June 27, 2019
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The hernia is a common reason for surgery in adults and most of us have heard about it. However, it may surprise us that hernia and hydrocele are also common in children. The cause and its treatment are slightly different from that of adults. The parents should not get worried about this condition, as surgical treatment of this condition is universally successful.

Causes, Symptoms & Other Factors…

Swelling in the Groin area is a common problem in children. It can be a painless swelling or painful swelling. They both can come on suddenly and develop slowly over time. Painful swelling is less common than painless swelling but is usually more serious, especially if it is severe and sudden. If a child has scrotal swelling at any age, one must see a doctor. Most scrotal swelling is not painful but still needs to be evaluated. If a child has pain from an injury to the testicles that lasts longer than an hour, one must see the doctor. In case, if there is a painful scrotal swelling that starts suddenly – this is a medical emergency.

Hernias and Hydroceles are the most common causes of scrotal swelling. They are caused by abnormal openings left behind when the testicles descend into the scrotum during development. Hydroceles are collections of fluid that pass down into the scrotum and are present in about 10 per cent of baby boys at birth. If an opening does not close by itself, a portion of the intestine may pass through the opening. This is called a Hernia. The Hernias occur in about 1 to 5 % of all newborns and are more common in premature babies. The treatment is waiting till 1-2 years of age for Hydrocele, whereas the Hernia needs immediate surgery.

Prevalence and Incidence…

In India, due to the limited paediatric surgical services available, the majority of the patients with Indirect Inguinal Hernia is managed by general surgeons. In a hospital in Delhi, Inguinal Hernias constituted 12.5% of all surgical procedures. Most of the children were over 1 year of age and only the symptomatic Inguinal Hernias were operated upon. Due to the high risk of incarceration in premature babies, a careful search for the presence of Inguinal Hernia is recommended.

Inguinal Hernia is one of the most common surgical conditions globally. An estimated 20 million Groin Hernias are repaired annually worldwide. Despite the high disease prevalence, relatively few studies of Inguinal Hernia epidemiology have been undertaken. A study from the UK found a 27 per cent lifetime risk for Inguinal Hernia repair in men and 3 per cent in women. Studies of groin hernia incidence are particularly limited. Data from the NHANES study have been used to make the most reliable assessment of Inguinal Hernia incidence in the US.

The annual Inguinal Hernia repair rate in the United Kingdom (130 per 100,000 population) is lower than the rate of repair in the US. Differing practice patterns among surgeons and referring primary care physicians may explain regional differences in the incidence.

In India, the services of paediatric surgeons are available only to a limited extent and are restricted at present to the major cities. And Inguinal Hernia repair in children is still one of the commonest procedures performed by paediatric or general surgeons. The peak incidence of Hernia is seen during the 1st month when one-third of children present within 6 months of age, and boys are affected 6 to 10 times more often than girls.

Hernias are a common disorder in the general population and may be more prevalent in children. Prompt surgical intervention is essential to prevent therapeutic implications and lifelong consequences. Regular screening and assessment of Inguinal Hernia among young children are important, particularly among infants aged less than 6 months and preschoolers. Moreover, early screening of inguinal hernia for children who were born prematurely, particularly within 6 months after birth, is crucial for Hernia repair.

About the Author…

Dr. Shandip Kumar Sinha is a Paediatric Surgeon and Urologist, who has a special interest in Minimally Invasive Paediatric Surgery, Paediatric Endourology and Reconstructive Paediatric Urology. He practices at Madhukar Rainbow Children Hospital, Malviya Nagar, Delhi as a Senior Consultant Paediatric Surgeon. He is an MBBS, MS and M.Ch (Pediatric Surgery). He is a former Professor (Paediatric Surgery) at Maulana Azad Medical College. He was also associated with LNJP and GB Pant Hospitals.

The Central Nervous System consists of the brain and the spinal cord. It is through this that we see, feel, hear, taste, act, fight, love, yearn, win, loose and remain aware about our environment.

A tumor that affects a part of this system therefore can lead to more damage than a tumor elsewhere in the body. Tumors that affect the brain, the spine or peripheral nerves may originate from the structures themselves or from surrounding tissues. Nature protects the nervous system by placing it inside an air conditioned, air tight, humidity controlled, unbending safe vault- the skull and the spinal column. Any tumor arising from the walls or its linings will also press on the inside contents.

Diagnosing and treating these tumors that affect the most intricate organ of our body obviously needs highly trained and skilled doctors and advanced facilities. This task can be done only by a team of specialists from departments of Neurosurgery, Neurology, Neuro-radiology, Neuro-oncology, and Neuropathology.

What is a brain tumor?

Any new growth (neoplasm) inside the head is called brain tumor. It may arise from the brain itself, or from its cavities(ventricles), or from its coverings (meninges) or the skull bone or its blood vessels.

What are the different types of brain tumor?

Brain tumors are classified according to the cell of their origin. About half of them are malignant (cancerous) and the remaining are benign (non-cancerous).

Are brain tumors treatable?

Yes, mostly they are treatable using one or more available modalities. Often, more than one modality is needed to effectively treat them. The location, size and type of the tumor along with age and condition of the patient, determine the risk versus benefits of treatment.

Are brain tumors curable?

The benign tumors are mostly curable if treated adequately. The cancers of the brain can only be controlled for variable lengths of time depending upon their nature and response to treatment.

How does a brain tumor present/ what are the symptoms?

The presentation of a brain tumor is mainly dependent on its location. Usual symptoms are:

  1. Headache: usually worst in the morning, often associated with vomiting. The intensity varies, usually becoming worse as time passes.
  2. Fits/Seizure: Uncontrolled and unprovoked shaking of a part or all of the body with or without loss of consciousness. It is more significant if it occurs for the first time in adult life; or the fits continue despite adequate medical treatment or they change their nature.
  3. Weakness: in one arm or a leg or on one side of face. It may gradually worsen over a period of time.
  4. Loss / diminution of vision in one or both eyes
  5. Loss/diminution of hearing in one or both ears
  6. Loss of appetite and weight
  7. Drowsiness or loss of consciousness
  8. Hormonal imbalance

What are the treatment options?

