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Pelvic discharge: Prevention is better than cure Now computer-guided knee replacement surgery Health Notes
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Pelvic discharge: Prevention is better than cure Not-so-shy Meera, 21, confided in her gynaecologist the symptoms that she could no longer hide, “foul smelling discharge, burning during urination, itching around the genitals and not feeling well and…..avoiding boy friends”. “Well, I don’t mind an examination, but I want to recover fast from this nuisance, which has lowered my self-esteem to the extent that I feel dehumanised before my friends,” Meera blurted and then put a volley of questions impatiently. “What it could be? Is it contagious? Is it serious? Can it be a venereal disease? Can it lead to cancer? Can it be cured in a short time? Will it require surgery? Will it affect my life when I get married? I am worried doctor.” The doctor counselled, “It could be vaginitis, it will require some investigations and adequate treatment. Your contacts will also require attention for any infection. But prevention would be necessary to ward off subsequent episodes. The discharge may be normal The discharge is such a common condition that every woman would have experienced it at one time or the other. There could be normal discharge that may be clear or white, thin or thick. It is not odorous, and there is no itching. The amount can vary, as can odour and hue (its colour can range from clear to a milky whitish), depending on the time in your menstrual cycle. For example, there will be more discharge if you are ovulating, breastfeeding, or are sexually aroused. The smell may be different if you are pregnant, or you haven’t been diligent about your personal hygiene. None of those changes is a cause for alarm. However, if the colour, smell or consistency seem significantly unusual, especially if accompanied by vaginal itching or burning, you could be noticing an infection. Causes of abnormal discharge When the discharge is yellow or green in colour, it is unlikely to be normal. A foul-smelling discharge is usually from an infection. A thick, white, itchy, cottage cheese-like non-odorous discharge is often caused by a yeast infection. Infections of vagina are termed as vaginitis. Vaginitis may also occur because of chemical irritation (e.g. excessive douching, or the excessive use of over-the-counter medications or cosmetics). Sexually transmitted diseases like Gonorrhoea and Chlamydia may cause abnormal discharge along with pain with urination, pelvic pain and bleeding. Chlamydia is most common in young women (18 to 35 years) who have multiple sexual partners. Herpes simplex virus is also common and is spread by sexual contact. The primary symptom of herpes vaginitis is pain associated with lesions or “sores”. These sores usually are visible on the genitals but occasionally are inside the vagina. Another source of viral vaginal infection is the human papilloma virus (HPV). This requires PAP smear testing. Use of steroids and antibiotics, birth control pills, diabetes, cancer of the cervix, pelvic inflammatory disease, menopause and some foreign body in the passage may be other causes. How to prevent vaginitis *
Keep your genital area clean. Wash daily. * Keep your genital area dry. Wear cotton underwear. Avoid nylon panties, pantyhose without a cotton panel and tight jeans. l* Good hygiene is important; toilet paper should be used to wipe from the front to the back side, and water ablution is better than the use of paper. *
Do not douche or use chemicals that may cause irritation or allergy. *
Do not use feminine hygiene products. * Do not take an antibiotic on your own, since antibiotic kills “friendly” bacteria that normally keep the yeast in balance. *
Do treat diabetes early, if detected. * Use condom, if sex is a must. Restraint and caution are the watchwords. *
Screening for sexually transmitted diseases and PAP smear at intervals is a good practice in the case of multiple sexual partners. *l While taking full treatment for yourself, take adequate treatment for your partner(s) also. *
Ask specifically, should I abstain from intercourse? Should I continue using the vaginal cream during my period, date for the next visit. *
Avoid cigarette smoking and other toxic products. * One research study found a definite role of vaginal probiotic capsule in the prevention of subsequent attacks of bacterial
vaginosis. * The possibility of cancer cervix rises with multiple partners. Shun the game and lead a sober life. The writer is a senior gynaecologist based in Chandigarh. Email — drkumar232@hotmail.com |
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Now computer-guided knee replacement surgery While the safety and effectiveness of knee replacement is widely acknowledged, the current challenge is to decrease the discomfort associated with the procedure and to hasten the recovery process. Computer-guided knee replacement surgery helps in overcoming these challenges. The overall success rates with computer-guided surgery are very high and have been verified by many medical researches. To understand it further, let us first have an idea about how the normal knee joint works. The knee joint is formed by the articulation of three bones: the lower end of the thigh bone (femur), the upper end of the leg bone (tibia) and the knee cap (patella). The bones are held together by a complex array of ligaments and tendons. A shiny substance called articular cartilage covers the ends of the bones, thereby acting like a cushion. Arthritis encompasses a group of conditions all of which act by causing deterioration of this cartilage. Once the cartilage is lost, the bones of the knee grind against each other, thereby wearing away and causing severe pain. In the early stages of the disease, an attempt is made to slow-down the progression by an appropriate use of cartilage supplements, physiotherapy and lifestyle modifications. However, when the majority of the cartilage is worn off, the patient needs knee replacement surgery. Total knee replacement involves removing the end of the bone that is damaged and resurfacing it with metal and plastic implants. The success of the surgery depends on the accuracy with which the bone is shaped, the ligaments are balanced and the size of implants determined. Till now, this used to be done with the help of alignment rods and other manual instruments, which was a source of surgical error. This led to sub-optimal results even with the use of the latest and most expensive knee implants. How is computer-aided knee