Hernia and Hydrocele
How to differentiate between Inguinal hernia and hydrocele?
Inguinal hernia is usually a reducible swelling with cry/cough impulse while a hydrocele is a tense cystic, clinically irreducible swelling without any impulse. Transillumination test is not reliable as can be present in both the cases.

Why hydrocele is irreducible swelling?
The pathogenesis of both hernia and hydrocele is same that is persistence of processus vaginalis.

The neck of hydrocele is very narrow and so even if you try to compress the swelling, the fluid from processus vaginalis will not go into the abdominal cavity. The parents will give a characteristic history of swelling being less during morning and then gradually starts increasing in size. While the opening of hernia sac is large enough to allow the free reduction of contents.

For how long one can safely wait in hydrocele?
The hydrocele which are constant in size through out the day time are usually scrotal type hydrocele and are seen in newborns. They are called as non- communicating hydroceles. It is this type of non -communicating hydrocele which tends to resolve spontaneously.

The hydrocele in which parents gives the history of increase and decrease in the size of swelling are called as communicating hydrocele and will require surgery.

The condition can be safely observed till 18mths to 2 years of age as it is harmless. But one should be sure that they are not associated with hernia.

When one should advice for hernia surgery?
Inguinal hernias never go away without surgery. This is a condition in which surgery is advised to be done as early as possible as the risk of hernia getting incarcerated is as high as 30 to 40%. If not tackled in time it can lead to major complications of gut and testis necrosis. Also emergency anesthesia may further increase the risk for the child.

How safe is inguinal hernia surgery in newborns and infants?
Like any other surgery anesthesia have its own risks. As the risk of hernia incarceration is very high especially in newborns, waiting for hernia repair is not a good option once a diagnosis of hernia is made.

The commonest problem of hernia surgery in newborns is postoperative apnea. To minimise this it is usual practice to perform surgery once the child is more than 49 wks of gestational age or weighing more than 2.2 kg. After surgery these patients needs to be monitored in hospital for 24 hrs for risk of postoperative apnea.

What is the surgical procedure done for hernia and hydrocoel?
The surgery in both the conditions is same that is the ligation of patent processus vaginalis called as “HERNIOTOMY�.

Are there any indications for performing bilateral repair in case of a unilateral inguinal hernia?
The risk of hernia manifesting on the contralateral side after unilateral repair is just 10 %. Although the patent processus vaginalis may be present in higher number of cases but it may not manifest as hernia later on. So as per present recommendations bilateral hernia repair is not routinely done in cases of a unilateral inguinal hernia.

Tattoo/Birthmark Removal
A tattoo design is formed by injecting ink and pigments into the dermis of skin through pricking method.

Though the idea of getting inked sounds fun, it happens quite often that people regret the choice of a permanent tattoo.

The good news is that it is now possible to remove the permanent tattoo fully/partially by latest treatment options.

Treatment Available
At Dermaheal Skin and Hair Clinic, permanent tattoo removal is done by most advanced Q- SWITCHED Nd : YAG LASER which is safe as well as effective. This laser is also used to reduce the appearance of:
Post inflammatory hyperpigmentation
Freckles and Lentigenes removal
Nevus of ota
Pigmentary Demarcation Lines
Birthmark

About The Procedure
Before beginning the treatment, numbing cream is applied to make the procedure more comfortable for the patient.
Laser is guided over the selected area of the tattoo that emits pulses of light energy which is absorbed by the pigments, heating and breaking them into smaller fragments. These particles are absorbed by our immune system which are then excreted through the lymphatic system. As these fragments are recognized as foreign substance/waste by our body, they are discarded by natural means of excretion (urine, sweat and fecal matter).
Number of sessions required depends on the shape, size and area of the tattoo. However usually minimum of 3-4 sessions are needed to visualize the difference in results.
The interval between each session ranges from 3-5 weeks.
Mild swelling and redness may occur post procedure, for which topical medications are prescribed.
One can expect a significant reduction in the appearance of tattoo following the sequential sessions.

At Dermaheal Skin and Hair Clinic
Get your permanent tattoo removed with advanced technology and at an affordable price.
To enquire in detail about laser tattoo removal and other cosmetic treatments best suited for your individual needs, schedule an appointment with our trusted and experienced dermatologist Dr. Navjot Singh Arora at Dermaheal Skin and Hair Clinic, Dwarka Sector 7, Delhi.

Dermal Fillers Treatment in Dwarka
Soft tissue fillers also known as dermal fillers are widely used as an anti aging treatment which significantly helps the patient to replace the lost facial volume thereby diminishing the appearance of creases and wrinkles.