             Surgery is the mainstay of treatment of brain tumors as most of them present with features of raised intracranial pressure like headache, vomiting and limb weakness. Biopsy is mandatory to know the type of tumor and plan further management. Other modalities like radiotherapy or chemotherapy work as adjuncts and act best after the bulk of the tumor has been surgically removed.

Is surgery for brain tumor useful and safe?

             Surgery is the very safe at a well-equipped center. For benign tumors, no further treatment is required after surgery. For malignant tumors, surgery combined with radiotherapy provides the best results. Safety of surgery is dependent on the tumor location and the condition of the patient at the time of surgery. Elective brain surgery is safer than driving on Delhi-NCR roads.

How do you make brain tumor surgery safe?

  1. Use of different specialized sequences of MRI to diagnose and define tumor accurately like MRS, Tractography.
  2. Use of high-end operative microscope.
  3. Use of Neuro navigation technique – computer associated localization of lesion.
  4. Use of high speed drills, CUSA, high-end bipolar cautery and graduated suction.
  5. Minimal access surgery for brain using endoscope.
  6. Modern anesthesia techniques (awake anesthesia, BIS monitoring etc.)
  7. Neurophysiological monitoring during surgery.

After surgery will I be able to work and live normally?

           Yes, but you will need a period of rest after surgery. Body takes time to heal from surgical insult. The return to normalcy is dependent on the nature and location of the tumor and your condition before surgery was done. Normally, the better you were at the time of surgery, the faster the recovery.

When should surgery be done?

           As soon as possible after the detection of the tumor to maximize the chances of recovery.

What is radiotherapy?

          Radiotherapy is the use of high doses of radiation to destroy tumor cells to shrink the tumor and possibly halt /slow its progression. Tumor cells in brain spread far from the edges of the tumor as seen on MRI. Surgery can only remove the visible tumor. Modern techniques are Gamma knife, Cyberknife and Stereotactic Radiosurgery.

How effective and safe is drug treatment for brain tumors?

            Used as an adjunctive therapy along with surgery and radiotherapy. Some agents notably there are no proven cases where any brain tumor has been successfully treated by those systems.

What did Temozolamide, do help in increasing the diseases free survival in many malignant brain tumors.

Will I have to take drugs for epilepsy all my life?

            The chances of tumor leading to seizures are highest in first year. Therefore, drug therapy to control/ prevent seizures is usually advised for one year, but it may need to be taken for the rest of life under certain specific conditions.

Are there any proven alternative therapies for Brain tumors?

           Despite claims by many practitioners of alternative systems (i.e. other than Allopathy)

I do wrong that I got this tumor in my head?

           Modern science still does not know for sure as to what causes most of the brain tumors and thus it is not possible at this time to say if there is anything you might have done differently to prevent a brain tumor.

About Author

Dr Rahul Gupta, M.B.M.S., MCh (PGIMER, Chandigarh)
Senior Brain, Spine and Endovascular Surgeon,Director and Head of Department, Department of Neurosurgery, 
Fortis hospital, Sector 62, NOIDA and Escorts, Okhla Delhi

Formerly,
Sugita Scholar, Nagoya Univ. School of Medicine, Japan – 2011
Assistant Professor,PGIMER,Chandigarh;
Associate Professor,  G B Pant Hospital,
MAMC, University of Delhi, New Delhi, India.
Ph – 91-9971700389, 

Agra – Robotic surgery have become the most advanced form of surgery in today’s era, ensuring several benefits as compared to conventional open surgery as well as laparoscopic surgery.  In order to raise and spread awareness about the procedure and success of robotic urological surgery, one of the leading healthcare providers in the country, Max Super Speciality Hospital, Saket had organised a press conference today at Amar Hotel Agra.

The occurrence of kidney failure or chronic kidney disease (CKD) cases in the country are rapidly increasing due to various factors such as Diabetes , Uncontrolled Hypertension, Genetic conditions, Autoimmune diseases, drug or alcohol abuse and urinary tract infections. With ‘Kidney Transplant’ being the only end solution for such cases, it is imperative for patients and their families to understand various types of a kidney transplant surgical procedures. Kidney transplantation is the organ transplant of a kidney into a patient with end-stage renal disease.

 A kidney transplant can be done with two methods – conventional and Robot-Assisted Kidney Transplant . Most of us are aware about the conventional surgeries which basically involves a 2-4 hour long surgery where the donor’s kidney is placed inside the recipient in order to give him an improved quality of life. A more advanced form of such surgeries offered at limited centers is through robot assisted kidney transplant. A robotic surgery, as its name suggests, is carried out by a surgeon with the help of robotic arms. The benefits of robotic surgery  includes the use of special instruments which are mounted on robotic arms, a high precision camera instead of enlarged surgical site, minimal incisions ensuring very little scarring, zero or very little blood loss, quick healing, early return to work and shorter hospital stay.

The conference further highlighted how robotic surgeries in urology procedures are much safer and more economical for any patient. The advance technology of robotics not only benefits the patients a great deal, as the recovery scale is quick, hospital stays are shorter due to minimal invasion and zero or minimum blood loss. On most occasions, patients are made mobile within 24 hours of any major surgery. Till date Max Healthcare has completed more than 100 numbers of successful robotic kidney transplants and more than 1000 numbers of overall robotic procedures.

Highlighting the success of robotic kidney transplants,Dr. Pragnesh Desai, Consultant – Department of Urology, Robotics, Kidney Transplantation & Uro-Oncology, Max Super Speciality Hospital, Saket, said,“The prevalence of Chronic Kidney Disease (CKD) in India has doubled over the last decade, and presently over five lakh individuals in the country are diagnosed with the disease. Out of these, only few are able to undergo a Kidney Transplant. It is important to prevent, identify and subsequently treat CKD on time[DC(1] . Thus, our focus is to educate, aware and enable patients to timely access and provide expert and quality healthcare services. Robotic Kidney Transplants have proven to have low complication rates, rapid recovery, and excellent graft function.”

