Watch your step to avoid accidents

by Nilma DOLE

Dr. Narendra Pinto

When we talk about orthopaedics, it means that it is a type of surgery concerning conditions involving the musculoskeletal system. Expert orthopaedic surgeons treat musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors, and congenital in both surgical and non-surgical ways. Speaking to the Sunday Observer was President of the Sri Lanka Orthopaedic Association, SAARC Surgical Care Society and the immediate past president of the College of Surgeons, Dr. Narendra Pinto who counts over 30 years of extensive experience in the field of orthopaedic surgery.

He said, "I have memories of when it was a poignant period in our history when the emergency ward of the General hospital was never closed because of the dedication and hard work done by our doctors who worked tirelessly to ensure the well-being of the patients."

In Sri Lanka, orthopaedic surgery has seen great developments with the advancement and technological innovations in this field the world over. In our country, access to free medical health care has contributed immensely to many of our patients to overcome their difficulties.

Dr. Pinto said, "Orthopaedics pertain to diseases of the bones, joints, cartilage, muscles tendons, nerves and even congenital deformities, developmental abnormalities and inflammations are part of orthopaedics," he said. "Certain inflammations such as rheumatoid arthritis especially at the end stage when it affects the bones and joints permanently may require orthopaedic surgical intervention to rectify it," said Dr. Pinto.

The doctor said that in Sri Lanka, trauma is the primary cause of admission of patients to the emergency and orthopaedic wards. Trauma could result from road traffic accidents, home accidents, occupational injuries, trauma resulting from acts of violence and sports injuries.

"Trauma due to war has now come to an end in our country thanks to the peace in the country," said Dr Pinto.

Surgery in progress

At present, road traffic accidents are the major cause of orthopaedic injuries which accounts for a majority of emergency admissions. "With many national sports going into professional level in recent times, there has been a growing increase in incidence of sports injuries. Occupational mishaps occur in people working with machinery and construction industry and could be largely prevented by adhering to safety precautions and protective gear," said Dr. Pinto.

"No matter what type of trauma is it, prompt first aid treatment is needed to stabilise the patient.

Securing a patient's airway is mandatory to save life, most of the external bleeding can be controlled by applying direct pressure with a piece of cloth over the bleeding site," said the doctor.

According to Dr. Pinto, mishandling a patient without proper orthopaedic support can trigger more severe complications.

In the event of a severe traumatic condition, the family and friends of the patient should get the patient admitted to the nearest hospital rather than worrying about getting the patient to a specialised hospital which may be far away. "For instance, if a patient is admitted to a base hospital, the medical staff can transfer the patient to a hospital with better care facilities after initial assessment and care," said Dr. Pinto.

He added, "If there is a trauma casualty, I would advise that the patient be placed in a horizontal position to protect the spine, splint any apparent fractures and transport the patient to hospital in the same position."

This is why our paramedics need to be properly trained and people should know that if there is an accident, the victim shouldn't be handled in a way that they get a second accident.

"In case of any accident within Colombo city limits, an ambulance service is available within a very short time by dialing 110 twenty-four hours a day. The public should be aware that emergency services are available right through the day and night even on weekends and public holidays.

A trauma victim being resuscitated

"Home accidents are also a major cause of orthopaedic trauma. People should be careful when getting onto unsafe platforms and ladders for reasons such as changing electric bulbs and fixing television antennas. I have seen many sad instances of paralysed cases resulting from such falls.

The elderly people living in our houses may get serious fractures even from trivial falls due to the osteoporotic nature of their bones. Making the home environment safe, correcting any vision defects supervising their medications to ensure that they are not over sedated and providing walking aids will go a long way in preventing such injuries," said Dr. Pinto.

"There have been vast advancements in the field of joint replacements. Hip, knee replacement surgeries are commonly carried out in most of the orthopaedic units all over the country. These replacements are mostly carried out for degenerative diseases and also following trauma to the hip joint.

In fixing fractures many treatment options are available. Bones could be lengthened, large defects bridged by way of special external fixators. Arthroscopy is a great innovation and is a useful tool of minimally invasive surgery in knee and shoulder joint conditions," said Dr. Pinto.

"The primary malignant neoplasms affecting bones in the early stages can be resected, preserving the limb by bridging the deficit by allograft available at the human tissue bank or by other means in many instances," said Dr Pinto.

