World's first medical networking and resource portal

Articles
Category : Women's Health
Medical Articles
Nov22
MEDICAL HOROSCOPE
Dear Sir/Madam

PHOENIX HOSPITAL & DIAGNOSTIC CENTRE, SCO 8, SECTOR 16, PANCHKULA hARYANA 134109 is launching a new concept and we are pretty sure you would agree, appreciate & participate that no doubt the marriage is settled in heaven & celebrated on earth, nevertheless, the health of would be couple is most important than comparing the horoscope of girl & boy. The horoscope is not going to give the details of health part of each person.

In present time & changing scenario knowing actual health details would be most satisfying & tension free at the time of wedding both for the girl’s as well as boy’s family.

Won’t you agree that just by comparing the compatibility of horoscope of both the boy and girl & thereby knowing their Gunas / Doshas does not in anyway solve the purpose except finding little solace and leaving rest in the hands of God? Such kind of compatibility does not give any kind of details of the diseases like HIV, VDRL, TB and Cardiac Problems etc. etc.

It is in the mutual interest of boy or girl and their families to know prior to nuptial knot the health picture which sometime later leads to unsavory situation and many a times divorce. By this even if need be congenital abnormality / chromosomal defects type diseases could also be known.

Therefore, PHOENIX HOSPITAL is launching

*HEALTHY
MARRIAGE KUNDLI
(MEDICAL HOROSCOPE)
OF WOULD BE COUPLE


‘Please visit for free consultation & counseling’
*Conditions apply
*Charges as applicable

Regards

Dr T M Aggrwal
Ph: 0172-5054321, 5011333


Category (Women's Health)  |   Views (22865)  |  User Rating
Rate It


Oct25
Cervix cancer—cervical cancer vaccine. DR NITIN KHUNTETA
Cervix cancer—cervical cancer vaccine

In India, Cervical Cancer is the most common cancer in women. Every year, in India, 132,000 new
cases are diagnosed and 74,000 women die due to this cancer. Globally, Each year, nearly 500,000 new cases are diagnosed of which nearly 270,000 women actually die.

Cervical Cancer is caused by the Human Papillomavirus (HPV).These are classified into 'high-risk' (oncogenic) and 'low-risk' types . 15 oncogenic HPV types have been linked to Cervical Cancer . Low-risk HPV types, such as HPV 6 and 11, are not known to cause cancer,but are responsible for benign genital warts . Globally, HPV 16, 18, 45 and 31 are 4 most common oncogenic HPV types. HPV 16 and 18 together account for 70%.
Together,HPV 16, 18, 45 and 31 are responsible for 80% of Squamous cell carcinomas of the cervix.These same 4 HPV types are also responsible for 90% of Adenocarcinomas of the cervix.

Oncogenic HPV can spread via skin-to-skin genital contact and does not necessarily require penetrative sexual intercourse. Men act as a reservoir of infection, capable of passing on the virus to their female partners who are then at risk of developing Cervical Cancer.

Yes! Cervical Cancer can now be prevented through vaccination.

Cervical cancer vaccine composed of HPV 16 and 18 antigens in the form of VLPs (Virus like particles) combined with a novel adjuvant system called AS04. Adjuvants play a key role in enhancing the immune response elicited by a vaccine. They are used in almost all commercially available vaccines.The most commonly used adjuvant is Aluminium hydroxide. The novel adjuvant system AS04 which combines traditional Aluminium hydroxide with MPL (i.e. Monophosphoryl Lipid A). MPL binds to a novel receptor called the TLR 4 on Antigen presenting cells.This interaction results in a better memory B cell response. Memory B cells are long-lived cells, which then constantly produce a sustained level of antibodies over a long period of time.

Cervical vaccine has been licensed for use in girls and women aged 10-45 years. Antibodies are an important correlate of long-term protection. It is believed that antibody levels that are consistently high over a period of time and are likely to stay high, would provide long term protection against Cervical Cancer.

It is recommended that subjects who receive a first dose of Cervical cancer vaccine complete the three-dose vaccination. If flexibility in the vaccination schedule is necessary, the second dose can be administered between 1 month and 2.5 months after the first dose. Vaccination should be postponed until after completion of pregnancy.

Cervical cancer vaccine is generally safe and well tolerated. The most frequently reported solicited symptoms after administration of vaccine are injection site reactions including pain, redness and swelling. The majority of the solicited local and general symptoms reported are mild to moderate in intensity.


Category (Women's Health)  |   Views (26428)  |  User Rating
Rate It


Oct05
BREAST HEALTH-BREAST CANCER
BREAST CANCER –BREAST HEALTH--------
DR NITIN KHUNTETA
MBBS, MS ( GEN. SURGERY),
M Ch (SURGICAL ONCOLOGY),
DNB (SURGICAL ONCOLOGY).
CONSULTANT SURGICAL ONCOLOGIST, Bhagwan Mahaveer Cancer hospital & Research Centre, Jaipur