Over the past years, Max Super Speciality Hospital, Saket has been actively working towards offering international standards of healthcare facilities in different regions across the country. The leading healthcare player organizes numerous health-camps, OPDs and screening camps for the residents of other regions like Varanasi, Agra, Chandausi, Gwalior, Meerut, Kanpur, Moradabad etc. and its neighboring areas.

17th june 2019, New Delhi : Our brain is undoubtedly the most vital organ in the human body and in case there is an infection in the brain then the functioning of all the organ systems gets affected. One of the most common infectious conditions that affect the brain includes viral encephalitis. It is basically an inflammation of the meninges, which is the membrane enclosing the brain and the spinal cord.

Due to inflamed meninges in encephalitis condition, the patient may suffer from a confused state of mind accompanied by fever, headache, occasional seizures and even sleepiness leading to complete or death!

Thus, understanding the severity of this situation we all must take care to prevent such conditions rather than opting for a cure. The article below talks about several measures to prevent such deadly infections from occurring but before that let us gather some more insights about the various causes of encephalitis.

Viruses are the most common cause of encephalitis. West Nile virus, cytomegalovirus, Herpes Zoster and Herpes Simplex are the most dangerous ones which readily result in severe infections. Either they can directly infect the brain or there can be reactivation of some past viral infection leading to brain damage. Also, there can be autoimmune damage wherein some viruses or vaccines induce some reactions that stimulate the immune system to attack the brain. Other than viral meningitis protozoan encephalitis and bacterial meningitis are also common.

Whatever may be the cause of meningitis, the symptoms are very painful for the sufferer. In order to prevent falling prey to such conditions, certain measures must be adopted as precautionary steps. Some of them are mentioned below:

Vaccination is the best prevention: Getting a shot of vaccination can keep encephalitis away. Currently, vaccinations are available only for bacterial meningitis and not viral ones. However, it is well studies that bacterial encephalitis is much riskier as compared to the viral one. Thus, getting these vaccines is always better prevention especially if you’re a resident of close quarter apartments. As per the guidelines from “Centers for Disease Control and Prevention,” you must get an initial vaccine shot at the age of 11- 12 followed by a booster dose at age 16- 18.

No sharing but only caring: We know you care for your dear ones but if they’re already infected with encephalitis then you need to maintain some precautionary measures. Encephalitis is communicable and spreads very quickly via respiratory or throat secretions from the infected person. So, maintain proper distance especially with respect to sharing of personal items like lipsticks, toothbrush, cigarettes, water bottles and glasses.

Some distance is always better: As mentioned previously encephalitis spreads via secretions just like any other bacterial or viral infection. Sneezing and coughing are the most common ways via which secretions of an infected person can reach you. So make sure to maintain the required distance. In case you’ve some patient in your family itself then take proper precautions. Ask the patient to keep his personal stuff separately, advise them to cover mouth while sneezing or coughing.

Good Hygiene for good health: Unhygienic lifestyle gives the infecting agents an easier pathway to attack you. Thus, if you do not want to fall prey to infections, make sure you maintain personal hygiene. Washing your hands often, especially before having your meals; wearing face masks when visiting crowded areas are all small steps towards a hygienic lifestyle.

Munch on immunity boosters: People with a stronger immune system tend to be healthier as compared to their counterparts. Thus, do not compromise on strengthening your immunity. With a strong immune system, your body can easily fight any infecting agent which may result in encephalitis or other infections. In order to host a strong immunity, you must include vitamin-rich food items. Incorporate fruits, vegetables, lean proteins and whole grains to your meal plans. Also, exercising and getting the right amount of sleep is of prime importance.

Predicting any infection is highly uncertain and fighting an infection is all the more difficult for our body. Especially brain infections are the most fatal of all and encephalitis is the most common brain infection prevalent amongst masses. However, by following the above listed measures you can definitely minimise your chances of falling prey to encephalitis and other brain infections.

The much loved sunny summers are back again! While the chilly winters restrict us to the walls of our rooms; summers bring the joy of traveling, dressing up, cold beverages and of course the best summer fruits. Along with the enjoyment which summer brings, the risk for several health conditions also hikes during summers. These are basically referred to as the summer diseases and to keep them at bay, we definitely need to know about such diseases and how to prevent us from falling prey to the scorchy sun!

So we have compiled these diseases along with the associated health tips with each condition. It will surely help you stay survive the summers better, so that summers remain the favorite season for the ones who love it.

Sunburn:

Hot sun which was cozy in winters will now burn the skin! High temperatures during summers can cause the rashes on your skin and resultant sweating can further increase the itching and can irritate you.

Tips : Try to wear clothes which cover your skin thoroughly. Wear cotton and lose clothes. Always carry an umbrella while going under the sun. Cover your head and face with a cloth to prevent the direct fall of sunlight. You can apply sunscreen lotion or cream with at least SPF 15 on the exposed parts of your body.

Dehydration:

Even though you work as per your regular schedule, but your body gets dehydrated very quickly in summers due to the exorbitantly high in temperature. This may lead to dehydration which again is a root cause of multiple health problems!

Tips : Drink plenty of water. Add in your worklist to drink a minimum of 12 glasses of water in a day. Drink purified water only, as bacteria and viruses are more prevalent in this season.

Conjunctivitis:

Soreness in eyes is called conjunctivitis. It causes inflammation in the eyes and is a kind of bacterial infection. Conjunctivitis infection are more prone in summers than in other seasons.

Tips : Wash your eyes with pure water. You can use an eye drop such as Fresh tears to keep the eyes moist and clean. You can also cover your eyes with sunglasses when coming under the sun as heat can inflame the eyes more.

