Breast lumps

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.

Breast lumps

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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DCC

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.

DCC
DCC

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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Effects on eyes

Increased screen time & its Effects on eyes in pandemic

Effects on eyes in pandemic

Increased digital screen time amid the COVID-19 pandemic has further increased the country’s rising burden of preventable eyes blindness, according to – All India Ophthalmology Society (AIOS). There is an immediate need to take preventive measures on thi very urgent basis, the society cautioned.

The Reason

The Covid-19 pandemic has brought unprecedented changes in human lives and behavior. The lurking fear of spreading the disease and lockdowns have confined people at home more than ever.

Digital gadgets have become an inseparable part of our daily lives. Our reliance on them has increased remarkably during the Covid-19 crisis and lockdown periods. 

The Covid-19 pandemic has led to a sharp increase in our screen time, owing to the increased time spent on virtual education, working from home, entertainment consumption, online shopping, and electronic communication with friends and family. Reliance on technology and digital solutions to keep children learning, entertained, and connected to the outside world has increased due to schools’ closure and strict containment measures. Most schools, too, have shifted to virtual and online classes for the continuation.

‘Screen time’ refers to the duration of time spent in activities that involve peering at a digital screen, including media viewing, working on a computer or tablet, electronic communication, and playing video games. Since the beginning of the Covid-19 stay-in periods, screen time in homes worldwide is at an all-time high. Internet usage is at an all-time high, and Google Classroom, social media usage, and online gaming have also gone up tremendously. One survey found that the number of people working remotely with digital devices during the Covid-19 pandemic has increased up to 30 percent.

It can also promote a sedentary lifestyle and affect sleep. Increasing screen-time due to the continuous usage of smartphones, laptops, computers, and other digital devices have profound effects on our eyes. It may result in a significant rise in complaints of eye issues, especially among children and young adults.

The eye problems related to near work experienced during or related to digital device usage are digital eye strain or computer vision syndrome. Reading a book or looking at a computer screen for long hours can contribute to eye dryness, making your eyes feel tired.

When you read or look at a computer, you don’t blink as frequently. We usually blink 12-14 times a minute, but while looking at a screen, our blink rate slows down, and the eyes get dryer. According to the American Academy of Optometry, anyone who exceeds two hours of computer use a day is at risk of computer vision syndrome. Computer vision syndrome (CVS) affects around 60 million people globally.

The American Academy of Ophthalmology noted that focusing on computer screens and digital displays can reduce a person’s blink rate by a third to half. This can cause your eyes to dry out and feel irritated, especially if you have an air conditioner that keeps your room’s humidity low. In most cases, symptoms occur because the task’s visual demands exceed the individual’s visual abilities to perform the job comfortably.

Symptoms

Eye strain from screen use can lead to visual disturbances and other physical discomforts, including tearing, gritty sensation, tired eyes, burning sensations, redness, blurred vision, and general eye fatigue. It can affect your vision, but it’s more of a comfort issue with an extended period’s device.

Eye strain and headaches can go hand in hand. For some people, eye strain can be a symptom of headache syndromes like sinusitis, tension headaches, or migraines. All of these things can change how your eyes feel.

Individuals who get migraines tend to be more visually sensitive, especially blue light; hence, electronics can cause more headaches. Accommodative eye strain tends to make your vision blurry or unfocused, while dry eyes are more likely to make your eyes physically hurt.

Secondary physical issues of eye strain include stiff neck, headache, backache, and overall fatigue. 

The bottom line is that too much screen time, whether for work or entertainment, is terrible for our health.

Eye strain can also happen when someone’s eyes have to work too hard due to incorrect prescriptions. If you are under-or over-corrected, which means that you have a wrong prescription, it can create eye strain by causing the eyes to overwork.

The excessive use of devices puts a strain on the eyes and is also a risk factor for myopia (nearsightedness). 

In other words, students staring at screens for prolonged periods may end up wearing glasses, and if they are wearing glasses already, the power may keep increasing.

The combination of more screen time and less outdoor time during the Covid-19 pandemic may damage our vision and put them at a higher risk of developing myopia or nearsightedness.

Causes for the digital eye strain

Less blinking: When you are hooked to any electronic devices, you tend to blink less. Less blinking causes dry eyes. Blinking is the natural reflex of the eyes to keep them moist. If blinking reduces to 6-8 times in a minute, it gradually results in dry eyes and becomes a cause for computer vision syndrome.

Improper workstation: If you have not set up your workstation correctly, it could cause computer vision syndrome. AC in offices strips the air of its moisture, thereby making the environment dry. This dryness, an improper workstation, or lousy sitting posture, makes people prone to computer vision syndrome.

Refractive errors: You might get accommodative eye strain because of undiagnosed vision problems like farsightedness, astigmatism, or issues with focusing.

