centre for organ trafficking. Par-liament in Cairo adopted a law to regulate organtransplants and limit trafficking in late February.
According to the United Nations, hundreds ofpoor Egyptians sell their kidneys and livers everyyear to buy food or pay off debts. MT
6
Jordanian organ traffickingsuspect held in Yemen
MAY-JUNE l 2010
U P D A T E
A SIMPLE eye test can help diagnose inherited men-tal health conditions such as bipolar disorder ormanic depression, according to new evidence.
Monash University neuroscientist Steven Millerled a national team of re-searchers to test the binocularrivalry rates of 348 sets oftwins -- 128 of whom wereidentical.
The test measured the twins’binocular rivalry—the ‘switch-ing’ of their visual perceptionfrom one image to the next,when two dissimilar imageswere simultaneously presentedone to each eye. Miller’s studyof twins showed that switchingrates were very similar be-tween each set of identicaltwins, yet were substantiallyless so for non-identical twins,suggesting a genetic contribu-tion to an individual’s switch-ing rate. ”By studying such a large group of identicaland non-identical twins we can determine the likeli-hood of genetics being responsible for certain biolog-ical traits,” Miller said.
Miller said testing of binocular rivalry was impor-
tant because it could be an indication of a person’smental health, based on his previous study of switch-ing rates in patients with bipolar disorder.
”A person without bipolar disorder will make theswitch between images everyone to two seconds. However, aperson with bipolar disordertakes three to four seconds, andup to 10 seconds, to switch be-tween the images,” Miller said.
”These results highlight thelink between our genetic make-up and the manifestation of cer-tain medical illnesses likebipolar disorder.”
The next stage of the re-search would test the reliabilityof using the switch rate to assistin the diagnosis of bipolar dis-order or a predisposition tobipolar disorder, said a univer-sity release.
”There is a lot of work aheadto find biological markers that could be used toscreen for a person’s susceptibility to a particular in-herited condition, paving the way for more accurateclinical diagnoses and more effective genetic stud-ies,” Miller said. MT
N E W S
7
Simple eye test can detectmental disorders
MAY-JUNE l 2010
U P D A T EN E W S
WASHINGTON: Novartis AG and Astellas Pharmaeczema drugs may need their warning labels ex-panded after dozens of new reported cases of can-cer and infection in children, US Food and DrugAdministration staff said in documents released onThursday. Agency scientists said 46 cancer casesand 71 infection cases have been reported in pa-tients aged 16 and younger from 2004 to 2008 withNovartis' Elidel and Astellas' Protopic.
Both drugs - also known as pimecrolimus andtacrolimus respectively - already carry strong warn-ings about cancer and infection, but officials shouldconsider expanding them to include the new post-marketing reports, they wrote. The documents werereleased ahead of an FDA advisory meeting Mondayto weigh potential safety concerns with a variety ofdrugs used in younger patients.
Additionally, other FDA staffers said the warninglabel for GlaxoSmithKline Plc's herpes drug Valtrexwas "insufficient" for certain central nervous sys-tem side effects in children, although no other con-cerns were seen. Another scientist noted concernsabout the use of Pfizer Inc's antibiotic Zmax in preg-nant women and the potential for it to cause stom-ach blockages in newborns.
The FDA will weigh the recommendations from itspanel of outside advisers before taking any action.
It was not clear what staff reviewers thoughtabout the weight-loss drug orlistat, marketed asGlaxo's Alli and Roche Holding AG's Xenical. Nonew safety concerns were seen with other drugs tobe discussed at the meeting, FDA staff said. MT
8
Cancer, infection seen withNovartis, Astellas drugs
Those drugs include:
• L'Oreal sunscreen ingredient Anthelios 40
• DuPont imaging agent Cardiolite (technetium Tc-99)
• Sanofi-Aventis allergy drug NasacortAQ (triamcinolone); five-disease vaccinePentacel; diphtheria, tetanus and per-tussis vaccine Daptacel
• Privately held Boehringer Ingelheim'sHIV drug Viramune (nevirapine)
• Glaxo's rotavirus vaccine Rotarix; diph-theria, tetanus and pertussis vvaccineKinrix
MAY-JUNE l 2010
U P D A T EN E W S
GASTROSTOMIES are used as a medium to longterm feeding strategy for children and adults withadditional dietary needs or an inability to swallow,and they may be inserted surgically, endoscopi-cally, or under radiological guidance. About 15 000gastrostomies are inserted annually in the UnitedKingdom. Complications include chemical peri-tonitis, infection, bowel perforation, haemorrhage,and aspiration pneumonia. But early recognitionand prompt action reduces the risk of seriousharm or death. Over six years (October 2003 to Jan-uary 2010) the National Patient Safety Agency(NPSA) received 22 reports (including five inci-dents in children) from clinical staff of harm fromdelayed response to serious complications aftergastrostomy insertion. Eleven patients died and 11became critically ill. Reported complications in-cluded nine cases of leakage of feed into the peri-toneal cavity and/or peritonitis, three colonicpunctures, and two complications related to haem-orrhage; under-reporting is likely.
surgical creation of an artificial opening intothe stomach through the abdominal wall. It is per-
formed to prevent malnutrition and starvation inpatients who have esophageal cancer or tracheoe-sophageal fistula, who may be unconscious for aprolonged period, or who are unable to swallow asa result of a cerebrovascular accident, Alzheimer'sdisease, or another disorder. It also permits retro-grade dilation of an esophageal stricture. The ante-rior wall of the stomach is drawn forward andsutured to the abdominal wall. A Foley catheter orother tube or a special prosthesis is then insertedinto an incision in the stomach, and the opening istightly sutured to prevent leakage of the stomachcontents. The device is clamped and is openedwhen liquid food supplement is instilled. After sur-gery glucose water may be given, followed by a slowcontinuous feeding of a warm blended formula toincrease absorption. The skin is kept clean and dryaround the site. Skin irritation indicates leakageof gastric secretions and digestive enzymes. MT
10
Early detection of complications after Gastrostomy
Viral agenda on WHO Assembly THE WORLD Health Organization is being urged to step up the fight against viral hepatitis and de-velop a comprehensive approach to its prevention and treatment, with a resolution on the disease tobe presented to the 63rd World Health Assembly later this month.
This will be the first time that the assembly has considered viral hepatitis, despite the huge burden ofdisease worldwide, said Steven Wiersma, medical officer and hepatitis focal point at WHO’s headquartersin Geneva. "One in 12 people in the world are chronically infected with hepatitis B [and] the burdenis extraordinarily high, yet somehow it’s been left off the world’s public health agenda," he said.
WHO is already active in preventing viral hepatitis by promoting immunisation and educating onblood and injection safety, but no comprehensive plan and no programmes for people who are chron-ically infected exist.
U P D A T EN E W S
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Govt declares breast cancerdrug Albupax sub-standard
ALBUPAX, A DRUG used in the treatment of breastcancer, has been declared as sub-standard by the Gov-ernment due to the presence of certain particles be-yond the acceptable limits.
The Central Drug Laboratory, Kolkata, in its test re-port has declared the drug "to be not of standard qual-ity" due to the presence of higher level of Endotoxinthan acceptable limits, Health Ministry sources said.
Albupax is the first generic version of the interna-tional brand ? Abraxane of Abraxis BioSciences,USA.
It has been indigenously developed by a companyin India and is the first albumin bound Paclitaxel innanoparticle to be developed in the country.
MAY-JUNE l 2010
S T O R Y
Can a painting on a wall orclassical music in the back-ground reduce recovery timefor a hospitalised patient?says Afzal kamal
C O V E R
13
Designed to
VERY soon, every single establishment will parade as a hotel indus-try unit. It’s bad enough that regular spaces such as salons andbanks imitate hotel-spa concepts, but now hospitals too seem to befollowing suit.
But when it comes to medical institutions catching up with thistrend, you cannot take it at face value – for good reason, really. Thelittle touches of the Leonardo da Vinci painting on the wall, the nat-ural window views and maybe Beethoven’s Ninth Symphony orPavarotti in the background in your average hospital room, couldpotentially reduce recovery time.
In other words, these décor changes (well, maybe not as grand asa da Vinci painting) go beyond the adage of old content in new pack-aging. The nub of healthcare design is to make a patient feel better– faster.
MAY-JUNE l 2010
S T O R YC O V E R
A quick sweep through scientific data to estab-lish the link between design and patient benefitsreveals that research is nascent. Still, it is hard toignore what is increasingly becoming the norm ofa hospital’s functioning – ambient facilities andhospitality. The former feature has hospitals goingthe extra mile to create a comfortable and pleasantatmosphere. Some do this by positioning pieces ofart and sculpture, others by designing the roomaround views of nature, and yet others by doingsomething as simple as carpeting an area to min-imise noise.
