Syphilis is caused by a germ called Treponema pallidum, This disease can be easily missed because a person can carry the germ of syphilis but may look healthy. Complications such as blindness, deafness and heart disease can occur many years after the initial infection and they do not respond to treatment at that stage. In its initial stage of infection, a sore appears in or around the genitalia (sex organs) usually about 2-3 weeks after sexual contact with an infected person. This sore usually heals on its own. The second stage of the disease is characterized by the appearance of some or all of the following features: a skin rash, loss of hair, enlargement of lymph nodes all over the body, sore throat, and a feeling of not being well. The skin rash may not be very obvious in dark skinned people and appears 3-6 months after genital sore appears. These symptoms also disappear gradually and the person goes into a latent or hidden stage, where the infected person feels well and healthy. The disease at this stage can be detected only by a blood test.
After many( usually 7-20 years) years of infection, complications such as blindness, paralysis and dementia occur in about 40% of patients. This stage is called tertiary syphilis. An infected mother may have several abortions and miscarriages. She could also infect the baby and cause congenital syphilis. (i.e. present at birth) The infection spreads through the placenta, from an infected mother to the unborn child. Most of the infected babies look normal at birth. involvement of the bones is common and the babies may develop swelling of the joints at around 6 weeks to 6 months of age; these are extremely painful, and as a result the baby may not move the limbs due to pain. Fever, anemia, failure to thrive, and irritability may be some of the features. Involvement of the nasal (nose) bone, teeth, enlargement of the liver and skin rashes are other later manifestations. The diagnosis is usually made by examining the scrapings from the lesions, and by doing the VDRL test. When a blood test is done a few days after the infection (soon. after the sore appears) the blood test may not be positive. Hence it is important to repeat the test again after 3 months. The VDRL may sometimes be positive in other conditions as well. In such instances other specific tests could be done to confirm the diagnosis. A blood test done during pregnancy helps to detect and treat congenital syphilis in the baby.
Treatment
Although syphilis can be completely cured when adequately treated in its early stages, treatment at the stage when complications set in is of little use. Self prescribed treatment with antibiotics such as tetracycline will suppress the disease but does not give a complete cure. Treatment is a prescribed course of Penicillin injections.
Gonorrhea
Gonorrhea is more prevalent than syphilis and is caused by bacteria Nisseria gonorrhoea (gonococci). The most noteworthy feature of this disease is that females frequently do not show any symptoms of the disease. Thus it is only the males (who get symptoms) that usually turn up for treatment. The larger infected pool of commercial sex workers usually does not seek treatment because they feel and look quite well. Symptoms in the male are burning sensation when passing urine, pus-like (thick and yellow) discharge from the tip of the urethra, and frequency of passing urine. If left untreated, complications can occur, but these are rare at present; these include swelling of joints, abscesses in the genital organs and infertility in women.Infection of the male urethra may lead to strictures (narrowing of the opening), and subsequent difficulty in passing urine. Infection of a pregnant mother may result in infection of baby's eyes, during birth. The eyes become reddened with a discharge. This may result in blindness, if untreated. Gonorrhea cannot be diagnosed by a blood test. The females in particular need to have a genital examination and special swabs taken for diagnosis. Penicillin used to be the drug of choice; however, many patients are now resistant to this drug.
Friday, July 19, 2013
Menopause
This is the period in a woman's life when her reproductive capacity is coming to an end. At this time she may develop many physical and psychological changes due to the alteration of the pattern of the sex hormones ( especially the reduction of estrogen). Menstruation which has occurred since she attained menarche now gradually stops. The average age of menopause is around the age of 45 to 55 years, but it may range from the late thirties to the early fifties. The menopause is defined as 6 months or more secondary amenorrhea of a woman aged 45 years or more. Menopause can be divided in to 2 categories, that is natural menopause and surgical menopause. Surgical menopause occurs when patient’s both ovaries removed surgically or patients who underwent hysterectomy.
The hormonal changes affect not only the reproductive system but also the entire body and mind. Most women adjust themselves to these changes without much discomfort. They may experience a few distressing symptoms for a short time, but these do not disrupt their normal pattern of life. A few, perhaps about 10% experience serious difficulties.
The symptoms of menopause, if and when they do occur, are similar to those of premenstrual tension. A woman who is in perimenopausal age will experience physical symptoms such as hot flushes which is a burning sensation spreads from trunk to face lasting for few seconds, giddiness (dizziness), trembling,tingling or numbness of hands and feet, loss of appetite, constipation, loss of weight, joint pains, palpitations, and dark circles around the eyes, dryness of the skin and the mucous membranes especially in the vagina (making intercourse difficult or painful), reduced sex desire, tiredness, night sweats, insomnia and increased urinary frequency. She may also experience several psychological symptoms such as mood swings, anxiety, loss of short term memory, lack of concentration, lack of self confidence and depression. The patient will experience few or more such symptoms in different degrees and it is variable from person to person.