Food poisoning:

Humidity in the environment allows bacteria to poison the vegetables and other food items. Consuming them will upset your stomach and will cause food poisoning. Since summers are related to increasing in humidity, chances of food poisoning are also higher.

Tips : Avoid uncooked and street food. Eat healthily. Always wash your vegetables with fresh water before use. Take small meals but frequently. Do not starve yourself.

Headache:

When sun rays strike on your head, penetration of heat can result in pain in your head. Headache is very common during the summers.

Tips : Drink plenty of water, it will keep you hydrated and fresh. Take coconut water, milk and juices in your diet. Keep doors and windows of your house or office closed during noon.

Cough and cold:

Taking cold beverages in the sweating condition can sore your throat. Also, alternatively shifting from Air conditioned rooms to open sunny environment results in disturbed regulation in the body. This results in cold and cough which can hamper your health.

Tips : Drink cold water or any other cold beverage only after relaxing and soaking sweat. Avoid moving directly from an air-conditioned room to open sunny areas. Instead turn off the AC 30 minutes before moving outside. Give your body time to adapt and only then step outside.

Summer depression:

Highest temperature months in summer are March to June. Severe climatic changes in these months can bring mood swings in the people. Many people are not able to tolerate heat and resultant depression cases are also high.

Tips : If you’re also super- sensitive to heat, avoid coming under the sun as much as the possible or at least avoid remaining under the sun for more than 3 hours. Keep your body hydrated and consume those food items which increase serotonin level in your body. Avoid caffeine especially in noon.

Asthma attack:

Presence of pollens in the atmosphere increases in the summer months and hence asthmatic patients start facing breathing issues. So, basically, summers are not so good for asthmatics and thus taking proper precautions becomes mandatory.

Tips : Cover your nose and mouth with a mask. Keep your allergy profile checked by your consultant. Take your medications properly on time. Do not eat those food items to which you are allergic.

Mosquito-borne diseases:

Mostly mosquito borne diseases start spreading during late summers. The growth of mosquitoes in the stagnant water at your home serves as the breeding ground for mosquitoes.

Tips : Apply mosquito repellant and cover all eating items adequately. Do not leave them open. Keep your nearby area clean. Use antiseptic solutions in your bathing and cleaning water. Always clean your coolers after every 2-3 days.

Sun Stroke:

With the sun shining upon the head, high heat and extreme temperature there are increased chances of sunstroke. Though it is rare but very much prevalent, so taking precautions becomes mandatory.

Tips : Keep yourself away from the direct fall of sunlight as much as possible. Avoid using two-wheelers during peak sunny hours. Keep yourself covered while moving out in the sun.

The sunny days are enjoyable if spent healthy. So take care of your health, don’t fall prey to the devil heat by taking the above listed precautions. Happy summers!

by
Mr Satkam Divya,
CEO, KlinicApp

नई दिल्ली, -हाथों व कलाइयों संबंधित बीमारियों के बारे में जागरुकता पैदा करने के लिए गंगाराम हास्पिटल में डा. सतनाम सिंह छाबड़ा के मार्गदर्शन में एक वर्कशाप का आयोजन किया गया. जहां कार्पल टनल सिन्ड्रोम नामक बीमारी के बारे में जानकारी दी गई. लगभग सभी प्रकार की क्रियाओं को अंजाम देने के लिए हम अपने हाथों का ही प्रयोग करते हैं. सोचिए, वह स्थिति कितनी दर्दनाक होती है जब हमारे हाथ सही ढंग से कार्य करने की अवस्था में नहीं होते. कभी-कभी यदि आप अपनी अंगुलियों में गुदगुदी, जलन या सुन्नपन, हाथ में दर्द, अंगुलियां हिलाने डुलाने में कठिनाई, मुट्ठी बंद होने पर असहजता का अनुभव करते हैं तो यह स्थिति सामान्य नहीं है बल्कि एक नई बीमारी का अंदेशा है जिसे कार्पल टनल सिन्ड्रोम के नाम से जाना जाता है.
नई दिल्ली स्थित सर गंगाराम अस्पताल के न्यूरो एंड स्पाइन डिपाटमेंट के डायरेक्टर डा. सतनाम सिंह छाबड़ा का कहना है कि कार्पल टनल सिन्ड्रोम हाथ में उत्पन्न होने वाली एक दुखदायी बीमारी है. कार्पल टनल हड्डियों और कलाइयों की अन्य कोशिकाओं द्वारा बनाई गई एक संकरी नली होती है. यह नली हमारी मध्य नाड़ी की सुरक्षा करती है. मध्य नाड़ी हमारे अंगूठे, मध्य और रिंग अंगुलियों से जुड़ी होती है. लेकिन कार्पल टनल में जब अन्य कोशिकाएं जैसे कि लिगामेंट्स (अस्थि बधंक तंतु) और टेंडन सूज या फूल जाते हैं तो इस का प्रभाव मध्य कोशिकाओं पर पड़ता है. इस दबाव के कारण आप का हाथ घायल या सुन्न महसूस होने लग सकता है. इसमें नो टेंडन और मध्य नाड़ी में चलकर हाथों में हलचल और शक्ति पहुंचाती है.
दरअसल सी.टी.एस. औरतों में अधिक पाया जाता है. खासकर गर्भवती महिलाएं, गर्भ निधोरक गोलियों का सेवन कर रही महिलाएं, माहवारी से राहत पा चुकी महिलाएं, आर्थराइटिस के मरीज, हार्मोंस में वृद्धि से असामान्य शरीर वाले व्यक्ति, तनाव ग्रस्त लोग, शराब के आदी व मोटे लोग, सिलाई बुनाई करने वाले, अधिक गंभीर कार्य करने वाले व घंटों तक ड्राइविंग करने वाले लोगों में इस बीमारी का अधिक जोखिम रहता है.डा.छाबड़ा ने यह भी बताया कि आधुनिक दौर में सी.टी.एस. से छुटकारा पाने के लिए एक सर्जरी भी की जाती है. जिसे कार्पल टनल रिलीज ऑपरेशन के नाम से जाना जाता है, जिसके दौरान ट्रांसवर्स कार्पेल लिगामेंट को काटा जाता है. जिससे दर्द से छुटकारा तो मिलता ही है साथ ही इससे कोशिकाओं को फैलाव के लिए अधिक स्थान मिल जाता है. साथ ही इन पर पडने वाला दबाव भी कम हो जाता है. हाथों व कलाइयों पर नियमित रूप से व्यायाम करना चाहिए, हाथों व कलाइयों पर अधिक दबाव डालने से बचना चाहिए. हाथों पर नियमित मसाज कराना चाहिए, कार्य करते समय छोटे-छोटे ब्रेक लेने चाहिए. हाथों पर बल डालते हुए नहीं सोना चाहिए. कार्य शुरू करने से पहले हाथों को गर्म कर लेना चाहिए. सही अवस्था में सोना चाहिए ताकि हाथों की नसों पर दबाव न पड़े, हाथों को बहुत कसकर नहीं बांधना चाहिए. जो लोग निरंतर कंप्यूटर के माउस और ट्रेकबाल्स का इस्तेमाल करते हैं उन्हें अपनी कलाई के जोड़ों को मोड़ कर रखने की बजाए अधिकतर सीधा रखकर काम करना चाहिए. जिन लोगों का अधिकतर समय डेस्क पर ही बीतता है तो कलाई पर पडने वाले दबाव को कम करने और पूर्ण आराम पाने के लिए उन्हें कार्यस्थल को भली-भांति जांच करके कार्य शुरू करना चाहिए. इस प्रकार की स्थिति में किसी भी तकिए, कुशन, व्यवस्थित की बोर्ड व ट्रे आदि का प्रयोग किया जा सकता है.