The incidence of breast cancer in India is on the rise and is rapidly becoming the number one cancer in females pushing the cervical cancer to the second spot.
The rise is being documented mainly in the metros. It is reported that one in 22 women in India is likely to suffer from cancer during her lifetime, while the figure is definitely more in America with one in eight being a victim of this deadly cancer.
Breast cancer is the most common form of cancer among women. According to a study by International Agency for Research on Cancer (IARC), there will be approximately 250,000 new cases of breast cancer in India by 2015. At present, India reports around 100,000 new cases annually.
Globally, every three minutes a woman is diagnosed with breast cancer in the world, amounting to one million cases annually. The incidence could go up by 50 percent to 1.5 million by 2020, says the World Cancer Report.
The chances of survival and cures for breast cancer is as high as 90 percent after complete treatment.
Breast cancer will become an epidemic in India in near future. Before it becomes the epidemic we should take appropriate measures to prevent development of breast cancer.
AVOIDING THE RISK FACTORS DECREASES THE CHANCE OF DEVELOPMENT OF BREAST CANCER ---
The rise in the incidence of breast cancer is due to changing lifestyles, i.e marrying late, the average child bearing age has increased to 30 and sometimes even beyond that, early weaning from breast feeding, the use of combined estrogen and progestin hormone replacement therapy (HRT) , obesity & lack of physical activity.
THE SMALLER THE CANCER IN BODY THE HIGER CHANCE OF CURE------ There are four stages of breast cancer. Stage 1 to 4. For to diagnose at earlier stage the following recommendation should be followed—
 Screening mammography---mammography is so far the only screening method that has been consistently proven to reduce deaths from breast cancer. It is considered the gold standard of screening, while breast self examination is, at best, a supplement to regular mammograms and breast exams by a doctor.
RECOMMENDATIONS—
• Women age 40 and older should have a screening mammogram every year, and should continue to do so for as long as they are in good health.
• Women at moderately increased risk (15% to 20% lifetime risk) should have their yearly mammogram.
• Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year.
• Schedule the mammogram when the breasts are not tender or swollen to help reduce discomfort and to assure a good picture. Try to avoid the week just before the menstrual period.
• On the day of the exam, don’t wear deodorant or antiperspirant; some of these contain substances that can interfere with the reading of the mammogram by appearing on the x-ray film as white spots.
• Discuss any new findings or problems in your breasts with your doctor or nurse before having a mammogram.
• To bring previously done mammograms so that they can be compared to the new ones.

 Breast self examination-------Goal- to report any breast changes to a doctor or nurse right away.
• Systematic step-by-step approach to examining the look and feel of one’s breasts.
• What to look-- lump or swelling, skin irritation or dimpling, nipple pain or retraction (turning inward), redness or scaliness of the nipple or breast skin, a discharge other than breast milk, or a change in the size of one breast,
• Best time for a woman to examine her breasts is when the breasts are not tender or swollen.
• Women who are pregnant, breast feeding, or have breast implants can also choose to examine their breasts regularly.
• Women who examine their breasts should have their technique reviewed during their periodic health exams by their health care professional.

 Clinical breast examination.---- Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional preferably every 3 years. After age 40, women should have a breast exam by a health professional every year.
 ACS RECOMMENDATIONS—
• Women age 40 and older should have a screening mammogram every year, and should continue to do so for as long as they are in good health.
• Women at moderately increased risk (15% to 20% lifetime risk) should have their yearly mammogram.
• Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year.
The treatment protocol for breast cancer depends on the stage of the cancer & general physical condition of the patient.
Surgery is the main modality for early & locally advanced breast cancer.
The two types of surgery to treat breast cancer are:
1--Surgery to remove the entire breast & axillary lymph nodes i.e radical mastectomy.
2--Surgery to remove just the area of the breast that contains cancer & axillary dissection (breast-conserving surgery) followed by radiation treatment.
Studies now show that breast-conserving surgery followed by radiation therapy is as good as mastectomy in treating early-stage breast cancer (Breast Conservation Trials, NSABP B-06).
Breast conservation surgery is not recommended in patients with---
Two or more tumors in separate areas of breast, H/O prior therapeutic irradiation to the breast, Pregnancy, Women with certain connective tissue diseases. e.g systemic scleroderma, lupus erythematosus, polymyositis, dermatomyositis, and mixed-connective tissue disorders. Women with a tumor larger than 5 cm (2 inches) that doesn't shrink very much with chemotherapy in small & medium size breast.
After breast conserving cancer surgery & subsequent radiotherapy, up to 50 to 60 % of woman have a residual deformity that requires surgical correction, by performing immediate remodelling of the breast at the same time as cancer removal. Plastic surgical techniques (oncoplastic & flap surgery ) should be integrated with the original operation .


Category (Women's Health)  |   Views (25186)  |  User Rating
Rate It


May28
PCOD - save your ovaries with homeopathy
PCOD ( poly cystic ovarian disease)

P – poly
C – cystic
O – ovarian
D – disease

• That’s what we can call it as PCOD in medical terminology, but now a time it’s a very common for non medico people also with the same PCOD name only.
• It is common to occur in all age groups of girls to ladies
• It is also known as PCOS that’s means Pelvic Cystic Ovarian Syndrom
• Poly means more than 1 or multiple, cystic means it’s a sac filled up with fluid inside, and when this type of condition occurs inside the ovaries of either side it is called as PCOD
• It is a condition where hormonal changes, masculine changes, irregular menses and many more symptoms of menstruating girls or ladies.
• Usually following are the symptoms of PCOD
1. Irregular menses either early or delayed(commonly it is delayed in nature)
2. Increase in weight constantly
3. frequent miscarriage or positive history of miscarriages
4. unwanted hair growth all over the body
5. infertility or difficulty in getting pregnancy
6. hair problems like falling, thinning, dandruff, graying, etc.
7. skin problems like acne, pimples, dryness of skin, small eruptions of face

after a prolong time of having PCOD in body such complications may develop at the later life like.
1. high blood pressure or hypertension
2. diabetes
3. high cholesterol
4. miscarriage

remark – it is an endocrine disturbance that causes primary anovulation and polycystic ovaries due to the continued stimulation of the ovary by pituitary luteininzing hormone. Its also called as
STEIN-LEVENTHAL SYNDROME.