INNOVATIVE AMBIENT CONCEPTSHealthcare architects, designers and space plan-
ners – as they are called – have introduced innova-tive design concepts ranging from the expected tothe unheard of.
They not only consider the R&D aspect of thesedesign technologies, they study the healing impactof factors such as room size and scale, privacy,lighting, ventilation, the colour of walls and fur-nishings, fabrics, art, music and views.
14
MAY-JUNE l 2010
S T O R Y
In fact, hospitals themselves evaluate the heal-ing impacts, says Amer Salha, the head of MedicalEquipment Planning at the American Hospital inDubai.
“The evaluation plays a major role in reviewingcurrent services and planning modifications, andconsiders the future expansion [of the hospital]. Ingeneral, hospitals are aware of the benefits of im-proved surroundings and pay more attention to pa-tient experience,” he says.
A few findings validate how changes in décor re-duce recovery time for a hospitalised patient. No-tably, findings from the Johns Hopkins Universitythat conducted a comprehensive review of 84 stud-ies on the impact of health to demonstrate that themind, brain and nervous system can be directly in-fluenced positively or negatively by elements in theenvironment. Further validation comes from astudy conducted by Marina de Tommaso and ateam from the University of Bari in Italy; theyhighlighted the aesthetic value of paintings onpain thresholds.
Music also forms a part of ambient facilities andthe right kind is known to have a positive effect onpatients. Studies from Pavia University in Italyshowed that listening to certain genres can slowthe heartbeat and lower blood pressure.
But regardless of what a hospital may choose toaesthetically improve its surroundings, the resultis positive: the patient feels better and the hospitalstands to benefit in terms of a shorter length ofstay, and hence, lower cost per case.
“A hospital’s rating is directly tied with its sur-
C O V E R
15
MAY-JUNE l 2010
S T O R YC O V E R
gical outcomes and the length of stay; the shorterthe stay, the higher the rating,”
Administration manager Garreth Estment fromThe City Hospital in Dubai, which won the Best In-terior Design Award at the Hospital Build AwardsMiddle East last year, agrees. He says, “If you thinkabout it, a nice and comfortable place makes yourelax. It also creates a positive frame of mind andthereby assists with the healing process.”
In the UAE, an example of this trend is the am-bient cardiac catheterisation laboratory at theSheikh Khalifa Medical City (SKMC) in AbuDhabi. It has been designed with scene projectors,special lighting and sound effects – all targeted atoptimising patient care. And more importantly, ithas been clinically proven to reduce anxiety.
However, aesthetic features by themselves aren’tenough. Functionality is just as important.
There should be a balance, says Estment. “Noamount of pleasant aesthetic surroundings candispel the anxiety of a clinical area if it isn’t func-tional.” In the same vein, ambient facilities need tobe customised because they do not provide a one-size solution.
DIFFERENT PROBLEMS, DIFFER-ENT SOLUTIONS
Ambient facilities need to be tailored accordingto whether it’s psychiatric, geriatric or postopera-tive care. Patients have different needs – whetherit is lighting or furniture. Salha says, “In the psy-
chiatric ward for example, we need to choose fur-niture to ensure that the patient doesn’t injurehimself. Whereas in the geriatric ward, we have tochoose beds with special pressure mattress to avoidbed ulcers.”
Healthcare design has to look at patients’ needsand how they react to different stimuli. “Each unitneeds to be suited to a specific medical specialityand the patient’s individual needs,” says Estment.
Take lighting for example. A study from the US-based Lighting Research Center (LRC) shows howinnovative lighting designs and advanced technolo-gies, including LEDs, photosensors and occupancysensors, can help seniors in long-term care envi-ronments maintain independence and be morecomfortable.
There are several other areas where the rightlighting can reduce the recovery period. Accordingto Estment, these areas include ophthalmology, ma-ternity wards, delivery rooms, paediatric wardsand dialysis units.
Salha adds: “Lighting is an important consider-ation in the psychiatric and geriatric wards too. It[lighting selection] is crucial to create the effect ofday and night for patients who are required to getrest or vice-versa.”In addition to aesthetic features,hospitals are also working towards providing up-to-date entertainment systems, internet connectiv-ity and a host of other amenities in the hope thatpatients will enjoy their stay and leave as soon asthey feel well enough to do so. MT
16
MAY-JUNE l 2010
L I N EP R O D U C T
18
MODEL: S-90
S-30
MAY-JUNE l 2010
L I N EP R O D U C T
19
MEDICAL AND DENTAL equipment is designedto aid in the diagnosis, monitoring or treatment ofmedical conditions. These devices are usually de-signed with rigorous safety standards. The med-ical equipment is included in the category Medicaltechnology.
There are several basic types:● Diagnostic equipment includes medical imaging machines, used to aid in
diagnosis. Examples are ultrasound and MRI machines, PET and CT scan-ners, and x-ray machines.
● Therapeutic equipment includes infusion pumps, medical lasers andLASIK surgical machines.
● Life support equipment is used to maintain a patient's bodily function.This includes medical ventilators, anaesthetic machines, heart-lung ma-chines, ECMO, and dialysis machines.
● Medical monitors allow medical staff to measure a patient's medical state.Monitors may measure patient vital signs and other parameters includ-ing ECG, EEG, blood pressure, and dissolved gases in the blood.
● Medical laboratory equipment automates or helps analyze blood, urineand genes.
● Diagnostic Medical Equipment may also be used in the home for certainpurposes, e.g. for the control of diabetes mellitus
● A biomedical equipment technician (BMET) is a vital component of thehealthcare delivery system. Employed primarily by hospitals, BMETs arethe people responsible for maintaining a facility's medical equipment
MAY-JUNE l 2010
H Y G I E ND E N T A L
Brushing
20
technique
Clean the outside of all upper
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tory, back and forth strokes pay-
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Clean the inside surface of all
upper teeth with the same
short, gentle, vibratory back
and forth strokes.
Simple Steps ofBrushing
1
2
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Repeat vibratory back and forth
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Cleaning the inner surfaces of
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Brush the biting surface of both
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3 4 5
MAY-JUNE l 2010
COSMETIC
ACNE VULGARIS is the most common formof acne. It is considered an abnormal responseto normal levels of the male hormone testos-terone. The response for most people dimin-ishes over time and acne thus tends todisappear, or at least decrease, after onereaches their early twenties. There is, however,no way to predict how long it will take for it todisappear entirely, and some individuals willcontinue to suffer from acne decades later, intotheir thirties and forties and even beyond. Itincludes several types of pimples. These acnelesions include blackheads, whiteheads,papules, pustules, nodules and cysts.
Mild to Moderate acne vulgaris consistsof the following types of acne spots:● WHITEHEADS ● BACKHEADS ● PAPULES Whiteheads: Whiteheads are formed when apore is completely blocked, trapping sebum(oil), bacteria, and dead skin cells, causing awhite appearance on the surface. In otherwords, Whiteheads are a combination of oils,sebum and cellular fragments that producefirm to hard plugs within hair follicles. Theyare closed from the skin's surface by cellulardebris at the follicle opening. Because theyhave no contact with oxygen, they do not oxi-dize or turn brown, as blackheads do. Theyform a light or yellow-white lump and arecalled milia (or milium, singular). When bac-teria is added to these plugs, the condition canlead to acne, especially cystic acne.Whiteheadsare promoted by excessive cellular exfoliation,which quickly clog or block the follicles. Someskin specialists believe individuals with fre-quent and multiple blackheads and white-heads produce sebum that is drier than normaland conducive to forming firm plugs. White-heads are normally quicker in life cycle thanblackheads
B E A U T Y &
23
Acne VulgarisAcne Vulgaris
MAY-JUNE l 2010
COSMETICB E A U T Y &
Blackheads: These appear when a pore is onlypartially blocked, allowing some of the trappedsebum (oil), bacteria, and dead skin cells to slowlydrain to the surface. The black color of a blackhead is caused by reaction of the skin's own pig-ment, melanin, reacting with the oxygen in the air.A blackhead is much more stable than a white headand takes a long time to clear. When bacteria isadded to black heads, the condition can lead to acnePapules: Dermatologists call any small solid cir-cumscribed bump in the skin a papule, as opposedto a vesicle which contains fluid or a macule whichis flat and even with the surrounding skin. Papulesare normally inflamed, pink or red in color. Squeez-ing a papule is not recommended as it might lead toscarring
Severe acne vulgaris results in:● NODULESM● CYSTS Nodules: As opposed to the lesions mentionedabove, nodular acne consists of acne spots whichare much larger, can be quite painful and can some-times last for months. Nodules are large, hardbumps under the skin's surface. Scarring is com-mon. Absolutely do not attempt to squeeze such alesion. You may cause severe trauma to the skinand the lesion may last for months longer than itnormally would. Dermatologists often have waysof lessening swelling and preventing scarring.Cysts: An acne cyst can appear similar to a nodule,but is pus-filled, and has been described as having
a diameter of 5mm or more across. They can bepainful. Again, scarring is common with cysticacne. Squeezing an acne cyst may cause a deeperinfection and more painful inflammation whichwill last much longer than if you had left it alone.Dermatologists often have ways of lesseningswelling and preventing scarring.