It should be stressed that the symptoms described above can be caused by other physical and emotional disorders, so it is best to allow the doctor to make the decision. It should be emphasized that many women are free of most of these distressing symptoms. It should be happily noted that menopause is only a temporary phase in the journey of life -the discomforts may last for a few years, but they will pass off. The period after menopause can be brighter, ‘happier, and more healthy; often a more balanced personality emerges, and a more productive period of life starts. Most of the symptoms of menopause, which are due to falling levels of sex hormones at this age, can now be treated satisfactorily with hormones (hormone replacement therapy-HRT). But it must be remembered that in such treatment, the drug dosage and duration of treatment should be subject to supervision by a doctor. Recently, fears have been expressed of an increasing incidence (occurrence) of cancer of the womb, breasts and ovaries in women receiving hormones (estrogen), the incidence being related to dose and duration. Fortunately this problem has now been overcome by using a combination of hormones (low dose estrogen and progesterone).
The hormonal changes affect not only the reproductive system but also the entire body and mind. Most women adjust themselves to these changes without much discomfort. They may experience a few distressing symptoms for a short time, but these do not disrupt their normal pattern of life. A few, perhaps about 10% experience serious difficulties.
The symptoms of menopause, if and when they do occur, are similar to those of premenstrual tension. A woman who is in perimenopausal age will experience physical symptoms such as hot flushes which is a burning sensation spreads from trunk to face lasting for few seconds, giddiness (dizziness), trembling,tingling or numbness of hands and feet, loss of appetite, constipation, loss of weight, joint pains, palpitations, and dark circles around the eyes, dryness of the skin and the mucous membranes especially in the vagina (making intercourse difficult or painful), reduced sex desire, tiredness, night sweats, insomnia and increased urinary frequency. She may also experience several psychological symptoms such as mood swings, anxiety, loss of short term memory, lack of concentration, lack of self confidence and depression. The patient will experience few or more such symptoms in different degrees and it is variable from person to person.
It should be stressed that the symptoms described above can be caused by other physical and emotional disorders, so it is best to allow the doctor to make the decision. It should be emphasized that many women are free of most of these distressing symptoms. It should be happily noted that menopause is only a temporary phase in the journey of life -the discomforts may last for a few years, but they will pass off. The period after menopause can be brighter, ‘happier, and more healthy; often a more balanced personality emerges, and a more productive period of life starts. Most of the symptoms of menopause, which are due to falling levels of sex hormones at this age, can now be treated satisfactorily with hormones (hormone replacement therapy-HRT). But it must be remembered that in such treatment, the drug dosage and duration of treatment should be subject to supervision by a doctor. Recently, fears have been expressed of an increasing incidence (occurrence) of cancer of the womb, breasts and ovaries in women receiving hormones (estrogen), the incidence being related to dose and duration. Fortunately this problem has now been overcome by using a combination of hormones (low dose estrogen and progesterone).
Amenorrhea or absence of periods
Normal menstrual cycle of a woman will range from 21 days to 42 days. Anything beyond this period is considered as abnormal. If periods are delayed or absent in the child bearing age, pregnancy must be considered first. Usually after a miscarriage (abortion), or after childbirth, there may be some delay in recommencing the periods; but, sooner or later, normal periods do set in. What is important is to realize that an ovum (egg) may be released two weeks prior to the first onset of such a period, and conception is possible with this "first egg". If this happens (which is not uncommon), the post abortal (after abortion) or postpartum (after childbirth) amenorrhea will then continue as a pregnancy amenorrhea. In other words, it is not necessary for a person to have a period before conceiving. Thus there is a need for contraception during this time, if pregnancy is to be avoided. It must also be mentioned that it is wrong to think that conception will not occur, as long as the mother is breast feeding. Breast feeding is known to delay the release of the ovum and it may therefore result in irregular periods but it does not altogether prevent the mother becoming pregnant.
It is always better to check presence of urinary hCG before doing anything with a patient with secondary amenorrhea. Patients sometimes seek drug therapy to get their “periods”, when they have amenorrhea. This is not recommended because, it a pregnancy is present, such drugs, which usually contain hormones(and do not usually cause an abortion) may cause abnormalities in the growing fetus. In countries where abortions are legalized a woman can get the pregnancy terminated. However, in countries where the law does not permit an abortion to be performed except to save the life of the mother, the solution to an unwanted pregnancy would be contraception, which is readily available. It is sad indeed that a young girl, often unmarried, desperate with an unwanted pregnancy, goes to an abortionist to get rid of her pregnancy. These criminal abortions can have disastrous complications such as local abscess formation, sepsis and subfertility in later life. Such sepsis even life threatening.