replacement done? In computer-assisted surgery, small markers are attached to the thigh and leg bones, which are sensed by an infra-red camera attached to a computer. The surgeon feeds intra-operative patient data to the computer, which enables the software to form a 3-D image of the knee joint. The process of data registration takes just five minutes, and hence the duration of surgery is not prolonged much. The computer software guides the surgeon through the various surgical steps. This enables the surgeon to shape the bone accurately, balance the ligaments with precision and calculate the exact size of the implants needed. Throughout process of the surgery, there is a provision to cross-check every step before proceeding to the next. Before the final implantation of knee prosthesis, the surgeon can accurately check the alignment of the leg, the range of motion of the new knee and the stability of the joint. Only when the surgeon is satisfied with the trial implants, the actual implantation is done. This procedure enhances the objectivity of the surgery and makes it much more predictable. Advantages of computer-aided knee replacement The biggest advantage of computer-aided knee surgery is that surgery becomes safer and the chance for a surgical error is nearly eliminated. According to several international studies, the incidence of mal-alignment in conventional knee replacement surgery (done without computer aid) can be as high as 30 per cent. This results in excessive pain after surgery, reduced bending of the knee and often early failure of the implant. However, with the advent of computer-navigated surgery, the success of the procedure has risen to over 98 per cent. Even in the difficult patient group, notably those with severe knee deformity or morbid obesity, the success rate is very high. In computer-aided knee replacement, recovery is much faster and better. Post-operative pain is much less, bleeding during surgery is decreased greatly, alignment of the joint is exactly accurate and trauma to the thighbone is totally avoided (in conventional surgery, rods are inserted into thigh bones for alignment). Bending of the knee joint after surgery is much better in computer-aided knee replacement. The current 4th generation high-flex knee implants, when used in conjunction with computer navigation, greatly increase the chances of patients being able to sit cross-legged after surgery. The surgical incision is also shorter because the need for greater visualisation is eliminated. All these factors have nearly eliminated the need for painful physiotherapy sessions post-operation. Now patients are only taught light exercises, which they can easily do themselves. Accurately placed implants tend to last much longer. Nowadays, a well-performed surgery, done at the right stage of the disease, is expected to last over 25-30 years. In our own series of over 3000 knee replacements done using computer navigation in the past four years, we have seen that the results of this procedure are far better than the conventional method. The postoperative pain scores are much less, and the need for physiotherapy sessions has decreased greatly. That is why the patient is able to resume a normal lifestyle much earlier and with much less surgical discomfort. The writer is Additional Director, Dept of Joint Replacement, Fortis Hospital, Mohali.
harsimran.singh@ fortishealthcare.com |
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Risk for obesity begins in the womb
Johannesburg: Weight problems can begin in the womb, German scientists say. Researchers at the Charite Hospital in Berlin compared results from 66 international studies involving around 640 000 patients from 26 countries across the globe and discovered that children with a birth weight of more than 4kg were twice as likely to suffer from obesity in later life as their peers who were normal weight, News24 reported. The study has thus urged doctors to pay heed to the issue of over-feeding, lack of exercise and diabetes during pregnancy since steps taken before birth could ensure a child does not have weight problems later in life. — ANI Asthma drug holds promise
for diabetes, obesity
Washington: Amlexanox, an off-patent drug currently prescribed for the treatment of asthma and other uses, also reverses obesity, diabetes and fatty liver in mice, a new study has found. The findings came from the lab of Alan Saltiel, the Mary Sue Coleman director of the University of Michigan’s Life Sciences Institute. “One of the reasons that diets are so ineffective in producing weight loss for some people is that their bodies adjust to the reduced calories by also reducing their metabolism, so that they are ‘defending’ their body weight,” Saltiel said. “Amlexanox seems to tweak the metabolic response to excessive calorie storage in mice,” he noted. — ANI
24 new genes behind
short-sightedness identified
London: Scientists have discovered 24 new genes that cause refractive errors and myopia (short-sightedness). Myopia is a major cause of blindness and visual impairment worldwide, and currently there is no cure. These findings could lead to finding better treatments or ways of preventing the condition in the future. During visual development in childhood and adolescence the eye grows in length, but in myopes it grows too long, and light entering the eye is then focused in front of the retina rather than on it. This results in a blurred image. This refractive error can be corrected with glasses, contact lenses or surgery. However, the eye remains longer, the retina is thinner, and this may lead to retinal detachment, glaucoma or macular degeneration, especially with higher degrees of myopia. — ANI
Modified `smallpox vaccine` virus triples liver cancer survival time
London: The virus used in the vaccine that helped eradicate smallpox is offering new hope to liver cancer patients. Researchers have found that a genetically engineered version of the vaccinia virus tripled the average survival time of people with a severe form of liver cancer, with only mild, flu-like side-effects, according to the New Scientist. Thirty people with hepatocellular carcinoma received three doses of the modified virus — code-named JX-594 — directly into their liver tumour over one month. Half the volunteers received a low dose of the virus, the other half a high dose. — ANI
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“It could be due to some infection with bacteria, protozoa, virus or fungi, sometimes more causes than one can be present at the same time,” the doctor opined and enquired if she could undergo internal examination!