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Amputation

Amputation is the surgical removal of all or part of a limb or extremity such as an arm, leg, foot, hand, toe, or finger.Reasons for Amputation

There are many reasons an amputation may be necessary. The most common is poor circulation because of damage or narrowing of the arteries, called peripheral arterial disease. Adequate blood flow is not supplied, the body’s cells cannot get oxygen and nutrients they need from the bloodstream. As a result, the affected cells begins to die and infection may set in.Image result for amputation

Other causes for amputation may include:

  • Severe injury (from a vehicle accident or serious burn, for example)
  • Cancerous tumour in the bone or muscle of the limb
  • Serious infection that does not get better with antibiotic other treatment
  • Thickening of nerve tissue, called a neuron

The Amputation Procedure

An amputation usually requires a hospital stay of five to 14 days or more, depending on the surgery and complications. The procedure itself may vary, depending on the limb or extremity being amputated and the patient’s general health.

Amputation may be done under general anaesthesia (meaning the patient is asleep) or with spinal anaesthesia, which numbs the body from the waist down.

When performing an amputation, the surgeon removes all damaged tissue while leaving as much healthy tissue as possible.

Sleeve Gastrectomy

Sleeve gastrectomy, also called a vertical sleeve gastrectomy, is a surgical weight-loss procedure. This procedure is typically performed laparoscopically, which involves inserting small instruments through multiple small incisions in the upper abdomen. During sleeve gastrectomy, about 80 percent of the stomach is removed, a tube-shaped stomach about the size and shape of a banana.

Limiting the size of your stomach restricts the amount of food you are able to consume. In addition, the procedure triggers the hormonal changes that assist with weight loss. The same hormonal changes also help relieve conditions  being overweight, such as high blood pressure or heart disease.

Why it’s done

Sleeve gastrectomy is done to help you lose excess weight and reduce your risk of potentially life-threatening weight-related health problems, including:

  • Gastroesophageal reflux disease
  • Heart disease
  • High blood pressure
  • High cholesterol
  • Obstructive sleep apnea
  • Type 2 diabetes
  • Stroke
  • Infertility

Sleeve gastrectomy is typically done only after you’ve tried to lose weight by improving your diet and exercise habits.

In general, sleeve gastrectomy surgery could be an option for you if:

  • Your body mass index (BMI) is 40 or higher (extreme obesity).
  • Your BMI is 35 to 39.9 (obesity), and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea. In some cases, you may qualify for certain types of weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems.

You must also be willing to make permanent changes to lead a healthier lifestyle. You may be required to participate in long-term follow-up plans that include monitoring your nutrition, your lifestyle and behaviour, and your medical conditions.

As with any major surgery, sleeve gastrectomy poses potential health risks, both in the short term and long term. Risks associated with the sleeve gastrectomy can include:

  • Excessive bleeding
  • Infection
  • Adverse reactions to anaesthesia
  • Blood clots
  • Lung or breathing problems
  • Leaks from the cut edge of the stomach

Longer term risks and complications of sleeve gastrectomy surgery can include:

  • Gastrointestinal obstruction
  • Hernias
  • Gastrointestinal reflux
  • Low blood sugar (hypoglycemia)
  • Malnutrition
  • Vomiting

Very rarely, complications of sleeve gastrectomy can be fatal.

 

Food and medications

Before your surgery, give your doctor a list of all medicines, vitamins, minerals, and herbal or dietary supplements you take. You may have restrictions on eating and drinking and which medications you can take.

If you take blood-thinning medications, talk with your doctor before your surgery. Because these medications affect clotting and bleeding, your blood-thinning medication routine may need to be changed.

If you have diabetes, talk with the doctor who manages your insulin or other diabetes medications for specific instructions on taking or adjusting them after surgery.

Other precautions

You’ll be required to start a physical activity program.

You’ll be required to stop any tobacco use 12 weeks before surgery and may be tested for nicotine prior to your surgery.

You may also need to prepare by planning ahead for your recovery after surgery. For instance, arrange for help at home if you think you’ll need it. People who have a sleeve gastrectomy are typically off work for four weeks.

Results

Sleeve gastrectomy can provide long-term weight loss. The amount of weight you lose depends on your change in lifestyle habits. It is possible to lose approximately 60 percent, or even more, of your excess weight within two years.

In addition to weight loss, sleeve gastrectomy may improve or resolve conditions related to being overweight, including:

  • Heart disease
  • High blood pressure
  • High cholesterol
  • Obstructive sleep apnea
  • Type 2 diabetes
  • Stroke
  • Infertility

Sleeve gastrectomy surgery can also improve your ability to perform routine daily activities, and can help improve your quality of life.

Anemia

Anemia is a very common blood disorder wherein the body lacks healthy red blood cells or hemoglobin. This condition leads to insufficient supply of oxygen to body tissues. It affects all age groups  and pre school children are at a higher risk of this disorder. It can be temporary or long term. The treatments for anemia vary depending on the severity of the condition. There are different types of anemia described. Though symptoms of all types of anemia are mostly the same, some types of anemia have specific symptoms as well.