Acne Rosacea can look similar to the aforemen-tioned acne vulgaris, and the two types of acne aresometimes confused for one another.
Rosacea affects millions of people, generally fe-males above the age of 30. It affects the middlethird of the face, and symptoms include skin red-ness and swelling in the areas that typically flushwhen we’re excited or embarrassed; telangiectases(the appearance of broken blood vessels), and, oc-casionally, acne-like papules and pustules. For thisreason, rosacea is often misdiagnosed as acne andtreated with acne medications. Without appropri-ate medical treatment Rosacea can cause swellingof the nose and excessive tissue growth resultingin a condition known as Rhinophyma.
Rosacea tends to be more frequent in womenbut more severe in men. If you think you may haverosacea, see a dermatologist right away. Whilethere is no known cure for this condition, it is treat-able – and early treatment will help prevent perma-nent damage to your skin.
Acne Mechanica is the acne that developswhen skin is under pressure, is undergoing fric-tion, is covered tightly or is exposed to heat.
24
MAY-JUNE l 2010
COSMETIC
Some situations when Acne Mechanica mayform are-
Tight clothing that rubs against the skin, Syn-thetic clothing that does not allow skin to breathe,Pressure of backpacks.
Some examples of such pressure that maycause acne mechanica are-
Poeple carrying backpacks, athletes wearing atight headband, women wearing bras with tightstraps etc. Any situation during which the skin istightly covered with cloth, rubbed and pressurizedmakes it vulnerable to acne mechanica. For exam-ple- people who wear very tight clothes made ofsynthetic material may get acne mechanica.
Who are more prone to acne mechanica? Those who have a tendency to develop body acne
are more prone to acne mechanica. Those withvery small comedones are prone to it. When thesesmall comedones are subjected to mechanical pres-sure and friction, they flare up as acne mechanica.
The treatment of acne mechanica is similar tothat of Acne vulgaris. To learn more about acnetreatments, click here - Acne Treatments.
To Avoid Acne Mechanica- Wear loose fitting cotton clothing, Avoid headbands, Avoid constant pressure on the skin by any object, Keep skin clean of perspiration. Wearing cotton clothes that breathe under your
regular clothes may help. Washing yourself thoroughly after removing
the irritating baggage/object may help. Severe Forms of Acne are rare, but they are a
great hardship to the people who experience them,and can be disfiguring and, like all forms of acne,can have psychological effects on the sufferer.
Severe forms of acne comprise of:● ACNE CONGLOBATA ● ACNE FULMINANS ● GRAM-NEGATIVE FOLLICULITIS ● PYODERMA FACIALE
Acne Conglobata: This is the most severe form ofacne vulgaris and is more common in males. It ischaracterized by numerous large lesions, whichare sometimes interconnected, along with wide-spread blackheads. It can cause severe, irrevocabledamage to the skin, and disfiguring scarring. It isfound on the face, chest, back, buttocks, upperarms, and thighs. The age of onset for acne conglo-bata is usually between 18 and 30 years, and thecondition can stay active for many years. As withall forms of acne, the cause of acne conglobata isunknown. Treatment usually includes isotretinoin, and although acne conglobata is sometimes resist-ant to treatment, it can often be controlled throughaggressive treatment over time.Acne Fulminans: This is an abrupt onset of acneconglobata which normally afflicts young men.Symptoms of severe nodulocystic, often ulceratingacne are apparent. As with acne conglobata, ex-treme, disfiguring scarring is common. Acne ful-minans is unique in that it also includes a feverand aching of the joints. Acne fulminans does notrespond well to antibiotics. Isotretinoin and oralsteroids are normally prescribed.Gram-Negative Folliculitis: This condition is abacterial infection characterized by pustules andcysts, possibly occurring as a complication result-ing from a long term antibiotic treatment of acnevulgaris. It is a rare condition, and we do not knowif it is more common in males or females at thistime. Fortunately, isotretinoin is often effective incombating gram-negative folliculitis.Pyoderma Faciale: This type of severe facial acneaffects only females, usually between the ages of 20 to40 years old, and is characterized by painful large nod-ules, pustules and sores which may leave scarring. Itbegins abruptly, and may occur on the skin of awoman who has never had acne before. It is confinedto the face, and usually does not last longer than oneyear, but can wreak havoc in a very short time. MT
By DDrr.. PPiiyyuusshh PPaannkkaajj
B E A U T Y &
25
How to lookYOUNGER?
Medgate Today spoke to Dr. Piyush, a famous
cosmetic physician & dermatologist about how to
maintain healthy skin
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CUTIS - CAREDr. PPIYUSH, M B B S, MD (SKIN)
Juran Chapra, Main Road(Opposit Road No.3) Muzaffarpur (Bihar)
Contact:
+91 9771764919 (Dr.)+91 9308801199 (Clinic)
INTERVIEW
DR.PIYUSH, Healthy, younger looking skin iswhat everyone dreams of, Could you tell ussome tips to maintain out skin healthy andyounger?
WELL, Healthy, younger looking skin is not hardto achieve. Looking after your appearance andmaintaining a regular routine and healthy diet canhelp to give you perfect looking skin, free from spotsand blemishes.
10 TIPS THAT WILL HELP YOU ONYOUR WAY TO BEAUTIFUL SKIN.
1Your outside appearance reflects what's onyour inside. Maintain a healthy and balanced
diet with plenty of fruits, vegetables ,Green saladsand sunflower seeds.
2Try and drink 6 to 8 glasses ofwater per day. This will help to
keep your skin moist, refreshedand supple, which will helpthe skin fight off developingwrinkles and blemishes.
3Moisturize! Applyingmoisturizer after a
warm face wash or awarm shower is the bestremedies for skin. Mois-turizing helps to restorethe oils that our skin hasand helps to keep the skinhydrated. Moisturizing formen is just as important as theoils in men's skin can be lost moreeasily than those in women.
4Protect yourself from sun and tanning studio's.The sun and tanning studio's are the main rea-
sons for premature aging. By applying self tanspray or keeping your face well protected from UVrays can help to prevent premature aging.
5Keep up regular exercise. Regular exercise helpsto keep the skin elasticity which prevents wrin-
kles. Exercise is also good for your body as a wholeas it helps to maintain a low amount of body fat.
6Taking vitamins and minerals helps to keepgoodness in the skin. Vitamins and minerals
have been developed to help your body. By takingone multivitamin can help to keep your skin freshand clean.
7Try and maintain a constant sleep pattern.Sleep is the body's time to restore itself and to
re-energise the body's organs and skin. By main-taining a regular sleep pattern, you will feel moreenergized and your skin will become morehealthy and fresher looking.
8Do not scrub and wash too hard. By doing thisit removes the required oils that the skin
needs to regenerate. When washing, wash lightlyand in circular motion. This helps to keep theblood flow in your skin and does not allow the es-sential oils to escape.
9Do not squeeze Acne. Although very tempting,by squeezing white heads and black heads, the
disease spreads and your acne will not disappear.By not squeezing your skin can heal the acne onits own and scars will not be formed. Constant
squeezing of acne will cause scarring ofthe skin.
10Finally, the most im-portant thing you can
do to help achieve, youngerhealthier looking skin isto stop smoking or neverto start. Smoking causespremature aging andyellowing of the teethand skin. The tobaccothat is released into theair dries out your skin,
while the smoke you in-hale constricts the flow of
blood to blood vessels, there-fore preventing your skin of
essential nutrients that your bodysupplies.MT
Dr. PPIYUSH
MAY-JUNE l 201028
MAY-JUNE l 2010
S P E A K
CHEST PAIN accounts for up to10% of new complaints at internalmedicine outpatient clinics and forup to 8% of all emergency depart-ment visits. Despite this prevalence,and that of coronary artery disease(CAD), diagnosis is often difficult.Although over 80% of outpatientspresenting with chest pain proceedto diagnostic testing, only one thirdsubsequently prove to have had amyocardial infarction, while 1% to8% of those with myocardial infarc-tion confirmed by cardiac enzyme levels are misdi-agnosed and discharged home.