The hernia is a common reason for surgery in adults and most of us have heard about it. However, it may surprise us that hernia and hydrocele are also common in children. The cause and its treatment are slightly different from that of adults. The parents should not get worried about this condition, as surgical treatment of this condition is universally successful.

Consider these figures…·       
  20 million Groin Hernias are repaired annually worldwide·  
   
  80% of all Inguinal Hernias occur in males·     

  85% of all Femoral Hernias occur in females· 
   
  Approx 670,000 Inguinal Hernia repairs are performed annually in the US  Most Hernias occur in males, with a male to female ratio of 6:1. Correct recognition and initiation of the proper therapeutic route is essential for an excellent outcome, which should approach optimum success·  
 
 Hernias occur in 1% to 4% of all infants. The incidence may reach 30% in premature infants depending on the child’s gestational age at birth. One-third of all children with Hernias present before six months of age. 

Causes, Symptoms & Other Factors…

Swelling in the Groin area is a common problem in children. It can be a painless swelling or painful swelling. They both can come on suddenly and develop slowly over time. Painful swelling is less common than painless swelling but is usually more serious, especially if it is severe and sudden. If a child has scrotal swelling at any age, one must see a doctor. Most scrotal swelling is not painful but still needs to be evaluated. If a child has pain from an injury to the testicles that lasts longer than an hour, one must see the doctor. In case, if there is a painful scrotal swelling that starts suddenly – this is a medical emergency.

Hernias and Hydroceles are the most common causes of scrotal swelling. They are caused by abnormal openings left behind when the testicles descend into the scrotum during development. Hydroceles are collections of fluid that pass down into the scrotum and are present in about 10 per cent of baby boys at birth. If an opening does not close by itself, a portion of the intestine may pass through the opening. This is called a Hernia. The Hernias occur in about 1 to 5 % of all newborns and are more common in premature babies. The treatment is waiting till 1-2 years of age for Hydrocele, whereas the Hernia needs immediate surgery.

Prevalence and Incidence…

In India, due to the limited paediatric surgical services available, the majority of the patients with Indirect Inguinal Hernia is managed by general surgeons. In a hospital in Delhi, Inguinal Hernias constituted 12.5% of all surgical procedures. Most of the children were over 1 year of age and only the symptomatic Inguinal Hernias were operated upon. Due to the high risk of incarceration in premature babies, a careful search for the presence of Inguinal Hernia is recommended.

Inguinal Hernia is one of the most common surgical conditions globally. An estimated 20 million Groin Hernias are repaired annually worldwide. Despite the high disease prevalence, relatively few studies of Inguinal Hernia epidemiology have been undertaken. A study from the UK found a 27 per cent lifetime risk for Inguinal Hernia repair in men and 3 per cent in women. Studies of groin hernia incidence are particularly limited. Data from the NHANES study have been used to make the most reliable assessment of Inguinal Hernia incidence in the US.

The annual Inguinal Hernia repair rate in the United Kingdom (130 per 100,000 population) is lower than the rate of repair in the US. Differing practice patterns among surgeons and referring primary care physicians may explain regional differences in the incidence.

In India, the services of paediatric surgeons are available only to a limited extent and are restricted at present to the major cities. And Inguinal Hernia repair in children is still one of the commonest procedures performed by paediatric or general surgeons. The peak incidence of Hernia is seen during the 1st month when one-third of children present within 6 months of age, and boys are affected 6 to 10 times more often than girls.

Hernias are a common disorder in the general population and may be more prevalent in children. Prompt surgical intervention is essential to prevent therapeutic implications and lifelong consequences. Regular screening and assessment of Inguinal Hernia among young children are important, particularly among infants aged less than 6 months and preschoolers. Moreover, early screening of inguinal hernia for children who were born prematurely, particularly within 6 months after birth, is crucial for Hernia repair.

