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Sep17
PROSTATE SPECIFIC ANTIGEN TEST(AGE SPECIFIC)
Prostate cancer remains the most commonly diagnosed and the third leading cause of cancer deaths among men in western countries , but most men with the disease dont die from it. In the United States a man has 15.8% chance of being diagnosed with prostate cancer but the risk of dying is 2.8%. The American cancer society still recommends that men at high risk and those 50 and over should be screened. Prostate specific antigen (PSA) is a protein produced by the cells of prostate gland. The PSA test measures the level of PSA in blood. Because this antigen is produced by the body and can be used to detect diseases, they are also called biological markers or tumor markers.New studies show that men who have low prostate specific antigen at 60yrs of age , do not really need future screening. But what do you say to men who are 40, 50 or 55 ? All men should start having their PSA levels checked before the age of 60, then at 60 if the PSA is less than 1 nanogram / ml , they are at low risk of prostate cancer. According to researchers , PSA level at age 60 is a good predictor of who were at risk , and that low levels at age 60 means you are unlikely to benefit from subsequent PSA tests as your risk of metastasis or death from prostate cancer is very low.Conversely , men with high PSA reading- 2ng/ ml or above should be monitored and screened, as they are at higher risk. A digital rectal examination (DRE) and PSA levels are used for screening. PSA can be elevated in both benign and cancerous conditions of the prostate , and the level tends to increase with age. The use of age specific PSA reference ranges are suggested as more accurate. Men at risk and above 50 and over should talk with their doctors about the risk and benefits of screening.The American Cancer Society also stresses that in some cases - such as men over 50 who are not expected to live for another 10 yrs , such tests should not be offered because they will cause more harm than good with treatments that has unpleasant side effects such as incontinence and impotence which can greatly affect the quality of their lives.


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Sep16
STRESS AND SUPERTRANSACTIONS
The transactions usually constitute those, which are carried out in unconscious realm, or in response to instinctual urges or emotional frenzy, or in accordance with well thought out and well planned exchanges. Usually these are called fair, when they are mutually agreed upon and unfair when they involve profit of some at the cost of others. The STRESS caused during routine transactions therefore can only be overcome if we try to blossom all our transactions into supertransactions.

Supertransaction means; acquiring a perspective, thinking, motivation; so as to achieve individual and global blossoming; through appropriate policies and plans, programs and actions.

When and if this happens in every walk of life and situation; naturally, spontaneously; urgently and inevitably; just like going through labor pains, giving birth to a baby, feeding a baby, blossoming of flowers, emanation of fragrance, bearing of fruits by the trees, then it is a SUPERTRANSACTION!

Supertransaction is characteristically devoid of any mercenary, commercial or condescending attitude.

In traditional terms; supertransaction means a most virtuous act (PUNYA or SATKARMA); in possible field of life; associated with A-grade happiness for one and all; and inseparable from NAMASMARAN!

WHAT IS NAMASMARAN?

Namasmaran usually embodies; remembering the name of God, Guru, great souls; such as prophets and whatever is considered as holy e.g. planets and stars. It is remembered silently, loudly, along with music, dance, along with breathing, in group or alone. Further, NAMASMARAN is either counted by some means such as fingers, rosary (called SMARANI or JAPAMALA), or electronic counter; or practiced without counting. The traditions vary from region to region and from religion to religion.

However the universal principle underlying
NAMASMARAN is to reorient our physiological and social being; with our true self and establish and strengthen the bond between; our physiological and social being; with our true self; and finally reunification or merger with our true self!

Since individual consciousness is the culmination of every activity in life; and NAMASMARAN the pinnacle of or culmination of individual consciousness; NAMASMARAN is actually opening the final common pathway to objective or cosmic consciousness; so that individual consciousness in every possible activity gets funneled into or unified with Him (our true self)!

Thus NAMASMARAN is in fact the YOGA of YOGA in the sense that it is the culmination of consciousness associated with every possible procedure and technique in the yoga that we are familiar with. It is the
YOGA of YOGA because it is the culmination of consciousness associated with all the activities in the universe, which it encompasses as well! It is YOGA of YOGA because everybody in the world irrespective of his/her tradition and the beliefs; would eventually, ultimately and naturally reach it; in the process of liberation. Even so called non believers also would not “miss” the “benefit of NAMASMARAN as they may remember true self through one symbol or another”!

Just as NAMASMARAN is YOGA of YOGA it is meditation of meditation also! This is because the natural and ultimate climax of every form of meditation; is remembering true self or merging with cosmic consciousness effortlessly!

These facts however have to be realized with persistent practice of NAMSMARAN and not blindly believed or blindly disbelieved with casual approach!

In short NAMSMARAN is super-bounty of cosmic consciousness for every individual to realize it (cosmic consciousness)! This is truly a super-bounty because a person, who experiences it, rises above mercenary, commercial and even professional and charity planes and manifest super- transactions in his or her life!

These are just few observations to give rough idea about what is NAMASMARAN. NAMASMARAN is an ocean of bliss. Its true meaning is beyond description in words and has to b experienced, not by one or few persons sporadically; but most preferably, by billions!

One is said to achieve ANUSANDHAN is a state of ultimate freedom; or being connected with true self; remembered through the name of God as inspired by the Guru (NAMASMARAN); in traditional practice. It is beyond all subjective considerations and pursuits; and has benevolent effect of facilitating ANUSANDHAN; on the entire universe!

The last point is; NAMASMARAN would certainly enlighten, empower and enable some people; out of those billions practicing NAMASMARAN; to evolve, guide and consolidate the global conscience and thereby manifest global unity and harmony and justice, through globally benevolent proper policies!

References:
Namasmaran: Dr. Shriniwas Kashalikar
Sahasranetra: Dr. Shriniwas Kashalikar
Holistic Medicine: Dr. Shriniwas Kashalikar
Stress: Understanding and Management: Dr. Shriniwas Kashalikar
Conceptual Stress: Dr. Shriniwas Kashalikar

All available for free download on

www.superliving.net
And
www.scribd.com/namasmaran

www.slideshare.net/drsuperliving
www.docstoc.com

DR. SHRINIWAS KASHALIKAR


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Sep14
Retrograde Intra Renal Surgery - MPUH Nadiad
MULJIBHAI PATEL UROLOGICAL HOSPITAL, NADIAD


JAYARAMDAS PATEL ACADEMIC CENTRE

Retrograde Intra Renal Surgery

Jayaramdas Patel Academic Centre (JPAC) at the Muljibhai Patel Urological Hospital (MPUH), Nadiad is organizing a two-day programme on ‘Retrograde Intra Renal Surgery (RIRS)’ on 16th & 17th September, 2010. Who will be in the driving seat? PCNL, RIRS, ESWL?

RIRS is a procedure for doing surgery within the kidney using a viewing tube called a fiberoptic endoscope. The scope is placed through the urethra (the urinary opening) into the bladder and then through the ureter into the urine-collecting part of the kidney. The scope thus is moved retrograde (up the urinary tract system) to a position within the kidney (intrarenal).

RIRS may be done to remove a stone. The stone is seen through the scope and can then be manipulated or crushed by a pneumatic probe or evaporated by a laser probe or grabbed by small forceps, etc.

The advantages of RIRS over open surgery are that it is a minimally invasive surgery with the elimination of prolonged pain after surgery, and much faster recovery.

Muljibhai Patel Urological Hospital has handled more than 23000 stone cases so far.

The two-day programme will cover all aspects of RIRS. The participants will also be able to see LIVE surgeries of Flexible URS for Lower Calyceal Stone, Calyceal Diverticular Stone, Ectopic Kidney and Mini/Micro perc for Kidney Stone and Ectopic kidney stone.

Faculty from abroad and India will be participating. They include Drs Olivier Traxer (France), M Prabhakar, Pawan Gupta, Anil Bradoo, PP Rao, and Abhay Khandekar. Medical Director and Managing Trustee of MPUH, Dr. Mahesh Desai; and Chairman of Dept of Urology, Dr. R B Sabnis will also be participating in the programme.

P A JOSEPH



P A JOSEPH


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Sep13
ADIPOSE TISSUE DISTRIBUTION AND COLON CANCER
Colon cancer is the second leading cause of cancer deaths in America, specially in older women . Being overweight increases a woman's risk of developing colon cancer but where she stores the body fat determines how long she survives with the disease. Researchers followed about 1,000 post menopausal women with colon cancer for an average of 10 years and found that the women who were heavier before diagnosis were more likely to die from the disease, earlier than their thinner peers - yet another reason to avoid obesity throughout your life. Doing so increases the chances of survival if you are diagnosed with colon cancer.
Body weight refers to how you carry extra weight. You have heard about two body shapes- the ''apple" and the" pear". Apples tend to be apple shaped carrying excess weight in their chest and abdomen and look heavier on the top. Pears tend to be pear shaped and carry excess weight in their waist , butt and thighs and look heavier on the bottom. Dozens of studies show that having an apple shaped body increases the risk of heart disease, high blood pressure, diabetes, stroke and breast cancers. Scientists looked at data for weight, body mass index, waist size and waist to hip ratio and found that carrying extra weight at the waist and hip appeared to be more a factor in colon cancer deaths than overall weight or BMI. In other words a unhealthy waist hip ratio or adipose tissue distribution towards your bottom is a very important factor in colon cancer deaths. A waist to hip ratio of 0.80 or below is considered low risk. For instance, a woman with a waist of 27 inches and a hip of 36 inches has a waist to hip ratio of 0.75.
So maintaining a healthy body weight, life long body size , maintaining a healthy waist to hip ratio is a recommendation one can give for all post menopausal women.A waist circumference more than 40 inches, in men increases their risk of colon cancer also . So make sure you are only EATING apples and pears, not LOOKING like one !