Some Remedies

Establish a good screen schedule: Reduce screen-induced eye strain by using your screen time wisely. It is essential to leave the screen at least two hours before you go to bed. Studies show that blue light emitting from screens can affect natural sleep and wake uncle. Try and make use of digital screens, mostly for work-related purposes.

The following are some suggested guidelines by various experts on time and curfews.

0-3 years: At this age, the brain is going through ‘the critical period’ due to the prolific growth taking place in the mind. Too much screen time during this age range can leave their still-developing brains permanently damaged. If unavoidable, then for children 18 months to three years old, parents should choose only high-quality media and watch it with their child, engaging and interacting with them. Less than 18 months is a vehement, no!

3-5 years: Less than one hour per day of high-quality programming is recommended, with parents watching along.

6-12 years: Two hours. This is where the negotiations begin. More than two hours is still known to cause significant alterations in mood and behavior.

Over 12 years of age, do not allow more than three hours of screen time. There is enough data on challenging adolescent behavior in correlation with screen or gadget use for more than three decades. Academic grades, sleep, mood, and substances have all been found to be correlated with increased.

Take frequent breaks: Follow the 20-20-20 rule. Your office job or study-related projects may demand you to stay glued to the computer screen for over 10 hours. While it may seem impossible for you to cut down on screen time, you can pursue the 20-20-20 rule. As per this rule, after every 20 minutes, take a 20-second break and focus your eyes on something at least 20 feet away. This will not only reduce eye strain but will also keep you active.

Exercising your eyes frequently: For eye convergence issues at home, do the ‘pencil push up’ exercise. Hold a pencil directly in front of your eyes, at arm’s length, then follow it with your eyes as you draw it slowly toward your nose. 

Blink often: Always remember to blink while watching television or doing work on any digital device. Blinking moistens the eyes to guard against dryness and irritation. Blinking happens without us having to overthink about it. However, prolonged computer work typically decreases blinking without the worker realizing it.

Use appropriate glasses: Computer glasses are specifically designed to reduce eye strain, headaches, eye fatigue, and eye soreness. Glare is the visual sensation you experience in excessive, uncontrolled brightness. Wear anti-glare/anti-reflective blue blocker glasses regularly if you’re always glued to the digital screens. These eyeglasses can filter out blue light emitted from digital devices.

Adjust your screen settings: If the current settings of your laptop or desktop are causing eye strain, then adjust the screen brightness, contrast, font size, and color temperature until you find what’s best for you. It’s also essential to upgrade your display if possible. The higher the resolution of your new monitor, the better off your eyes will be. Larger productions will result in less strain.

  • Ensure there is adequate lighting around you.

Good lighting is quite essential in the workplace to avoid any visual strain. Keep bright lighting overhead to a minimum, use blinds to prevent glare, or get a glare screen. Position the computer screen in such a way that it reduces reflections from windows or overhead lights.

When using a computer or other digital device for extended periods, that’s around. It should be approximately half as bright as what’s typically found in an office environment.

Exercise: Stretch your neck and shoulders frequently. During break time, move your arms and legs. Walk a bit.

Get a comprehensive eye test done: If you’re witnessing recurrent headaches, watery eyes, and blurred vision, then it is time for you to get a thorough eye examination done.

Drink plenty of water: Children ignore drinking water unless they’re thirsty. Drinking water keeps the body hydrated. It not only flushes out body waste but also regulates body temperature. Most importantly, it hydrates the eyes, flushes out salt, and reduces eye strain.

  • Eating more greens:

 Include green leafy vegetables in your diet to keep your body and eyes healthy. The nutrients present in green vegetables, like lutein and zeaxanthin, carry anti-inflammatory properties and antioxidants that keep the eyes healthy.

Use artificial tears: If your eyes feel irritated or dry, ask your eye doctor about using artificial tears to help combat dry eyes.

The Verdict

As we plan the future of education in the age of Covid-19, schools and policymakers must consider children’s vision needs while designing new initiatives. Schools, teachers, and parents can work together to incorporate eye health strategies and protect children as they learn online.

Encourage communication between you and your child. We as elders should initiate less screen time for our children to follow the same habits. Large populations are at risk of digital eye strain, especially during the Covid-19 pandemic. Hence, proper digital device usage and appropriate screen time with all precautionary measures are essential to avoid this issue. 

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Antidepressants used during pregnancy

Antidepressants used during pregnancy

A lot of women suffer from depression, especially during pregnancy. This depression mustn’t go untreated as it can affect the mother’s health and hamper the child’s growth and development.

Antidepressants are usually the first-line drugs used. But during pregnancy, the question arises if it is safe to use these antidepressants and what effects, if any, occurs to the infant? 

What is depression?

Depression is a mental disorder that leads to a loss of interest and consistent sadness with low moods. It is caused by various reasons such as hormonal imbalances, genetic factors, or stressful environments, which leads to an alteration of neural activity in the brain.