आज कल की भागदौड़ जिंदगी में हर कोई किसी ना किसी दर्द से पीडित है. किसी को कमर दर्द, सिरदर्द, पैर दर्द तो किसी को ज्वाइंट में दर्द रहता ही है. व्यक्ति को खासतौर से हड्डियों के कमजोर होने के कारण इस तरह की समस्याएं झेलनी पड़ती है. उनमें से अॅास्टियोपोरोसिस एक ऐसा रोग है जिसमें हड्डियों का घनत्व घट जाता है. दूसरे शब्दों में कहा जाए तो हड्डियों की मोटाई सामान्य से कम हो जाती है. इसके परिणामस्वरूप, हड्डियां कमजोर होने लगती हैं और आसानी से टूट जाती हैं. हड्डियों में दर्द होना ऑस्टियोपोरोसिस का एक सामान्य लक्षण है. लेकिन लक्षण का पता प्रायरू नहीं चल पाता है. ऑस्टियोपोरोसिस में, पेशियों पर जोरदार या औचक जोर पडने पर भी कभी-कभी हड्डी टूट सकती है. इस तरह के फै्रक्चर का एक सामान्य स्थल वर्टिब्रल कॉलम है जिसमें वर्टिब्रा प्रायरू चरमरा जाता है. इसके रोगियों की कूबड़ निकली हुई हो सकती है. वर्टिब्रा के ध्वस्त होने के गंभीर मामलों में नीचे के अंग पक्षाघात के शिकार हो सकते हैं. फै्रक्चर के लिए दूसरी कमजोर जगह जांघ की हड्डी है. हालत के बेहद गंभीर या खराब हो जाने के मामलों में, छाती को थपथपाने भर से ही पसलियां टूट सकती हैं. तथ्य यह है कि सभी हड्डियां धीरे-धीरे बिस्कुट की तरह कमजोर पड़ जाती हैं और हल्के से छुने पर भी कर्राह उठती हैं. नई दिल्ली स्थित सर गंगाराम अस्पताल के न्यूरो एंड स्पाइन डिपाटमेंट के डायरेक्टर डा. सतनाम सिंह छाबड़ा का कहना है कि ऑस्टियोपोरोसिस के कारण ही बुढ़ापे में लोगों का वजन कम होने लगता है. असामयिक रूप से मेनोपॉज का होना या किसी वजह से अंडाशय को निकलवा देना या उसका खराब हो जाना ऑस्टियोपोरोसिस के महत्वपूर्ण कारण हैं. यहां तक कि सामान्य मोनोपॉज के बाद भी, आगे के 15 वर्षों में हड्डियों से काफी कैल्शियम निकल जाता है जिसके परिणामस्वरूप महिलाएं ऑस्टियोपोरोसिस की शिकार हो जाती हैं. साथ ही प्रेग्रेसी के दौरान और बाद में भी शरीर में उपर्युक्त मात्रा में कैल्शियम की पूर्ति ना होने के कारण भी औरतों की हड्डियां काफी कमजोर होने लगती है जिसकी वजह से विटामिन डी की कमी से ऑस्टियोपोरोसिस में तेजी आ जाती है. अगर तमाम सावधानियों के बावजूद फै्रक्चर हो ही जाए तो दर्द से राहत दिलाने का सर्वश्रेष्ठ उपाय है काइफोप्लास्टी सर्जरी. इस सर्जरी के अंतर्गत पीछे की ओर से एक बहुत ही छोटा चीरा लगाया जाता है जिसके माध्यम से चिकित्सक एक पतली सी नली डाल देता है.फ्लूरोस्कोपी का प्रयोग करते हुए नली को सही स्थान तक पहुंचा दिया जाता है. नली संबंधित वर्टिब्रा के पेडिकल के माध्यम से फै्रक्चर हुए हड्डी तक रास्ता बनाती है. एक्स-रे छवियों का प्रयोग करते हुए चिकित्सक अब नली के माध्यम से एक विशेष बैलून वर्टिब्रा तक पहुंचाता है और बड़ी ही सावधानी से बैलून को फुलाता है. फुलने के साथ ही बैलून फै्रक्चर को ऊपर उठा देता है जिससे टुकड़े अधिक सामान्य स्थिति में आ जाते हैं. इससे अंदर की कोमल हड्डी भी ठोस हो जाती है और वर्टिब्रा के अंदर एक कैविटी का निर्माण हो जाता है। इसके बाद बैलून को हटा लिया जाता है और चिकित्सक निम्न दबाव पर विशेष रूप से तैयार किए गए उपकरण का प्रयोग, कैविटी को सीमेंट जैसे पदार्थ पोलिमिथाइलमिथेक्राइलेट (पीएमएमए) से भरने के लिए करता है. प्रवेश कराए जाने के बाद वह घोल तेजी से कड़ा हो जाता है जिससे हड्डियां स्थिर हो जाती हैं.डा. सतनाम सिंह छाबड़ा का कहना है कि ओस्टियोपोरोसिस को एक खामोश रोग कहा जाता है क्योंकि हड्डी फै्रक्चर होने से पहले तक आम तौर पर इसके कोई भी लक्षण प्रकट नहीं होते. अक्सर ही यह फै्रक्चर स्पाइन, नितंब या कलाई में होता है. जहां तक पुरुषों का सवाल है, तो उनके सेक्स हॉर्मोन में अचानक कमी नहीं आती, बल्कि वह 70 साल की उम्र तक बना रहता है. इससे पुरुष आम तौर पर ऑस्टियोपोरोसिस से बचे रहते हैं. कम सेक्स हॉर्मोन वाले युवा पुरुषों में ऑस्टियोपोरोसिस का जोखिम बहुत अधिक होता है और उन्हें इसे लेकर सतर्क रहना चाहिए. बहुत लंबे समय से ओस्टियोपोरोसिस को सिर्फ महिलाओं का ही रोग समझा जाता रहा है क्योंकि इससे प्रभावित होने वाले मरीजों में 80 प्रतिशत महिलाएं ही होती हैं. लेकिन पिछले 5 से 10 वर्षों के बीच हुए विभिन्न रोग-विषयक शोधों से यह पता चला है कि ओस्टियोपोरोसिस पुरुषों को भी बेहद गंभीर रूप से अपना शिकार बनाता है. कई बार जब पुरुषों को यह पता भी चल जाता है कि वे इस रोग से ग्रस्त हैं तो भी बहुत सारे लोग डायगोनिसिस (रोग निदान) पर ही सवाल उठाने लगते हैं. पुरुषों और महिलाओं को इससे संबंधित कई एक समान खतरे हैं. पर्याप्त मात्रा में कैल्शियम और विटामिन डी का न मिलना खतरे को बढ़ाता है, क्योंकि ये पोषक तत्व हड्डी को होने वाले नुकसान से बचाते हैं. वजन बढ़ाने वाले व्यायामों का अभाव भी खतरे को बढ़ा सकता है क्योंकि इन गतिविधियों से हड्डी का घनत्व बढ़ता है. पुरुषों में अतिरिक्त खतरे की वजह धूम्रपान, बहुत अधिक शराब पीना, ओस्टियोपोरोसिस का पारिवारिक इतिहास, हल्की त्वचा, छोटी हड्डियां, तीन महीने से अधिक समय तक कोर्टिकोस्टेरॉयड दवाओं का प्रयोग तथा गुर्दा या यकृत रोग सहित विभिन्न बीमारियां हो सकती हैं. पुरुषों को 45 वर्षों के बाद बोन मिनरल डेंसिटी (बीएमडी) टेस्ट करवाना चाहिए और अगर हड्डी का आकार छोटा हो तो हड्डियों को होने वाले नुकसान को रोकने और फै्रक्चर के खतरे को कम करने के लिए दवा लेने के संबंध में डॉक्टर से सलाह लेनी चाहिए. यह एक ऐसा रोग है जो चुपके से वार करता है और मरीज जब तक संभलता है तब तक बहुत देर हो चुकी होती है. इसलिए थोड़ा संकेत मिलते ही चिकित्सक की सेवाएं लेने में देर नहीं करनी चाहिए और अगर तमाम सावधानियों के बावजूद फै्रक्चर हो ही जाए तो काइफोप्लास्टी सर्जरी ही दर्द समाप्त करने और हड्डियों को जोडने का सर्वश्रेष्ठ उपाय है.