There are many other causes, other than a pregnancy where amenorrhea may occur. As mentioned before, the menstrual cycle is under the influence of hormones, both from the ovaries and the part of the brain called the hypothalamus and pituitary. Thus stressful situations, such as domestic problems, and school examination tensions, may produce amenorrhea. Other causes of amenorrhea includes, using oral contraceptive pills, contraceptive injections such as Depo -Provera, subdermal implant (Norplant), drugs such as reserpine(for high blood pressure), digoxin(for heart failure), being on a “crash diet" (sudden and severe reduction of food in an attempt to slim), premature menopause (which may occur around 35 years), trauma (injury) to the womb by repeated scrapes or curettage (D & C, i.e. Dilatation and Curettage), tumors of endocrine (hormone-producing) glands such as disease or tumors of the ovaries and chronic diseases such as tuberculosis.
Medical advice should be sought when there is amenorrhea, unless it is due to a fairly obvious cause such as pregnancy, where there would be other indications.
It is always better to check presence of urinary hCG before doing anything with a patient with secondary amenorrhea. Patients sometimes seek drug therapy to get their “periods”, when they have amenorrhea. This is not recommended because, it a pregnancy is present, such drugs, which usually contain hormones(and do not usually cause an abortion) may cause abnormalities in the growing fetus. In countries where abortions are legalized a woman can get the pregnancy terminated. However, in countries where the law does not permit an abortion to be performed except to save the life of the mother, the solution to an unwanted pregnancy would be contraception, which is readily available. It is sad indeed that a young girl, often unmarried, desperate with an unwanted pregnancy, goes to an abortionist to get rid of her pregnancy. These criminal abortions can have disastrous complications such as local abscess formation, sepsis and subfertility in later life. Such sepsis even life threatening.
There are many other causes, other than a pregnancy where amenorrhea may occur. As mentioned before, the menstrual cycle is under the influence of hormones, both from the ovaries and the part of the brain called the hypothalamus and pituitary. Thus stressful situations, such as domestic problems, and school examination tensions, may produce amenorrhea. Other causes of amenorrhea includes, using oral contraceptive pills, contraceptive injections such as Depo -Provera, subdermal implant (Norplant), drugs such as reserpine(for high blood pressure), digoxin(for heart failure), being on a “crash diet" (sudden and severe reduction of food in an attempt to slim), premature menopause (which may occur around 35 years), trauma (injury) to the womb by repeated scrapes or curettage (D & C, i.e. Dilatation and Curettage), tumors of endocrine (hormone-producing) glands such as disease or tumors of the ovaries and chronic diseases such as tuberculosis.
Medical advice should be sought when there is amenorrhea, unless it is due to a fairly obvious cause such as pregnancy, where there would be other indications.
Measles and Rubella
Measles (medical term: rubeola) is an infection caused by the measles virus, which enters the body through the respiratory tract. On entering the body, the virus starts multiplying and produces thousands of viruses. After a few days it causes the illness. The period between the entry of the infective agent and the development of an illness is referred to as the incubation period. The incubation period for measles is about 2 weeks. The illness starts with fever, which can be very high - sometimes 40 to 41°C (104 to 106° F). Usually there are aches and pains, vomiting, loss of appetite, and cough; sometimes, loose stools (occasionally with blood and mucus). The eyes are often somewhat red and tearing. The inside of the cheeks and throat also maybe reddened. On about the 3th or 5th day of the fever, a rash appears, first on the face and then on the chest, trunk, and limbs. Usually, about a day after the rash, the fever comes down, and the patient feels better. The rash usually clears up in 3 or 4 days.
The patient is infectious from about 2 days before the fever to the time of disappearance of the rash. This period is called the infectious or infective period. During this period the patient can convey the infection to someone else, by scattering thee virus during coughing, talking, laughing, or even when breathing out. While most patients get well within a week there are some especially malnourished children, who develop serious complications such as pneumonia, diarrhea and encephalitis. Apart from the greater susceptibility to complications, the malnourished children become more malnourished. Some develop a bacterial infection of the eyes, which, if not properly treated, can lead to blindness; or middle ear infections, which can lead to deafness. If the chest infection is not properly treated, a chronic lung infection called bronchiectasis may develop. Another dangerous repercussion is the reactivation of healed tuberculosis of the lungs. Yet another serious but rare complication is a chronic incurable disorder of the brain - subacute sclerosing pan encephalitis (SSPE), which may occur about 7 years later. Fortunately the measles vaccine given on 9 months of age has brought down the incidence of this disease dramatically.
Treatment
There is no special drug that kills the measles virus, in the way that antibiotics destroy bacteria. The treatment which is directed towards the relief of symptoms, maintenance of proper nourishment, and the prevention of complications, include the, treatment of fever, a nourishing diet and sufficient fluids; there is invariably a poor appetite, and perhaps vomiting and loose stools; small amounts of nourishing fluids (milk, soups, or any other palatable drink) should be given at frequent intervals; if there is diarrhea, carry out the treatment to prevent dehydration. Also a cough syrup or steam inhalation with coriander is helpful for the cough. Eyes should be protected from the glare of lights. Consult a doctor without delay if the patient has symptoms such as persistent fever and cough, fast breathing or difficulty in breathing, fits, persistent vomiting and diarrhea, or any other abnormal changes.