The first diagnostic step is to take a careful his-tory.TYPICAL ANGINA IS CHARACTER-IZED BY:● Risk factors (smoking, diabetes, hypertension,
hyperlipidemia, family history of CAD)● Location (mid Retrosternal and/or radiating to
left arm, throat, jaw, epigastrium, right arm)● Quality (tight, squeezing, constricting, suffo-
cating, burning, crushing, heavy)● Duration (minutes)● Mode of noset (physical or emotional stress)Mode of relief (rest or sublingual nitrates).
Where the history is insufficient on its own,physical examination and noninvasive tests aidthe diagnosis. Althought physical findings areoften normal in stable angina, S4 or S3 gallop maybe detected during a bout of pain, along with a mi-tral regurgitant murmur, paradoxically split S2,bilateral basal rales, or chest wall heave. Eachsuch finding makes CAD more likely, especially ifit disappears when the pain subsides. Similarly, ev-idence of noncoronary atherosclerotic disease,such as a carotid bruit, diminished pedal pulses,or an abdominal aneurysm, also increases the like-lihood of CAD. Other physical markers of risk fac-tors include elevated blood pressure, xanthoma,and retinal exudates.
The two main noninvasive tests are electrocar-diography (ECG) and echocardiography. Since 12-lead ECG is normal in 50% of patients with chronicstable angina, it cannot exclude CAD. However, ev-idence of left ventricular hypertrophy or ST-seg-
ment and T-wave changes consistentwith myocardial ischemia favor thediagnosis of angina. Q waves indica-tive of previous myocardial infarc-tion also increase the likelihood ofCAD, although an isolated Q wave inlead III or a QS pattern in leads V1and V2 is often nonspecific.
During chest pain the ECG be-comes abnormal in half the anginapatients with a normal resting ECG.Sinus tachycardia is common, Bradyarrhythmia less so. Other indicators
are ST-segment and T-wave depression or inversionon the resting ECG and their pseudo normalization
during pain. As for echocardiography, wall motionabnormalities and a low ejection fraction increasethe probability of CAD.
The clinician suspecting CAD should estimateits probability, given that pretest probability deter-mines the accuracy of the standard exercise test asa first-line diagnostic procedure. Chun et al de-scribed the effect of pretest probabilities varyingfrom 5% to 50% to 90%: a low probability of CAD(5%) confers a dramatically low positive predictivevalue (21%) on an abnormal test. With an interme-diate probability (50%), a positive test result in-creases the likehood of CAD to 83%, while anegative test result decreases the like hood to 36%.In patients with ahigh probability (90%), a positivetest result raises the probability of CAD to 98%,while a negative test results carries accurate nega-tive predictive value. MT
CHEST PAINIs it my heart pain?
D O C T O R
29
How muchweightwomen
should gainduring
— Surprisingly little if they’realready overweight.
FITNESS
EATING FOR two? New guidelines are setting howmuch weight women should gain during pregnancy— surprisingly little if they’re already overweight.The most important message: Get to a healthyweight before you conceive, says the Institute ofMedicine in the first national recommendations onpregnancy weight since 1990.
It’s healthiest for the mother — less chance ofpregnancy-related high blood pressure or diabetes,or the need for a C-section — and it’s best for thebaby, too. Babies born to overweight mothers havea greater risk of premature birth or of later becom-ing overweight themselves, among other concerns.
Meeting the guidelines could be a tall order, con-sidering that about 55 percent of women of child-bearing age are overweight, that preconceptioncare isn’t that common and about half of pregnan-cies are unplanned.Once a woman’s pregnant, theguidelines issued on Thursday aren’t too differentfrom what obstetricians already recommend, al-though about half of women don’t follow that ad-vice today.
AMONG THE NEW RECOMMENDA-TIONS:● A normal-weight woman, as measured by BMI
or body mass index, should gain between 25and 35 pounds during pregnancy. A normalBMI, a measure of weight for height, is be-
H E A L T H &
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HUDA CCLINICJail Road, Muzaffarpur (Bihar)
Email: [email protected] PPerson:
Mr. Shadab Ahmad (Chairman)Contact No. +91 621 2249154
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FITNESSH E A L T H &
tween 18.5 and 24.9.● An overweight woman — BMI 25 to 29.9 —
should gain 15 to 25 pounds during pregnancy.● For the first time, the guidelines set a standard
for obese women — BMI of 30 or higher: 11 to20 pounds.
● An underweight woman — BMI less than 18.5— should gain 28 to 40 pounds.
What if a mom-to-be has gained too much? On av-erage, overweight and obese women already aregaining five more pounds than the upper limit.
But pregnancy is not a time to lose weight, “It’snot, ‘Hey you gained enough, now you need to stop,’”Siega-Riz said. “Let’s take stock of where you’re atand start gaining correctly.”
Indeed, underweight and normal-weight mothersshould put on a pound a week for proper fetalgrowth in the second and third trimesters, theguidelines say. The overweight and obese need abouthalf a pound a week.
Hopping on the scale during prenatal checkupsmakes for a sensitive moment, especially in a cul-ture that cherishes the stereotype of late-night icecream-and-pickles snacks.
Implementing the guidelines may take a move “tochange the whole culture about pregnancy” and eat-ing, Siega-Riz said. She noted that in studies of theoverweight, “most of these women will tell you thatthey’ve never been told how much weight to gain.”The guidelines call for increased nutrition and ex-ercise counseling during pregnancy, saying doctorsor midwives may need to consult a dietitian to tailor
a woman’s care no matter her starting weight.Also, providers should discuss whether a
woman plans to breastfeed, which notonly is optimal for the baby but helps thenew mother shed pounds, too.“It’s really a teachable moment,” said
guidelines co-author Dr. Patrick Catalano,obstetrics chairman at Ohio’s Case
Western Reserve University.“When women
are pregnant,they may be
more accepting”of weight discussions
“because it’s also in the best interestof their babies.” Obstetricians, who have strug-gled with how to advise heavier women as U.S.obesity rates have soared over the past twodecades, welcomed the guidelines — especiallythe recognition that babies born too large tendto grow into overweight children at risk fortheir own health problems. Not too many yearsago it was rare to see a 9-pound, or larger, new-
born.
“Pregnant women should not be eating for two,”said Dr. Ellen J. Landsberger, who specializes inhigh-risk pregnancies at New York’s MontefioreMedical Center. “You want a healthy baby? On bothends, you have to eat the right amount.”
But is it realistic for obese women to gain as littleas 11 pounds?
“We think it’s possible. We also think it will be achallenge,” said Cornell University nutrition spe-cialist Dr. Kathleen Rasmussen, who chaired the In-stitute of Medicine committee. In the Bronx, NyreePaten illustrates that challenge: She had been put-ting on weight for three years and discovered shewas pregnant at her peak, just over 300 pounds, seri-ously obese even for someone 6 feet tall. Her doctordiagnosed diabetes at her first prenatal checkup.Landsberger found Paten, 35, a nutritionist and pre-scribed insulin for the diabetes. Paten said she’sgained only about 2 pounds by week 24, while regu-lar ultrasounds show her baby is growing well.
“Thank God I’ve been doing good,” says Paten,who feels more energetic because she’s eating better.So is her 8-year-old son. First to go: sugary sodas andjuices in favor of water.
“It’s all about knowing and being educated onhow to eat,” adds Paten, who’s lined up the nutri-tionist to help her lose weight once her baby is born.The guidelines say women expecting twins can gainmore: 37 to 54 pounds for a normal-weight woman,31 to 50 pounds for the overweight, 25 to 42 poundsfor the obese. There’s not enough information to setrecommendations for triplets or more.
The institute stressed that the guidelines areaimed at U.S. women, not for parts of the world withdifferent nutritional and obstetric needs.MT
MAY-JUNE l 201032
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MAY-JUNE l 2010
COSMETICB E A U T Y &
34
acupunctureeffective or not?
MAY-JUNE l 2010
COSMETIC
LIKE MASSAGE, acupunc-ture is difficult to study be-cause it’s hard to give a“fake” massage or “placebo”acupuncture. Says Clauw: “In‘sham’ or placebo controlledtrials in chronic pain, morestudies have shown thatacupuncture doesn’t work.But that doesn’t necessarilymean that it’s not effective—it might be that there really isno such thing as shamacupuncture. Acupuncturemight somehow be effectivein engendering a placebo re-sponse.” Whether that mat-ters if someone feelssignificant pain relief is aquestion only the patient cananswer. “The best evidencethat it’s effective is that a lotpeople will pay out of pocketto use it,” he says.
Clauw himself conducteda fascinating imaging studyof acupuncture, finding thatwhile patients with fi-bromyalgia reported de-
creased pain with both fakeand real acupuncture, fakeacupuncture affected brainopioid receptors in a waythat was more comparableto that seen with placebo.“Sham acupuncture maywork via placebo effectsand active acupuncturemay work by more specificeffects. That could help ex-plain why trials don’t showmuch difference,” he says.