Treatment – IN HOMEOPATHY – it is strongly recommended that PCOD is best treated in homeopathy only and there are various medicines for that few are symptomatic and few are constitutional treatments. Out of them symptomatic treatments gives immediate relieve to symptoms but constitutional treatments treats person as a whole and tries to remove PCOD from the body and will maintain that good health for a longer phase also.

Herewith we are giving some of the names of homeopathic medicines name with witch you can relieve the patients suffering but make sure do consult any of the homeopathic doctor before prescribing any medicine by self.
Ustiligo, belladona, apis mellifica, medorrhinum, lillium tig, graphites, ova tosta, pulsatila, lachesis, arsenicum album, and many more which can treat PCOD but with strict physician observation only.

#Apis mellifica. [Apis]
Few remedies cause as many ovarian symptoms as Apis. It has an active congestion of the right ovary going on to ovaritis, with soreness in the inguinal region, burning, stinging and tumefaction. Ovarian cysts in their incipiency have been arrested by this remedy; here one of the indicating features is numbness down the thigh. It has also proved useful in affections of the left ovary. Tightness of the chest may also be present, with the occurrence of a reflex cough and urging to urinate. Mercurius corrosivus. Hughes prefers this remedy in ovarian neuralgia. Peritoneal complications also indicate it.

#Belladonna. [Bell]
As this remedy is one particularly adapted to glandular growths it is especially useful in acute ovaritis, and more so if the peritoneum be involved. The pains are clutching and throbbing, worse on the right side, the slightest jar is painful, and the patient is extremely sensitive. The symptoms appear suddenly; flushed face and other Belladonna symptoms are present. Platinum. Ovaries sensitive, burning pains in them, bearing down, chronic ovarian irritation with sexual excitement. Much ovarian induration is present. Palladium. Swelling and induration of right ovary. It lacks the mental symptoms of Platinum, such as mental egotism and excitement. Aurum. Ovarian induration. Lilium. Ovarian neuralgias. Burning pains from ovary up into abdomen and down into thighs, shooting pains from left ovary across the pubes, or up to the mammary gland. Staphisagria. Very useful in ovarian irritation in nervous, irritable women. Hypochondriacal moods.

#Lachesis. [Lach]
Pain in left ovary relieved by a discharge from the uterus; can bear nothing heavy on region. Hughes and Guernsey seem to think that Lachesis acts even more prominently on the right ovary; others believe the opposite, the tendency of affections being, however, to move from the left toward the right side. Suppuration and chronic enlargements of ovary may call for Lachesis. Zincum. Boring in the left ovary relieved by the flow, somewhat better from pressure; fidgety feet. Graphites. Swelling and induration of the left ovary; also pains in the right ovarian region with delayed scanty menses. Argentum metallicum. Bruised pain in left ovary and sensation as if ovary were growing large. Naja. Violent crampy pain in left ovary. Dr. Hughes valued it in obscure ovarian pains not inflammatory in nature.

#Arsenicum. [Ars]
Burning tensive pains in the ovaries, especially in the right. Ovaritis relieved by hot applications. Patient thirsty, irritable and restless. Colocynth. Ovarian colic; griping pains, relieved by bending double; stitching pains deep in right ovarian region. It is also a useful remedy,according to Southwick, in ovaritis of left ovary with colicky pains. A dropsical condition may be present. Hamamelis. Ovaritis and ovarian neuralgia. Ludlam praises this remedy in the sub-acute form of gonorrhoeal ovaritis; it allays the pain and averts the menstrual derangement. Ovaritis after a blow. There is agonizing soreness all over the abdomen. An external application of hot extract of Hamamelis acts marvelously in subduing the distress and pain consequent to ovaritis. Iodine. Congestion or dropsy of the right ovary. Dwindling of the mammae; dull, pressing, wedge-like pain, extending from right ovary to uterus like a plug, worse during menstruation. Thuja. Left-sided ovaritis, with suspicion of veneral taint, calls for Thuja. Grumbling pains in the ovaries all the time, with mental irritability, call for Thuja. Podophyllum has a pain in the right ovary, running down the thigh of that side. Numbness may be an attending symptom.

Homeopathy treats the patient not the disease, complete symptoms of the patient(Mental and Physical) are taken into consideration to find the appropriate remedy which is the most similar to the patients symptoms. When prescribed according to the patients symptoms Homeopathic medicine are known to work very fast and without any side effects or complications of any kind and once cured there are no relapse or comebacks 100% cure. For more either post your complete symptoms or better to consult a reputable Homeopathic Practitioner for the successful treat ment of your ailment. Giving just the name of the disease or disorder is showing someone the tip of the iceberg what lays underneath is what you have to treat and cure. And that is the key to the success of Homeopathic Medicine.
for more informations about homeopathic medicines for the same or any other ovarian disease please log on to - www.homeotouch.com


