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19Dec2020

Multiple Sclerosis – Neurology

An autoimmune disease is a condition where the immune system starts attacking its own body’s cells. This detrimental effect can lead to various complications and other diseases. The immune system cannot differentiate between foreign cells and its own cells, which leads to this condition. They can either target one organ, in Type 1 diabetes, or target multiple organs, in systemic lupus erythematosus.

What is Multiple Sclerosis?

Multiple Sclerosis, also known as encephalomyelitis disseminate, is an autoimmune disease that attacks the myelin sheath of the nerve cells in the brain and spine. The myelin sheath is an insulating layer of proteins and fats that protects the axon of the nerve cells. This sheath allows proper electrical impulses to take place quickly and efficiently. It is made by two cells, oligodendrocytes, and Schwann cells.

During multiple sclerosis, the immune system starts eating away at the myelin sheath. It disrupts the electrical signals to pass effectively from cell-to-cell and causes a range of symptoms, from muscle weakness to paralysis in the legs. It can lead to permanent damage or deterioration of nerve cells. When a nerve fiber is exposed, the impulses can be slower or can stop completely.

Statistics

6.4% of women and 2.7% of men are likely to develop some kind of an autoimmune disease at some point in their lifetime. More than 2.3 million people in the world have multiple sclerosis. In India, almost every 5-10 per 1,00,000 individuals have multiple sclerosis. A study in 2015 stated that the number of people diagnosed with multiple sclerosis per year had almost doubled.

Causes Multiple Sclerosis

Since it is an autoimmune disease, the exact cause of multiple sclerosis is unknown. However, a couple of factors can increase the risk of this disease.

Age: multiple sclerosis is one of the most common disabilities in younger adults. It can develop at any age but is usually seen in adults from the age of 20-40.
Sex: Women have a double or triple higher chance of developing multiple sclerosis than men. This could be due to the role of female hormones.
Inheritance: multiple sclerosis is not hereditary but it can get passed down generations. The risk of siblings or children developing multiple sclerosis is higher.
Infections: a research article conducted in 2014 states that multiple sclerosis can be linked with microbial infections like Chlamydia pneumonia and staphylococcus aureus produced enterotoxins.
Race: Caucasian people, usually of European descent, have the greatest risk of developing multiple sclerosis, whereas people of Asian or African descent, have the least risk.
Vitamin D: People with lower levels of vitamin D have a higher risk of developing multiple sclerosis.
Climate: climate does not cause this disease but it can worsen the symptoms of multiple sclerosis. This is usually temporary.

Symptoms of Multiple Sclerosis

The symptoms of multiple sclerosis are unpredictable and can vary from person to person. Some symptoms of multiple sclerosis include:

Muscle stiffness, pain and spasms of the extremities.
Tingling and numbness in various parts of the body.
Vision problems like double vision, blurred vision and sometimes even loss of vision.
Fatigue and weakness due to nerve deterioration in the spinal cord.
Dizziness and incoordination in balance, often similar to vertigo.
Bladder, bowel and sexual dysfunction where patients lose bladder and bowel control.
Cognitive issues like disorientation, shortened attention span and loss in memory.
Emotional health is affected leading to irritability and mood swings.

Diagnosis:

There is no specific test to diagnose multiple sclerosis. However, various other tests can rule out different diseases with similar symptoms to arrive at a conclusion. They are:

Blood test: A blood test can check for specific biomarkers that may be associated with multiple sclerosis.
Spinal tap: A puncture in the lumbar region of the spine can sample the cerebrospinal fluid for any abnormalities in antibodies.
Magnetic resonance imaging: An MRI can detect lesions on the brain and spinal cord which could be an underlying cause of multiple sclerosis.
Evoked potential test: An evoked potential test measures the speed of nerve messages along sensory nerves to the brain and a visual or electrical stimuli test used in the diagnosis of multiple sclerosis.

Treatment:

There is no cure for Multiple sclerosis. Treatment is focused on 3 main concerns:

Treatment for attacks

Corticosteroids: they decrease inflammation but have various side effects like fluid retention, mood swings, and an increase in blood pressure and blood glucose levels.