Dyspepsia:

Discomfort mainly concentrated in upper abdomen

by Dr. Upali WERAGAMA

Dyspepsia is a recurrent or persistent pain or discomfort that is primarily located in the upper abdomen. The "discomfort" is an uncomfortable feeling but does not reach the level of pain. The discomfort is mainly concentrated in the upper abdomen, although a person may also have pain in other areas. Approximately 25 percent of people worldwide experience dyspepsia.

Dyspepsia can develop as a result of various underlying conditions (e.g. gastric acid reflux, gastritis, stomach ulcers, cancer of oesophagus, stomach and pancreas.) However a common type of dyspepsia is "functional" (or "non-ulcer") dyspepsia. This refers to dyspepsia that occurs without an identifiable cause.

Symptoms - People with dyspepsia can have one or more symptoms, including:

Indigestion

Discomfort or pain in the abdominal area

Bloating

An early sense of fullness with meals (early satiety)

Some patients with dyspepsia also experience nausea, vomiting, a lack of appetite, weight loss, or other symptoms and findings.

Types of dyspepsia - There are two major categories of dyspepsia: "Functional" dyspepsia refers to the dyspepsia that occurs with no obvious abnormality in the digestive tract. "Organic" or "non-functional" dyspepsia refers to conditions that have a visible abnormality in the digestive tract.

Causes - It is not clear what causes the signs and symptoms of functional dyspepsia. However, researchers have focused on several factors that may be involved.

Motor or nerve coordination - Normally, the process of digesting food involves a complex series of events that requires coordination of the nerves and muscles of the digestive tract. Abnormalities in this system may lead to delayed emptying of the stomach contents into the upper region of the small intestine, resulting in nausea and vomiting, an early sense of fullness with eating, and bloating. Delayed gastric emptying is found in approximately 30 percent of people with dyspepsia. However, many people with delayed gastric emptying have no symptoms of dyspepsia.

Visceral sensitivity - Enhanced visceral sensitivity is an increased sensitivity to pain, or a lower threshold for pain, that occurs when normal stretching or enlargement of the stomach occurs. Studies have consistently shown that people with functional dyspepsia often have visceral hypersensitivity.

Helicobacter pylori infection - Helicobacter pylori (H. pylori) is a bacterial infection of the stomach that can lead to inflammation (gastritis) or ulcers. There may be a relationship between infection with H. pylori and functional dyspepsia.

Psychological and social (psychosocial) factors - People with functional dyspepsia may be more likely to have certain mood problems, such as anxiety or depression. This is not to say that a person's pain is "in their head" or "made up", although treating the underlying depression or anxiety may improve a person's symptoms of abdominal discomfort.

Diagnosis - There are a number of reasons why a person can develop symptoms of dyspepsia. Organic (non-functional) dyspepsia can cause symptoms that are similar to those of functional dyspepsia, or the symptoms may be slightly different. A doctor will perform a medical history and physical examination to narrow the possible list of causes, with special attention to the following: Is the pain "gnawing" or worsened by hunger? Is the pain worsened by certain movements or pressure on certain areas of the abdomen? Do you take medications for pain, such as aspirin, ibuprofen? Do you have a history of ulcers? Do you have heartburn in addition to upper abdominal discomfort? Do you have intense pain in the upper right or middle of the abdomen? Does the pain extend to the back or between the shoulder blades? Does this happen periodically, along with vomiting, sweating, or feeling restless? Have there been changes in your bowel habits (eg, constipation or diarrhoea)? Have you recently unintentionally lost weight, vomited repeatedly, or had difficulty swallowing?

Testing recommendations - The best way to diagnose functional dyspepsia is not clear. People who are older than 45 or with serious symptoms, such as repeated vomiting, weight loss, difficulty swallowing, or a low blood count, should have an upper endoscopy procedure.

People who are younger than 45 and who do not have serious symptoms are generally offered noninvasive tests. If symptoms fail to improve within four to eight weeks or if more serious symptoms develop, further testing, including upper endoscopy, is usually recommended. Other diagnostic tests may be recommended in selected cases.

An upper endoscopy is a procedure that allows a doctor to examine the upper part of the gastrointestinal (GI) system, which includes the esophagus (swallowing tube), the stomach, and the duodenum (the first section of the small intestine).