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SYMPTOMS

  • Lack of energy, feeling f tired and weak
  • feeling of fatigue
  • headache and chest pain
  • paleness of skin
  • fast and irregular heart beat.
  • Dizziness
  • Cold hands and feet
  • Shortness of breath

 CAUSES

A person can be anemic due to various reasons. It can occur due to decreased production of red blood cells, blood loss, destruction of red blood cells etc. The cases of anemia are specific to the types of anemia.

TYPES AND TREATMENTS

  • Iron deficiency anemia:  Iron molecules are associated with hemoglobin that carries oxygen to body tissues through blood. Lack of iron caused due to blood loss , heavy menstrual bleeding, ulcer, cancer etc leads to lack of hemoglobin production. This type is  very common in pregnant women without iron supplementation. The treatment includes iron supplementation.
  • Vitamin deficiency anemia:  Apart from iron body requires folate and vit B-12 for the production of healthy red blood cells..Therefore lack of this vitamin can lead to vitamin deficiency anemia.It is also called pernicious anemia. The symptoms include irritability, diarrhea, and a smooth tongue. Treatments include dietary supplements and B-12 shots
  • Aplastic anemia: It occurs when the body doesn’t produce enough red blood cells. It is caused by infections, certain medicines, autoimmune diseases and exposure to toxic chemicals.  The specific symptoms include fever, frequent infections, and skin rashes. The treatment includes blood transfusions or bone marrow transplantation.
  • Anemia of chronic disease: Diseases  such as cancer, HIV/AIDS, rheumatoid arthritis, kidney disease, Crohn’s disease and other chronic inflammatory diseases  can decrease the production of red blood cells.
  • Anemia associated with bone marrow disease: Blood production in the bone marrow is affected by diseases such as leukemia and myelofibrosis. It can cause anemia.
  • Hemolytic anemias: It occurs when red blood cells are destroyed faster than bone marrow can replace them.  The symptoms include jaundice, dark colored urine, fever, and abdominal pains.
  • Sickle cell anemia: This is an inherited hemolytic anemia. It’s caused by a defective form of hemoglobin that forces red blood cells to assume an abnormal sickle shape. These irregular blood cells die prematurely, resulting in a chronic shortage of red blood cells.  Thesymptoms include painful swelling of the feet and hands, fatigue, and jaundice. Treatment includes oxygen therapy, pain relief, and intravenous fluids. There may also be antibiotics, folic acid supplements, and blood transfusions.

 

Kidney stone

Kidneys are the excretory organs in humans which remove fluid waste from the blood  as urine. Lack of fluid amount added to the accumulation of certain mineral crystals leads to sticking together of clumps of wastes to form the kidney stone. It is also called renal calculi.Usually men are at more risk than women. It is usually accompanied by severe pain while urinating.

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The major risk factors for  the occurrence of  kidney stone are

  • Reduced intake of water
  • Following a diet rich in protein, sodium and/or sugar.
  • Obese nature of the body.
  • Weak and unhealthy kidney.
  • High levels of cystine, oxalate, uric acid or calcium in urine.
  • Swelling or irritation in bowel or joints.
  • Certain medications
  • A family history of kidney stone.

In severe cases kidney stones are accompanied with complications like severe pain while urinating, pain in back or lower abdomen, blood in the urine and nausea and vomiting.Other symptoms of kidney stones include  pus in the urine, reduced amount of urine excreted, burning sensation while urinating, frequent urge to urinate,  fever and chills if there is an infection. It can also lead to other kidney complications like Chronic kidney disease.

To prevent kidney stone is to follow a healthy diet with plenty of water and adequate  consumption of calcium. Limiting sodium and animal protein (meat, eggs) in the diet may also help to prevent kidney stones. However any changes in the diet should be made only with the advice of the doctor. Intake of basil, celery, apples, grapes and pomegranates protect the kidneys from kidney stones.

The treatment for kidney stones is carried out by rehydrating the patient via an intravenous (IV) tube, and administration of an anti-inflammatory medication. Since passing of the stone is accompaned by severe pain narcotics are used to relieve the pain. Lithotripsy  is a treatment that breaks the kidney stone into smaller pieces and allow it to pass.

 

Urinary Tract Infection

Urinary Tract Infections (UTI) is characterised by a burning sensation while urinating. It is caused by microbes that can overcome the body’s defenses in urinary tract.It affects the kidneys, ureters and the bladder. Though it affect both men and women of all ages groups, mostly women have the risk of developing a lifetime risk of this infection.The chances of recurrent experiences are also higher in women. UTIs are caused by

  1. Escherichia coli (E. coli), usually found in the digestive system.
  2. Chlamydia and mycoplasma which can infect the urethra and not the bladder.

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The factors that increase the chances of a UTI are sexual intercourse, diabetes,  poor personal hygiene, having a urinary catheter ,bowel incontinence ,blocked flow of urine ,kidney stones,  contraception, pregnancy, menopause, suppressed immune system, use of spermicides and tampons, heavy use of antibiotics, which can disrupt the natural flora of the bowel and urinary tract.