Plasma exchange: exchanging plasma in the blood for albumin is used when the patient doesn’t respond to steroids

Treatment to slow the progression

Treatment in the early stages can lower the relapse rate, slow the formation of new lesions, and reduce the risk of brain atrophy. For primary-progressive MS, ocrelizumab (Ocrevus) is the only FDA-approved disease-modifying therapy. There are various options available for relapses of MS such as Injectables (Interferon beta medication, Glatiamer acetate), oral medication (Dimethyl fumarate, Teriflunomide), or infusion treatments (Natalizumab).

Treatment for symptoms

Physiotherapy: Stretching and strengthening exercises can reduce muscle weakness and improve gait problems.

Muscle relaxants: Relieves muscle stiffness and spasms.

Medications to reduce fatigue and improve mood: Selective serotonin reuptake inhibitors can be used for depression and Amantadine can decrease fatigue.

Conclusion:

Living with any chronic illness is not an easy task. The key to combating the ill effects of multiple sclerosis is early detection, right treatment, and therapy. It is important that one continues to move on with their daily tasks as much as possible. Having a positive outlook on life can really help make multiple sclerosis not as intimidating as it is.

Do check our recent blog – https://www.saideephospital.com/2020/11/17/the-most-common-dental-problem-pyria/

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14Dec2020

Health care 1 Comment

Coronary Angiography

Coronary angiography is a diagnostic procedure performed to check the blood flow and presence of any obstruction (blockages) in coronary arteries that supply blood to the cardiac muscles.

How Coronary Angiography is done?

This procedure is done through the radial artery that is present in the wrist and the femoral artery (thighs). Anyone location is chosen to do this procedure. The sheath is placed within the artery using a needle. A tube-like structure known as the diagnostic catheter is passed through the artery towards the aorta ( the biggest blood vessel arising from the heart). The end of the catheter is placed at the opening of the arteries and a contrast dye is injected into the coronaries.

At the same time, fluoroscopy is done which permits the visualization of the flow of the dye through the coronaries and can be seen on a screen. Fluoroscopy uses X-rays to visualize the coronaries. Images are then acquired at diﬀerent angles to get a complete idea of the coronaries. The catheter is removed along with the sheath from the artery. The wound is then dressed and heals with proper post-care.

Is it painful? Does it create a wound?

A small puncture hole on the skin about 2 mm in diameter is created using a needle puncture. It is done under local anesthesia and does not require any stitches. When properly done it is painless and all that is felt is a tiny prick of the needle.

Does it require admission to the hospital?

It can be done as an out-procedure and the patient can go home on the same day itself. Usually, patients can be discharged after 4 hrs when done via the radial artery and 6 hours when done via the femoral artery.

Is it a dangerous or life-threatening procedure?

It is a relatively safe procedure and needs to be done only by an expert. As it is an invasive procedure, complications may arise depending on various factors involved in a patient’s medical history. Some minor complications that may arise include hematoma at the puncture site, vasospasm, minor allergic reaction to the dye. Very rarely, life-threatening complications like myocardial infarction, arrhythmias, anaphylaxis, stroke, renal failure, or death may occur. However, these are extremely rare cases and occur in less than 1% of patients.

Can coronary angioplasty be done immediately after angiography?

Yes. Angioplasty which involves stenting the blockages seen on angiography can be performed immediately after angiography depending on the clinical circumstances.

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14Dec2020

Medical Leave a comment

Kangaroo Baby Care

Kangaroo Care is a practice of holding a baby that involves skin-to-skin contact. The baby, who is usually naked apart from a diaper, is placed in an upright position against a parent’s bare chest. Both mothers and fathers can do kangaroo care. It’s often used with premature infants while they’re still within the hospital.

What is kangaroo care?

Holding your baby close to your chest is a surreal experience that can help build the bond between you and your new family member. This type of touch isn’t just for bonding — it’s also medically beneficial for your infant. Kangaroo care is a method of holding your baby close to your chest. It allows for skin-to-skin contact between you and the baby. The process involves that during each session, your baby will be placed (naked except for a diaper and hat) on your chest (also bared to allow skin-to-skin) for up to a few hours. A blanket, shirt, hospital gown, or robe will be wrapped around you and over your baby’s back for warmth. This wrapping of your infant into your chest looks very much like a mother kangaroo holding her baby in her pouch — which is where the name kangaroo care comes from.