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Sep12
Osteogenesis imperfecta
Osteogenesis imperfecta
OI and sometimes known as Brittle Bone Disease, or ‘Lobstein syndrome’.Osteogenesis imperfecta is disorder of congenital bone fragility caused by mutations in the genes that codify for type I procollagen. It is a common heritable disorder of collagen synthesis that results in weak bones that are easily fractured and are often deformed. It is also known as Brittle Bone Disease, or ‘Lobstein syndrome’. This condition affects an estimated 6 to 7 per 100,000 people worldwide. Several distinct subtypes have been identified. All of them lead to micromelic (short-limbed) dwarfism of varying degree. Depending on severity, the bone fragility may lead to perinatal death or cause severe deformities that persist into adulthood. A wide array of clinical manifestations of the disease may be seen. These partly depend on the genetic subtype. Types I and IV are the most common forms of osteogenesis imperfecta, affecting 4 to 5 per 100,000 people.

The following 4 types of osteogenesis imperfecta have been reported. Type I - mild forms, type II - extremely severe, type III, severe type IV – undefined.

People with this disease are born with defective connective tissue, or without the ability to make it, usually because of a deficiency of Type-I collagen. This deficiency arises from an amino acid substitution of glycine to bulkier amino acids in the collagen triple helix structure. The larger amino acid side-chains create steric hindrance that creates a "bulge" in the collagen complex. As a result, the body may respond by hydrolyzing the improper collagen structure. If the body does not destroy the improper collagen, the relationship between the collagen fibrils and hydroxyapatite crystals to form bone is altered, causing brittleness. Another suggested disease mechanism is that the stress state within collagen fibrils is altered at the locations of mutations. These recent works suggest that osteogenesis imperfecta must be understood as a multi-scale phenomenon, which involves mechanisms at the genetic, nano-, micro- and macro-level of tissues.
In osteogenesis imperfecta, the modes of inheritance, family history, clinical features, and radiologic findings vary.Four distinct types are identified: type I, which is the dominantly inherited form with blue sclerae; type II, which is the perinatal lethal form; type III, which is the progressively deforming form with normal sclerae; and type IV, which is the dominantly inherited form with normal sclerae.
In general, type I is the mildest form of disease; type IV, type III, and type II, respectively, increase in severity.



As a genetic disorder, Ti is an autosomal dominant defect. Most people with OI receive it from a parent but it can be an individual (de novo or "sporadic") mutation. Osteogenesis imperfecta is relatively rare. In some cases, the parent has osteogenesis imperfecta and the condition has been genetically transmitted to the child. But, the child's symptoms and the degree of disability could be very different from that of the parent. In some children, neither parent has osteogenesis imperfecta. In these cases, the genetic defect is a spontaneous mutation.
The primary pathology in osteogenesis imperfecta is a disturbance in the synthesis of type I collagen, which is the predominant protein of the extracellular matrix of most tissues. In bone, this defect of extracellular matrix causes osteoporosis, which leads to an increase in the tendency to fracture. Besides bone, type I collagen is also a major constituent of dentin, sclerae, ligaments, blood vessels, and skin; therefore, individuals with OI may also have abnormalities of these structures.
The process of collagen molecule formation starts with the synthesis of procollagen. This precursor consists of a long triple-helix protein flanked by 2 propeptides at its 2 terminals. Procollagen is synthesized and then secreted into the extracellular compartment, where the amino- and carboxy-terminal propeptides are cleaved; thus, the functional collagen molecule is formed. These molecules then assemble into an ordered fibril. Mutations that interfere with expression of the collagen gene, formation of the triple helix (amino acid sequencing), or procollagen secretion affect the structure and function of collagen fibrils, resulting in a form of OI.
Electron microscopic studies of OI demonstrate a decrease in the diameter of the collagen fibril, relative to the collagen fibril of healthy persons, and smaller-than-normal apatite crystals.
A number of genetic defects cause the abnormal type I collagen synthesis that leads to OI. OI generally arises from mutations in 1 of 2 genes that encode for the synthesis and/or structure of type I collagen: the COL1A1 gene on chromosome 17, and the COL1A2 gene on chromosome 7. Mutations in these genes may cause abnormal collagen to be produced and may lead to a decrease in the production of normal collagen. The varying degree to which these 2 factors manifest themselves results in the different phenotypic expressions of OI. Milder forms of OI are caused primarily by a decrease in production of normal collagen, whereas more severe forms are caused primarily by the production of abnormal collagen. These abnormalities may be dominantly inherited, or they may be the result of sporadic mutation.
Common causes of nonorthopedic morbidity in type I and type IV OI are joint hypermobility, which causes chronic joint pain, hearing impairment, and brainstem compression.Children with type III OI often require orthopedic care because of their progressive deformities. Standing and walking are often impossible because of spinal compression fractures and scoliosis. Progressive thoracic deformities are associated with recurrent pneumonias that often limit the patient's lifespan.


Type I: The life expectancy of patients with all forms of OI other than type III is often assumed to be shortened. However, according to Paterson et al, the life expectancy of patients with OI type IA is the same as that of the general population. Type IA is a subtype of type I OI in which dentinogenesis imperfecta (tooth abnormalities) does not occur. Type IB is a rare form of type I OI in which dentinogenesis imperfecta does occur. In types IB and IV, mortality is modestly increased in comparison with that of the general population; there is no statistically significant difference in life expectancy. Type II: This form of OI is fatal in the perinatal period.

Type III: Only in type III OI is life expectancy affected. However, patients with type III OI who survive beyond the age of 10 years have a better outlook than other patients with OI.
Osteogenesis imperfecta does not seem to have a predilection for any particular race. No known sex predilection is reported for osteogenesis imperfect. The onset of fractures and deformities varies according to the type of osteogenesis imperfecta (OI) that is present.
For type I, the age of onset is variable. This form most commonly appears during the preschool years when the child is starting to stand. Onset after puberty is uncommon, although fractures may recur in adulthood after menopause or after periods of inactivity, such as after childbirth. Type II occurs in utero. In type III, abnormalities are present at birth (ie, abnormalities develop in utero) in more than 50% of patients. Fractures are frequent during the first 2 years of life.Type IV abnormalities are present at birth in approximately 30% of patients. The onset of this form is during infancy or the preschool years.
The clinical features of osteogenesis imperfecta (OI) depend on the type, but bone fragility with multiple fractures and bony deformities are the common hallmark of all types.
The major presenting signs and symptoms of OI include blue sclerae, hearing loss, tooth abnormalities (dentinogenesis imperfecta), joint laxity, and abnormal skin texture (smooth and thin skin). Other features that are common to multiple OI types include bleeding diathesis (easy bruising) and respiratory distress.
OI is classified into 4 distinct types: I-IV. Some cases of OI do not fit easily into any of the 4 types. A type V category has been added to include patients with osteoporosis or interosseous membrane ossification of the forearms and legs, as well as patients who are prone to the development of hypertrophic calluses.




The type 1 prototypical and most common form of OI is associated with the best prognosis. The mode of inheritance is autosomal dominant. The distinguishing clinical features of type I are blue sclerae, which occurs in patients of all ages, and presenile conductive hearing loss; in addition, most patients with type I OI have a family history of hearing loss. Bone fragility is mild, and there are minimal bony deformities. The stature of patients with type I OI is often normal or near normal. Ligamentous hyperlaxity, resulting in joint hypermobility or subluxation, is common. Approximately 20% of patients have kyphoscoliosis.
Dentinogenesis imperfecta is present in some families but not in others.12 Therefore, type I OI is subclassified to distinguish patients without dentinogenesis imperfecta (type IA, more common) from those with dentinogenesis imperfecta (type IB, rare). Some investigators have suggested that these 2 subgroups are biochemically distinct and that individuals with OI type IB, whose bodies make structurally abnormal collagen, are more similar to those with OI type IV than to those with other types of OI, including type IA.
Type II is the most severe form of OI. It is characterized by extreme bone fragility that almost invariably leads to intrauterine or early infant death. The cause of death is most often respiratory failure. The mode of inheritance is autosomal recessive. The sclerae are blue and occasionally dark blue or black. Clinically distinguishing features include intrauterine growth retardation, thin and beaded ribs, crumpled long bones, and limited cranial and/or facial bone ossification. Limbs are short, curved, and angulated.
Type II OI can be further subdivided into types IIA, IIB, and IIC on the basis of the radiographic features of the long bones and ribs. Patients with type IIA or IIC inevitably die in the perinatal period; rarely, patients with type IIB survive into early childhood.
Type III is the next most severe form of OI after type II. It is the most severe form in which survival extends beyond the perinatal period.
Its hallmark feature is severe bone fragility and osteopenia, which is progressively deforming. The mode of inheritance is thought to be autosomal recessive. Multiple fractures and progressive deformity affect the long bones, skull, and spine and are often present at birth. Postnatal growth failure is severe. Kyphoscoliosis is common. Sclerae are either normal from birth, or they progress from pale blue in infancy to a normal appearance by adolescence.
Type III OI is probably the form that is best known to radiologists and orthopedic surgeons. Children with type II OI tend to have severe dwarfism caused by spinal compression fractures, limb deformities, and disruption of growth plates.
Type IV OI is distinguished from type I OI by the slightly increased, though still variable, severity of bone fragility and by the presence of normal sclerae. The mode of inheritance is autosomal dominant. Mild to moderate bony deformity of the long bones and spine is present; the incidence of fracture is variable. Basilar impression of the skull, with consequent brainstem compression, is common; it is reported in 70% of patients.