Treatment

Understanding the condition - Being diagnosed with functional dyspepsia may be a relief to some people and a frustration to others. It is important to understand that symptoms are not imaginary. One or more treatments may be recommended, often in combination; having realistic expectations of the benefits of treatment may help to reduce frustration. If there are mood problems, such as anxiety or depression, an evaluation with a mental health specialist (e.g. psychologist, counselor) may be recommended.

Lifestyle changes - Some people benefit from avoiding fatty foods (which can slow the emptying of the stomach), and eating small frequent meals. Foods that aggravate symptoms should be avoided, if possible, although eliminating entire food groups is not recommended. If there are questions about which foods should be avoided, this should be discussed with a doctor and/or dietician.

Medications - Certain medications may help reduce the symptoms of functional dyspepsia.

H. pylori therapy - Treatment of H. pylori is recommended if an ulcer is diagnosed. Acid reducing medications - Some people benefit from treatment with medications that inhibit or reduce the production of stomach acid (e.g. H2 blockers and proton pump inhibitors).

Visceral analgesics - As mentioned previously, some people with dyspepsia are sensitive to enlargement (distension) of the stomach. Medications that relieve visceral pain are being studied.

Pain medications - Low doses of an antidepressant medication may be recommended to reduce pain, even if the patient is not depressed. The doses of these drugs are typically much lower than that used for treating depression. It is believed that these drugs reduce pain perception when used in low doses. Their full effect may not be seen for weeks to months.

Prognosis - Dyspepsia is typically a relapsing condition. In studies, 60 to 80 percent of people continue to have symptoms of varying degree two to three years after being diagnosed. However, most people feel better once their condition has been properly diagnosed, and many will respond to the treatments discussed above.

(The writer is Consultant Physician and Gastroenterologist.)

Health snippets

Consuming grapes and green tea could leave you with iron deficiency

Eating certain polyphenols, substances found in many fruits and vegetables, decreases the amount of iron the body absorbs, which can increase the risk of developing an iron deficiency, State nutritional scientists have found.

"Polyphenols have been known to have many beneficial effects for human health, such as preventing or delaying certain types of cancer, enhancing bone metabolism and improving bone mineral density, and decreasing risk of heart disease," said Okhee Han, assistant professor of nutritional sciences.

"But so far, not many people have thought about whether or not polyphenols affect nutrient absorption." The researchers, led by Han, studied the effects of eating grape seed extract and epigallocatechin-3-gallate (EGCG) found in green tea. They used cells from the intestine - where iron absorption takes place - to assess the polyphenols' effect and found that polyphenols bind to iron in the intestinal cells, forming a non-transportable complex. This iron-polyphenol complex cannot enter the blood stream. Instead, it is excreted in the faeces when cells are sloughed off and replaced.

Iron is necessary to carry oxygen from the lungs throughout the body and for other cellular functions. People already at risk for iron deficiency increase that risk if they consume high amounts of grape seed extract or EGCG."Iron deficiency is the most prevalent nutrient deficiency in the world, especially in developing countries where meats are not plentiful," said Han.

"People at high risk of developing iron deficiency - such as pregnant women and young children - should be aware of what polyphenols they are consuming." Han and her colleagues looked at the heme form of iron found in meats, poultry, and fish. The result has been published in the Journal of Nutrition. (ANI)

Drugs can reset body clock to ease psychiatric disorders

London: It is possible to treat a host of health problems by resetting the body clock with the help of drugs.

"This might include some psychiatric diseases and certain circadian sleep disorders," said Andrew Loudon, study author from the University of Manchester in Britain.

"It can be really devastating for our brains and bodies when something happens which disrupts the natural rhythm of our body clocks," Loudon said.

"This can be a result of a disease or as a consequence of jet lag or frequent changes between day and night shifts," he said, according to the journal Proceedings of the National Academy of Sciences. "We've shown that it's possible to use drugs to synchronise the body clock of a mouse and so it may also be possible to use similar drugs to treat a whole range of health problems associated with disruptions of circadian rhythms," he said.

"We've discovered that we can control one of the key molecules involved in setting the speed at which the clock ticks and in doing so we can actually kick it into a new rhythm," he added. Most living creatures and plants have an internal body timing system called the circadian clock. There is a complex system of molecules present in every cell that drives rhythm in everything from sleep in mammals to flowering in plants. (IANS)