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Sunday, 30 January 2011

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Ultrasound is not harmful

“There are various controversies surrounding ultrasounds but they are not harmful to people and are very important in determining successful pregnancies,” said consultant obstetrician and gynaecologist,National Hospital Dr. Viyabhushana. “Ultrasound is a type of sound pressure associated with a frequency greater than the upper limit of human hearing which is roughly 20,000 hertz,” he said. According to the doctor, humans can’t hear the ultrasound waves but animals can hear them, and this kind of practice is present even in radio waves.

Medical sonography (ultrasonography) is when ultrasound is used to create images to see a graphic representation of visuals within the body. “When a pregnant woman comes to do an ultrasound, it is important to highlight that it is 100 percent safe and it won’t affect the developing foetus. Plus it can also give some idea about how the baby is developing in the womb,” said Dr. Viyabhushana. Ultrasounds are essential and the waves travel from 3 to about 8 megahertz in the body of a woman who is being checked. “Ultrasound waves cut into the skin but isn’t detected through the bone. We apply a gel for the ultrasound to be trapped because it travels faster through air,” said the doctor. Moreover, ultrasounds are not harmful because they are not rays, or harmful radioactive waves sent into the body. Soft tissue imaging of many other parts of the body is conducted with ultrasound.

Dr. Viyabhushana said, “In the first trimester of pregnancy (4 to 8 weeks), an ultrasound is done to see if the pregnancy is ectopic (foetus developing in the Fallopian tube) or intrauterine (inside the uterus).” According to the doctor, an ectopic pregnancy is dangerous and should be carefully detect to prevent complications. “There is also a threat of bleeding which can be harmful to the foetus and other complications which can arise if an ultrasound isn’t done to find the cause of the problem,” said Dr. Viyabhushana.

An ultrasound in 12 weeks determines the foundations of pregnancy whereby a foetus can be visibly seen. “We can see if the foetus could be forming as twins, and there are five types of twins which is known to medical science,” said Dr. Viyabhushana. In addition to this, he said that the Crown-rump Length can be measured. “This is the measurement of the length of a human embryo or a foetus from the top of the head (crown) to the bottom of the buttocks (rump),” he said. The doctor said that calculating the date of delivery from the exact time of when the menstruation cycle stops is an unlikely chance. “About 10 to 40 percent of the time, this theory can’t be applied to women due to various factors. So we have various data published in medical journals on test-tube babies (IVF babies) that has information recording the exact date of pregnancies,”said the doctor. He said that from the Crown-rump Length, we can determine when the delivery will take place due to different charts mapping how the foetus is formed and how to calculate the date. This is known as ‘Date the pregnancy’ or the gestational age, said the doctor.

Sex determination is only accurate after 12 weeks and sometimes, this has to be carefully determined in order to prevent any problems. “Unexplained foetal deaths, abnormalities, still birth problems all can be determined in about week 14 of the pregnancy,” said Dr. Viyabhushana.

The two types of ultrasounds are tri-vaginal and tri-abdominal where tri-vaginal checks vaginal screening and tri-abdominal screens stomach and tummy problems.

“If there are complications in the stomach wall, certain deformities, it all can be checked. In fact, we have come across cases where the foetus have a missing skull, few more fingers and even missing organs,” said Dr. Viyabhushana.

Anencephaly is rather common problem when a neural tube defect happens when the cephalic (head) end of the neural tube fails to close, usually between the 23rd and 26th day of pregnancy, prominently shown as a missing skull exposing the brain. “Most do not survive birth, accounting for more than 50 percent of miscarriages. If the infant is not stillborn, then he or she will usually die within a few hours or days after birth from cardiorespiratory arrest,” said the doctor.

Even though we think that sometimes ultrasounds may be identified in the future as harmful risks or even due to fear, currently most doctors feel that based on available information the benefits to patients outweigh the risks.


Chikungunya! Once bitten...

After the floods, diseases spread by mosquito bites -like chikungunya - are on the rise. Chikungunya fever is a debilitating viral illness that is caused by an insect-borne virus, Chikungunya virus (CHIKV).

The term ‘chikungunya’ means ‘that which bends up’ in the Kimakonde language (an African language). This refers to the stooped posture of patients who are afflicted with severe joint pain in this disease.