Hearing loss or a family history of hearing loss is noted in patients with this type of OI, as is dentinogenesis imperfecta. Type IV OI is also subclassified to distinguish patients without dentinogenesis imperfecta (type IVA) from those with it (type IVB). Compared with type I OI, hearing loss is less common in type IV, and dentinogenesis imperfecta (type IVB) is more common. Some authors have distinguished a self-limiting variant of OI, known as temporary brittle-bone disease. Its clinical features are identical with those found in cases of child abuse.
While there is no cure for osteogenesis imperfecta, there are opportunities to improve the child's quality of life. Treatment must be individualized and depends on the severity of the disease and the age of the patient. Care is provided by a team of health-care professionals, including several types of doctors, a physical therapist, a nurse-clinician and a social worker.
In most cases, treatment will be nonsurgical.
Medical bisphosphonates, given to the child either by mouth or intravenously, slow down bone resorption. In children with more-severe osteogenesis imperfecta, bisphosphonate treatment often decreases the number of fractures and bone pain. These medications must be administered by properly trained doctors and require close monitoring.
Casting, bracing, or splinting of fractures is necessary to immobilize the bone so that healing can occur. Movement and weight bearing are encouraged as soon as possible after fractures to increase mobility and decrease the risk of future fractures.
In surgical treatment, repeated fractures of the same bone, deformity, or fractures that do not heal properly are all indications that surgery may be necessary. Metal rods may be inserted in the long bones of the arms and legs. Some rods are a fixed length and must be replaced as the child grows. Other rods are designed like telescopes so they can expand along with the bone growth. However, other complications may occur with telescoping rods.
In many children with osteogenesis imperfecta, the number of times their bones fracture decreases significantly as they mature. However, osteogenesis imperfecta may become active again after menopause in women or after the age of 60 years in men. Scoliosis, or curvature of the spine, is a problem for many children with osteogenesis imperfecta. Bracing is the usual treatment for scoliosis, but it is often ineffective in children with osteogenesis imperfecta. Spinal fusion, in which the vertebrae are realigned and fused together, may be recommended to prevent excessive curvature.
At present there is no cure for OI. Treatment is aimed at increasing overall bone strength to prevent fracture and maintain mobility.
There have been many clinical trials performed with Fosamax (Alendronate), a drug used to treat women experiencing brittleness of bones due to osteoporosis. Higher levels of effectiveness apparently are to be seen in the pill form versus the IV form, but results seem inconclusive.

Bone infections are treated as and when they occur with the appropriate antibiotics and antiseptics.
Physiotherapy used to strengthen muscles and improve motility in a gentle manner, while minimizing the risk of fracture. This often involves hydrotherapy and the use of support cushions to improve posture. Individuals are encouraged to change positions regularly throughout the day in order to balance the muscles which are being used and the bones which are under pressure.
Children often develop a fear of trying new ways of moving due to movement being associated with pain. This can make physiotherapy difficult to administer to young children. With adaptive equipment such as crutches, wheelchairs, splints, grabbing arms, and/or modifications to the home many individuals with OI can obtain a significant degree of autonomy.
Spinal fusion can be performed to correct scoliosis, although the inherent bone fragility makes this operation more complex in OI patients. Surgery for basilar impressions can be carried out if pressure being exerted on the spinal cord and brain stem is causing neurological problems.
Because osteoporosis and multiple fractures are hallmark features of osteogenesis imperfecta (OI), other disorders that cause multiple fractures or decreased bone mineralization may be considered in the differential diagnosis. Such disorders including juvenile osteoporosis, steroid-induced osteoporosis, menkes (kinky-hair) syndrome, hypophosphatasia, battered child syndrome (syndrome X), temporary brittle-bone disease.

References:
http://emedicine.medscape.com/article/947588-overview

http://emedicine.medscape.com/article/411919-overview

http://ghr.nlm.nih.gov/condition=osteogenesisimperfecta

http://orthoinfo.aaos.org/topic.cfm?topic=A00051

http://hwmaint.jmg.bmj.com/cgi/content/abstract/16/2/101

N.B.: This article is excerpted from the book MUSCULOSKELETAL INJURIES for UNDERGRADUATES


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Sep12
Overuse Injuries in Orthopaedics practice
Overuse Injuries in Orthopaedics practice

INTRODUCTION

Overuse injuries are injuries of the musculoskeletal and nervous systems that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression (pressing against hard surfaces), or sustained or awkward positions. It is also known as Repetitive Strain Injury or Cumulative Trauma Disorders. These are most commonly used to refer to patients in whom there is no discrete, objective, pathophysiology that corresponds with the pain complaints. Stress fracture is also a common overuse injury, which scientist already described it since 1855. Overuse injuries due to repetitive motion are common in occupational, recreational, habitual activities and elite athletes. [1] The examples of overuse injuries are Golfer's elbow, Tennis elbow, Baseball pitchers’ elbow, Javelin throwers’ elbow. These conditions have acquired names derived from activities in which they were encountered when they were first described.

PATHOPHYSIOLOGY
Normally, our tissues adapt to the stresses placed on them over time. Different types of stresses include shear, tension, compression, impingement, vibration, and contraction. Tendons, ligaments, neural tissue, and other soft tissues can undergo mechanical fatigue, resulting in characteristic changes depending on their individual properties. As a respond, the tissues attempt to adapt to the demands placed on them. In the process of adapting, they can incur injury unless they have appropriate time to heal. The rate of injury simply exceeds the rate of adaptation and healing in the tissue.
In stress fractures, it is resulted from recurrent and repetitive loading of bone. It differs from other types of fractures in that; most of them have no acute traumatic event preceding the symptoms. Usually, the patient has a history of an increase and/or change in the character of activity or athletic workouts, increase in frequency of doing activity, or change in posture during activity. Bones may be more prone to stress fractures if the bone is weakened, as in individuals with osteoporosis.
There are a lot of hypothesis as why does the injury happens in repetitive tasks. One of them is the depletion of adenosine 5’-triphosphate (ATP) in the muscle fibers, which leads to reduction of sarcoplasmic reuptake of Ca2+ resulting in high concentrations in the cytosol, allowing Ca2+ –dependent activation of phospholipase, the generation of free radicals, and damage to the muscle fibers involved. [1]
Other hypothesis involving Prostaglandin E2, which has been found to be present in high quantities in overuse tissues in rat and chicken models. [2] This mediator has been suggested to influence cell proliferation, increase collagenase, and decrease collagen synthesis. As the result of increasing loads on these tissues, nitric acid and prostaglandin amount are altered. However, a contradicting hypothesis based on rat-model observations shows that overuse of muscle may lead to an understimulation of tendon cells, rather than overstimulation.
In another study, alterations in regulation of genes within tendons undergoing overuse have been shown in the rat model, in which there is upregulation of genes associated with cartilage, and down-regulation of genes associated with tendon.[3] This might suggests that overuse may cause a morphologic alteration of tendon tissue, resulting in the cartilaginous changes in the tendons
From another point of view, psychosocial factors might play a role in overuse injuries for decades. This includes work satisfaction, perceived physical health, perceived mental health, coping mechanisms of the patient and his/her family, perception of work-readiness, and anxiety.
RISK FACTORS:
Risk factors for overuse injury are not only depends on the biomechanical changes of the action, but also intrinsic factor of the patient. Sex differences play a role in certain overuse injuries. For example, the incidence of carpal tunnel syndrome is higher among female compared to male. This has a variety of possible causes, including anatomical differences in the carpal tunnel, hormonal differences, differences in the activities performed by men and woman, biomechanical differences such as elbow carrying angles, Q-angles, femoral anteversion, and lean body mass. Stress fractures typically affect individuals who are more active, and the incidence probably increases with age due to age-related reduction in bone mineral density (BMD).
Although stress fractures result from repeated loading, some other causes such as menstrual disturbances and irregularities, lower dietary calcium intake, caloric restriction, less oral contraceptive use, muscle weakness, decreased testosterone level in male endurance athletes and leg-length differences are risk factors for stress fractures.[4] A study among military recruits has shown that recruits with stress fractures had significantly narrower tibiae and increased external rotation of the hip.
HISTORY:
It is important to obtaining complete information on the onset, timing, and frequency of symptoms; any associated symptoms; and alleviating and exacerbating factors. Information about specific activity or technique problem is also essential. Other relevant symptoms may include a history of popping, clicking, rubbing, erythema, or vascular phenomena. In athlete, specific attention must be paid to training details, equipment fit, and technique. The most salient historical feature in the diagnosis of stress fracture is the insidious onset of activity-related pain. In early stage, the pain is usually mild and felt toward the end of the inciting activity. As the disease progresses, the pain may worsen and occur earlier, limiting participation in sports activities. Rest may relief the pain in the early stages, but as the injury progresses, the pain may persist even after cessation of activity. Other than that, night pain is a frequent complaint. Usually, the patient has no recent history of trauma to the affected area.
Long-bone fractures usually lead to localized pain, while pain from injury of trabecular bone is more diffuse. Possible risk factors that precipitated or contributed to the injury should be identify. These include details of the athlete's training history both in terms of volume and intensity, intensive sustained muscular activity, muscle fatigue, structural malalignments, biomechanical inefficiencies, concurrent injury, or poor bone health status. Diagnosis is usually based on clinical findings and high index of suspicion because fracture site or new bone formation is visible on radiography maybe only after several weeks.
PHYSICAL EXAMINATION
The examination in case of overuse injury follows the basic method of orthopaedic examination; consist of inspection (including alignment and anatomical structure), palpation, and passive (including athlete's flexibility) and active range of motion (ROM). Usually, tenderness and guarding are present. During ROM examination, crepitus; painful or painless usually can be appreciated. On local examination, erythema, swelling, and anatomic derangement raise the possibility of an acute injury or infection, as well as the presence of an inflammatory disease. Some special test or maneuvers can be applied to help in making diagnosis, such as “Hop test” and “Fulcrum test”, or Tinel and Phalen tests at the wrist.[5] But, no single physical examination test is sufficiently sensitive and specific to permit the unequivocal diagnosis of a stress fracture. So, the doctor should correlate the history with examination, together with high clinical suspicion to consider the overuse injury as one of the possible diagnosis.