Category (Women's Health)  |   Views (23013)  |  User Rating
Rate It


May07
Diagnostic Laparoscopy in Primary and Secondary Infertility
Rationale for Procedure
Laparoscopy is typically the final step of a workup for infertility and is used to avoid open surgery. Diagnostic laparoscopy can be used as an adjunct to salpingography to help diagnose causes of infertility. Lesions that may not be seen with salpingography and are viewed better with laparoscopy include endometriosis and adhesions.
Technique
The lithotomy position is employed so that cervical manipulation can be used. When cervical manipulation is not needed, standard supine positioning is used. A primary trocar site is placed in the periumbilical region, and additional trocars are placed in the right and or left lower quadrants as needed [1]. Methylene blue or other dye can be injected into the fallopian tube to check for patency. Peritoneal fluid can be obtained to check for endometriosis. Endometriosis observed should be biopsied and classified with tools such as the American Society for Reproductive Medicine Guidelines. Adhesions can be identified and classified as mild, moderate, or severe. Pathology affecting the fallopian tube can be classified as mild (a superficial vascular pattern suggesting congestion or inflammation and/or minimal kinking, and/or minimal fibrosis), moderate (salpingitis, isthmica, nodosum, distal phimosis, high degrees of vascular change, fibrosis, ampullary dilation after visualization with chromotubation), or severe (obstruction of the tube proximally or distally). Treatment of identified pathology can be initiated at this time.
Indications
• Infertility particularly after normal hysterosalpingography
Contraindications
• Inability to tolerate general anesthesia or significant pelvic adhesions that may preclude safe access or visualization
Risks
• Procedure- and anesthesia-related complications
Benefits
• Identification of the reason for infertility
• Possible therapeutic intervention
• Confirmation of lack of pathology may also be important for further treatment options
Diagnostic Accuracy of the Procedure
The diagnostic yield of the procedure for infertile women after negative hysterosalpingography has been described to range between 21 and 68% (level III) [1,2,4]. Identified pathology includes intrinsic tubal disease (3-24%), peritubal adhesions (18-43%), and endometriosis (up to 43%) [1,3-5]. The procedure has been described to have a higher yield in secondary infertility (54%) compared with primary infertility (22%) (level III) [1]. Furthermore, DL has been shown to alter treatment decisions in at least 8% of patients (level III) [2] and may lead to earlier intervention with assisted reproductive technology [4].
Procedure-related Complications and Patient Outcomes
Procedure-related complications include bowel injuries, bleeding, urologic injuries, vaginal cuff wounds, peritonitis, and pelvic pain. In a large multicenter French study (n=30,000), diagnostic and therapeutic laparoscopy were found to be associated with a 3.3 per 100.000 mortality and a 4.6 per 1,000 morbidity risk (level II) [7]. Complications requiring conversion to laparotomy occurred in 3.2 per 1,000 patients. The risk of complications was related to the complexity of surgery and the experience of the laparoscopist. One in four intraoperative complications was missed during the procedure.
After laparoscopy up to 45% of patients may become pregnant within 1 year, many without in vitro fertilization (level III) [3,4]. While bilateral tubal occlusion on laparoscopic inspection usually signifies the need for in vitro fertilization, pregnancies in patients with this pathology have been described [5].
Cost Effectiveness
There are no available data on the cost effectiveness of DL for infertility.
Limitations of the Available Literature
The quality of the available literature is limited, as all of the available studies are retrospective studies from single institutions. Furthermore, there is a paucity of data on long-term outcomes and pregnancy rates and no data on cost-effectiveness and quality of life. In addition, there is no consistency in the reporting of pregnancy success after laparoscopy, as some studies consider the use of in vitro fertilization a success and others a failure. These shortcomings limit our ability to provide firm recommendations.
Recommendations
Diagnostic laparoscopy can be used safely in female patients with infertility (grade B). Diagnostic laparoscopy may be considered in appropriately selected infertile patients even after normal hysterosalpingograms, as important pelvic pathology may be identified in a significant number of patients (grade C). The paucity of available data and the low level of evidence do not substantiate a firm recommendation for the procedure.
Bibliography
1. Hovav Y, Hornstein E, Almagor M, Yaffe C. Diagnostic laparoscopy in primary and secondary infertility. J Assist Reprod Genet. 1998;Oct;15(9):535-7.
2. Tanahatoe S, Hompes PG, Lambalk CB. Accuracy of diagnostic laparoscopy in the infertility work-up before intrauterine insemination. Fertil Steril. 2003
Feb;79(2):361-6
3. Komori S, Fukuda Y, Horiuchi I, Tanaka H, Kasumi H, Shigeta M, Tuji Y, Koyama K. Diagnostic laparoscopy in infertility: a retrospective study. J Laparoendosc Adv Surg Tech A. 2003; June;13(3):147-51.
4. Corson SL, Cheng A, Gutmann JN. Laparoscopy in the “normal” infertile patient: a question revisited. J Am Assoc Gynecol Laparosc. 2000 Aug;7(3):317-24.
5. Mol BW, Swart P, Bossuyt PM, van der Veen F. Prognostic Significance of Diagnostic Laparoscopy for Spontaneous Fertility. J Reprod Med. 1999 Feb;44(2):81-6.
6. Chapron C, Querleu D, Bruhat M, Madelenat P, Fernandez H, Pierre F, Dubuisson J. Surgical Complications of Diagnostic and Operative Gynaecological Laparoscopy. Human Reproduction. 1998 13(4):867-872.