As dermal fillers get absorbed by the body as the time passes, so it can only provide a temporary effect ( generally up to one and a half years )

Uses Of Dermal Fillers
Dermal fillers help in recontouring the facial features by uplifting the face and restoring a smoother appearance to the overall face.
It gives additional plump to cheeks which re-establishes a youthful and fresh look.
Dermal fillers are also used as lip fillers, reshaping the lips according to the individual’s desires, making them more supple, hydrated, luscious and beautiful.
Dermal fillers also help in reducing the appearance of nasolabial folds.
Patients with under eye shadows are the ideal candidates to get under eye fillers.

It improves the appearance of sunken eyes and enhances the tear troughs.

Under eye fillers dramatically improve the wearisome look and intensifies the features instantly.

How it works
Dermal fillers are carefully introduced to the dermis of the skin by different techniques of injection therefore they are sometimes also called as Injectable fillers.
Use of proper injection techniques is very important as it determines the even distribution of fillers to the site of insertion.
Dermal fillers come in the form of prefilled syringes containing local anaesthetic agents which when injected causes a mild stinging sensation which subsides after some time.
Dermal fillers are usually injected around cheeks, lips, and jaws and sometimes around eyes and forehead according to the requirement.

Post Care
We provide detailed counseling regarding the pre and post instructions and management followed by the procedures as proper post care is equally important to maintain the efficacy of the treatment.
The treated area should not be manipulated immediately by pressure in any way unless advised.
Life span of soft tissue fillers is hampered by constant exposure to environment of extreme temperature.

At Dermaheal Skin and Hair Clinic
Derma heal Skin and Hair Clinic ensures to provide our patients the best quality of fillers which enlivens their faces instantly leaving their skin glowing, hydrated and contoured.
Schedule an appointment with Dr. Navjot Singh Arora at Dermaheal Skin and Hair Clinic, Dwarka Sector 7, Delhi to know more about the fillers best suited for you based on your personalized requirements and get the rejuvenated look you deserve.

Healthy Kidneys For Healthy Kids

Better kidney health for kids: What you should know!
Did you know that kidney diseases can start young? Literally. Unlike in the case of grown-ups, children can develop kidney diseases due to congenital defect, prematurity, or past hospitalization. "Also, children with a high-risk birth and early childhood history should be watched closely in order to help detect early signs of kidney disease in time to provide effective prevention or treatment. Needless to say that the sooner the issue is diagnosed, better can be the results," adds Dr Sidharth Kumar Sethi, Consultant, Pediatric Nephrology, Medanta, The Medicity, Gurgaon.

Early signs of kidney disease in kids
Early diagnose of kidney problem can help treat the ailment in time. Here are some signs that you should watch out for:

- Swelling around the eyes-face -feet- abdomen- whole body - Bed wetting (5 years or older) can be since birth or if the problem recurs after the child had stopped bed wetting for some time -Frequent urination - Crying during urination (in infants) - Painful urination (in older kids) - Unpleasant-smelling urine -Unexplained low-grade fever or recurrent fever episodes - Urine that is cloudy, bloody or dark brown - Persistent abdominal pain - Childhood renal stones - Frequent severe headaches - High blood pressure - Producing less urine -Producing more than 2 litre urine/ day -Poor appetite (in older children) - Poor eating habits, vomiting (in newborns & infants) - Slow growth or weight gain -Weak urinary stream, dribbling of urine stream - Weakness, excessive tiredness or loss of energy - Pale skin appearance

Protection plan
Have lots of water: To keep kidneys healthy, kids should stay hydrated- mostly by drinking water. Their pee should be pale in color, and they should drink more than usual when exercising especially under a hot sun. Kids should avoid nutrient-spiked drinks. Enough water is still the best and safest bet to meet their fluid needs.

Avoid sports drinks and processed: Today's diets are so extreme and unhealthy. Vitamin waters, sports or energy drinks, processed 'super-foods' are not nutritious and add to the risk of obesity in children.

Avoid too much protein: Protein intake should be in adequate amount. It is advisable to not make your kids indulge in too much protein.

Excess salt is bad: Too much sodium (in junk food, burgers, chips and street food) can contribute to high blood pressure. Eating more whole foods, choosing fewer processed foods- emphasizing those with made without added salt or sauce can help lower sodium intake. Cooking more at home can also help families slash sodium. Cut back on table salt and salty snacks.

Regular exercise: Increasing physical activity not only helps to reduce blood pressure, but it can help a child who is overweight reach and maintain a healthy weight. Sports and exercise programs at school may be good ways to increase the child's activity level.