CAUSES

The primary factor leading to overuse injury is repetitive activity, although the specific type of force leads to different outcomes. Repetition is part of the definition of overuse injury. The concept is that overuse injury is associated with repeated challenge without sufficient recovery time. Another terms to describe repeated activities are cycles and fundamental cycles. While cycle is a large-scale activity that is repeated throughout the day, fundamental cycle is a small component of a cycle that may be repeated several times during the performance of a cycle. Repetitiveness and force exerted are features of a task that increase the risk of sustaining an overuse injury.

However, some studies have shown that cycle times and repetitive motions do not specifically lead to overuse injury in the upper extremity, but as possible causes for injury.[1] It is shown that vibration; especially over long periods is a factor in increasing the risk of many injuries such as lower back pain, intervertebral disk injury, and wrist injury. Apart from the above, malpositioning of limbs away from their neutral position increases the risk for overuse injury.


DIFFERENTIAL DIAGNOSIS
Differential diagnoses vary and depend on location, symptoms, history and physical examination.
o Shin splints (medial tibial stress syndrome) can mimic stress fractures ot the tibia. Shin splint pain tends to be present at the start of activity, while overuse injury at the end. Tenderness to palpation over a wide region of the tibia and the tibialis muscle, whereas the pain from stress fractures tends to be localized to a specific area on the tibia.
o True fractures can be differentiated from overuse injury by an obvious history, with a traumatic event being recalled by the patient with acute onset of pain.
• Muscle strains; may be acute or chronic. Chronic muscle strains can be differentiated from overuse injury by the location and by factors that exacerbate or worsen the injury.
• Costochondritis may mimic the pain seen in stress fractures of the ribs. Rib stress fractures should be suspected in athletes who participate in rowing sports, such as crew rowing. The pain of costochondritis may be more diffuse or widespread than the pain from stress fractures of the ribs. .[4]
• Nerve entrapment syndromes can also mimic overuse injury, but can be differentiated by presence of numbness in the former.[4]
• Popliteal artery entrapment syndrome is another cause of lower extremity pain. This also present with increased pain and/or swelling with exercise, which is more diffuse than the pain associated with stress fractures. Measurement of ankle blood pressures before and during exercise or an angiogram may help with the diagnosis.
DIAGNOSIS AND INVESTIGATIONS

Radiography
Stress fractures may not show up on radiographs for the first 2-4 weeks after injury. The first radiographic finding may be a localized periosteal reaction or an endosteal cortical thickening. The low sensitivity of radiographs for stress fractures gives advantage to bone scanning, magnetic resonance imaging (MRI), and computed tomography (CT).
Magnetic resonance imaging (MRI)
MRI not only provides information about bone integrity and fracture orientation, but also can demonstrate focal tissue damage and edema.
Technetium-99m bone scanning
It took 72 hours for Technetium bone scan findings to be positive in the case of a stress fracture. However, a positive bone scan finding is nonspecific, and it may be indicative of another diagnosis, such as an infection or a neoplastic process. In a study which compare conventional radiography and bone scanning for the initial detection of stress fractures, positive findings were reported in 96% of bone scans, whereas only 42% positive findings were reported on radiographs.
Electrodiagnostic testing
Electrodiagnostic testing (such as EMG, nerve conduction studies) can be very useful in cases of peripheral nerve compression or injury; such testing can provide evidence of the location and severity of the injury. However, EMG and nerve conduction studies are not tests with high specificity, although they can provide much-needed information when vague symptoms are the chief complaint. They are also very useful for documenting work-related injuries.
Laboratory Tests
These tests are relevant if the individual is discovered to have metabolic bone disease or another comorbidity such as inadequate nutritional status.

TREATMENT
Physical Therapy
Patient should have rest, particularly avoidance of the inciting activity. Total bed rest is virtually never advisable for these patients. Instead, participation in a carefully planned physical therapy program is important. The physical therapy program also offers the patient the chance to see that movement will not lead to ongoing tissue damage, thus preventing significant "sick behaviors" or kinesophobia. Ill-fitting equipment, overtraining, or technique flaws commonly cause overuse injury in athletes. So, specialized fitted equipments hould be provided, while sports psychology is worthwhile in combating overtraining, and sport-specific coaching is often invaluable. Coaches, athletes, and physicians must work together to correct these problems.
Occupational Therapy
Occupational therapists can help to identify workplace modifications. In cases of individuals who develop overuse injuries as a result of the interface with adaptive equipment, occupational therapy may be of great benefit. Simple modifications in the manner in which the patient performs activities of daily living or modifications in the equipment itself can provide relief.


Surgical Intervention
Surgical intervention is required only if conservative approaches fail, or if the injury is amenable to surgery. Most common problems that lead to surgery in overuse injury are decompression of nerves and repair of lax or failed ligaments. Surgical procedures most typically involve open-reduction internal fixation and pinning of the associated fracture sites. Surgeries that are performed solely to relieve pain in the absence of objective findings are notorious for suboptimal outcomes.
Medication
Combined injection of corticosteroids and local anesthetics is quite helpful in persons with overuse injury.[1] Pain relief enables more effective participation in therapy, and it may help to limit the likelihood that the patient will develop a chronic pain syndrome. Usually, injections should be performed after less invasive measures fail. In some rare condition, immediate relief of pain may be necessary to allow participation in an athletic or performing arts event, and this can be achieved through injection therapy.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are mainstays in the treatment of overuse injuries. However, there are evidences that revealed that true inflammation is rarely a component of these disorders, especially tendinopathies. So, the use of simple analgesics has become more prevalent in the treatment of such disorders. Muscle relaxants, opiates, corticosteroids, tricyclic antidepressants, and sleep medications have a role in the specific treatment of individuals with overuse injury.

PREVENTION
Nutritional measures: calcium supplementation
A study by Schwellnus and Jordaan found that there is no benefit with calcium supplementation (500 mg/d) beyond the usual dietary intake in male military recruits.[6]
Biomechanical measures: orthotics and shoe inserts
The use of orthotic devices and shoe inserts has been studied as a preventive measure for lower-extremity stress fractures. It is found that the incidence of lower-extremity stress fractures was lower in the group using semirigid orthoses (15.7%) or soft biomechanical orthoses (10.7%) than in the control group (27%). Additionally, the recruits better tolerated the soft biomechanical orthoses than the semirigid orthoses.[7]
In a prospective study of stress fractures, shock-absorbing orthotic device worn within military boots decreases the incidence of stress fractures. [8] There is a statistically significant decrease in the incidence of femoral stress fractures in the orthotic device group.
COMPLICATION
High-risk stress fractures
Even though nonunion of stress fractures is uncommon, but it can occur. To prevent this, stress injuries should be closely followed up for early surgical intervention. These include stress fractures of the neck of the femur, the anterior cortex of the tibia, the tarsal navicular, and the bases of the second and fifth metatarsals. Other high-risk stress fractures include stress fractures of the patella and medial malleolus.
Low-risk stress fractures
Low-risk stress fractures include most upper-extremity stress fractures, except for the fractures through the physis of the humeral head (little leaguer's shoulder) and fractures through the medial epicondyle (little leaguer's elbow), which may have complications due to the involvement of the growth plate.[9] Other low-risk stress fractures include stress fractures of the ribs, pelvis, femoral shaft, fibula, calcaneus, and the metatarsal shafts.














REFERENCES:
1. eMedicine. Scott R Laker, MD. Overuse Injury, Mar 12, 2008.

2. Flick J, Devkota A, Tsuzaki M, et al. Cyclic loading alters biomechanical properties and secretion of PGE2 and NO from tendon explants. Clin Biomech (Bristol, Avon). Jan 2006; 21(1): 99-106.