Some have claimed thate l e c t r o a c u p u n c t u r e —which runs a small currentthrough acupuncture nee-dles—is more effectivethan needles alone, butClauw says it’s even harderto parse out placebo effectshere. “It may give astronger placebo effect,” hesays. For people in pain,however, that could be agood thing.MT
B E A U T Y &
35
YOU MUST be surprised that the common low-costorange, available in every market, is a star amongthe twenty fruits (mango, fig, orange, strawberry,goji, red grape, cranberry, kiwifruit, papaya, blue-berry, sweet and sour cherries, red raspberry,seaberry, guava, blackberry, black currant, date,pomegranate, acai, and plums) chosen by Dr. PaulGross to be superfruits. Even though the orangeranks number three, in reality it ties up with the fig,
The orange is cultivated in many parts of theworld, South-East Asia, the Middle East, Africa,Brazil, and the United States. Orange juice is theonly superfruit product traded on the New YorkStock Exchange as a commodity in worldwide trad-ing. Orange juice is also the most popular among alljuices. It is served freshly squeezed or canned in par-ties, for breakfast, at receptions, and in homes andrestaurants. Availability in stores and low cost makethe high nutritional value of the orange and juice ac-cessible to a good section of the world population.
The orange, Citrus sinensis, is a member of thecitrus family (lemon, lime, grapefruit, tangerine,mandarin, kumquat). The fruit itself comes in dif-ferent varieties and diversity in tastes and has mul-tiple uses. Its variations range from navel orange,Persian, blood, and cara cara navel to tangerine and
mandarin.Orange pulp is not the only part of the fruit,
which is healthy, but also the fleshy white substance,pith, surrounding the pulp and the segments. Thepith is where the prebiotic (soluble) fiber andbioflavonoids are found. Citrus bioflavonoids are themost bioavailable to the body. The fruit offers heart-healthy pectin (apples have it, too) and polysaccha-rides. The healthful fiber of the fruit works toprotect the body from cancer and blood vessels fromcholesterol buildup. That is not all! There is more tothis superfruit.
Orange’s merits led it to be named superfruit. Itcontains most essential nutrients needed to main-tain good health. The fruit and its peel are rich invitamins A (through its precursor beta-carotene),Bs, and C, important minerals, both soluble and in-soluble fiber, and phytochemicals like carotenoidsand polyphenols in the deep orange pigment. Thefruit is rich in iron for preventing anemia and cal-cium for building bone. The peel and zest are em-ployed for making gravy, marmalade, desserts togarnish and add zest. They help breakdown fat infood (duck a la orange). Eating a whole fruit after afatty meal breaks down fat. Niacin, vitamin B3, isabundant in the fruit; it protects the heart.
MAY-JUNE l 2010
FITNESSH E A L T H &
36
Healthy orange
MAY-JUNE l 2010
FITNESS
Freshly squeezed orange juice has become a uni-versal breakfast staple. It provides a good concen-tration of necessary nutrients (vitamins A, Bs, andC), especially if loose bits of the pulp and fiber areleft inside the juice for extra nutrients, texture, andflavor. For maximum benefit, drink orange juice im-mediately before the nutrients start breaking down.
All oranges are not equal in phytochemicals.Though they all contain polyphenols, the blood or-ange with its red pulp is higher in anthocyanins andlycopene. The flavonoid, hesperidin, is found in theflesh, but moreover in the peel. Many of these phy-tochemicals are undergoing research for their anti-inflammatory and antioxidant properties againstdisease. One of these compounds is d-limonenefound in the peel is getting tested for its neutralizingeffect on gastric acid to relieve heartburn and gas-tro-esophageal reflux disease (GERD). The chemicalalso showed activity on cancer cells in studies.
Research on oranges and their juice is underwayto further verify their effects on allergies includingasthma (vitamin A and C), inflammation (phyto-
chemicals), cholesterol and vascular disorders(pectin, B3, carotenoids), and cancer (soluble fiber,phytochemicals).
Being affordable and widely available neither di-minish the superfruit’s popularity nor its impor-
tance to health and disease. Fresh whole, dried,juiced, or cooked with its pith and rind, the or-ange is an important fruit to include in our dailydiet with beverages, desserts, marmalade, ingravies, yogurt, snacks, salads and cakes. Thehigh vitamin C content of fresh orange juice
makes it a good base for fruit salads in order tostop other fruits like apples from oxidizing (turn-
ing brown) and also to maintain their fresh appear-ance. Whole fresh oranges and their freshly-squeezed juice with pulp are exceptionally delicious,quenching to thirst, and valuable to health. Don’tdiscard the peel and pith; they come with equallyprecious nutrients and phytochemicals.
Individuals with medical conditions or on med-ication should consult their physicians when theydecide to introduce anything new in their diet evenif it is natural, MT
H E A L T H &
37
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V I E W SE X P E R T
THIS IS the plaintive expression of avictim of the disease know as Arthri-tis. ARTHERITIS today drives mil-lions of sufferers to their physicianseach year seeking relief from thepain, immobility, and deformity itcan cause. In India, according torecords, ARTHERITS has reached anepidemic level as many as 100 millionpeople, who comprise about 10% ofthe country’s population sufferingform this crippling disease.
Arthritis disorders of one kind oranother have always plaguedmankind and animals. Many peoplesuffer form the aches and pains ofdamaged or inflamed joints. Someare just uncomfortable and some be-come crippled as result of the diseasethat has been recognised since pre-historic times but understood in only
the past few decades. Any part ofyour body can become inflamed orpainful form arthritis.
Arthritis refers to the painful in-flammation of a joint. In some formsof Arthritis inflammation bringswith it swelling, pain and redness.Some forms of the disease are the re-sult of normal ware and tear on thebody structure whereas other formshave no connection with these natu-ral processes.
There are some forms which are ofconstant and lasting nature whilstsome such as bursitis, housemaid’sknee and tennis elbow may be of tran-sient nature. The first thing to get outof the way is the myth that there is asuch thing as a single disease called“Arthritis”. The truth is that the word
“arthritis” is about as usefuland specific as the word ‘infec-tion’ and just as there are hun-dred different types of theinfection, there are over a hundreddifferent types of “arthritis”.
WHAT CAUSES ARTHRITIS :-i. Normal ageing process and
wear and tear are the likely fac-tors for causing lack of elastic-ity and the flexibility of thecartilage in the joints.
ii. Overstraining the back maycause damage to the ligamentsand other vertebral discs.
iii. Occupation and lifestyle mayalso be related to Arthritis. Foreg. A particular kind of postureon strain on a particular joints
may cause osteoarthritis ofthat part of the joints.
iv. Excessive weight may alsoaffect the larger weightbearing joints – chieflyhips, knees and spine.
v. Hereditary factor – inci-dence of rheumatioidarthritis is higher thanexpected in twins andfirst degree relations.
vi. Rise in uric acid in bloodserum is likely to causegout.
vii. Mental tension/Stresscannot be ruled out forthe emotional and physi-cal mainifestation of thedisease, pain and depres-sion.
40
ARTHRITISCause and treatment“Once the pain started in all my joints, mywhole life was just pain.”
MAY-JUNE l 2010
V I E W S
viii. Damp and cold weather oftencauses and aggrevates this dis-ease.
ix. Having stiffness or pain whenyou move, could be sign ofarthritis.
OTHER FACTORS THATCAN CAUSE ARTHRITIS :-A. Hidden Birth Defects. B. Injuries C. Infections D. Drug side effects E. Biochemical factors F. Nutritional deficiencies G. Hormonal Factors H. Altered Immune System.
MAJOR FORMS OFARTHRITISOsteo Arthrits Rheumatoid Arthritis
Osteo Arthritis :- Occurs mostoften at the ends of the fingers,thumbs, neck, lower back, knees andhips. It is the most common form ofArthritis. It is a degenerative jointdisease, the degenerative factor beingassociated with the articular carti-lage and joint surfaces. Patients knowthis disease as old age arthritis.
All the joints in the body may beaffected by Osteo arthritis. Howeverit is most commonly experienced inthe weight bearing joints, knees, hipsand lumber spine. Physicians catego-rize cases of Osteoarthritis as pri-mary and secondary. The primaryform seems to begin by itself, with nospecific cause, while the secondarytype may have many causes but oftenresult from too much stress andstrain on a joint. Primary Osteoarthritis occurs mostly in womenand may have hereditary componentbecause it seems to appear more insome families than in others.
Osteo arthritis can be diagnosedby X-Ray examination.