Category (Women's Health)  |   Views (15025)  |  User Rating
Rate It


May07
Diagnostic Laparoscopy for Pelvic Pain and Endometriosis
Rationale for the Procedure
Chronic pelvic pain is typically defined as pelvic pain lasting more than 6 months and is a complex disorder with multiple etiologies. It affects many women and can severely impair their quality of life and lead to frequent visits to gynecologists. The etiology of chronic pelvic pain is frequently obscure despite the use of many diagnostic tests. Diagnostic laparoscopy is an excellent tool for direct visualization of the pelvis and may help identify the etiology of the patients’ pain. The procedure facilitates therapeutic intervention and may help ameliorate the morbidity of an open exploration.
Technique
The procedure can be employed under general anesthesia or conscious sedation. The latter approach must be used with the technique of conscious pain mapping during which the patient can respond to intraperitoneal manipulations that may identify the source of pain. Smaller trocars and lower pneumoperitoneum pressures should be used with this technique to decrease the operative pain [2,3].
The patient is placed in the lithotomy position. The initial access site is usually peri-umbilical. Additional trocars can be placed in the left lower or right lower quadrant [1]. A manipulator can be placed on the cervix and a rectal probe can be used if necessary for further retraction; these instruments are usually not used during conscious sedation.
During the procedure, identified adhesions are divided, and lesions suspected to be endometriosis should be biopsied and classified. In the absence of visible endometriosis lesions, random biopsies may demonstrate endometriosis in 30% of patients with typical symptoms. Free peritoneal fluid should be sampled and examined for the presence of endometriosis. Endometriosis lesions can then be fulgurated or removed.
Indications
• Chronic pelvic pain of unknown etiology after appropriate noninvasive workup
Contraindications
• Procedure intolerance
• Known dense pelvic adhesions that may make an accurate evaluation of pelvic pathology impossible or may impede safe abdominal access
Risks
• Procedure- or anesthesia-related complications
Benefits
• Potential identification of the source of the chronic pelvic pain
• Possibility for immediate therapeutic intervention
• Potential improvement in the patient’s quality of life
Diagnostic Accuracy of the Procedure
Diagnostic laparoscopy has been demonstrated to identify endometriosis, adhesions, or other abnormalities of the appendix and ovaries as the source of chronic pelvic pain [3].
In patients with clinical suspicion of endometriosis, DL has been shown to confirm the diagnosis in 78-84% of patients (level III) [4,6]. Random peritoneal biopsies and peritoneal fluid cytology have been shown to improve the diagnosis of endometriosis by 20% (level III) [4,8]. In addition, up to 22% of patients with findings of endometriosis during DL have had previous nondiagnostic laparoscopy (level III) [4]. The diagnosis of endometriosis is more likely when multiple complex pigmented lesions are observed during DL [1].
For pelvic inflammatory disease, the visual accuracy of DL alone was found to be 78% (sensitivity 27% and specificity 92%) (level III) [5]. In the same study, the diagnostic accuracy of the procedure was significantly higher for more experienced laparoscopists. Pain mapping identified a direct source for the pain in 80% of patients with adhesions but was inconsistent in patients with endometriosis [3].
Procedure-related Complications and Patient Outcomes
Procedure-related complications include bowel injuries, bleeding, urologic injuries, vaginal cuff wounds, peritonitis, and pelvic pain. In a large multicenter French study (n=30,000), diagnostic and therapeutic laparoscopy were found to be associated with a 3.3 per 100.000 mortality and a 4.6 per 1,000 morbidity risk (level II) [7]. Complications requiring conversion to laparotomy occurred in 3.2 per 1,000 patients. The risk of complications was related to the complexity of surgery and the experience of the laparoscopist. One in four intraoperative complications were missed during the procedure.
For laparoscopic pain mapping, under conscious sedation, one study showed 48 of 50 women had improvement (level II) [3].
Cost effectiveness
There are no available data on the cost effectiveness of DL for chronic pelvic pain.
Limitations of the Available Literature
The quality of the available literature is limited, as almost all of the available studies are retrospective studies from single institutions. Furthermore, there is a paucity of data on long-term outcomes and little data on cost-effectiveness and quality of life. These shortcomings limit our ability to provide firm recommendations.
Recommendations
Diagnostic laparoscopy can be safely applied in the diagnosis of chronic pelvic pain (grade B). The procedure may identify the etiology of chronic pelvic pain in a proportion of patients, and its diagnostic accuracy may be improved by the technique of conscious pain mapping (grade B). Nevertheless, the existing evidence does not allow firm recommendations, and further research is needed to establish the value of DL for chronic pelvic pain (grade B).
Bibliography
1. Ueki M, Saeki M, Tsurunaga T, Ueda M, Ushiroyama N, Sugimoto O. Visual Findings and Histologic Diagnosis of Pelvic Endometriosis Under Laparoscopy and Laparotomy. Int J Fertil. 1995;40(5):248-253
2. Demco L. Mapping the Source and Character of Pain due to Endometriosis by Patient-Assisted Laparoscopy. J Am Assoc Gynecol Laparosc. 1998; 5(3):241-245.
3. Almeida Jr O, Val-Gallas J. Conscious Pain Mapping. J Am Assoc Gynecol Laparosc. 1997 Nov; 4(5):587-590.
4. Wood C, Kuhn R, Tsaltas J. Laparoscopic Diagnosis of Endometriosis. Obstet Gynecol. 2002; 42:3:277.
5. Molander P, Finne P, Sjoberg J, Sellors J, Paavonen J. Observer Agreement With Laparoscopic Diagnosis of Pelvis Inflammatory Disease Using Photographs. Obstet Gynecol., 2003 May;101(5 Pt 1):875-80
6. Mettler L, Schollmeyer T, Lehmann-Willenbrock, Schuppler U, Schmutzler A, Shukla D, Zavala A, Lewin A. Accuracy of Laparoscopic Diagnosis of Endometriosisg. JSLS, 2003 Jan-Mar;7(1):15-8.
7. Chapron C, Querleu D, Bruhat M, Madelenat P, Fernandez H, Pierre F, Dubuisson J. Surgical Complications of Diagnostic and Operative Gynaecological Laparoscopy. Human Reproduction. 1998 13(4):867-872.
8. Stowell S, Wiley C, Perez-Reyes N, Powers C. Cytological Diagnosis of Peritoneal Fluids. Acta Cytol 1997; 41:817-822.