3. Archambault JM, Jelinsky SA, Lake SP, et al. Rat supraspinatus tendon expresses cartilage markers with overuse. J Orthop Res. May 2007; 25(5): 617-24.

4. eMedicine. John M Martinez, MD. Stress Fractures, Apr 17, 2008.

5. eMedicine. Vincent N Disabella, DO, FAOASM. Elbow and Forearm Overuse Injury, Feb 12, 2008.

6. Schwellnus MP, Jordaan G. Does calcium supplementation prevents bone stress injuries? A clinical trial. Int J Sport Nutr. Jun 1992; 2(2): 165-74.

7. Finestone A, Giladi M, Elad H. Prevention of stress fractures using custom biomechanical shoe orthoses. Clin Orthop. Mar 1999;360: 182-90

8. Schwellnus MP, Jordaan G, Noakes TD. Prevention of common overuse injuries by the use of shock absorbing insoles – A prospective study. Am J Sports Med. December 1990; 18:636-641.

9. Boden BP, Osbahr DC, Jimenez C. Low-risk stress fractures. Am J Sports Med. Jan-Feb 2001; 29(1): 100-11.


N.B. This article is excerpted from the Book : OVERUSE INJURIES IN ORTHOPEDIC PRACTICE: Diagnostic Enigma and Mananagement Principles

Editorial Reviews
Product Description
Overuse injuries are injuries of the musculoskeletal and nervous systems that may be caused by repetitive tasks, forceful exertions,vibrations,mechanical compression,or sustained or awkward positions.It is also known as Repetitive Strain Injury or Cumulative Trauma Disorders. These are most commonly used to refer to patients in whom there is no discrete,objective,pathophysiology that corresponds with the pain complaints.Physical activity is a great way for kids to build bone strength, prevent obesity and stay healthy,when paired with safety and prevention practices. With youth sports injuries rising at alarming rates,overuse injuries such as sore bones and muscles, and swollen or injured joints need prompt attention in child athletes to prevent chronic musculoskeletal problems later in life. Understanding overuse injuries can guide you to designing your training to reduce the risk of injury and help you to recognize and treat them as they inevitably occur.Overuse injuries can be defined as the product of "too much,too fast,too soon." The topics discussed in these chapters are conditions commonly seen by the author in his long stint as an orthopedic and sports medicine consultant.
About the Author
Prof Gourishankar Patnaik is internationally renowned orthopedic and Spinal surgeon. A topper throughout he has over two decades of teaching and research experience at various medical colleges in India, Oman, USA and Malaysia. A globe trotter he has authored many books. A gifted Surgeon his research interests include diabetes, Neurotrauma and E-learning.