डॉ  सागरिका अग्गरवाल , स्त्री रोग विशेषज्ञ , इंदिरा आई वी  एफ हॉस्पिटल , नई दिल्ली  

तम्बाकू की खपत को बढ़ाने के लिए तंबाकू या उसके उत्पादों के विक्रय, खरीद या विज्ञापनों में शामिल कंपनियों पर हमेशा नजर रखी जाती है। यहां तक कि इसके बारे में कहा भी गया है कि अनाकर्षक पैकेजिंग और ग्राफिक स्वास्थ्य चेतावनी से भी तंबाकू की बिक्री में कमी लाने में मदद मिलती है। दुनियाभर में लगभग 1.4 अरब लोग तंबाकू का इस्तेमाल करते हैं और दुनिया भर में हर साल 10 व्यक्ति में से कम से कम एक व्यक्ति की मौत तंबाकू के उपयोग के कारण होती है। 2020 तक, तंबाकू के उपयोग में 20-25 प्रतिशत तक कमी लाकर 10 करोड़ लोगों की समयपूर्व मौत को रोका जा सकता है। टेलीविजन या रेडियो पर तम्बाकू के विज्ञापन पर प्रतिबंध लगाने, तम्बाकू के खतरों और सार्वजनिक स्थानों में धूम्रपान को रोकने की आवश्यकता को प्रदर्षित करने वाले नये और प्रभावी सार्वजनिक जागरूकता अभियान जैसे धूम्रपान रोधी प्रयासों और उपायों पर अमल कर ऐसा करना संभव है। आंकड़ों से पता चलता है कि 1955 में धूम्रपान करने वालों की संख्या में 37.6 प्रतिशत की कमी आई थी जबकि 2017 में 30.9 प्रतिशत की कमी आई है।