Category (Women's Health)  |   Views (15308)  |  User Rating
Rate It


May07
Public Hospitals in India Dr. Shriniwas Kashalikar
Public Hospitals
in India

Dr.
Shriniwas
Kashalikar


Since the public services and especially public health services, affect most of us, it is essential to find out the root causes of their deficiency and try to deal with them. This is one of the intellectual measures of stress management and benefits every individual concerned.

The causes of degeneration of quality of public health services in public hospitals in India; is the prevalence of the two concepts on which these institutions work. These concepts are, free medical care and economic dependence of these institutions on the government revenue and donations.

FREE MEDICAL CARE
The free medical care gives rise to parasitism, beggarly tendency, meekness and irresponsibility towards personal and public health amongst the patients.

The free medical care creates a special and extremely favorable situation and golden opportunity for the powerful, rich and famous individuals to exploit the government revenue and tax payers’ money.

The free medical care leads to zero returns and subsequent deterioration in the facilities given to patients and employees.

The free medical care associated with perpetual absence of returns leads to unjustifiably low salaries, delay in filling the vacancies, excessive working hours and duties, and delay in promotions.

This state of affairs demoralizes the sincere and dedicated employees and promotes irresponsibility, lethargy, absenteeism, corruption etc.


ECONOMIC DEPENDENCE OF THESE INSTITUTIONS ON THE GOVERNMENT REVENUE AND DONATIONS
The public hospitals are not self-sufficient and do not have any productive/commercial projects to support them. Naturally since there are no returns either from patients or from any other source, for what is spent, the public hospitals are always in loss.

This has lead to inadequate progress in terms of inadequate facilities, inadequate salaries, inadequate employment in terms of number of employees in almost every category, protracted duty hours, worsening working conditions, worsening of staying conditions for the employees and crowding of patients due to huge patients/employee ratio.

All these factors have lead to deterioration of the quality of medical care. In fact because of this a large number of lower middle class and even poor patients turn to private practitioners, consultants and hospitals.

This deterioration can be overcome by trying to make the public hospitals self-sufficient. For this, the concept of free medical care has to be replaced by more just system of payment. This would bring adequate revenue to ensure progress in terms of adequate facilities, adequate salaries, appropriate employment which could ensure normal duty hours, improvement in working conditions, improvement in staying conditions for the employees and preventing excessive and many times [because the services are free] unnecessary crowding of patients.

One may raise the objection that this is difficult to implement in case of very poor, helpless, unsupported patients.

It is very true that no sensitive and sensible individual would think of doing it as well. These patients who are in agonies, in emergencies, or helpless etc. should be made exception and a separate arrangement can be made for them. But in most other cases the problem can be overcome by making provision for payment through “services” or soft loans.

Another way to make the public hospitals self-sufficient is by buttressing them with productive / commercial projects. One can think of more innovative plans as well.

This is important because:
A] it would inculcate a sense of responsibility towards one’s own health, towards public funds, towards public services, amongst everyone including the patients.
B] it would generate the sense of accountability, satisfaction and fulfillment amongst the employees
C] It would ensure optimal progress in medical care especially in terms of holistic approach
D] It would improve the lives of patients as well as employees
E] It would make the revenue hitherto squandered on free medical care available for other developmental work thereby facilitating national progress.
F] it would reduce the corruption born of out of injustice
G] it would reduce the crowding and degeneration of private medical care.

DR. SHRINIWAS KASHALIKAR


Category (Women's Health)  |   Views (7296)  |  User Rating
Rate It


May07
Torsion of the fallopian tube in a pre menarcheal 12year old girl: A rare case report
Isolated torsion of the fallopian tube in pre menarcheal girls is very rare. However correct diagnosis and treatment are needed in order to optimize salvage of fallopian tube. While torsion of the adnexa is relatively common, isolated torsion of the fallopian tube alone, first described in 1890(Sutton, 1890) remained a rare occurrence with an incidence of 1 in 1.5million women(Hansen, 1970). It most frequently during menstruating years, but also has been reported in pre and pause menopausal women. It has also been reported in infants and pre menarcheal girls. Many etiologies for tubal torsion have been suggested including hydrosalpinx, tubal carcinoma, prior tubal ligation(Krissi et al 1997), ovarian and paraovarian masses, pregnancy, hydatid of Morgagni and peristaltic abnormalities. The condition may also occur in pregnancy, labour and pre menstrual period.
Diagnosis of this condition is often delayed because of the rarity of its occurrence and prolonged investigations to rule out more common causes of acute abdominal pain.

Case Report:
13year old Miss. X, who has not attained menarche, was referred to our centre with history of lower abdominal pain of two days duration and with an ultrasound scan report showing right ovarian cyst of 5x3cm, for diagnostic laparoscopy. She has no significant past medical and surgical illnesses. She has not attained menarche. On examination there was no pallor, vital signs were stable, has normal secondary sexual characters, systemic examination was normal. Abdominal examination revealed no palpable mass or tenderness. Transabdominal scan showed uterus to be 3.5x2.2cm, endometrium 3mm, right adnexal mass of 4.5x4cm seen, which is anechoic with fine basal echoes. Left ovary was not seen. Ultrasonic diagnosis of right ovarian cyst was made and laparoscopy was decided. At laparoscopy the peritoneum, appendix, pouch of Douglas and upper abdomen were normal. Uterus was normal looking, both ovaries normal. Right tube was twisted thrice along with a paratubal cyst of 4cm. The cystic mass appeared bluish. Untwisting of the right tube , right paratubal cystectomy done, edges reformed. Intraoperative and post operative period were uneventful. The patient was discharged was discharged the next day. HPE diagnosis was consistent with paratubal cyst(twisted).