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Sep10
DOCTORS ON STRIKE-HOW FAR IS THIS JUSTIFIED?
DOCTORS ARE ON STRIKE AT JODHPUR! WHOLE RAJASTHAN! AT SAFDARGANJ HOSPITAL! NOIDA!GAZIABAD! KOKATA! NORTH BENGAL MEDICAL COLLEGE! ----------SO MANY PATIENTS DIED! NO TREATMENT FOR POORS!PATIENTS ARE RETURNING HOME!MOVING TO PRIVATE CLINICS!GOVERNMENT HAS FAILED!-----THESE SLOGANS ARE COMMON ON ELECTRONIC MEDIA GIVING 24X7 NEWS AND PRINT MEDIA.EVEN AT ANY PLACE,HOME,OFFICE, CLUB,RESTURANTS,PARK,HOTELS,AMUSEMENT CENTRES OR LIBRARY ANY GENRAL PERSONS WILL BE OF VIEWS THAT MEDICAL IS A NOBLE PROFESSIONS,A PROFESSION TO SERVE THE HUMAN BEING ACCEPTING ALL SUFFERINGS TO THYSELF,SO DOCTORS AND ITS FAMILY MEMBERS LIKE NURSES,HOSPITAL STAFFS,PARAMEDICS, MEDICAL STUDENTS, TEACHERS, RESEARCH SCHOLARS,LAB ASSISTANTS, DIAGNOSTIC CENTRES ,HOSPITAL, PRIVATE CLINICS MEDICAL REPRESENTATIVES AND DRUG MANUFACTURERS AND RETAIL SELLERS SHOULD NEVER CALL FOR STRIKE CLOSING THEIR WORK COMPLETELY, ABSTAINING FROM EXAMINING,PRESCRIBING AND TREATING PATIENTS AT WHATEVER REASON AND WHATEVER COST OF PERSONAL OR COMMUNITY SUFFERINGS AS THEY ARE WORSHIPED LIKE GOD AND GENERAL PEOPLE SEE AN IMAGE OF GOD IN DOCTOR'S BODY.
SECONDLY FOR MAKING A GOVERNMENT DOCTOR,GOVERNMENT PAYS A HUGH MONEY COLLECTING FROM TAX PAYER'S POCKET SO DOCTORS HAVE NO RIGHT TO CEASE WORKS -MANY CHANNELS AND WRITERS ARE ADVISING GOVERNMENT TO BRING LAWS LIKE ASMA TO BAN DOCTOR'S STRIKE AND CEASEWORK AND PUNISH DOCTORS OPENLY FOR VIOLATION OF THEIR DUTY FOR PERSONAL OR COMMUNITY GAIN.
SUCH POPULISTIC AND GENERAL VIEWS ARE OFTEN SOUNDED BY LEADERS OF POLITICAL PARTIES AND SOCIAL WEFARE GROUPS WITHOUT GOING INTO DETAIL OF SUFFERINGS WHICH THE WHOLE MEDICAL WORLD UNDERGOES BEFORE SUBMITTING THEMSELVES TO THIS LAST PAINFUL WEAPON OF SUBMITTING THEMSELVES FOR STRIKE!OR CEASE WORK! EVEN DURING SUCH STRIKE MOSTLY DOCTORS KEEP OPENS EMERGENCY SERVICE BUT NUMBER OF PATIENTS IN GOVERNMENT AND SEMI GOVERNMENT CENTRES ARE SO MUCH THAT IT CANNOT TAKE LOAD OF PATIENTS SMOOTHLY ,SECONDLY MEDIA PEOPLE BECOMES SO ACTIVE THAT THEY START REPORTING NEWS OF DEATH AND SUFFERINGS SO MUCH FOCUSING THE STRIKE THAT IT APPEARS AS IF IT IS ALL BECAUSE OF STRIKE WHERE AS FACTS REMAIN THE SAME THAT SUCH KIND OF SUFFERINGS AND DEATH ARE COMMON IN THESE HOSPITALS BECAUSE OF LATE ARRIVALS OF SERIOUSLY ILL PATIENTS,INABILITY TO PROVIDE ADEQUATE MEDICINES,INVESTIGATIONS, TREATMENT FACILITIES TO THESE PATIENTS FREE BY GOVERNMENT WHO SPEND LESS THAN 3% OF GDP ON HEALTH WHEREAS 30% IS PAID FOR ARMY AND DEFENSE,AT MOST OF GOVERNMENT CENTRES ADEQUATE MEDICAL STAFFS,NURSES, PARAMEDICAL ASSITANTS AND HELPERS ARE LACKING,EVERYTHING IS LEFT ON TREATING DOCTORS AS THEY WILL MANGE EVERYTHING AND THEY ARE AT FAULT FOR EVERY MISTAKES OR LACK OF TREATMENT OR IF ANY COMPLICATION OR DEATH RESULT FROM TREATMENT .NOW A DAYS PEOPLE FROM EVERY CORNERS BLAME DOCTORS FOR SUCH PROBLEMS OF NOT GETTING GOOD TREATMENT OR DEVELOPING COMPLICATION OR DEATH AND FOR PROTESTING INSTEAD OF LAUNCHING PROTEST OR COMPLAINS THROUGH HOSPITAL OR POLICE OR ADMINISTRATION,TAKES LAW IN THEIR HAND AND TO MAKE ISSUE HIGHLIGHTED IN MEDIA AND EVEN POLITICAL PARTIES AND MANY CLUBS,NGO.S, SOCIAL WORKERS AND EVEN SOME MISCREANTS JOIN THESE PROTESTORS OPENLY AND ATTACK DOCTORS,NURSES,MEDICAL STUDENT, PARMEDICAL STAFFS AND MEDICINE SELLERS PHYSICALLY INFRONT OF EVERY BODY(MEDIA-WHO INSTEAD OF CONTROLLING SUCH JEHADI PROTESTORS REMAIN ENGAGED IN TAKING PHOTOGRAPHS AND TAKING BITES TO SELL THEIR NEWS TO EARN MONEY BY PUTTING MORE MASALA AND TARDKA AND PRESENTING THEMSELVES AS FIRST CHANNEL TO DICOVER IT AND TO GAIN MORE AND MORE TRP,POLICE; IS OFTEN CALLED FOR CONTROLLING LAW AND ORDER BUT MANY PLACES THEY DONOT REACH IN TIME BECAUSE MOSTLY CRIME IS COMMITTED BEFORE THEIR REACHING AT SPOT AND EVEN REACHING IN TIME,THEY MOSTLY REMAIN SILENT BECAUSE OF POLITICAL PRESSURE OR ATLEAST CONTOL DEMONSTATORS AND PROTESTORS WHO USE BAD UNPARLIAMENTARY LANGUAGES AND SLOGANS TO MALIGN "DOCTORS" AS SPEAKING IS OUR BASIC RIGHT,MOSTLY MOB BECOME FURIOUS BEFORE MEDICAL ADMINSTRATORS AND DOCTORS AND START DAMAGING HOSPITAL PROPERTY BY BRAKING RECEPTIONS,DIGNOSTIC CENTRES,OT, OPD LAUNGE,INDOOR INSTRUMENTS ,BEDS AND FUNITURES,AT SOME PLACES THEY PUT THESE ON FIRE BEFORE LAW PROTECTING FORCE IN NAME OF SHOWING AGONY ,GRIEVNCES AND SHOCK FOR DEATH OR MISS MANGEMENT OF THEIR NEAR ONES AS IF DOCTORS HAS CREATED THE ACCIDENT OR DISEASE TO THAT PERSON AND DOCTOR IS THE ONLY SOLE RESPONSIBLE FOR SUCH ACCIDENT.EVEN IN MOB GENERAL PEOPLE ALSO BECOMES PART OF THESE DEMOSTRATIONS THNKING THAT DOCTORS ARE CORRUPT,THEY EARN HUGH MONEY BY CHEATING GENERAL PEOPLE,MOVE IN GOOD CARS AND LIVE IN GOOD HOUSES BY TAKING COMMISSION FROM DRUG COMPANIES,DIAGNOSTIC CENTRES ILLEGAL PRACTICE FROM GOVERNMENT HOSPITAL TO PRIVATE HOSPITALS AND AS GNERAL PEOPLE ARE NOT GETTING GOOD SERVICE FOR THEIR HEALTH PROBLEMS AS GOVERNMENT CLAIMS AS IT IS FREE AND FAIR BUT PRACTICALLY DUE TO LESS INVESTMENT IT IS ALSMOST ABSENT ,SO DOCTORS BECOME EYESORE OF COMMON PEOPLE TOO AND POLITICIAN AND ADMINSTRATOR ALSO REMAIN SILENT AS THEY KNOW PUBLIC WANTS DEFAME AND DISREPUTE OF DOCTORS SO IF THEY SUPPORT DOCTORS IN SSUCH CRISIS PEOPLE AND MEDIA WILL DESTROY THEIR VOTE BANK AND IMAGE,SO DOCTORS ARE LEFT FOR BEATING AND PHYSICAL HURT IN OPEN DAY LIGHT.
EVEN GOD WILL BE BEATEN ON BASIS OF SOME FILTHY CHARGES WHERE HE IS NOT DIRECTLY INVOLVED OR WHERE DEATH OR COMPLICATION IS A PART AND PARCEL OF THE TREATMENT PROCEDURES WHERE LIFE AND DEATH ARE EXISTING SHARING SHOULDER OF EACH OTHER
,GOD WILL TOO REACT WHAT TO TALK OF THESE HUMAN BEINGS ,HOW ONE CAN ASPECT A FEARLESS GOOD TREATMENT BY DOCTORS WHEN WHOLE SOCIETY IS STANDING AGINST HIM FOR NOT PROVIDING GURANTED GOOD TREATMENT AND RECOVERY,DOCTORS ARE MOSTLY SHACKEN BY CONSUMER PROTECTION ACT,RTI ACT,VIGILANT AND INTROSPECTING MEDIA WHO IS ALWAYS IN HOSPITAL TO CLICK ANY STORY ON DOCTORS PATIENT TUSSEL OR ANY MISHAPPENING IN HOSPITAL TO EARN TRP AND IF SUCH SHOCKED AND TREMOROUS DOCTORS ARE BEATEN OPENLY,THEIR REPUTATION IS CHALLENGED SO OPENLY IN SOCIETY,THRE IS NO OPTION LEFT BUT TO ASK FOR PROTECTION AND FORM GOOD LAWS AND BRINGING STRICT ACTIONS AGAINST MISCREANTS SO THAT SUCH ACCIDENTS DONOT HAPPEN IN FUTURE BUT AS THIS IS A NORM IN OUR PRESENT SOCIO POLITICAL SYSTEM THAT UNLESS YOU PRESENT YOUR SELF IN A VERY SERIUOS UNPARLIAMENTARY MANNER NO BODY LISTENS TO YOU,EVEN PARLIAMENTS AND ASSEMBLY SHOWS US SOMANY ROUDY AND BREAKING MIKES,CHAIRS AND WINDOWS IN THESE HOUSES BY ELECTED MLSAS AND MPS AS GOVERNMENT DONOT LISTEN TO THEIR SIMPLE PROTEST.
EVRY DEATH IS PAINFUL ,NO DOCTORS WANT THAT SOMETHING WRONG OR COMPLICATION OR DEATH OCCURS TO HIS/HER PATIENTS (EVEN EVRY GENERAL PERSON ACCEPTS IT) BUT DURING SUCH ACT SUCH THINGS ARE FORGOTTEN AND AN ONE THEME AGENDA OF BRUTALLY ATTACKING DOCTOR'S AND THEIR FAMILY MEBERS OF MEDICAL WORLD PHYSICALLY AND DAMAGING HOSPITAL PROPERTY IS TAKEN,INSTEAD OF RECOMMENDING FOR PUNISHMENT OF THESE PEOPLE,POLITICAL LEADERS START SCORING THEIR GAIN AGANIST RULING PARTY FOR SUCH ACT,STRATS ENCOURAGING THEM MORE AND MORE AND RECOMMENDS FOR THEIR IMMEDIATE RELEASE EVEN CUGHT BY POLICE ,MEDIA SHOWS THEM AS GREAT PCIFIER,NGO'S ANS SOCIAL WORKERS, CLUB ALL COMES FOR THE RESCUE OF THESE TROUBLE SHOOTERS JUSTIFYING THEIR PROTEST AS NATURAL BECAUSE A HUMAN LIFE HAS BEEN LOST AND DECLARES "DOCTORS"AS CRIMINALS WHO HAS COMMITTED THE CRIME MAKING HIM RESPONSIBLE FOR EVERY SUCH MISDOING FORGETTING ALLOCATION OF MONEY,FACILITIES, INFRASTRUCTURES STAFF,WILL POWER,WORK CULTURE ETC., IN THESE HOSPITALS.
SO MANY TYPE OF CRIMES ARE COMMITTED IN OUR SOCIETY BUT IN MOST OF THEM MASS DOESNOT PARTICIPATE,INVESTIGATION AUTHORIITE S LIKE POLICE,CID,CBI AND STF WORKS AND EVEN PUBLIC OR MISCREANTS TRY TO SABOTAGE SUCH INVESTIGATIONS ,THEY ARE BOOKED AND TAKEN TO TASK BUT IN CASE OF MEDICAL INVOLVEMENT, "DOCTORS" HAVE BEEN MADE SOFT TARGET AS IF ANY BODY CAN HIT THEM PHYSICALLY AND DAMAGE THE HOSPITAL PROPERTY,NO EXELEMPARY PUNISHMENT IS IMPOSED (GOVERNMENT OF ANDHRA HAS BROUGHT A LAW TO ARREST AND RECOVER MONEY FROM MISCREANTS AND PROTESTOR DAMAGING HOSPITAL PROPERTY ) BUT SUCH LAW SHOULD BE PASSED BY OUR PARLIAMENT AND SUCH AN EXAMPLE SHOULD BE CITED BY ARRESTING AND RECOVERING FROM SUCH PROTESTORS THAT IN FUTURE NO BODY SHOULD TAKE LAW IN HAND,MEDIA SHOULD STOP SHOWING AND REPORTING SUCH INCIDENTS AS THEY ENCOURAGE MORE PEOPLE TO TAKE LAW IN THEIR HAND.BUT FACTS REMAIN THIS,MEDIA IS FREE! POLICE CANNOT ACT! POLITICIANS ARE WELL WISHERS OF PEOPLE,NGOS AND SOCIAL WORKERS ARE SERVING SOCIETY! POLICE CANOT BE CONTROLLED AND DISCIPLINED !ADMINISTRATION AND LAW MAKERS NEVER SOLVE PROBLEM BY SIMPLE WRITING, DEMANDS, DEMONSTRATIONS,PROTESTS UNTIL AN EXTREME STEP IS TAKEN IN THE FORM OF STRIKE OR CAESE WORK IS TAKEN ,THEN THEY RESPOND BY GIVING MERE CONSOLATIONS ,ARRANGING POLICE PICKETING AND SECURITY PROTECTION FOR FEW DAYS,AS THE TIME PASSES EVERYTHING AGAIN COMES TO SAME PREVIOUS STAGE, A NEW INCIDENT TOOK PLACE AND EVERY THING IS REPEATED IN THE SAME WAY.
THEREFORE,IT IS NEED OF TIME THAT OUR POLITICIANS ,ADMINISTRATORS,MEDIA AND PEOPLE SHOULD SIT TOGHTHER AND THINK'WHY DOCTORS ARE BOUND FOR STRIKING" ,SOLVE THEIR PROBLEM IN TIME,LISTEN TO THEIR REPRESENTATIONS AND JUSTIFIED DEMANDS (WHEN EVERY PARLIAMENTARIANS AND BUREAUCRATS ARE ENJOYING SO MUCH HIKED PAY AND FACILITIES,WHY DOCTORS WHO TREAT THE PATIENTS ARE PAID SO BADLY,WHY THEIR BASIC AMENTIES,FACILITIES ARE NOT IMPROVED, WHY MORE CAPITA IS NOT EXPENDITURES ON HEALTH,WHY FACILITIES OF BED,DIAGNOSTIC CENTRES,MEDICINES AND ADEQUATE STAFFS ARE NOT INCREASE IN HOSPITALS,WHY A PUBLIC RELATION OFFICERS IS NOT APPOINTED IN HOSPITALS WHO ACCEPTS ALL GRIEVANCES AND REPORT TO MEDIA AS WH IS AT FAULT FOR MISMANGEMENT OF PATIENTS AT HOSPITAL,WHY A DOCTOR IS MADE RESONSIBLE FOR ANY MISHAPPENING IN HOSPITAL?)CREATE SO MUCH AWARENESS IN PUBLIC THAT THEY UNDERSTAND ALL SUCH MIS HAPPENINGS AND NEVER RESORT FOR SUCH ACT OF TAKING LAW IN HAND.
THESE ARE BASIC QUESTIONS WHICH A GOD WILL ALSO LIKE TO BE RESOLVED BECAUSE MOST OF TIME HE IS NOT AT FAULT AND NO BODY ERRONEOUSLY BLAME HIM,SYSTEM IS POLLUTED AND AS HE IS DIRECTLY AT TOP IN HOSPITAL ,SO HE CANNOT BE BLAMED BECAUSE INDIRECT BOSSES ARE IN POLITICS AND ADMINISTRATIONS. EVERY GENRAL PEOPLE HAVE RIGHT TO COMPLAIN TO ADMINISTRATION,POLICE,JUDICIAL COURT,STRICT ACTION SHOULD BE TAKEN IF DOCTOR IS FOUND AT FAULT BY INVESTIGATIONS OF COMPETENT AUTHORITY ,OUR COURT SHOULD BE MADE RESPONSIVE FOR EARLY TRIAL AND JUDGEMENT ,ALL ADMINSTRATIONS AND POLITICIANS SHOULD SHARE THEIR DISCREPANCIES AND FAULTS(INSTEADING OF PASSING WHOLE BUCK TO "DOCTOR")AND RESORT TO DOCTOR'S PERSONAL OR COMMUNITY PROBLEMS AS SOON AS POSSIBLE SOTHAT SUCH A HARSH AND UNJUSTIFIED WEAPON OF PROTEST "STRIKE OR CAESE WORK " IS EVER TAKEN BY DOCTORS .EVEN DOCTORS SHOULD TAKE STERN MEASURES TO IMPROVE PATIENT DOCTORS RELATIONSHIP BY DOING SOME GOOD SOCIAL WORKS AS MANY DOCTORS ARE DOING INVOLVE MEDIA AND GENERAL PEOPLE IN POLITICIANS IN THESE PROGRAMMES SO THAT NOBLE WORK OF DOCTORS GET MAXIMUM EXPOSURE IN SOCIETY SO THAT GENERAL PEOPLE COMES IN SUPPORT OF DOCTORS AND HAVE TO BE REMAIN UNITED SO THAT GOVERNMENT AND ADMINISTRATIONS LISTEN TO DOCTORS ,NOW A DAYS SELF DEFENCE IS BEST DEFENCE RESPECTING LAWS OF OUR COUNTRY.SO MERE CRTICISM WILL NOT YIELD ANY RESULT,DOCTORS ARE MOST IMPORTANT MEMBERS OF SOCIETY WHO SPEND SO MANY VALUABLE TIME ABOUT 15 YRS MINIMUM TO BE A GOOD DOCTOR WHO HAS TO READ THROUGHT OUT LIFE AND UP TO DATE TO REMAN AS GOOD DOCTOR WITH VERY LOW PAYMENT INCOMPARISON TO MBA,IIT,BUREAUCRATS AND CEO OF MODERN COMPANIES AND A PROPER RESPECT AND RECOGNITION IS ESSENTIALS TO THEM AND OUR SOCIETY AND ADMINISTRATION SHOULD BRING ALL CHANGES IMMEDIATELY SOTHAT SUCH HOOGALINISM,VADILISM AND GOONDISM IS STOPPED IN OUR HEALTH ENVIORNMENT.
DR.D.R.NAKIPURIA
SILIGURI