Day-time bite

Chikungunya virus is spread by the bite of an infected mosquito.

Mosquitoes become infected when they feed on a person infected with chikungunya virus. Infected mosquitoes can then spread the virus to other humans when they bite them. Aedes aegypti (the dengue fever mosquito), a household container breeder and aggressive daytime biter, which is attracted to humans, is the primary carrier of chikungunya virus to humans.

Known history

Chikungunya fever was first recognized in epidemic form in East Africa in 1952-1953.

The virus was first isolated in Tanzania. In India CHIKV was first isolated in Kolkata in 1963.

Following that, epidemics occurred in Tamil Nadu (1964), Maharashtra (1973), Andhra Pradesh and Karnataka (2005). As of April 29, 2009, the Directorate of National Vector Borne Disease Control Programme in India has reported over 2,700 suspected cases of chikungunya fever, with no deaths reported.

The most affected areas in India are the Karnataka, followed by AP, Goa, and Kerala.

Symptoms

The incubation period (time from infection to illness) can be 2 to 12 days, but is usually three to seven days. Chikungunya virus infection can cause a debilitating illness. Fever and severe joint pain are accompanied by chills and constitutional symptoms like headache, extreme sensitivity (excessive sensitivity to light), conjunctival infection, myalgia (muscular pain), fatigue (weakness), loss of appetite, nausea and abdominal pain. Migratory polyarthritis mainly affects the small joints of the hands, wrists, ankles and feet with lesser involvement of the larger joints. Erythematous rash may appear on day two or three of the disease and is most intense on the trunk and limbs, and may peel off as scales. Red spots under the skin (petechiae) are occasionally seen, but unlike dengue, this virus is not a regular cause of the hemorrhagic fever syndrome.

A few patients may develop leucopenia (low white cell counts), mildly decreased platelet counts, elevated liver enzymes and C-reactive protein.

Acute chikungunya fever typically lasts for a few days to a few weeks, but as with dengue fever, some patients have prolonged fatigue lasting several weeks. Additionally, some people continue to experience incapacitating joint pain and recurrent joint effusions for several months to years.

Very rarely the disease becomes fatal by producing complications such as meningitis and encephalitis (infection spreading to the brain).

Pregnancy and Chikungunya

Pregnant women can become infected with chikungunya virus during all stages of pregnancy and have symptoms similar to other individuals. Most infections occurring during pregnancy will not result in the virus being transmitted to the foetus. The highest risk for infection of the foetus/ child occurs when a woman has virus in her blood at the time of delivery. There are also rare reports of first trimester abortions occurring after chikungunya infection. Currently, there is no evidence that the virus is transmitted through breast milk.

Diagnosis

Chikungunya is diagnosed by ELISA blood test (same as that for HIV AIDS screening). Blood test is the only reliable way to identify chikungunya since the symptoms are similar to much more deadly dengue fever. Also co-occurrence of these diseases is seen in many places.

Treatment

There is no specific antiviral treatment currently available.Treatment is symptomatic and can include rest, fluids, and medicines to relieve symptoms of fever and pain. Aspirin should be avoided during the acute stages of the illness.

In arthritis not responding to analgesics, Chloroquine is recommended. Infection appears to confer life long immunity. The best way to prevent chikungunya virus infection is to avoid mosquito bites. There is no vaccine or prophylactic drug currently available.

(The writer is a Consultant Microbiologist)

Courtesy: BPositive


Reducing your risk of depression

It may not always be possible to prevent depression. However, the following strategies may help reduce your risk of becoming depressed:

* Be aware of your personal risk of depression.

* Have a psychiatric evaluation and psychotherapy, if needed.

* Develop a strong social and spiritual support system.

* Reduce your stress.

* Exercise regularly.

* Get treatment for alcohol and drug abuse.

* Eat healthfully.

* Get the necessary amount of sleep.

Be aware of your personal risk of depression

Be alert to factors that can increase your risk for depression, such as:

* Family history, * High levels of stress, * Major life changes, such as: * Death of a relative, * Assault, * Severe marital or relationship problems, * Psychological factors, such as: * Low self-esteem, * Perfectionism, * Sensitivity to loss or rejection, * Inadequate social support, * Previous episodes of depression, * Chronic physical illness, * Heart attack, * Chronic pain, * Hormonal changes, including postpartum depression or menopause, * Anxiety, * Medications that can cause depression, * Alcohol or drug abuse

Have a psychiatric evaluation and psychotherapy, if needed

If you feel overwhelmed by stress or are experiencing symptoms of depression, see your doctor for a physical exam and mental health evaluation. You may be referred for further evaluation or counseling, if appropriate.