Rheumatoid Arthritis: - It is thesecond most common form of arthritis.It is an inflammatory disease thoughinvolved with joints, it is not degenera-tive. It is an auto immune disease inwhich the body immune system (thebody’s way of fighting infection) at-
tacks healthy joints, tissues and or-gans. The natural defence mechanismof the body recognizes some compo-nent of the joint lining (Synovium) asan enemy and attacks it. When an im-munological attack is taking place it isnormally accompanied by inflamma-tory reaction. Inflammation of the syn-ovial membrane may spread to otherparts of the joint and the inflamed tis-sue may grow into the cartilage sur-rounding the bone ends, causing it todeteriorate. When the cartilage disinte-grates, scar tissue forms between thebone ends, fusing the joints, making itrigid and difficult to move.
TEST FOR DIAGNOSIS :-i. X-ray ii. ESR(Erythrocyte sedimentation
rate) – indicates the presence ofany inflammation in the body.
iii. RA factor ( Rheumatoid factor)– an abnormal antibody presentin most people who haveRheumatiod, arthritis. In nor-mal conditions the presence ofan antibody is nil.
OTHER FORMS OFARTHRITIS :- A. Anky losing spondylitis B. Bursitis C. Carpat Tunnel Syndrome D. Gout E. Polymyalgia rheumatica & sys-
temic Lupus Erythematosus F. Infectious Arthritis G. Juvenile rheumatoid Arthritis H. Lumbago or Fibrostis I. Polymyositis J. Psoriatic arthritis K. Reactive arthritis L. Rheumatic Fever M. Tendintis N. Tennis elbow
TREATMENT OPTIONSFOR ARTHRITIS :-● Pain Relif Medications ● Corticosteroids ● NSAIDS ● Surgery ● Nutritional Suppliments ● Heat and cold treatments ● Massage, Rest & Exercise
Pain Relief Medication :- Drugsthat relive pain are often used in thetreatment of arthritis, Althoughthey may provide some temporary re-lief, they do not actually help inarthritis. Pain killers such as aceta-minophen, propoxyphene, oxy-codone, Demerol and codeine areused in short term treatment ofarthritis pain.
Corticosteroids :- Steroids are themost potent anti-inflammatory drugsavailable. They can rapidly reducepain and inflammation. But theymust be used under a physican’scareful supervision because they cancause numerous side effects if takenin high daily doses from more than a2 months periods. Over long periodsof times, the bone becomes brittle,the skin becomes thin and cataractsmay develop. Steroid users may alsobecome psychologically dependenton them, making it difficult to stopinspite of their physicians advice.
SOME MEDICATION GEN-ERALLY APPLIED ARE :-● Adalimumab, Humira /Inj● Anakinra, Kineret (Injectable)● Azathioprine – Injection, Imu-
ran● Cox-2 Inhibitors● Infliximab – Injection, Remi-
cade● Ieflamomide, Arava● Methotraxate – Injection,
Rheumatrex● Salfaslazine, Azulifidine● Neproxen● Methyprednisolove, Medrol,
Depo-Medrol● Diclofenac, Voltaren,
Cataflam,Voveron-SR● Surgery :- One of the major
treatment aspects is surgerywhich include–
● Partial Joint Replacement● Total Joint Replacement
Conclusion : After briefing al-most all the general aspects of thiscrippling disease – called Arthritis,one must say that one can controlarthritis successfully in the earlystage, otherwise it may prove disas-trous. MT
E X P E R T
41
MERGING
TECHNOLOGYTalents with
The Reciprocating GaitOrthosis or RGO is themost frequently used
brace for the ambulatoryneeds of a paralyzed child
or adult.
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V I E W SE X P E R T
THERE ARE other types of RGO’s presently inuse, the dual-cable and horizontal cable producedby Fillauer, Inc., and others. RGO braces provideexcellent walking function as compared to otherdevices. Hands-free standing and the use of the or-thosis counteracts the tendency for hip contrac-tures. With every step, as one leg flexes, the otherleg must extend and thereby stretch out the hipcontracting structures. Agile patients can be fittedas early as 18 months of age, giving them a betterchance for walking and standing and therefore en-joying earlier the physiological, skeletal and psy-chological benefits of being upright.
RGO BENEFITSRGO is a walking brace for people with little or
no control of their lower extremities often due toneuromuscular disorders or injuries. The device isideally suited for patients with spina bifida, trau-matic paraplegia, muscular dystrophy, and os-teogenisis imperfecta.
RGO OFFERS THE FOLLOWING AD-VANTAGES: Efficient ambulation - compared to other RGOsis more energy efficient. This saves exertion forpeople with muscle weakness. Also for patientsprone to weight gain the ease of walking encour-
THE RRECIPROCATING Gait Orthosis or
RGO is the most frequently used brace for
the ambulatory needs of a paralyzed child
or adult. There are other types of RGO’s
presently in use, the dual-cable and hori-
zontal cable produced by Fillauer, Inc.,
and others. RGO braces provide excellent
walking function as compared to other
devices. Hands-free standing and the use
of the orthosis counteracts the tendency
for hip contractures. With every step, as
one leg flexes, the other leg must extend
and thereby stretch out the hip contract-
ing structures. Agile patients can be fit-
ted as early as 18 months of age, giving
them a better chance for walking and standing and
therefore enjoying earlier the physiological, skeletal and
psychological benefits of being upright.
RGO BBENEFITS
RGO is a walking brace for people with little or no con-
trol of their lower extremities often due to neuromuscu-
lar disorders or injuries. The device is ideally suited for
patients with spina bifida, traumatic
paraplegia, muscular dystrophy, and
osteogenisis imperfecta.
RGO ooffers tthe ffollowing aadvan-
tages:
l Efficient ambulation - compared to
other RGOs the ISOCENTRIC® is more
energy efficient. This saves exertion
for people with muscle weakness. Also
for patients prone to weight gain the
ease of walking encourages more
physical activities. The hip muscles
that are used for walking are exercised
and conditioned as the person walks in
the brace.
l “Hands-free” standing, balance and support - Wearers
can have their hands available for activities of function
while standing. The brace not only stabilizes the hip, knee
and ankle joints but it also balances (positions) the per-
son so they can stand without the use of crutches or
walkers.
l Dynamic “hip stretching” - Many Spina Bifida and peo-
ple with paraplegia are prone to hip flexion contractures.
44
OR
THO
TIC
S &
PROS
THET
IC
MOHAMMAD TTAHIR JJAMALOrthotics & Prosthetic DUBAI
MAY-JUNE l 2010
V I E W SE X P E R T
45
This tendency is counteracted by the
fact that the brace connects the two
legs in such a way that flexing of one
leg causes extension of the opposite
side. It is like getting therapy or
stretching with every step a person
takes.
l Steps are achieved by advancing the
leg one of three ways.
1. Use of hip flexor muscles.
2. Use of lower abdominal muscles.
3. Use of trunk extension
CARE AAND MMAINTENANCE OOF
RGO’S
RGO components are made from
high strength aluminum (2024-T4). It
is possible to make minor adjustments
or bends without annealing or soften-
ing of the aluminum. To make major ad-
justments or bends requires annealing
or softening of the aluminum to prevent
the aluminum from becoming brittle.
Take tthe ffollowing ssteps:
1. Remove all springs and screws
from part to be annealed.
2. Hold the bar horizontally.
3. Apply some wet soap to the top
surface of the area to be bent.
4. Heat the undersurface of the area
with a torch until the soap starts to
turn dark brown.
5. At the very moment the soap
starts to turn dark, drop the part
quickly into a container of cold
water.
6. Try bending it now, it should feel
soft and easy to bend. If it still feels
hard repeat the annealing process.
Repeat the process as many times
as it takes to achieve the desired
shape. As you continue bending the
aluminum will work harden over
time even as the patient continues
to use it MT
ages more physical activities. The hip muscles thatare used for walking are exercised and conditionedas the person walks in the brace. “Hands-free” standing, balance and support -Wearers can have their hands available for activi-ties of function while standing. The brace not onlystabilizes the hip, knee and ankle joints but it alsobalances (positions) the person so they can standwithout the use of crutches or walkers. Dynamic “hip stretching” - Many Spina Bifidaand people with paraplegia are prone to hip flexioncontractures. This ten-dency is counteracted bythe fact that the brace con-nects the two legs in such away that flexing of one legcauses extension of the op-posite side. It is like gettingtherapy or stretching withevery step a person takes. Steps are achieved by ad-vancing the leg one ofthree ways. 1. Use of hip flexor mus-
cles. 2. Use of lower abdomi-
nal muscles. 3. Use of trunk extension
CARE AND MAINTENANCE OFRGO’S
RGO components are made from high strength alu-minum (2024-T4). It is possible to make minor adjust-ments or bends without annealing or softening of thealuminum. To make major adjustments or bends re-quires annealing or softening of the aluminum to pre-vent the aluminum from becoming brittle.