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Sep10
Turmeric and its anti cancer properties
CHEMOPREVENTIVE EFFECT OF
CURCUMIN IN COLORECTAL CANCER

INTRODUCTION
Colorectal cancer is main cause of cancer deaths in western countries. It accounts about to 15% of all cancers. Aetiology of colon cancer is multi-factorial and complex but diet is one of the important factors to cause and prevent cancers, like high animal fat consumption is associated with an increase in rate of colon cancer and frequent consumption of vegetables and fruits, due to presence of bioactive food components, decreases the risk of human cancers. This observation has led to research focused upon chemopreventive agents, especially those obtained from the diet. Recently researches have been focused on identifying, dietary phytochemicals that have the ability to inhibit the formation of cancer. Researches have shown that extracts of plants or their ingredients possess inhibitory effects against chemically induced carcinogenesis. Although, nutritional intervention may not be sufficient to protect/or reduce risk of colon cancer in high risk individuals. A complementary approach for secondary prevention would be to recognise and distinguish between chemopreventive agents. The effectiveness of these various chemopreventive agents, together with nutritional interventions in high-risk individuals should then be assessed. Medicinal plants or their crude extracts have been traditionally used in the prevention and/or treatment of several chronic diseases by various different ethnic cultures world wide. In India the incidence rate of large and small bowel cancers are low, but rectal cancer is more common in India as compared to colon cancer. This low incidence of colon cancer in Indians can be due to high intake of starch and the presence of natural antioxidants such as curcumin, found in spice turmeric which is exclusively used in Indian cooking.

Diferuloylmethane, a yellow pigment more commonly known as curcumin, is one of the active phytochemical found in plants of species of Zingiberaceae. Plants like ginger, saffron and turmeric are some of the plants that have plenty of curcumin. In the Indian subcontinent and Southeast Asia, turmeric has traditionally been used as a treatment for inflammation, skin wounds, and tumours. Turmeric is a significant ingredient in most commercial curry powders. It is also used to give a yellow colour to some prepared mustards, canned chicken broth, and other foods, and is also used as a fabric dye.

HISTORY OF CURCUMIN
Turmeric is known as the poor man's saffron, it is an ancient spice whose use dates back to the time of the Egyptian pharaohs. Highly prized by both Muslims and Indo-Europeans for its medicinal uses, it is just coming into its own as a powerful natural medicine in the West where research is beginning to confirm the potent roles it plays as an anti-inflammatory, anticancer, anti-mutagenic and antioxidant remedy. A traditional remedy in Ayurvedic medicine, an ancient Indian healing system that dates back over 5,000 years, it has been used through the ages as an "herbal aspirin" and "herbal cortisone" to relieve discomfort and inflammation associated with an extraordinary spectrum of infectious and autoimmune diseases. Indian Materia Medica, a standard Ayurvedic reference, cites dozens of conditions in which turmeric can be helpful as an adjunctive therapy including tissue injury or irritation, microbial infections, fevers, allergies, sinusitis, gastritis, colitis, hepatitis, kidney disease arthritis dermatitis, phlebitis, tuberculosis and autoimmune disorders. It is also cited as a remedy for liver disorders accompanied by jaundice. Topically, it can be used as a poultice to reduce inflammation and swelling due to sprains, cuts, bruises and superficial infections, including those of the eye -- which are treated with an eyewash containing turmeric that cools and soothes burning eyes. Another traditional use is to relieve congestion -- inhaling the fumes of burning turmeric directly into the nostrils is said to cause copious mucous discharge. Turmeric also is given to relieve diarrhoea and fevers, as well as vertigo, when applied directly to the scalp. Used for skin infections, colic, menstrual problems and congestion in China and Cambodia, the tuber also is used as a tonic, stimulant and diuretic in Madagascar. In Chinese traditional medicine it is known as "Jiang Huang," and used to eliminate flatulence; resolve liver and urinary problems, menstrual disorders, haemorrhage, and fever and chest pain; and prepared as a poultice for sores, wounds, bruises and infections. “There is also a vegetable which has all the properties of the true saffron, as well as the colour, and yet it is not really saffron” - Marco Polo, Thirteenth Century.

TIMELINE
Although the chemical structure of this remarkable spice, food preservative and dye was identified in 1910 it was only in the 1970s and 1980s that its many, varied health-promoting properties were identified. Recent, research is confirming what traditional healers have known all along, that the fresh juice of the root reduces swelling in bruises, wounds and insect bites and the dried powder kills parasites, relieves head colds and arthritic aches and pains. Research is also beginning to show that turmeric may be a valuable anticancer agent.