German Measles or Rubella is an infection caused by the rubella virus, through the respiratory tract. The incubation period is about 2-3 weeks. There is mild fever for 2 or 3 days; a rash like that of measles, but less intense and lasting perhaps only a day or two; usually enlargement of the lymph glands (to about the size of an orange seed) at the back of the head and neck. Complications are extremely rare. We need not have taken much notice of this illness, if not for the fact that if a pregnant mother gets this infection, during the first three months of pregnancy there is a risk that her baby might have certain defects. These include: heart disease (due to abnormal development of the chambers of the heart), cataract of the eyes, deafness, and faulty development of the brain resulting in mental retardation; this is called the rubella syndrome. It is given as MMR, a combined vaccine for Mumps, Measles and Rubella at one year and three years of age.
The patient is infectious from about 2 days before the fever to the time of disappearance of the rash. This period is called the infectious or infective period. During this period the patient can convey the infection to someone else, by scattering thee virus during coughing, talking, laughing, or even when breathing out. While most patients get well within a week there are some especially malnourished children, who develop serious complications such as pneumonia, diarrhea and encephalitis. Apart from the greater susceptibility to complications, the malnourished children become more malnourished. Some develop a bacterial infection of the eyes, which, if not properly treated, can lead to blindness; or middle ear infections, which can lead to deafness. If the chest infection is not properly treated, a chronic lung infection called bronchiectasis may develop. Another dangerous repercussion is the reactivation of healed tuberculosis of the lungs. Yet another serious but rare complication is a chronic incurable disorder of the brain - subacute sclerosing pan encephalitis (SSPE), which may occur about 7 years later. Fortunately the measles vaccine given on 9 months of age has brought down the incidence of this disease dramatically.
Treatment
There is no special drug that kills the measles virus, in the way that antibiotics destroy bacteria. The treatment which is directed towards the relief of symptoms, maintenance of proper nourishment, and the prevention of complications, include the, treatment of fever, a nourishing diet and sufficient fluids; there is invariably a poor appetite, and perhaps vomiting and loose stools; small amounts of nourishing fluids (milk, soups, or any other palatable drink) should be given at frequent intervals; if there is diarrhea, carry out the treatment to prevent dehydration. Also a cough syrup or steam inhalation with coriander is helpful for the cough. Eyes should be protected from the glare of lights. Consult a doctor without delay if the patient has symptoms such as persistent fever and cough, fast breathing or difficulty in breathing, fits, persistent vomiting and diarrhea, or any other abnormal changes.
German Measles or Rubella is an infection caused by the rubella virus, through the respiratory tract. The incubation period is about 2-3 weeks. There is mild fever for 2 or 3 days; a rash like that of measles, but less intense and lasting perhaps only a day or two; usually enlargement of the lymph glands (to about the size of an orange seed) at the back of the head and neck. Complications are extremely rare. We need not have taken much notice of this illness, if not for the fact that if a pregnant mother gets this infection, during the first three months of pregnancy there is a risk that her baby might have certain defects. These include: heart disease (due to abnormal development of the chambers of the heart), cataract of the eyes, deafness, and faulty development of the brain resulting in mental retardation; this is called the rubella syndrome. It is given as MMR, a combined vaccine for Mumps, Measles and Rubella at one year and three years of age.
Umbilical and inguinal hernia
Hernias are also a common surgical problem in infancy and childhood. It is very common to see umbilical hernia than any other hernias in the body.
Umbilical hernia of children
The mother may notice an undue prominence at baby's navel, which becomes more noticeable each time baby cries, coughs or strains. This usually becomes obvious a few weeks after birth. This prominence is called an umbilical hernia. It results from a weakness of the tissues of the abdominal wall at the navel, which causes some of the contents inside the abdomen to get slightly pushed out from inside, giving rise to a small lump. This lump can be easily pushed inside. Frequently the defect in the abdominal wall does not allow the introduction of the fingertip. Within months such umbilical hernias often close spontaneously.
In the course of an year or eighteen months, as the natural prominent belly becomes flattened, and when the abdominal muscles become strengthened as babies start to stand and walk, these defects close up and the hernia disappears. The practice of strapping the abdomen or tying a coin over the defect is not recommended. However, where the defect is large and admits the finger tip easily, chances are that surgical repair may be required, and this may be carried out once the baby has reached two years (or earlier if it is a big hernia). if the hernia causes pain, is red or inflamed, or is tense and cannot be pushed inside, or if there is any such doubt, consult a doctor urgently. Umbilical hernia, or a hernia on a side of the umbilicus, may occur in older persons. Sometimes the hernia is in the midline a few inches above the umbilicus; this is called a ventral hernia. These hernias need operative treatment.