Develop a Strong Social and Spiritual Support System A network of supportive relationships is beneficial for the prevention and treatment of depression. Supportive relationships serve as a buffer against stress, which can sometimes trigger depression.

A high level of religious involvement is associated with a reduced risk of depression. Spiritual faith in the context of organized religion can have a buffering effect on depression. In a group setting, it can provide the additional benefit of social support.

Reduce your stress

A variety of relaxation techniques can help you cope with stressors that may contribute to depression. Examples include meditation, deep breathing, progressive relaxation, yoga, and biofeedback. These techniques help you pay attention to tension in your body and release it with exercises that help quiet your mind and relax your muscles. You can also reduce stress by getting adequate sleep, rest, and recreation.

Exercise regularly

Regular exercise helps you relieve stress and may help prevent or reduce depression. Aerobic exercise and yoga have been found to be particularly beneficial for reducing stress and improving mood. Aerobic exercise can raise the levels of brain chemicals that affect mood, such as endorphins, adrenaline, serotonin, and dopamine. Other benefits of exercise include: weight loss (if necessary), increased muscle tone, and higher self-esteem. Yoga provides the benefits of stretching and deep relaxation.

Courtesy: AHealthyMe


Social phobia: Not just shyness

We all get butterflies at some point in our lives, but when fear of social interaction threatens to take over your life, it’s time to seek help.

Suzanne, an intelligent woman in her thirties, had been lonely for much of her life. She’d been stuck in the same secretarial job because she was afraid of working with people above her job level. She wanted to meet a man, but was sure she’d say something stupid and be rejected. Her few good friends couldn’t get her to go to restaurants or even parties because she was afraid other people might think she was a sloppy eater. The few times she agreed to go, her heart was pounding and she began to blush and perspire. When her primary care physician finally referred her to a psychologist with experience in anxiety disorders, she was relieved to discover she had a treatable condition with a name social phobia.

What is social phobia?

Many people get nervous in certain social or business situations.

There is nothing unusual about feeling anxious before making a presentation, going out on a first date, going to a party where you don’t know many people, or having dinner with the boss.

What’s different about social phobia, also known as social anxiety disorder, is that you have an extreme fear of being judged by other people and acting in ways that might embarrass or humiliate you. You are also afraid of becoming the centre of attention and worry that everyone is looking at you. As a result, you go to great lengths to avoid the social situations you fear. If you find yourself in one of these situations, such as a party, you experience intense anxiety that is out of proportion to the event.

Social phobia usually begins in adolescence, although symptoms like extreme shyness may occur in earlier years. The disorder is chronic, although stress may cause the intensity to fluctuate.

How does it differ from shyness?

“Social phobia is not just shyness,” says Stefan Hofmann, Ph.D., director of the Social Phobia Treatment Program at Boston University.

“It’s a disorder that causes significant interference with people’s occupational, personal, and social lives, but treatment is available.”

Although social phobia responds readily to treatment, many people remain undiagnosed or misdiagnosed, in part because many people who suffer from social phobia are embarrassed to admit it. In addition, many clinicians don’t know how to recognize social phobia and provide appropriate treatment. Because a large number of people with social phobia also suffer from depression or alcohol or drug problems, diagnosis and treatment can become more complicated.

What are the two types?

Some people are afraid of a specific situation, often involving public speaking or performing. This severe stage fright may dampen the career of a musician, actor, or salesman. Other people have generalized social phobia, which is a fear of several, if not most, social situations.

In both types of social phobia, anxiety before, during, and after events and avoidance of feared situations significantly interfere with everyday life. However, generalized social phobia usually has more serious effects because it occurs in a number of different situations.

In both types of social phobia, physical symptoms may occur. They may include.

* Heart palpitations

* Excessive sweating

* Blushing

* Dry throat and mouth

* Shaky voice

* Trembling

* Nausea

* Shortness of breath

* Dizziness - Courtesy: aHealthyMe

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