“Kangaroo care first started in the 1970s, as a means to promote bonding and early breastfeeding in full-term infants,” is believed. “In the late 70s, this practice was extended to preterm infants due to over-crowded nurseries, high mortality rates, high infection rates and a lack of resources, like warming devices, known as isolettes. Fast forward nearly 50 years, and the practice of kangaroo care is frequently used in NICUs around the world, due to its profound benefits to both mother and infant.”

We understand that the concept of skin-to-skin is much like kangaroo care, and in many cases, the terms are used interchangeably. In the current day, skin-to-skin is typically a term used for full-term infants, describing how much of the first hours and days of the infant’s life are spent against the mother’s chest, promoting both bonding and breast milk production. Kangaroo care is more often used when referring to the care of a pre-term baby in the NICU receives.

What are the benefits of kangaroo care?

There are many benefits of kangaroo care. It’s not only good for both premature and full-term babies but also for the parents. Both the mother and the father can practice skin-to-skin bonding with the baby.

The benefits of kangaroo care to your baby include:

Stabilizing your baby’s heart rate.
Improving your baby’s breathing pattern and making the breathing more regular.
Improving oxygen saturation levels (this is a sign of how well oxygen is being delivered to all of the infant’s organs and tissues).
Gaining in sleep time.
Experiencing more rapid weight gain.
Decreasing crying.
Having more successful breastfeeding episodes.
Having an earlier hospital discharge.

The benefits of kangaroo baby care.

Improving bonding with your baby and the feeling of closeness.
Increasing your breast milk supply.
Increasing your confidence in the ability to care for your new baby.
Increasing your confidence that your baby is well cared for.
Increasing your sense of control.

Why does kangaroo care work?

The benefits of kangaroo baby care listed above have all been demonstrated in research studies. In fact, studies have found that holding your baby skin-to-skin, it can stabilize the heart and respiratory (breathing) rates, improve oxygen saturation rates, better regulate an infant’s blood heat and conserve a baby’s calories.

When a mother is practicing kangaroo care, her infant typically snuggles into her breasts and falls asleep within a couple of minutes. The breasts themselves are shown to vary in temperature to match your baby’s temperature needs. In other words, your breasts can increase in temperature when your baby’s body is cool and may decrease in temperature when the baby is warm.

The extra sleep that your infant gets while snuggling with mom and therefore the assistance in regulating blood heat helps your baby conserve energy and redirect calorie expenditures (use) toward growth and weight gain. Being positioned on mom also helps to stabilize your infant’s respiratory and heart rates. Research has also shown that practicing kangaroo care can have a positive impact on your baby’s brain development.

Do check out our recent blog – https://www.saideephospital.com/2020/12/12/breast-lumps-may-or-may-not-be-malignant-but-they-should-not-be-ignored/

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12Dec2020

Uncategorized 2 Comments

Breast lumps may or may not be malignant, but they should not be ignored.

Breast lumps are a common occurrence in women. While only 10 – 20% of breast lumps are malignant, the majority are benign lesions such as fibroadenoma in teenagers and young adults, and fibrocystic change and cysts in older women.

Only approximately 10 to 20% of breast lumps are malignant. You might be surprised to find a breast lump, but it’s important to remember that it may not aﬀect your long-term health. Early detection of breast cancer can save lives, and women aged 40 and above are strongly encouraged to undergo regular mammographic screening.

How Your Breasts Should Feel

Breast tissue varies inconsistently, with the upper-outer part of your breast being firm and the inner-lower parts feeling somewhat softer. If you are a woman, your breasts can become more tender or lumpy during your menstrual cycle. Breasts tend to get less dense as you get older.

It is important to be familiar with how your breasts normally feel so you are aware of changes. We do not recommend to examine this on your own because there’s little evidence that breast self-examination reduces the risk of dying from breast cancer.