Inguinal hernia
“Inguinal” refers to the groin. Due to a weakness of the muscles in the groin (either on one side or both sides) the contents of the abdominal cavity may get pushed from inside, resulting in a lump in the groin. This hernia is seen in males at all ages; infants, children or adults. It is commoner in adult males than children. There is a fullness on either one or both groins. This may be particularly noticeable on standing, crying, or coughing, and may disappear when lying down. If the hernia gets bigger, it usually goes into the scrotum as well; it is then called an inguinoscrotal hernia. Usually this lump can be reduced (i.e. push it back into the abdominal cavity). The treatment is surgical repair of the hernial orifice which is called herniotomy and mesh repair. A polypropylene mesh will be placed in the abdominal wall during the surgery to strengthen the abdominal wall. If there is pain over the hernia, it usually indicates that an obstruction has developed. If the hernia gets incarcerated(adhesion of the content of the hernia to the hernial sac) or obstructed immediate surgical attention is necessary. If the obstruction is not relieved the hernia can go on to the stage of strangulation (tightly compressed) where the blood supply to the contents inside the hernia gets cuts off and this becomes a surgical emergency.
Umbilical hernia of children
The mother may notice an undue prominence at baby's navel, which becomes more noticeable each time baby cries, coughs or strains. This usually becomes obvious a few weeks after birth. This prominence is called an umbilical hernia. It results from a weakness of the tissues of the abdominal wall at the navel, which causes some of the contents inside the abdomen to get slightly pushed out from inside, giving rise to a small lump. This lump can be easily pushed inside. Frequently the defect in the abdominal wall does not allow the introduction of the fingertip. Within months such umbilical hernias often close spontaneously.
In the course of an year or eighteen months, as the natural prominent belly becomes flattened, and when the abdominal muscles become strengthened as babies start to stand and walk, these defects close up and the hernia disappears. The practice of strapping the abdomen or tying a coin over the defect is not recommended. However, where the defect is large and admits the finger tip easily, chances are that surgical repair may be required, and this may be carried out once the baby has reached two years (or earlier if it is a big hernia). if the hernia causes pain, is red or inflamed, or is tense and cannot be pushed inside, or if there is any such doubt, consult a doctor urgently. Umbilical hernia, or a hernia on a side of the umbilicus, may occur in older persons. Sometimes the hernia is in the midline a few inches above the umbilicus; this is called a ventral hernia. These hernias need operative treatment.
Inguinal hernia
“Inguinal” refers to the groin. Due to a weakness of the muscles in the groin (either on one side or both sides) the contents of the abdominal cavity may get pushed from inside, resulting in a lump in the groin. This hernia is seen in males at all ages; infants, children or adults. It is commoner in adult males than children. There is a fullness on either one or both groins. This may be particularly noticeable on standing, crying, or coughing, and may disappear when lying down. If the hernia gets bigger, it usually goes into the scrotum as well; it is then called an inguinoscrotal hernia. Usually this lump can be reduced (i.e. push it back into the abdominal cavity). The treatment is surgical repair of the hernial orifice which is called herniotomy and mesh repair. A polypropylene mesh will be placed in the abdominal wall during the surgery to strengthen the abdominal wall. If there is pain over the hernia, it usually indicates that an obstruction has developed. If the hernia gets incarcerated(adhesion of the content of the hernia to the hernial sac) or obstructed immediate surgical attention is necessary. If the obstruction is not relieved the hernia can go on to the stage of strangulation (tightly compressed) where the blood supply to the contents inside the hernia gets cuts off and this becomes a surgical emergency.
Cleft lip and cleft palate
Cleft lip and cleft palate are deformities of the lip, nose, and the roof of the mouth which may occur in about one in a thousand newborn babies. In these babies the upper lip is split and this split may continue into the nostril and right along the palate which is the roof of the mouth. One side of the lip and nostril or both sides may be affected. To see such a deformed face in a newborn baby would be deeply distressing, and very often a severe shock to the mother who has awaited the new arrival with joy and great expectations. Nevertheless, there is no need for despair. With careful treatment a baby with cleft lip and palate could be made to look near normal and also eat, drink and speak normally. For successful treatment parental cooperation and participation is essential. They must be motivated to get rid of the sorrow and play their role with courage.
Management
Most of these babies cannot suck milk in to their mouth because of the cleft in the palate. But if milk is introduced into the mouth they can swallow it with a little difficulty. There will be leakage into the nose, but this does not cause problems. Milk could be introduced into the mouth by one of several methods. At the beginning a spoon or a pipette could be used to place small quantities of milk on the side of the tongue. Gradually the baby could be trained to drink out of a bottle which should be either compressible (a plastic bottle) or if it is glass it must have a rubber balloon attachment which could be compressed so that milk is propelled into the mouth. As breast milk is best, expressed breast milk should be given to the baby in the way described above.
