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| HEALTH & FITNESS |
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Anal fistula — simple solutions for a complex disease
Don’t panic in cervical pain or giddiness
Rising cases of autism
Cell phone exposure damages DNA, brain, sperm
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Anal fistula — simple solutions for a complex disease
Anorectal benign conditions (ABC) — piles, anal fistula and anal fissure — are common and affect a large number of people. There is a common belief that cure or good treatment for these conditions doesn’t exist, and the chances of recurrence after treatment are very high. However, the latest treatment options not only have a high success rate but are also minimally invasive, meaning that they can be done with the least amount of cutting or surgery. A brief outline of the latest development in the treatment of anal fistula is given here: The conventional treatment is fistulotomy, seton, advancement flap and fibrin glue. The latest treatments on the horizon are anal fistula plug and LIFT (ligation of intersphincteric fistula tract). Fistulotomy — The tract is laid open; the intervening tissues, including the sphincter muscle, are cut. It is good for low fistulas. This method is an invasive and there is an inherent risk of incontinence (loss of control over bowel motions), especially in high fistulas, as the latter lead to more cutting of sphincter muscle. Seton treatment — A suture or thread (medicated ones; Ksarshutra, as described in Ayurveda) is put in the fistula tract. It can be a loose draining type or tight cutting type when it requires to be tightened regularly. The fistula gets treated due to the medication or mostly due to the slow cutting by the seton. The seton treatment also carries with it the risk of incontinence in higher complex fistulas. Advancement flap — The fistula tract is cored out and the internal opening is closed with the layer of rectal mucosa (inner lining of rectum). This method is invasive, results in a large wound and is technically quite demanding. Fibrin glue — Glue is a liquid and can be biological or synthetic. It is injected into the fistula tract where it solidifies and helps to close the fistula tract. However, the long-term closure results have been around 15-18%. So, it has fallen out of use these days. Anal fistula plug — This is a new addition to the armament of surgeons. In this method, a plug made of absorbable material is inserted into the fistula tract by a special technique. The plug is slowly dissolved by the body and replaced by body tissues, thereby closing the fistula tract. The fistula tract closure is not due to mechanical reasons but owing to a biological action. Due to this reason, in this method, the success rate is better than in the case of fibrin glue. The main advantage of the plug procedure is that the risk of incontinence is zero. This is so because the plug procedure doesn’t involve cutting of the sphincter muscle. Pain is minimal and recovery is almost immediate. It is very suitable for high, complex and recurrent fistulas. Ligation of inter-sphnicteric fistula tract (LIFT) procedure — In this recently developed method, the sphincter muscle is not cut. Rather a plane is developed between the two sphincters (internal and external), and the fistula tract is cut and removed. Though an invasive method, the advantage is that the sphincter muscle is not cut and the risk of incontinence is minimal. It’s a technically demanding operation and should be done by dedicated colo-rectal surgeons. It is also a good procedure for high fistulas. An anal fistula, though a complex disease, is fully treatable. However, one should always consult an expert colo-rectal surgeon because inexperienced surgeons or quacks can further complicate the problem. The writer is a senior laparoscopic & colo-rectal surgeon at Fortis Hospital, Mohali. Email-drgargpankaj@
yahoo.com)
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Don’t panic in cervical pain or giddiness
Sudden wry neck or spasm in the neck muscles occurs mostly in the morning with pain only or pain with giddiness. Cervical giddiness is a common condition when one feels the surroundings are in rotation against the body posture and happens at the change in posture. Some get it while lying down in bed when they take sides to the left or the right, and some feel the bed-quake when they try to sit from a lying down position. Some shout for help and catch hold of their bed or the bath door if it happens in a standing posture. The most common reason for giddiness is bad stomach. Acidity, gastritis, indigestion and gas formation are responsible for nausea and vomiting along with giddiness. Taking too much strong tea or coffee, heavy smoking and drinking, eating ‘masala’ curries, irregular eating habits and tension contribute to gastritis and indigestion. Long-standing bad stomach leads to muscle spasms and body aches. Watching TV with three to four pillows behind the neck and shoulders keeps the neck in the forward position for a longer time and if one sleeps in this position, he may get up with a wry neck in the morning. The computer buffs also get such problems when they sit in a easy sagging or sliding posture in the chair and go on watching the screen for long hours. Those who indulge in neck-down desk work without any neck exercise are also prone to have such episodes of giddiness. So, a bad posture of the neck leads to cervical disc inflammation and giddiness. Sometimes pain radiates to one side of upper limb. It is not migraine or vertigo. This is the beginning of cervical spondylosis, and by the age of 40 years the frequency increases. Older population is more prone to wry neck and cervical ‘chakkar’. Sedentary life-style, irregular eating habits and working without exercise adds to frequent episodes of cervical strain and giddiness. The doctor’s advice for bad stomach and blood pressure control is a must. Anyway, do not get scared because simple giddiness is a sign of some underlying cause and we have to treat the cause. Meanwhile, whenever ‘chakkar’ happens, one should keep the mouth open for deep breathing and take “Nimboo-pani” with salt and a tablet of paracetamol followed by some neck exercise before going to the doctor. Manipulation and physiotherapy are the treatment of choice to give long lasting relief after diagnosing the cause. The sleeping posture needs care. A three-to-four inch thick poly-fill pillow may be used for sleeping as per the body frame, taking care not to put the shoulder on the pillow when sleeping on the sides. Using your elbow as a pillow on a pillow should be avoided. The best remedy is regular exercise for the neck and keeping the digestive system in perfect order. The writer, Senior Orthopaedic Surgeon, The Apollo Clinic, Chandigarh, is the author of “Bedroom Exercises for Busy People” Email- dr.bhimsain@ yahoo.in
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Rising cases of autism