Chemically there is a decrease in serotonin, norepinephrine, and dopamine levels. These hormones cause the feeling of pleasure and happiness, and without this, the mind remains in a state of despair.  

During pregnancy, many women can undergo symptoms of depression without even realizing it. Pregnancy can often take a toll on the body and cause decreased energy levels and appetite and changes in sleep cycles and mood. Funnily enough, these are very similar to the symptoms of depression. The main symptoms of depression include:

• Hopeless outlook

• Low Interest 

• Fatigue

• Anxiety

• Irritability

• Appetite changes

• Wavering emotions

• Suicidal thoughts

The Chemistry

Chemically, serotonin, norepinephrine, and dopamine are catecholamines secreted by the adrenal glands. Catecholamines play an essential role in learning, memory, mood control, anxiety, fear, social and reproductive behavior. When there is any change in the body’s emotional or physical conditions, these catecholamines are released to mediate the differences.

There is a decrease in these catecholamines during this phase, either by increased degradation by monoamine oxidases or hormonal imbalance. This is where the anti-depressants come to the rescue but inhibit the uptake or degradation of these much-needed catecholamines. 

Statistics

Almost 3-7% of women take antidepressants during pregnancy, which often increases after the fetus’s birth. Postpartum depression affects nearly 20% of the population. There is also an increased risk of depression by almost 20% of women who have suffered some kind of physical abuse or affective disorder. 

Making a decision 

Looking at these side effects, some women choose not to consume antidepressants, fearing for their fetus’s safety and wellness. However, when untreated, this condition can be fatal, and if the mother is not medically sound, it can directly affect the infant. 

Depending on the type of patient and the situation, it is up to the medicinal practitioner to decide whether it is suitable for the patient to undergo treatment or not. The administration is restricted in the third trimester unless necessary, and usually, only one type of drug is administered, i.e., monotherapy. 

In conclusion, depression is a severe mental disorder that should be handled effectively in the case of pregnancy as it affects the mother and the unborn fetus. Various therapies are found to be useful, but side effects do prevail in certain instances.

It is worth calculating the risks and benefits of treating this disorder to understand what works for the patient.

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Root Canal Treatment

Root Canal Treatment

A root canal, or more specifically, a root canal treatment, is a procedure dentists use to save a badly infected tooth instead of removing it altogether. 

The pulp is the root’s innermost area, which is richly supplied with blood vessels and nerves. Any kind of sensation of the tooth, like sensitivity or pain, arises from this area. 

The root canal by itself is a region of space in the root of the tooth.

What is Root Canal Treatment?

This is also known as endodontic therapy, endodontic treatment, or root canal therapy. It involves the cleaning, disinfection, decontamination, and filling of the infected area of the root canal.

Removal of the tooth’s pulp and subsequent filling can prevent further microbial contamination and the spread of this infection. However, if the tooth is too damaged, dentists will most likely remove the tooth and replace it with dental implants or partial dentures. 

Why do we need this root canal treatment?

When a tooth gets infected, the bacteria attack the enamel first and slowly make their way through the dentin and eventually into the pulp.If the pulp gets infected, it can lead to tooth abscesses. Symptoms include:

  • Terrible toothaches that can radiate to the jaw and bone.
  • Increased sensitivity to extreme temperature changes
  • Pain while biting 
  • Fever may be present 

More severe cases of infection can also cause bone decay and tooth loss. 

The Procedure

Root canals previously would be excruciating procedures. With newer methods and better technology, it’s a procedure that will not cause a lot of pain and keep teeth healthy and clean. 

Local anesthesia is usually administered to patients undergoing this treatment. An opening is made through the tooth’s crown, and specific instruments are guided into the tooth’s innermost pulp area.

The infected pulp is then removed. Once the tooth is completely clean, the dentist will fill it with inert materials like gutta-percha, a cement made up of zinc-oxide eugenol.

Epoxy resin is used as a binder for gutta-percha. Antiseptic materials like paraformaldehyde containing N2 may also be used. 

Complications

Although this procedure aims to eliminate infection and pain in the mouth, a couple of complications could occur.

  • Infection: infection after a root canal is not common, but if present, it can cause damage in and around the area of the root canal. 
  • Accumulation of unwanted materials: Cholesterol crystals can accumulate and cause irritation and lesions.
  • Immune response: this procedure can trigger an overactive immune response that leads to adverse health impacts.
  • Toxic materials: Filling materials such as amalgam contain mercury and other metals, which can be harmful. 

Modern technology and recent findings have made complicated procedures such as root canals easier to carry out with a higher success rate. The pain caused due to a root canal is tolerable than the pain of an infected tooth.

Moreover, having a lax attitude can also spread the infection to other teeth in the mouth. Regular checkups, good mouth hygiene, and eating healthy foods can help prevent any kind of complication to the teeth.

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