With patience, mothers learn to feed the baby adequately, and if this is carefully done there will be no problems about feeding. These babies have to undergo two or three operations before they are two years old. It is important to maintain a good nutritional status for them to be fit for these operations. The baby with the cleft lip and palate must be carefully looked after at home. They are more liable to get throat and ear infections. During cold days they should not be bathed, taken out or exposed to cold weather. Ideally only one person, preferably the mother, must handle the baby. Visitors must not be allowed to touch and fondle the infant. They may carry germs, which cause infections in the baby. If ear or throat infections occur treatment must be obtained as early as possible. These infections could weaken the general condition and also may cause complications later when the child undergoes operations.
The baby must be seen by a surgeon who could undertake surgical repair of the cleft lip and palate. This must be done very early so that the surgeon could plan the treatment. Timing of the operations depends on the type and severity of the cleft. Sometimes the surgeon may decide on certain non surgical treatment procedures before the operation. These may include the construction of a simple appliance, which the baby has to wear in the mouth. There is no discomfort and the baby usually learns to tolerate it. These appliances help to make the cleft narrow and thereby make the operation easier. There are several other doctors who could ensure that the baby gets the best treatment. The surgeon may want a family physician or a child specialist to see these babies. These doctors will see whether the babies are growing normally and whether they are fit for the surgery. They will also check whether the baby has other illnesses and abnormalities. Sometimes abnormalities in the heart, spine, brain and other organs may be present in infants with cleft lip and palate. These, if present, must be treated as soon as possible.
Management
Most of these babies cannot suck milk in to their mouth because of the cleft in the palate. But if milk is introduced into the mouth they can swallow it with a little difficulty. There will be leakage into the nose, but this does not cause problems. Milk could be introduced into the mouth by one of several methods. At the beginning a spoon or a pipette could be used to place small quantities of milk on the side of the tongue. Gradually the baby could be trained to drink out of a bottle which should be either compressible (a plastic bottle) or if it is glass it must have a rubber balloon attachment which could be compressed so that milk is propelled into the mouth. As breast milk is best, expressed breast milk should be given to the baby in the way described above.
With patience, mothers learn to feed the baby adequately, and if this is carefully done there will be no problems about feeding. These babies have to undergo two or three operations before they are two years old. It is important to maintain a good nutritional status for them to be fit for these operations. The baby with the cleft lip and palate must be carefully looked after at home. They are more liable to get throat and ear infections. During cold days they should not be bathed, taken out or exposed to cold weather. Ideally only one person, preferably the mother, must handle the baby. Visitors must not be allowed to touch and fondle the infant. They may carry germs, which cause infections in the baby. If ear or throat infections occur treatment must be obtained as early as possible. These infections could weaken the general condition and also may cause complications later when the child undergoes operations.
The baby must be seen by a surgeon who could undertake surgical repair of the cleft lip and palate. This must be done very early so that the surgeon could plan the treatment. Timing of the operations depends on the type and severity of the cleft. Sometimes the surgeon may decide on certain non surgical treatment procedures before the operation. These may include the construction of a simple appliance, which the baby has to wear in the mouth. There is no discomfort and the baby usually learns to tolerate it. These appliances help to make the cleft narrow and thereby make the operation easier. There are several other doctors who could ensure that the baby gets the best treatment. The surgeon may want a family physician or a child specialist to see these babies. These doctors will see whether the babies are growing normally and whether they are fit for the surgery. They will also check whether the baby has other illnesses and abnormalities. Sometimes abnormalities in the heart, spine, brain and other organs may be present in infants with cleft lip and palate. These, if present, must be treated as soon as possible.
Periodontal disease
Periodontal disease, which is also known as "gum
disease“ or Pyorrhea, leaves the tooth itself intact and destroys the tissues
which support the tooth in the underlying bone. It is caused by poor oral
hygiene and the consequent accumulation of plaque at the gum margin. lt is one of
the common causes of bad breath. The disease may commence as a gingivitis when
plaque at the gum margin causes a swelling of the gum, the gum boil, due to
bacterial action on the gums, and causes bleeding gums. This is an important
and easily recognizable sign of periodontal disease at any age. There may be
blood on the toothbrush or in the saliva after brushing. It is a good practice
to occasionally check for bleeding gums before a mirror immediately after
brushing small segments of the gum –say across 6 teeth.