Conclusion:
Isolated fallopian tube torsion is rare entity especially in pre menarcheal age. At first episode of torsion of fallopian tube, tubal preservation must be the rule unless the tube is totally necrotic. A timely diagnosis and surgical intervention may allow preservation of the tube.


Category (Women's Health)  |   Views (13588)  |  User Rating
Rate It


Apr30
ELECTION
In India, which is the largest democracy in the world the parliamentary elections are in offing.
Every one is possessed and charged with the elections. Some say they are useless and some say that they are the most useful; in fact sacred!
Do we really care to elect the best amongst the millions of emotions and thoughts arising every moment in our mind? Do we really try to behave in accordance with the best emotion and thought in our mind? Do we respect democracy in our life?
Whether you respect democracy or not; if you want to be democratic in your life; then there is a way!
Practice NAMSMARAN. Gradually the best of emotions and thoughts would triumph in your life and hence in public life!
This is SUPERLIVING!
You may give it a trial and verify!
Dr. Shriniwas Kashalikar


Category (Women's Health)  |   Views (8448)  |  User Rating
Rate It


Apr17
Strength Training For Women
It is important to understand that the basic principles of strength training apply as they are for both sexes. However in the case of women some specific areas need to be addressed such as pregnancy, menopause, and others that arise due to structural and physiological differences. This is where strength training concepts need due modification with these specific needs in mind. The following guidelines for assessment and exercise prescription take into consideration these specific areas for designing and implementation of effective strength programs for women of all ages and varying fitness levels.
Various kinds of Strength:

For all practical purposes Strength can be defined as: The ability of a muscle or muscle group to exert Maximum Force. However the concept of strength is not all that simple when applied to working examples. This gives rise to various specific definitions of the strength. Let’s take time to understand some of them, in order to better our understanding of the concept.

• Anaerobic Strength:
• Aerobic Strength:
• Starting Strength:
• Explosive Strength:
• Absolute Strength:
• Relative Strength:
• Linear Strength Endurance
• Non-Linear Strength Endurance

Benefits of Strength Training (with * specific to women):

1) Functional Capacity
2) Disease Prevention
3) Stress Release*
4) Body Composition*
5) Bone Health*
6) Improved Sexual Function*
7) Reduction in symptoms of Menopause*
8) Easier, safer Pregnancy*
9) Easier Child Birth*
10)Healthier Infants*
11)Faster return to Pre-Pregnancy Wt*
12)Improved Hydration Status
13)Improved Thermoregulation
14)Improved Glucose Tolerance
15)Improved HDL levels
16)Reduced Triglycerides
17)Injury Prevention
18)Improved Sports Performance
19)Improved Balance*
20)Improved overall quality of life
21)Promotes Longevity and Vitality

Assessing Strength:
1 Repetition Maximum (1 RM): is the maximum weight that one can lift for any given movement in one single effort.

The 1 RM is the standard method used for measuring strength in most fitness and performance settings. Strength measurements are restricted to certain compound movements only due to the risk of injury involved in trying to test strength levels of smaller muscles. For all practical purposes the body can be divided into four basic segments to test strength. These are:

• Muscles of the anterior shoulder girdle: or the pushing muscles. These comprise of the pectoralis group, deltoids, serratus anterior, and triceps. The standard exercise used to test these muscles is the bench press.

• Muscles of the posterior shoulder girdle: or the pulling muscles. These comprise of the lattissimus dorsi, teres major, rhomboids, trapezius, biceps, and brachialis. The standard exercise used to test these muscles is either the bent row, or the lat pulldown.

• Muscles of the trunk: these act as the stabilizers and coordinate movements between the upper and lower body. These comprise of the abdominals, obliques, erector spinae, and the quadratus group. Generally strength testing is not done for these muscles, which are involved in flexion, extension, lateral flexion, and rotation of the spine. The reason being these are small and weak muscles, thus risk for injury is extremely high.

• Locomotors: as the term suggests these are the muscles that help us move around. The main muscles in this group are the gluteus group, quadriceps, and hamstring, namely the knee and hip extensors. The standard exercise used to test these muscles is the squat or the leg press.

Testing for 1 RM:
1. After a thorough warm up, perform a couple of sets with a light weight that can allow about 15 reps or so.
2. Now increase the weight so that 8 to 10 reps can be managed.
3. Then increase weight to allow about 5 to 6 reps.
4. At this point increase 2.5 to 5 lb per effort for bench press and bent rows, and 5 to 10 lbs for leg press and squats, till 1 RM is reached.
5. Allow full recovery between attempts (2 to 2.5 min).

Note: strength testing can also be performed for simple exercises if the muscle group involved is strong enough, such as the knee curl and extension. In the case of extremely strong individuals small muscles such as the biceps and abdominals can also be tested.

Inherent Problems with Strength Testing:

Strength Testing requires a maximal effort. This greatly increases the risk of injury even for highly trained athletes. To safely test unconditioned athletes we use:

Predicted 1 RM: this method is based on the fact that most individuals can manage a certain number of repetitions with a given percentage of their personal 1 RM value for a certain lift. The approximate corresponding repetitions for various percent values of 1 RM are given in the table below:

%1RM 100% 95% 90% 85% 80% 75% 70% 65% 60%
Reps 1 2 2-3 4-5 8 10 12 14 16

Testing for Predicted 1 RM:
1) Warm up the subject thoroughly.
2) Make her perform one set of a given movement with a very light weight eith which she can manage about 20 reps fairly easily.
3) After about 2 min rest, increase the weight slightly so that she can manage about 15 reps fairly easily.
4) Now for the third set increase the weight with which you feel that she should be able to barely manage 10 to 12 reps.
5) After a two minute rest interval make the subject squeeze out as many reps as is possible. Ensure strict form and full ROM.
6) Compare the results to the table given above.
7) If the subject manages less than 10 reps that is just fine.
8) But if she does more than 15 reps, the test is not valid. Let her rest for five minutes and re-test after increasing the resistance suitably.