In fact, breast self-examination may cause harm because you’re more likely to find a noncancerous lump, which could be a source of worry. In some cases, this may lead to unnecessary medical procedures to ensure that the lump is benign.

Instead of performing breast self-examination, most experts recommend that women simply be aware of what their breasts normally look and feel like. You should report any changes or concerns to your doctor.

a lump changes or grows larger
your breast is bruised for no apparent reason

Signs You Should See a Doctor

Remember, most breast lumps are noncancerous. However, you should make an appointment to see your doctor if:

you discover a new lump
an area of your breast is noticeably diﬀerent from the rest
a lump does not go away after menstruation

the skin of your breast is red or begins to pucker like an orange peel
you have an inverted nipple (if it was not always inverted)
you notice a bloody discharge from the nipple

At Saideep hospital, we recognize the needs women have when it comes to selecting and receiving expert consultations and treatments for any type of breast disease, cancerous, and non-cancerous. We oﬀer a one-stop solutions center, dedicated to looking after breast health.

Our breast imaging center enables women to have their breast ultrasonography, surgical consultation, minimally invasive biopsies, and procedures all under one roof, and with quick turnaround time.

The center is governed and dictated by a multi-disciplinary team of breast surgeons, radiologists, reconstructive surgeons, oncologist together with pathologists and physiotherapists.

With digital mammography, more cancers are getting detected, earlier. It is also significantly more accurate in detecting breast cancers at the earliest stage, or when it is hidden by dense tissues. A screening mammogram is generally recommended for women age above 40 years of age or earlier if she has a family history of breast cancer.

We can help you if you

Discover a breast lump
Are concerned about your breast cancer risk
Have an abnormal mammogram and/or breast ultrasound report
Have an abnormal breast biopsy result
Have been diagnosed with breast cancer and seek treatment
Want a second opinion
Need arm physiotherapy for prevention or management of shoulder stiﬀness, reduced arm mobility and/or lymphedema
Want to learn about breast self-examination

Our Range of Services

Breast imaging studies such as mammography and ultrasound
Image-guided biopsy of breast lesions
Minimally invasive breast surgery including core biopsy or lumpectomy
Oncologic breast surgery including oncoplastic surgery and breast reconstruction where necessary
Adjuvant chemotherapy and radiotherapy including neoadjuvant chemotherapy for downstaging of breast cancers
Breast self-examination training and counseling
Emotional and psychological support by medical professionals

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10Dec2020

Medical Leave a comment

Delayed Cord-Clamping in Preterm Deliveries – the benefits of DCC

The benefits of DCC

For babies who are born healthy, the planet Health Organisation (WHO) recommends delaying cord clamping (DCC). It means the umbilical cord isn’t clamped immediately after birth but after waiting for one to 3 minutes. That way, the baby remains connected to the placenta and receives oxygen-rich blood and essential nutrients.

Delayed umbilical cord clamping appears to be beneficial for the term and preterm infants. DCC has also been advocated during preterm delivery to enhance hemodynamic stability during the first time of life. The hemodynamic eﬀects of this in premature infants after birth has potentially beneficial hemodynamic changes over the early days of life.

In term infants, delayed cord clamping increases hemoglobin levels at birth and improves iron stores within the first several months of life, which can have a positive eﬀect on developmental outcomes.

There’s a slight increase in jaundice that needs phototherapy during this group of infants. Health care providers adopting delayed cord clamping in term infants are making sure that mechanisms are in place to monitor for and treat neonatal jaundice.

In preterm infants, delayed umbilical cord clamping is related to significant neonatal benefits, including improved transitional circulation, better establishment of red blood corpuscle volume, decreased need for transfusion, and lower incidence of NEC and intraventricular hemorrhage.

Delayed umbilical cord clamping isn’t related to an increased risk of postpartum hemorrhage or increased blood loss at delivery, nor was it related to a diﬀerence in postpartum hemoglobin
levels or the necessity for transfusion.

Given the advantages to most newborns and concordant with other professional organizations, multiple associations and communities of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for a minimum of 30–60 seconds after birth.