At the gingivitis
stage, the disease is reversible provided proper attention is given to oral
hygiene. If this is not done and the condition is allowed to persist for months
and years, the fibrous attachment, which anchors the tooth to the bone, is
frequently destroyed gradually. This may go on slowly for many years until finally
the teeth become shaky and are lost. Things are probably made worse by the
presence, under the gum, of hard deposits of calculus (tartar). Calculus or
tartar refers to the plaque that has got calcified over a period of time due to
its improper removal, No plaque means no tartar; so tartar or calculus implies
poor oral hygiene. Plaque can be removed efficiently by tooth brushing, while
the calculus can only be removed mechanically by a dental surgeon using a
procedure called scaling. On the other hand scaling will hardly be necessary
for people who clean their teeth properly. Furthermore it is quite wrong to
regard the loss of teeth with advancing age -a familiar occurrence - as normal.
On the contrary it is due to a disease, which can be, and ought to be, prevented
and controlled.
Prevention of periodontal disease
The prevention of the disease is based on sound personal
oral hygiene throughout life, in other words, there must be daily mechanical
removal of plaque using a toothbrush or chewing stick. It is recommended to
brush the teeth at the morning and at the evening after the meals. The overall
objective is to maintain a good oral hygiene so that the progress of the
disease, if at all, will be slow enough for the teeth to last a lifetime
despite some loss of bone support. As an aid to oral hygiene, plaque disclosing
agents or some dyes can be used to stain and show up the plaque. They do not in
themselves remove the plaque. Furthermore the use of dental floss and
interdental cleaning aids will help remove plaque from sites which the brush
may not reach easily. Advice may be obtained from a dentist about the use of
such aids. Deposits of calculus resulting from past neglect of oral hygiene
will harbor plaque and make cleaning of the teeth more difficult.
Dental caries and toothache
Dental caries are dental decay or cavities in teeth and it
is an infective disease, which is caused by sugar in the diet. In other words without
the presence of sugar there will be no cavities in teeth. Germs a group of
bacteria called ‘acid forming’ bacteria which include Streptococcus mutans, Lactobacillus, which are present in the dental plaque, thrives and multiplies
in the presence of sugar. The moment sugar containing foods and drinks are consumed,
these bacteria begin to ferment the sugar, producing acid inside the plaque.
The acid thus formed is strong enough to attack the tooth under the plaque
deposit, and early decay begins. If this process is allowed to recur many times
a day owing to the frequent intake of sweet foods and drinks, a dental cavity will be formed with time.
Therefore the chances of decay are greatly increased if foods and drinks
containing sugar are consumed frequently.
On the other hand if sugars are taken
in low concentration or infrequently the tooth is given time to reverse the
damage process. A toothpaste with fluoride is helpful in preventing and reversing
this damage. Once cavities are formed they do not necessarily keep getting
deeper. Depending on sugar intake and use of fluorides they can stop
progressing and get healed. Consequently the progress of caries is slow, and in
children it may take around 2 years for decay to penetrate the outer covering
of the tooth, which is called enamel. In adults this may take 3 years. Once
dental decay has passed through the enamel into the next layer of dentine and
thence deep into the pulp of the tooth, there can be severe pain toothache.
Further neglect of this condition may lead to the spread of infection resulting
in the formation of a dental abscess (also called alveolar abscess), which if
untreated may give rise to unpleasant consequences. At this stage the tooth can still be saved by
what is called a root filling. This is nowadays a commonplace, though somewhat
elaborate, procedure.If caries has destroyed the tooth "beyond repair, and
if a root filling is not available, the tooth will have to be extracted. Also
the dental caries are well known risk factor to cause infective endocarditis in
later life. Therefore it is very important to keep your teeth clean and take
necessary treatments for existing dental caries without any delay.
Prevention of dental caries
The basic formula is the reduction of refined sugar in the
diet and the appropriate use of fluoride. There must be a reduction in the
quantity and frequency of the intake of foods and drinks, which contain added
sugar. Caries is predominantly a disease of childhood. Therefore a great
responsibility rests on parents to inculcate healthy dietary habits from the
earliest age. Frequent sweet snacks and drinks during the day (in between meals)
should be avoided; the teeth should be brushed within an hour of taking sugary
foods. The time honored rule is that sweet foods should be restricted to main
mealtimes only, preferably once or twice a week after a meal.
Keeping teeth clean
The first set of teeth in childhood is called primary teeth
or deciduous teeth. This set has 20 teeth. Sometimes the primary teeth are also
referred to as temporary teeth since they fall off with the eruption of the permanent teeth. The average time of eruption of primary teeth and their
falling off is happen over several years. The permanent teeth begin to erupt
from about the age of 6-7 years. With the eruption of permanent teeth the child
will go into a mixed dentition period where the child will have mixture of
primary and permanent teeth. The mixed dentition period lasts until about 12
years. Eventually a adult will have 32 teeth consisting of 8 teeth on either
side , on the upper and lower jaws; these are 2 incisors, 1 canine, 2 premolar
and 3 molar. The last molar may not erupt in many persons for very long period.