If your child is between the ages of two and three years and his development is keeping you worried, please check with the following signs and symptoms. The child is withdrawn, refuses to have social contact even with kids and avoids playing with them, is losing language which he had already acquired, fails to respond to his name, has poor eye contact, moves constantly, shows patterns of repetitive behaviour like rocking, spinning and hand flapping. If some or all of these signs are present in your child, please consult a developmental specialist and have him evaluated for autism. Autism or autism spectrum disorder, also called pervasive development disorder (PDD), is catching our world by surprise. The incidence of autism is on the rise. This rise is very fast. The Centre for Disease Control in the United States recently released statistics showing that one in every 110 children in the US has autism. This is very alarming. What is more disturbing is the fact that this trend is on the increase. Although we don’t have any clear data on the incidence of autism in India, we know that it is on the rise. And what is more troublesome is that till date no cause has been identified for autism. Autism is usually diagnosed between the ages of 18 months and three years. Although signs and symptoms of autism may be present earlier, these are very difficult to identify. The symptoms can range from very mild to very severe. This means that not every kid will develop the same kind of autism. Broadly speaking, autism mainly affects the verbal and non-verbal communication, social interaction and the behaviour of the child. Communication is affected by delayed speech development, less speech, difficulty in using speech, repetitive speech and to a level where there is no speech. Nearly 40 per cent children with autism never develop speech. Social interactions are affected by the failure to establish friendships with children of the same age, showing withdrawn behaviour, lack of interest in sharing enjoyment, activities and achievements with others. They can also lack emotional understanding and reciprocity; this means that it is difficult for kids with autism to understand feelings of pain, sorrow and emotions of others. Autistic kids can have marked disability in expressing their own emotions whether verbally or non-verbally. They show signs of repetitive behaviour or stereotyped behaviour like hand flapping and spinning, and also signs of hyperactivity. Kids with autism show addictive tendency towards certain topics or objects like looking rotating objects, television advertisements, sticks, soaps or a particular toy. Homoeopathy can help kids with autism. Although not all children with autism respond to homoeopathic treatment, a certain segment of them with a mild-to-moderate level of autism at times show great signs of recovery. Autistic kids with speech (however little) and less hyperactivity show very encouraging improvements with certain homoeopathic medicines. Age of the child has a major effect on the treatment outcome — younger the child, the better are the chances of improvement. The writer is a Chandigarh-based homoeopathic specialist. Email —
vikas@drhomeo.com
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Cell phone exposure damages DNA, brain, sperm Washington: A group of international scientists has released what they call ‘stunning proof’ confirming cell phone use can disrupt DNA, impair brain function and lower the sperm count. A meeting on Monday by the Environmental Health Trust with the Turkish cancer society and Gazi University revealed the new research that the scientists say shows just four hours of cell phone exposure can damage DNA, brain and sperm function.
The other new important work from Australia shows damage to human sperm. “We are deeply concerned about what this could mean for public health,” said Prof. Nesrin Seyhan , WHO and NATO adviser, who is head and founder of the Biophysics Department and Bioelectromagnetics Laboratory at Gazi University in Ankara. “This work provides a warning signal to all of us. The evidence justifies precautionary measures to reduce the risks for everyone of us,” says Prof. Wilhelm Mosgoeller from the Medical University of Vienna who has led European research teams, which found that RF-EMF induce DNA breaks. — ANI
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Health Notes Washington: Two people in Toronto have reportedly acquired the enzyme associated with extensive antibiotic resistance called the ‘New Delhi metallo-ß-lactamase-1’ (NDM-1). The enzyme is common in India and Pakistan and is spreading worldwide through travel, medical tourism and its ability to transfer between bacteria. In one of the two cases,
the patient had not travelled outside southwestern Ontario in over a decade and no source could be identified for the organism. However, in the other
case, the patient had been hospitalized in India for a medical procedure and acquired the organism there. — ANI
Scientists closer to finding cause of Alzheimer’s disease
Washington: Scientists have come a step closer to finding out what the causes of Alzheimer’s disease are. Recently the number of genes known to be associated with Alzheimer’s disease has increased from four to eight, including the MS4A gene cluster on chromosome 11. New research has expanded on this using a genome-wide association study (GWAS) to find a novel location within the MS4A gene cluster, which is associated with Alzheimer’s disease. Alzheimer’s disease is the most common
cause of dementia in the developed world. It irrevocably destroys cells in the brain that are responsible for intellectual ability and memory. Despite
continued investigation, the causes of Alzheimer’s disease are not yet fully understood but they
are thought to be a mixture of genetic and environmental factors. — ANI
Why influenza induces
asthma attacks
London: A study has found a previously unknown biological pathway that helps explain why influenza induces asthma attacks in children with the disease. Researchers at Children’s Hospital, Boston, studied a mouse model and found that influenza activates a newly recognized group of immune cells called natural helper cells, presenting a completely new set of drug targets for asthma. Senior investigator Dale Umetsu of Children’s Division of Immunology said if activation of these cells, or their asthma-inducing secretions, could be blocked, asthmatic children could be more effectively protected when they get the flu and possibly other viral infections. Although most asthma is allergic in nature, attacks triggered by viral infection tend to be what put children in the hospital, reflecting the fact that this type of asthma isn’t well controlled by existing drugs. —
ANI
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Anal fistula is an abnormal communication between the skin of the buttocks and the rectum. It leads to a regular discharge of pus, swelling and pain. It has afflicted humans for centuries. Hippocrates described this disease and its treatment about 2000 years ago. An English surgeon, John Ardene, wrote a book, “Treatises of fistula in ano and hemorrhoids”, in 1376 and described the operations of fistulotomy and seton use for the treatment of fistula. King Louis XIV of England was also treated for anal fistula in the 18th century.