The earliest scientific paper on curcumin was published in year 1976 Sharma O P proposed the antioxidant activity of curcumin and related compounds. Gupta B et al, (1980) published Mechanism of Curcumin induced gastric ulcer in rats. Role of curcumin as an anti-inflammatory was demonstrated by Rao T S et al in 1982 and Mukhopadhyay A et al in 1982. In early 1983 a paper by Jiang T L et al, demonstrated effects of curcumae species on human tumour stem cell assay, however curcumae were relatively ineffective on the human tumours tested by him. However two years later in 1985 Kuttan R et al, saw inhibition in ovary cells of Chinese Hamsters by curcumin. A new model for evaluating nonsteroidal anti-inflammatory drugs (NSAIDs) was described by Satoskar R R et al in 1986. In the end of year 1989 researchers from Amala Cancer Research Centre, India demonstrated inhibition of chemical carcinogenesis by curcumin. There was no looking back after this year, a decade of research work on curcumin and turmeric suggested it as a potent anti-cancer and chemo preventive phytochemical. Recent studies are also suggesting curcumin as potent herbal remedy to fight against breast, colon, hepatic, skin and other cancers of gastric tract. Newer studies have suggested that curcumin inhibits HIV replication by blocking the long-terminal repeat region on HIV's genes.

CONCLUSION
Mechanism of curcumin is poorly known and many varied theories have been suggested about its action. But from these studies we can infer that curcumin inhibits carcinogenesis in large bowels.

Dr Varsha B Patel
www.homeotouch.com


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Sep10
Diet for a healthy pregnancy
Diet for a healthy pregnancy
For a mum-to-be, it is even more important to have a well balanced diet, as what you eat has to meet the needs of the mother as well as the developing baby in the womb. In the first trimester most of the physical and mental growth of the baby takes place, one should be very careful in terms of health and diet. During these 1st three months, important organs and the nervous system are developed, hence it is essential to eat a balanced diet from the beginning. The baby takes up room in the abdomen leaving less space for the stomach and thus making it harder for one to eat also leading to morning sickness, yet one need to eat nutritious diet to ensure proper growth and development of the baby.

A nutritious diet includes adequate amount of proteins, fats, carbohydrates, minerals and vitamins, selected from five basic groups – fresh fruits, vegetables, whole grain products, proteins (meat, fish, pulses, and lentils), milk and other dairy products. Eat a variety of food as possible but in moderation, as too much of any food can cause excessive weight gain. Try and eat 3 big meals and 3 small meals throughout the day.

Some essential nutrients to be considered while planning the diet:

Folic acid: it is one of the key ingredients required for the development of the nervous system. Deficiency of folic acid in first few weeks would cause neural tube defect and other birth defects like cleft lip and congenital heart disease. At least 4 mg of folic acid should be consumed from the day of conception and during the first trimester. Natural sources of folic acid – dark green leafy vegetables, liver, yeast, beans, citrus fruits and now also available in fortified bread and cereals. As folic acid is easily destroyed while cooking, best is to either steam the vegetables or eat them raw. Folic acid supplements can be taken under your physician’s supervision.

Iron: iron aids the production of hemoglobin. As the blood volume increases during pregnancy, hemoglobin levels should also increase, for which the iron requirement also increases. An average woman needs about 15 mg of iron daily and during pregnancy the requirement doubles up to 30-50 mg per day. Include food rich in iron like – potatoes, raisins, dates, broccoli, green leafy vegetables, whole grain breads, meat and iron fortified cereals. Iron derived from food is not enough to combat the need hence iron supplements should be consumed under the guidance of your physician. Iron is best absorbed when taken along with vitamin C, hence the supplements should be consumed with an orange or sweet lime juice. Also certain medications, calcium rich food, caffeinated drinks and antacids inhibits absorption of iron so should be avoided with iron supplements.

Calcium: it is essential for the development of bones and teeth of the baby. It starts forming about the eight week of pregnancy. One needs about double (1200 mg) the quantity of calcium than normal. One needs to consume at least 3 servings of milk and milk products. Apart from dairy products foods high in calcium are – green leafy vegetables, salmon, tofu, broccoli, peas, okra, beans, brussel sprouts, sesame seeds, bok choy, almonds.

Proteins: Protein is most important nutrient required for the proper development of the baby. Eat variety of protein rich foods to ensure adequate protein intake. Incorporate vitamin B6 along for proper utilization of protein. Sources – nuts, peas, lentils, beans, dairy products, egg white, fish and meat. Animal sources are also high in fat, so choose lean cuts of meat and limit your intake.

Vitamin A: essential for the embryonic growth of the baby, for the development of heart, lungs, kidneys, eyes and bones, the circulatory, respiratory and the central nervous system. Vitamin A is also essential during the third trimester as after the birth of the baby, it helps mother with the postpartum repair. But Vitamin A intake should not exceed the recommended dosage (750mg /2500 IU). Over dose of vitamin A can cause birth defects and liver toxicity.

Vitamin C: it helps in development of a strong placenta, improves your immunity thus prevents infections, it also enhances iron absorption. As vitamin C is not restored in our body, a daily supply is essential. A considerable amount of vitamin is lost in prolonged storage and while cooking, hence it is best to eat fresh food and steam the vegetables or eat them raw. Sources – fresh fruits like – strawberries, raspberries, kiwi, grapefruit, passion fruit, orange, sweet lime etc, fresh vegetables – green leafy vegetables, beans, broccoli, Brussels sprouts, cabbage, tomatoes etc.

Fiber: constipation and piles are most common conditions during pregnancy; high fiber diet should be consumed to prevent it. Sources- fresh fruits and vegetable, brown rice, beans, nuts, cereals and pulses are very good sources of fiber.

Water: pregnant women should drink at least 8 to 10 glasses of water per day. It plays important role during pregnancy – carries nutrients from mother’s food to the baby, it prevents constipation, piles, UTI and during last trimester drinking enough water prevents from dehydration and thus prevents contractions and premature labor. Juices can replace for fluids but they are high in calories and one can gain extra weight. Tea, coffee and aerated drinks cannot be included in total amount of fluids as they contain caffeine which reduces the amount of fluid in our body.

Certain foods are no no during pregnancy:-

Canned and processed food
Spicy food
Tea, coffee, aerated drinks. Caffeine is linked to low birth weight, it is also one of the cause for miscarriage.
Hot chocolate, sugary foods like cakes, candies, sodas, colas.
Reduce salt intake, especially when you have swelling and high blood pressure during pregnancy. Do not completely avoid salt as it is an important nutrient.
Shark, swordfish, marlin, they may have high levels of mercury.
Raw sea food such as oyster and sushi.
Raw or undercooked meat, poultry and eggs, they may contain bacteria which can harm your baby.
Certain cheese like brie and camembert and blue veined cheese like stilton, they all contain listeria, a bacteria that can harm your unborn child.
Liver and liver products as they are high in retinol a form of Vitamin A, too much of this vitamin is not good for the development of the baby.
Junk, fatty and sugary food.
Do not eat left over, frozen and deep frozen food.
Avoid alcohol and tobacco during pregnancy. It is known to cause physical defects and learning disabilities and emotional disturbances in children. If you have to drink, u can have no more than one or two units of alcohol and not more than twice a week. DON’T GET DRUNK.
Do not go on diet during pregnancy can harm you and the developing baby. Remember weight gain during pregnancy is a very positive sign for a healthy pregnancy.

Treat yourself occasionally

If you are pregnant does not mean that you have to give up all your favorite food. Once in a while you can enjoy the luxury of an ice cream or desserts, but it should not be the mainstay of your diet. But when you occasionally indulge, don’t feel guilty. ENJOY EVERY BITE!

Dr Varsha B Patel
www.homeotouch.com


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Sep10
Diet and health tips
1. Folic acid should be taken at least 6 months before planning a pregnancy.
2. Take high fiber diet, will keep cholesterol levels and blood pressure in check.
3. To have healthy glowing skin drink at least 8-10 glasses of water and eat lots of fruits and vegetable.
4. Adequate protein intake and diet rich in minerals and vitamins is necessary for healthy, shiny, bouncy hair.
5. Avoid canned and processed food, they contain lots of preservatives that are harmful.
6. Kicking meat from diet helps cut the risk of heart disease, diabetes, obesity and cancer.
7. Instead of eating 3 meals a day, eat 4-5 small meals to regularize blood sugar levels.
8. Substitute soya for other high protein drinks, it contains phytoestrogens that help prevent breast and ovarian cancers.
9. Bananas are good for hypertensives, they are high in potassium and low in sodium also are rich in fibre and thus restores normal bowel movement.
10. Avoid too much fibre as that can cause bloating and flatulence, consume lots of water along with a high fibre diet as it helps in forming a bulk.
11. People often over-eat to overcome feelings of boredom, depression, anxiety. Exercise releases endorphins or feel-good hormones, thus helps to distress.
12. Aqua aerobics, swimming improves muscle tone and strengthens injured joints and muscles.
13. Breathe consciously to improve mental health. If you are confused, anxious take a few deep breaths and confidence will be regained.
14. Never starve your self in order to lose weight. In starvation body stores more fat. Instead eat healthy and in moderation.
15. Practice meditation regularly, helps relieve stress, rejuvenates you and helps to improve your focus.
16. 2 hours of regular out door sports is essential to promote mental and physical growth in children.
17. Do not wash your hair more then twice a week. It weakens the roots of the hair.
18. Sleep early and wake up early keeps you energetic and elevates your mood.
19. Fasting once a week gives rest to gastrointestinal tract and thus improves the digestive system.
20. Avoid kneeling and climbing stairs if you are suffering from arthritis of knee joint.

Dr Varsha B Patel
www.homeotouch.com


Category (Diet, Fitness & Nutrition)  |   Views (4242)  |  User Rating
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