Take the following steps:
1. Remove all springs and screws from part to beannealed.
2. Hold the bar horizontally. 3. Apply some wet soap to the top surface of the
area to be bent. 4. Heat the undersurface of the area with a torch
until the soap starts to turn dark brown. 5. At the very moment the soap starts to turn
dark, drop the part quickly into a container ofcold water.
6. Try bending it now, it should feel soft and easyto bend. If it still feels hard repeat the anneal-ing process. Repeat the process as many timesas it takes to achieve the desired shape. As youcontinue bending the aluminum will workharden over time even as the patient continuesto use it. MT
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F E A T U R ES P E C I A L
48
ABSTRACTObjective To document patients' preferred dress
styles of their doctors and modes of address. Design Descriptive survey. Setting Inpatients and outpatients at a tertiary
level hospital, New Zealand. Participants 202 inpatients and 249 outpatients,
mean age 55.9 (SD 19.3) years. Main outcome measures Ranking of patients'
opinions of photographs showing doctors wearingdifferent dress styles. A five point Likert scale wasused to measure patient comfort with particularitems of appearance.
Results Patients preferred doctors to wear semi-formal attire, but the addition of a smiling face waseven better. The next most preferred styles weresemiformal without a smile, followed by white coat,formal suit, jeans, and casual dress. Patients weremore comfortable with conservative items of cloth-ing, such as long sleeves, covered shoes, and dresstrousers or skirts than with less conservative itemssuch as facial piercing, short tops, and earrings onmen. Many less conservative items such as jeanswere still acceptable to most patients. Most patientspreferred to be called by their first name, to be intro-duced to a doctor by full name and title, and to seethe doctor's name badge worn at the breast pocket.Older patients had more conservative preferences.
Conclusions Patients prefer doctors to wear semi-formal dress and are most comfortable with conser-vative items; many less conservative items were,however, acceptable. A smile made a big difference.
INTRODUCTIONFirst impressions can make a difference. How a
doctor dresses may be important in determining the
DoctorapperianceSurvey of patients' preferences for doctors' appearance and mode of address
MAY-JUNE l 2010
F E A T U R E
success of the patient-doctor rela-tionship.
Doctors' attire has been mouldedby tradition and fashion over cen-turies. The past decades have seenmajor changes to the medical work-force and to societal expectationsthat have led to changes in doctors'choice of dress. One change is theincreased proportion of female doc-tors entering the profession with notraditionally defined "dress code."Another is the move away from med-ical paternalism, resulting in fewerdoctors choosing the traditionalwhite coat. Overall, doctors' dressstyles have become less formal thanin previous decades.
Most previous studies have fo-cused on white coats. Two Aus-tralian studies showed that 36-59%of patients thought that junior doc-tors should wear white coats. Rea-sons given includedprofessionalism, identification, andhygiene, yet white coats may be asource of, rather than a barrier to,cross infection. British and Ameri-can studies carried out up to the late1990s showed that patients weremore comfortable with traditionalstyles of appearance, such as whitecoats, formal suits, short hair,shirts, and ties.5 6 Casual items suchas sandals, sports shoes, and jeansevoked negative responses. Otherfactors, such as neatness or facialexpression, were also considered im-portant and had the potential toover-ride the effects of attire.7 8
Reported preferences may be con-tradicted when patients see actualexamples of different dress styles.9Two studies involved dress stylesbeing alternated in doctors to com-pare measurement of patient satis-faction, and found that dress did notcorrelate with estimates of a clini-cian's courteousness, concern, orprofessionalism.9 10
Just as fashion changes so mayopinions. More contemporary viewsare needed. Furthermore, few stud-ies have looked at clothing optionsother than white coats. Preferencesmay be determined by the familiar,
so that if a doctor wears a white coatthis may become acceptable to thepatient. Similarly, style of dress maydepend on the work culture of an in-stitution. Many doctors adapt theirstyles to fit in with colleagues' expec-tations, whereas some attempt tostand out deliberately. Doctors mayalso dress in a way that they feel isacceptable to their patients, and it islikely that patients dress to pleasetheir doctors.
These complex interplays can re-sult in novice doctors becoming un-clear about best practice, and manyof our junior colleagues have askedfor current information about whatdress styles are acceptableto patients. We documentedthe preferences of a rangeof patients within one hos-pital, with the aim of in-forming doctors' practice.
METHODSWe invited adult inpa-
tients and outpatients atChristchurch Hospital, NewZealand to take part in thestudy. Outpatients attendingclinics that covered a rangeof medical and surgical spe-cialties were approachedconsecutively in the waitingroom over one week in De-cember 2003. Inpatientsfrom a wide range of wards
were surveyed sequentially over an-other week. Inpatients were ex-cluded if the nursing staff deemedthem too unwell or if they were ab-sent from their bed for an extendedperiod on the specific day.
Our survey comprised two parts.For the first part we presented pa-tients with two sets of six photo-graphs—one set of a young maledoctor and the other of a young fe-male doctor (see bmj.com). Eachphotograph depicted a differentdress style. These styles were ca-sual, jeans, semiformal, white coat,and formal suit. The sixth photo-graph showed a semiformal stylewith the doctor smiling. The casualphotographs showed the male doc-tor wearing khaki trousers and apolo shirt and the female doctorwearing a sleeveless top, sandals,and short skirt. Other photographsshowed both doctors wearing jeans,but with the male doctor wearing ashort sleeved shirt with a collar andthe female doctor a long sleevedknitted top. The semiformal photo-graphs showed the male doctorwearing dark trousers with a longsleeved shirt and tie and the femaledoctor a blouse with a dark colouredskirt or trousers. The white coatphotographs had both doctors wear-ing dark trousers. A fifth style hadmale and female doctors wearing
S P E C I A L
49
MAY-JUNE l 2010
F E A T U R ES P E C I A L
dark suits. For all photographs thestance, position of the stethoscope,and hairstyle were kept constant.The photographs were presented topatients in random order.
DOCTORS' DRESS Patients were asked to rank each
set in order from their most preferreddoctor (ranked 1) to their least pre-ferred (ranked 6). They were asked tochoose their four most preferred doc-tors from the complete set of 12 pho-tographs (no order or sex restrictionrequired).
In the second part of the survey thepatients were asked to complete awritten questionnaire, which includedrequests for personal information andquestions on the degree of comforteach respondent felt with doctorswearing specified items of clothing.Responses were graded according to afive point Likert scale, ranging from"very uncomfortable" to "very com-fortable." In addition participantswere asked where identification tagsshould be worn, what name they likedto be referred to by their doctor (firstname or title and surname), and howthey liked doctors to introduce them-selves. We provided four options for adoctor's introduction: first name only,first and last name, title and first andlast name, and title and surname. Op-tions for the location of an identifica-tion tag were at the waist, breastpocket, or anywhere as long as a namebadge was worn.
We calculated mean ranks for thephotograph sets and compared theseusing Student's t tests. Mean scoreswere calculated for each Likert scalequestion. We used analysis of vari-ance or Student's t test to compare re-spondent's ages according toprefe re nce s and to compare rankingsor scores according to age groups. ABonferroni correction was made toadjust for multiple comparisons suchthat differences were regarded as sig-nificant if the P value was less than0.0012. We calculated a projected sam-ple size of 450 to provide 0.80 power at= 0.05 to obtain descriptive statisticswith a 4% margin of error.
RESULTSThe sample population
comprised 606 patient; 155declined or were unavail-able. We recruited 249 out-patients and 202 inpatients,comprising 214 men and232 women (five did notprovide their sex) with amean age of 55.9 years (SD19.3 years). Six people didnot provide their age. Intotal, 127 people were agedless than 45 (28%), 144 were45-65 (32%), and 174 weremore than 65 (39%).
Figure 1 shows the dis-tributions of mean ranksfor each of the clothingstyles, including the re-sults for the photographswith doctors smiling. Pa-tients ranked the semifor-mal style the best,especially when accompa-nied by a doctor smiling.
Table 1 shows the meanrankings and significanceof the differences forpaired dress styles. Eachstyle is compared with thenext most popular styleoverall. Table 2 shows theproportions of each stylechosen among patients' topfour.
STYLE CHOSEN IN PA-TIENTS' TOP FOUR
A patient's age was significantlyassociated with the photographrankings for some clothing styles.The smiling photograph was ex-cluded from this analysis. Olderpeople gave more negative rankingsfor the male doctor in semiformalstyle (mean ranking 1.9 for peopleunder 45, 1.9 for people aged 45-65,and 2.5 for people older than 65; P <0.0001). We found no effect of pa-tient's age for the female doctor insemiformal style. Older patientsgave more positive rankings formale doctors wearing white coats(mean ranking 2.9 for people under45, 2.5 for people aged 45-65, and 2.3
for people older than 65; P < 0.0001)and for female doctors (mean rank-ing of 3.2 for people under 45, 2.7 forpeople aged 45-65, and 2.4 for peopleaged more than 65; P < 0.0001).