General Guidelines for Strength Training:
1. Address all of the body’s energy systems.
2. Use mainly structural and compound movements.
3. But at the same time use various movements.
4. Train all major muscle groups.
5. Avoid imbalances between opposing muscle groups.
6. Use high intensity and low to moderate volumes.
7. Allow enough time for recovery.
8. Provide optimum nutrition.
9. Use variation to avoid plateaus.
10. Have a progressive periodized approach for safe optimal results.

Training Intensity:

Poor Fitness Extremely light resistance (< 50% 1 RM) or
simple free-hand weight supported movements.
Low Fitness Beginners 50 to 60% of 1 RM
Regular Exercisers 70 to 80% of 1 RM ( also for Hypertrophy)
High Fitness 85 to 100% of 1 RM (also for Strength and Power)

Volume:

Poor Fitness 2 sets per movement x 10 to 20 reps x
5 to 10 movements
Low Fitness Beginners 15 to 20 reps x 8 to 12 exercises x
1 to 3 circuits
Regular Exercisers 4 to 6 sets large muscle groups +
2 to 3 sets small muscles.
Hypertrophy Beginners 10 sets, intermediate 12 to 15 sets, and
advanced 20 to 25 sets per muscle group
High fitness & Strength Beginners 4 to 6 sets, Advanced 8 to 10
sets (only compound movements)

Recuperation (Acute & Chronic):

Acute Chronic
Poor Fitness 1 min 24 hours
Low Fitness Beginners 2 to 0 min bet circuits 48 hours
Regular Exercisers 1 min to 30 sec bet sets 72 to 96 hours
Hypertrophy 1 min to 30 sec bet sets 96 hours to 1 week
High fitness & Strength 2.5 to 5 min bet sets 96 hours to 1 week

Guidelines for Pregnant Women:
1) Reduce intensity to 60 to 70% due to slack muscles and tendons.
2) Avoid supine movements.
3) Avoid abdominal strengthening and use ab/back support.
4) Avoid impact.
5) Avoid dehydration and excess temperatures.
6) Make necessary dietary modifications to suffice exercise and fetal needs.

Guidelines for osteoporosis and arthritis:
1) Make sure to get correct nutrients for bone health (refer table below).
2) Moderation is the key word for injury prevention.
3) For arthritis, reduce intensity to 50 to 60 % and fol low the 4 hour pain rule.
4) Take enough antioxidants.

This table lists all the essential nutrients for a healthy skeletal system, how much of each do you require, anti-nutrients that inhibit their uptake, and the foods that are good sources of them:

Nutrient RDA* Inhibitors Best food sources - per 100 gm serving.

Calcium Child 600 mg
Adult 800 mg Lack of exercise, tea, coffee, alcohol, lack of hydrochloric acid in the stomach, hormonal imbalance.
Milk (120 mg), yogurt (149), Swiss cheese (925), Cheddar cheese (750), almonds(234), Brewer’s yeast (234), parsley, coriander, spinach (250), corn tortillas (200).

Vitamin D
Child 10 mcg
Adult 10 mcg
Lack of sunlight, fried foods.
Herrings (22.5mcg), mackerel (17.5), salmon (12.5), oysters (3), cheese (2), eggs (1.5).

Magnesium
Child 170 mg
Adult 300 mg
Large amts of Calcium from milk products, proteins, fats, oxalates, phytates.
Wheat germ (490 mg), almonds (270), cashew nuts (267), brewer’s yeast (231), buck wheat flour (229), peanuts (225), cooked beans (37), Garlic (36), raisins, green peas (35).
Phosphorus
Child 800 mg
Adult 800 mg
Too much iron, magnesium, aluminum.
Present in almost all foods.

Vitamin C
Child 35 mg
Adult 40 mg
Smoking, alcohol, pollution, stress, fried food, tea, coffee.
Peppers (100 mg), watercress (60),
Cabbage (60), broccoli (110), cauliflower (60), strawberries (60), lemons (80), kiwi fruit (85), oranges (50), tomatoes (60).

Zinc
Child 7 mg
Adult 15 mg
High calcium uptake, low protein uptake, copper, alcohol, excess sugar, phytates, oxalates.
Oysters (148 mg), ginger root (6.8), lamb (5.3), dry split peas (4.2), egg yolk (3.5), peanuts (3.2), almonds (3.1), whole wheat (3.2 mg)

What is the “Q” angle?

The “Q” angle is the angle at which the femur tapers inwards in females, due to broader pelvis. Over time weak muscles and chronic valgus stress can cause the knees to bend inward, causing severe pain and injury to the joint. It can be prevented through correct strength training at an early age.

Program Design & Periodization:

The benefits of a periodized program are:
1) Ensure steady progress.
2) Safety and injury prevention.
3) Avoid Chronic fatigue, chronic injury and burnout.
4) Provide variation and make training interesting.
5) Facilitate Adherence.
6) Successful achievement of long term goals.


Category (Women's Health)  |   Views (18845)  |  User Rating
Rate It


Browse Archive