Who should be screened?
Following children should be screened by a specialist for blood and urine test; growth and blood pressure:

Family history of kidney disease
Children born early or small-for-date
Obese children; or those not growing well
Abnormal antenatal ultrasound
History of urine infection
Abnormal urine examination
It is also extremely important for the health community to encourage pregnant females to undergo antenatal ultasonography. With the growing cases of kidney issues in children, it is crucial that we encourage and facilitate education, early detection and a healthy life style in children, starting at birth and continuing through to old age, to combat the increase of preventable kidney damage and to treat children early.

Nephrotic Syndrome

Most people have two kidneys, one on either side of the body just beneath the ribcage. Healthy kidneys filter the blood and allow small particles of waste products and water to be excreted as urine. Kidneys also play important role in the control of blood pressure, maintenance of bone health and formation of red blood cells.

What is nephrotic syndrome?
Nephrotic syndrome occurs when the kidneys leak large amounts of protein (especially albumin) into the urine. It is these proteins which is mainly responsible for holding water in the blood vessels, and when they are lost in urine, their level decreases in the blood which causes the water to come out of the blood vessels and cause swelling (edema).

What causes Nephrotic Syndrome?
In most cases, the exact cause of nephrotic syndrome is not known. There is no relationship with diet or socioeconomic status of the family. It is non-infectious and does not transfer to other family members

What are the symptoms?
The most common symptom is swelling (edema). It first appears on the face, especially around the eyes which is most prominent in the morning when the child gets up and decreases by the evening.

Other symptoms include: Frothy urine, weakness and tiredness, passing less urine than usual, recurrent infections, diarrhoea.

What is the treatment?
Prednisolone (steroid) is the drug of choice when the child is first diagnosed. Most children respond to this drug with disappearance of the protein in the urine and loss of swelling within 1-2 weeks (we call this REMISSION). Other drugs like diuretics, ACE inhibitors, etc may be required for symptomatic treatment.

Those who do not respond to steroids are given second line drugs like Cyclophosphamide, MMF, Levamisole and other immunomodulators as decided by your doctor according to the individual patient profile.

Duration of treatment: First episode is treated for 3 months and subsequent episodes are treated as decided by your physician.

What are the side effects of the treatment?
Common Side Effects of Steroids are:

Decreased resistance to infections such as cough and cold
Increase in appetite
Flushed, swollen cheeks and stretch marks on the skin
Rise in blood pressure
Behavioral problems e.g temper tantrums, or mood changes.
However most of the side effects are reversible and wean off once the steroid is stopped.

Long term supervision and course of nephrotic syndrome
In most cases the child with nephrotic syndrome becomes completely well with prednisolone treatment, and there are very few who require second line treatment which includes immunomodulators and other drugs.

The child may remain well for several months or longer. During this period, the child should be regarded as being normal, and should not be made to feel different from other children.

In majority of cases, however, nephrotic syndrome recurs. The recurrence is indicated by appearance of swelling around the eyes, which, if untreated, gradually increases to involve the face, feet, legs and abdomen, and in such conditions, doctor should be consulted immediately. Relapses are common in early childhood but decrease with age.

More than 90% of children with nephrotic syndrome go into adulthood with their kidneys functioning normally.

What are parents expected to do at home?
Starting and stopping of medicines should be strictly done as advised by the doctor.
Daily urine protein monitoring by urine dipsticks till negative for three days then atleast thrice a week during remission.
Keep a diary of all urine results so that your doctor can review your child’s progress in clinic. The dose of Prednisolone and any other medications and other comments should also be recorded.
In remission phase immediately report to the doctor under following conditions:
Swelling around the eyes
Decreased urine output
Urine protein 1+ or more for persistent 2-3 days
Any sign of infection like cough, cold, coryza.

Dietary advice for your child:
The child should be given a diet with enough proteins. High protein food items include milk and milk products, dal, chana, soyabean, eggs, meat and fish.

If the child is edematous, the doctor might advise salt restriction. Once the swelling disappears, the child can have his usual diet. It must be understood that salt has no role in the causation of nephrotic syndrome. No benefit can be expected by prolonged restriction of salt unless advised by the doctor for some other reason (e.g., if the blood pressure is high).

When is kidney biopsy required?
Very few children require kidney biopsy. Certain conditions in which children do not respond to daily treatment or have persistent gross hematuria, persistent hypertension, low complement level (C3 / C4) require kidney biopsy.

What immunizations are necessary?
Children who are on steroid medications and other immunosuprressives can become very unwell if exposed to CHICKENPOX or MEASLES, therefore they should be immunized for the same and also receive pneumococcal vaccine.