The relative rankings of the se-lected dress styles for female andmale doctors, respectively. Age wassignificantly associated with re-sponses to specific items of cloth-ing. Items worn by female doctorsthat were significantly (P < 0.001)less acceptable to older patientswere (in order starting with theleast acceptable by mean ranking)facial piercings, short tops, brightlydyed hair, training shoes, sandals,loose hair, skirts above the knee,long earrings, several rings, andsleeveless tops. Items worn by maledoctors that were significantly (P <
50
MAY-JUNE l 2010
F E A T U R E
0.001) less acceptable to older pa-tients were (starting with the leastacceptable by mean ranking) facialpiercings, brightly dyed hair, ear-rings, T shirts, training shoes, longhair, several rings, tie depicting acartoon character, and no tie.
FEMALE & MALE DOC-TORS' ITEMS
Most patients (356, 79%) pre-ferred to be called by their firstname, with only 20% preferringtitle and surname. Participants whopreferred to be called by their titleand surname were older (mean age61) than those who preferred to becalled by their first name (mean age54; t = 3.1, P < 0.01).
Nearly half (208, 46%) of the pa-tients preferred doctors to intro-
duce themselves by titleand first and last name("Dr Jane Smith"), 27%(122) by first and lastname ("Jane Smith"), 15%(68) by title and surname("Dr Smith"), and 10% (46)by first name only("Jane"). We found noclear preference accord-ing to age (F = 1.33, df = 3,P = 0.27).
Most patients (344,76%) stated that doctorsshould always wear aname badge. The breastpocket was the preferredsite (280, 62%), with "any-where as long as theyhave a name badge" thesecond most popular (117,26%). Only 9.5% (43) ofpatients thought that thewaist was the best placefor a name badge.
DISCUSSIONPatients prefer doctors
to dress in a semiformalstyle, but when accompa-nied by a smiling face it iseven better, suggesting afriendly manner may bemore important than sar-torial style.
Although previousstudies have shown that patientsprefer doctors to wear white coats,we found that patients prefer asemiformal style of dress over for-mal suits and white coats. In linewith previous studies, casual dressstyles were less popular. This find-ing, and the association with age,suggests the beginnings of a trendaway from patients preferringwhite coats. In general, patientsprefer more conservative items ofclothing.
Most patients prefer their doctorto call them by their first name butprefer doctors to introduce them-selves using title and first and lastnames. Few patients prefer the mostcasual option of first name only orthe most formal option of title and
surname. The breast pocket was themost favoured location for a namebadge.
The size of our study provided agood cross section of opinions andgave sufficient power to detect smalldifferences in patient preferences.The use of ranking of photographsprovided good comparative data andovercame the problem where peoplemay state preferences in theory thatare different from preferences inpractice.9
The use of the smiling option inrelation only to semiformal dressmay have introduced some bias. Forexample, the higher preferences forthe semiformal non-smiling doctormay have arisen by its associationwith a smile on another photo-graph. Ideally each dress stylewould have been presented with asmiling and non-smiling version, orthe smiling option should have beenrandomly associated with any ofthe dress styles. Although these re-sults are representative of the pa-tient population at one hospital inNew Zealand, we cannot be surethey would be generalisable to otherpopulations.
In view of differences comparedwith earlier studies, repeating thisstudy at regular intervals to tracksecular changes would be of value.We predict that the trend will con-tinue for decreasing popularity ofwhite coats. Although sex interac-tions were not apparent in thisstudy, looking more specifically forthis would be worthy of furtherstudy. Similarly, qualitative workthat explores why patients react incertain ways would be of interest.
Dress style and manner are wellwithin a doctor's control and there-fore can be altered to fit most withpatient preference. In the NewZealand setting this would involvedressing in a tidy, semiformal man-ner in conservative clothing. Ask-ing patients if they prefer to becalled by their first name may aidcomfort. Doctors should introducethemselves fully and clearly, supple-mented by a name badge worn at
S P E C I A L
51
MAY-JUNE l 2010
G U A R DL I F E
52
An EmergencyOxygen Guideline
An EmergencyOxygen Guideline
With the publication of the emergency oxygenguidelines by British Thoracic Society (BTS),
MAY-JUNE l 2010
G U A R D
BY DR.SHEREE SMITH, Imperial College London, UK
MANY CLINICIANS may reflect on this newguidance and re-evaluate current emergency oxy-gen protocols within their own departments. Oxy-gen therapy is widely used in both chronic andacute conditions and trauma care. This evidencebased guidance from the UK seeks to provide aclear oxygen management pathway for cliniciansas well as make available detailed information onthe subject area of the physiology and pathophysi-ology of oxygen. The primary change to practicewithin this guideline is the use of oxygen titrationto achieve a Sp02 within a predetermined oxygensaturation target range as measured by pulseoximetry.
RINCIPLE AIMThe principle aim of oxygen therapy is to re-
lieve hypoxaemia. Oxygen therapy should be usedto achieve normal or near normal saturations (94%to 98%) in most patients, apart from those who suf-fer from particular conditions where theirphysiologic response may be different, suchthose at risk of hypercapnia respiratory fail-ure. For patients with chronic diseases wherehypercapnia is known, this guideline indi-cates that oxygen therapy ought to be deliv-ered 24% at 2-4 litres in hospital settings toachieve a target oxygen saturation within arange of 88% to 92%.
For patients who are critically ill and nothypercapnic, a high concentration of oxygenis often an imperative with
The principle aim of oxygen therapy isto relieve hypoxaemia
the documentation to the percent of con-centration, flow rate and the patient’s oxygensaturation at commencement of therapy,being of equal importance. We now know thatpatients who experience breathlessness with-out a physiological basis such as hypoxaemia,benefit little from oxygen therapy and that theuse of non-pharmacological interventions areworth considering.
In acute situations, accurate clinical infor-mation is extremely important and in observ-ing the effect of oxygen therapy the need formonitoring oxygen saturation through theuse of pulse eximetry can not be underesti-mate.
When using pulse oximetry, one needs to beaware that readings may be inaccurate whennail varnish or false nails have not been re-moved. Also hand tremors are known to com-prise the accuracy to these situations the use
of ear probes are recommended.
EMERGENCY GUIDELINES
This BTS emergency oxygen guideline supportsprevious published information for both asthmaand Chronic Obstructive Pulmonary Disease(COPD) guidance.
Similar to those who experience trauma withoutany other underlying chronic condition, high con-centration oxygen at high flow is recommended bythe SIGN and BTS (2008) guideline for people whoexperience an acute asthma episode.
In addition, it is suggested that oxygen therapyshould be titrated to achieve saturations of at last92% in asthama
Oxygen therapy is widely used in bothchronic and acute conditions and trauma care
Patients. The emergency oxygen guideline goesfurther by advocating that any wet nebulisationshould be delivered through an oxygen-driven de-vice particularly when the acute asthma patient is
L I F E
53
MAY-JUNE l 2010
G U A R DL I F E
in a critical sate. At the beginning of this guidelinethere is an algorithm for the clinical managementof adults with acute asthma in emergency depart-ments and this quick summary may prove usefulfor clinicians in busy departments.
For people with COPD a number of considera-tions are required when implementing oxygentherapy as we know COPD has different pathophys-iology to asthma. People who experience frequentexacerbations have a more rapid decline in lungfunction and quality of life. The emergency oxygenguideline recommends that people who experiencean exacerbatin of their COPD should be given oxy-gen therapy through a venturi mask at 28% or24% at the appropriate flow rates according to thedevices. The emergency oxygen guideline furtherand suggests that the patients clinical history mayplay a significant role in the setting of target oxy-gen saturations to be achieved.
For example, a small proportion of COPD pa-
tients have ongoing hypercapnic respiratiory fail-ure (10%) whilst others with mild disease maycontinue to have normal blood gases which onlydeviate when they experience an exacerbation.
Therefore it is clinically important to assessCOPD patients on a case by case basis to be able todetermine a target saturation range to be achievedthrough oxygen therapy titration.
This emergency oxygen guideline has a lot tooffer the clinical management of patients in theemergency department .
The extensive physiology and pathophysiologysections add support for the appropriate use ofoxygen as a therapy.
Furthermore this additional information pro-vides a substantial update for busy clinicians onthe evidence available for the use of emergencyoxygen. MT
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NEWS l DOCTOR SPEAK l SPECIAL FEATURE l BEAUTY & COSMETIC l LIFE GUARD l ACUPUNCTURE
Vol.I Issue 1 May-June 2010
Gateway to Health & Medical World
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