फर्टिलिटी पर धूम्रपान का प्रभाव

धूम्रपान स्वास्थ्य के लिए हानिकारक है। इस सावधानी से हम अपने दैनिक जीवन में हर जगह रूबरू होते हैं। लेकिन अभी भी तम्बाकू के आदी लोग इसे अनदेखा करते हैं। तंबाकू न केवल फेफड़ों को नुकसान पहुंचाता है बल्कि दिल, गुर्दे और यहां तक कि शुक्राणुओं को भी नुकसान पहुंचाता है। यह पुरुषों और महिलाओं में इनफर्टिलिटी का कारण बन सकता है। चाहे तंबाकू हो या हुक्का, सच्चाई यह है कि यह स्वास्थ्य के लिए हानिकारक है। आंकड़ों से पता चलता है कि भारत में धूम्रपान के कारण हर साल लगभग 60 लाख लोगों की मौत हो जाती है। हाल के शोध से पता चलता है कि 18 वर्ष से अधिक उम्र की चार में से लगभग एक महिला धूम्रपान करती है। धूम्रपान का एक्टोपिक गर्भावस्था से संबंध हो सकता है और इसके कारण फैलोपियन ट्यूबों में समस्या आ सकती है। एक्टोपिक गर्भावस्था में, अंडे गर्भाशय तक नहीं पहुंचते हैं और इसकी बजाय फलोपियन ट्यूब के अंदर प्रत्यारोपण हो जाते हैं।
डॉ सागरिका का कहना है की धूम्रपान महिलाओं में इनफर्टिलिटी की संभावना को 60 प्रतिशत तक बढ़ा सकता है।इसके कारण गर्भाशय में परिवर्तन आ सकता है जिसके कारण गर्भाशय कैंसर होने का खतरा बढ़ जाता है।सिगरेट में मौजूद रसायन अंडाशय के भीतर एंटीऑक्सीडेंट स्तर में असंतुलन पैदा कर सकते हैं। यह असंतुलन निषेचन को प्रभावित कर सकता है और स्पष्ट है कि इसके बाद इम्प्लांटेशन में कमी आ जाएगी।
तम्बाकू का पुरुष प्रजनन क्षमता पर भी भारी दुष्प्रभाव पड़ता है। यह रक्त वाहिकाओं को नुकसान पहुंचाता है और रक्त प्रवाह को प्रभावित करता है। कुछ अध्ययनों में धूम्रपान के प्रभाव का इरेक्टाइल डिस्फंान और यौन प्रदर्शन में कमी से भी संबंध पाया गया है। तम्बाकू के कारण क्रोमोसोम को भी क्षति पहुंच सकती है और शुक्राणु में डीएनए फ्रैगमेंटेशन हो सकता है। धूम्रपान शुक्राणु को नुकसान पहुंचाते हैं जिसके कारण निषेचन की संभावना कम हो जाती है। धूम्रपान करने वाले लोगों के शुक्राणुओं से विकसित भ्रूण में डीएनए की क्षति के कारण उसके जीवित रहने की संभावना कम होती है। आईवीएफ  भी प्रजनन क्षमता पर धूम्रपान के दुष्प्रभाव को पूरी तरह से काबू पाने में सक्षम नहीं हो सकता है। धूम्रपान करने वाली महिला को आईवीएफ  के दौरान अंडाशय को उत्तेजित करने वाली अधिक दवा लेने की आवश्यकता होती है और फिर भी रिट्रीवल के समय कम अंडे होते हैं। इसके अलावा धूम्रपान करने वाली आईवीएफ रोगियों में धूम्रपान नहीं करने वाली महिलाओं की तुलना में गर्भावस्था दर 30 प्रतिशत कम होती है। गर्भावस्था के दौरान धूम्रपान करने से गर्भस्थ बच्चे को भी नुकसान पहुंच सकता है। यहां तक कि धूम्रपान करने वाली महिलाओं में समय पूर्व प्रसव पीड़ा हो सकती है और स्वास्थ्य समस्याओं से पीडि़त बच्चों को जन्म दे सकती हैं।


Glaucoma or ‘Kala Motia’ is a condition wherein an increased intraocular pressure damages the optic nerve thereby affecting vision. A fluid known as aqueous nourishes the front part of the eye. In the normal eye, the rate of production of aqueous matches the rate of its drainage, thereby maintaining optimal pressure inside the eye. With age, disease, trauma or other factors, the channels carrying this fluid may get blocked, increasing the pressure inside the eye. This increased pressure damages the optic nerve, which is the conduit of visual messages to the brain. Working silently, glaucoma damages the outer or peripheral vision first while maintaining the central vision.

Glaucoma is called the silent thief of sight because in the early stages of the disease, there may be no Symptoms. This condition threatens vision and is known to gradually steal sight without warning. By the time glaucoma is detected, the patient has already suffered extensive peripheral vision damage which can no longer be restored.

It is the leading cause of blindness in the United States and a study presented at the World Ophthalmological Congress in 2008 has projected India as the next glaucoma capital. Almost 68% Indians run the risk of developing the disease and nearly 1.2 lakh Indians go blind every year due to this disease.

YOU ARE AT RISK, IF:

You are 45 years of age or above

You have a family history of glaucoma

You have health problems such as diabetes, hypertension or thyroid disease

You suffer from myopia or nearsightedness

You have had ocular trauma or intra ocular surgery in the past.

TYPES OF GLAUCOMA

There are two major types of glaucoma – Chronic or Primary Open- Angle Glaucoma (POAG) and Closed or Acute Angle-Closure Glaucoma. The chronic open angle form of glaucoma is the most common form. Damage to vision is gradual and generally painless. In the Closed or Acute form, the intraocular pressure increases very rapidly due to a sudden and severe block of fluid drainage within the eye. Significant symptoms indicating the presence of acute glaucoma appear immediately. This condition has to be treated quickly by an ophthalmologist otherwise blindness may occur.

SYMPTOMS

  • Inability to adjust the eyes to darkened rooms such as theaters
  • Poor night vision
  • Frequent changes in eyeglass prescription
  • Gradual loss of peripheral vision
  •  Blurred vision
  • Feeling of a blind area in the eye
  •  Seeing rainbow colored halos around lights
  •  Severe eye pain, facial pain, nausea and vomiting
  •  Red eye

CURE FOR GLAUCOMA

Glaucoma cannot be cured but it can be controlled so that further damage to the optic nerve can be slowed down or halted. This can only be done through disciplined and regular treatment from an ophthalmologist. The treatment of glaucoma is life-long.

MANAGEMENT OF GLAUCOMA

Glaucoma treatment may include medical management, surgical management or management by lasers. Medical management is done with eye drops. Surgical management includes a procedure where an opening is made to create a new drainage pathway for the fluid to leave the eye easily. Management by lasers includes procedures such as trabeculoplasty, in which a laser is used to pull open the trabecular meshwork drainage area; iridotomy, in which a tiny hole is made in the iris, allowing the fluid to flow more freely; and cyclophotocoagulation, in which a laser beam treats areas of the ciliary body, reducing the production of fluid.

Treating Ways

There is no proven way to prevent glaucoma. Frequent monitoring, regular checkups can help detect the disease in its early stages.

Don’t let glaucoma limit your life. You can continue with what you were doing before glaucoma was diagnosed. You can make new plans and start new ventures.

Take your medicines exactly as prescribed. Use the right drop in the right eye at the right time in the right way.

Try to schedule time for taking medication around daily routines such as waking, mealtimes and bedtime.

Drinking large quantities of water on empty stomach early morning should be stopped. This habit temporarily increases the Intra Ocular pressure.