Keeping teeth clean
Baby's teeth may be cleaned with a cotton bud or soft piece
of cloth. A small brush can be used from about the age of 12 months. Parents
should clean their children's teeth until they are about 4 years. The routine
must be pleasant and enjoyable. In that way children will grow to accept oral
hygiene as a part of daily life. Parents must set the example by brushing their
own teeth with the child watching. The brush should be held in a pen or finger
grip and the nylon bristles must be angled at about45 degrees where the gums
meet the teeth. The reason for brushing is to remove plaque, which is the cause
of the 2 main dental diseases, dental caries (cavities) and periodontal
disease(pyorrhea).
Plaque
Plaque is an off-white, smelly, sticky, substance, which
forms normally and adheres to the teeth towards the end of the day. On the
smooth surfaces of teeth it starts forming at the gum margin and increases in
thickness with time, while spreading out to cover a greater area of the tooth
surface. It also forms inside the tiny pits and fissures on the biting surfaces
of teeth, which the toothbrush may not reach. Plaque contains various types of
germs (bacteria) and their products, including food particles. It can, to a
large extent, be removed by regular tooth brushing, using a toothbrush or a
chewing stick, once in the morning and again before retiring to bed. Whatever
the brushing technique used,the important thing is to brush away the plaque at
the margin. That is where plaque formation frequently commences and where it
causes damage. Toothpaste is not an absolutely essential ingredient in tooth brushing;
it is the toothbrush that is essential. The finger is not a substitute for a toothbrush.
However it is advantageous to use a toothpaste containing fluoride, whenever
possible except in certain areas where fluoride is high in drinking water to
prevent dental carries. Fluoride toothpaste makes the surface enamel layer of
the tooth harder and stronger, and thereby makes it more resistant to bacterial
attack.
How much toothpaste should be used on the brush at a time’? Answer:
About the size of an average peanut (groundnut) for children - slightly more
for adults. Additional amounts unnecessarily increase the cost incurred, and
also has the disadvantage of causing ingestion (swallowing) of too much of
fluoride. In situations where toothpaste is not affordable, a non-irritating
wisp of soap would do.
Wednesday, July 17, 2013
Hepatitis A, Hepatitis B and Hepatitis C
Hepatitis A
The type of hepatitis commonly prevalent in worldwide is the
hepatitis A. It is due to a virus that gains entry into the body through the
mouth (gastrointestinal route) as in typhoid, and causes an infection of the
liver. The symptoms are: fever, vomiting, abdominal pain (usually in the upper
part), yellowish (or tea-colored) discoloration of the urine, and yellowish discoloration
of the sclera of the eyes (called jaundice). The illness usually clears up
within a week or two, but occasionally it can cause complications and death.
Therefore it is wise to consult a doctor for treatment. Its prevention is the
same as for prevention of other bowel diseases that spread feco-oraly. Care
should be specially taken in the disposal of the patients' urine and feces, as
the virus is present in these excretions. if there is no water-seal latrine,
the feces and urine should be covered with an antiseptic, such as lime powder,
and then buried. An injection of gamma globulin gives passive immunity for
about 3 months; this used to be recommended for visitors to endemic areas.
There is now no need for this, as a vaccine is available.
Hepatitis B
Hepatitis B is reported to be the 9th leading cause of death
worldwide, resulting in 2 million deaths per year. In the developed countries
hepatitis B is the prevalent type of hepatitis, because hepatitis A has now
been effectively controlled with good sanitation. It is caused by a virus
similar to the Hepatitis A virus, but of a different strain. The virus usually
enters the body through body fluids ( eg. Sexual intercourse) ) or injections,
if the needle or syringe has not been adequately sterilized; or through blood transfusion,
if the blood has not been screened for the presence of the virus. Other modes
of entry of the virus include transmission from mother to child during and
after childbirth; sharing earrings, toothbrush, razor, or needle ( injection of
narcotic drugs, acupuncture, tattooing ) of an infected person. Touching
anything that has been contaminated with the virus ( even though in a dried form)
can cause infection with hepatitis B virus.
Those at high risk include health
care workers, laundry workers ( especially in health institutes), patients
receiving frequent blood transfusions, commercial sex workers, intravenous drug
users and babies of infected mothers. Many infected persons do not have any
symptoms during the initial period. Others may have flu-like symptoms, or manifestations
similar to hepatitis A. However in about 5 to 10% of those infected, the
disease causes chronic hepatitis which may lead to cirrhosis or liver cancer in
10 to 20 years. Such patients are infectious and they can transmit the disease
to others through contaminated blood or blood products; they are carriers of
the disease. There is an effective vaccine that provides protection against
hepatitis B infection.
Hepatitis C
Hepatitis C is a rare disease similar to Hepatitis B. It
also can lead to chronic liver disease in most of the patients, several years
later, and be a cause of cancer of the liver.
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