From the articles of WHO

Delayed umbilical cord clamping (not earlier than 1 min after birth) is recommended for improved maternal and infant health and nutrition outcomes.

From 2012 WHO guidelines on basic newborn resuscitation:

In newly born term or preterm babies who do not require positive-pressure ventilation, the cord should not be clamped earlier than 1 min after birth.

When a newly born term or preterm babies require positive-pressure ventilation, the cord should be clamped and cut to allow eﬀective ventilation to be performed.

Newly born babies who do not breathe spontaneously after thorough drying should be stimulated by rubbing the back 2–3 times before clamping the cord and initiating positive-pressure ventilation.

From 2012 WHO recommendations for the prevention and treatment of postpartum haemorrhage:

Late cord clamping (performed approximately 1–3 min after birth) is recommended for all births while initiating simultaneous essential neonatal care.

Early umbilical cord clamping (less than 1 min after birth) is not recommended unless the neonate is asphyxiated and needs to be moved immediately for resuscitation.

Remarks:

The evidence base for recommendations on the optimal timing of umbilical cord clamping for the prevention of postpartum hemorrhage includes both vaginal and cesarean births. The WHO guideline development group considered this recommendation to be equally important for cesarean sections.
Delayed umbilical cord clamping (DCC) should be performed during the provision of essential neonatal care.
Recommendations for the optimal timing of umbilical cord clamping apply equally to preterm and term births. The guideline development group considered the benefits of delayed cord clamping for preterm infants to be particularly important.
Some health professionals providing care for an HIV positive pregnant woman and/or working in high HIV prevalent settings have expressed concern regarding delayed cord clamping as part of the management of the third stage of labor. These professionals are concerned that, during placental separation, a partially detached placenta could be exposed to maternal blood and this could lead to a micro-transfusion of maternal blood to the baby. The evidence shows that the benefits of delaying cord clamping for 1-3 minutes outweigh the risks of transmission of HIV. HIV testing should be oﬀered intrapartum, if not already done. WHO recommends that all HIV-positive pregnant and breastfeeding women and their infants should receive appropriate antiretroviral (ARV) drugs to prevent mother-to-child transmission of HIV. Thus, the proven benefits of at least a 1–3-minute delay in clamping the cord outweigh the theoretical, and unproven, harms. Delayed cord clamping is recommended even among women living with HIV or women with unknown HIV status. HIV status should be ascertained at birth, if not already known, and HIV positive women and infants should receive the appropriate ARV drugs.
Delayed umbilical cord clamping should not be confused with the milking of the cord. The terms are not necessarily synonymous (milking refers to physically expressing blood from the umbilical cord). Various recent studies are assessing the eﬀect of cord milking, practiced at diﬀerent times after birth, with a variety of “milking” times, associated with early or delayed cord clamping. These studies need further analysis, as cord milking has

been proposed as an alternative DSC, especially for preterm infants.

The WHO guideline development group considered that the package of active management of the third stage of labor includes a primary intervention: the use of a uterotonic drug. In the context of oxytocin use, controlled cord traction may add a small benefit, while uterine massage may add no benefit for the prevention of postpartum hemorrhage. Early cord clamping is generally contraindicated.
Clamping “not earlier than one minute” should be understood as the lower limit period supported by published evidence. WHO recommends that the umbilical cord should not be clamped earlier than is necessary for applying cord traction to reduce post-partum hemorrhage and speed expulsion of the placenta, which the guideline development group clarified would normally take around 3 minutes.
For basic newborn resuscitation, if there is an experience in providing eﬀective positive- pressure ventilation without cutting the umbilical cord, ventilation can be initiated before cutting the cord.

From an Experimental Observation POV

Providing additional placental blood to the preterm baby by DCC by 30-120 seconds resulted in

Fewer babies needing transfusions for anemia
- Better circulatory stability
- Reduced risk of intraventricular hemorrhage (all grades)
- Reduced risk of necrotizing enterocolitis
- Reduced late-onset sepsis

Check out our recent post on Antidepressants Used During Pregnancy https://www.saideephospital.com/2020/11/29/antidepressants-used-during-pregnancy/

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