SYMPTOMS

  1. Pain or a burning sensation when urinating.
  2. Strong and frequent urge to urinate
  3. Cloudy, bloody, or strong-smelling urine
  4.  Nausea and vomiting
  5.  Abdominal pains

PREVENTION

1.Drink lots of water and urinate frequently.
2.Reduce alcohol and caffeine that can irritate the bladder.
3.Urinate shortly after sex.
4.Wipe from front to back after urinating and bowel movement.
4.Keep the genital area clean.
5. Use sanitary pads or menstrual cups instead of tampons.
6.Avoid use of diaphragm or spermicide for birth control.
7. Wear cotton underwear and loose-fitting clothing to keep the area around the urethra dry.

Leg amputation

Leg amputation is the surgical removal of legs either above or below the knee. This surgery is carried out as a result of poor blood circulation because of damage or narrowing of the arteries. As a result the blood cells in these region get deprived of oxygen and nutrients which in turn lead to infection and necrosis of the tissues.

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Amputation is also carried out due to injuries from accidents and burns, infections which are incurable with antibiotics,blood clots, cancerous tumor at the region, diabetes and nerve thickening and to prevent the disease from spreading farther into the body. The purpose of the surgery is to restore one’s ability to function and improving total health.

The procedure for amputation is done under general anesthesia  or with spinal anesthesia.

 TYPES

  1. Above the knee amputation: lt is also called a trans femoral amputation. Here the amputation occurs at the middle part of the thigh bone. After this type of amputation knee joint will not be present. Here walking with a prosthesis post surgery will be difficult.
  2. Below knee amputation: It also known as a trans tibial amputation and is the most common type. Here the knee joint will be present and walking with a prosthesis is more comfortable.
  3. Hemipelvic amputation: Here the hip-joint and part of the pelvis is amputated. It also known as a trans pelvic amputation. It is mostly done in case of a malignant tumor at the region. Here walking with a prosthesisis difficult
  4. Toe amputation: Here the toe is amputated due to poor supply of blood to the toe.
  5. Partial foot amputation: Here the toes and part of the long bones of the foot are amputated. This is also known as a trans metatarsal amputation.
  6. Disarticulation: Here amputation occurs through a joint. It helps to preserve the growth plate in the bone in a child.

Blood pressure

Blood pressure is the measurement of the pressure of the blood in the artery. A high or low blood pressure is a symptom of an underlying medical condition. Blood pressure has a normal range which is 120/80 mm Hg. The highest value of normal range is reached when the  heart muscle contracts and pumps blood, a cycle called systole.The lowest value of normal range is reached when the  the heart relaxes and refills with blood, a cycle called diastole. Based on the circumstances the blood pressure of a person may vary. Blood pressure above 140/90 mm Hg is considered as high.  A high blood pressure can put your arteries , muscles and heart at risk. It can also affect eyes kidneys and legs .It can also end up in stroke and heart attacks. The blood pressure of a person do not remain constant throughout the day. It fluctuates depending on the work done, the amount of fluid in the body , medicines in the blood stream and time of the day. It also varies with emotions sleep and exercise.

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The blood pressure is measure using a sphygmomanometer. It uses the height of a column of mercury to reflect the circulating pressure and is measured in millimetres of mercury. Today full automated digital blood pressure monitors are also available which makes it easier to check the BP at home without the help of a doctor or medical practitioner.

A high blood preassure is also called hypertension. There are many factors that contribute to hypertension. They are being overweight, reduced or lack of  physical activity, consumption of alcohol, smoking old age and stress. Family history of high blood pressure is also generally a factor for hypertension. An undiagnosed and untreated hypertension can lead to  coronary heart disease (CHD). Hypertension can be prevented or reduced by following a healthy lifestyle. Choices like regular exercise, balanced diet with reduced salt and fat, eating  plenty of vegetables and fruits, quitting smoking and alcohol consumption and maintaining a healthy weight  etc can help cntrol high blood pressure.

 

 

Tuberculosis (TB)

Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can also damage other parts of the body.

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TB spreads through the air when a person with TB of the lungs or throat coughs, sneezes, or talks. If you have been exposed, you should go to your doctor for tests. You are more likely to get TB if you have a weak immune system.

Symptoms of TB in the lungs may include

  • A bad cough that lasts 3 weeks or longer
  • Weight loss
  • Loss of appetite
  • Coughing up blood or mucus
  • Weakness or fatigue
  • Fever
  • Night sweats

Skin tests, blood tests, x-rays, and other tests can tell if you have TB. If not treated properly, TB can be deadly. You can usually cure active TB by taking several medicines for a long period of time.

Treatment

Given the many effective medications available today, the chances are great that a person with TB can be cured. It is important, however, for the person to understand the disease and to cooperate fully in the therapy program.

Both latent TB infection and active TB disease are treated with antibiotics. Treatment lasts at least six months because antibiotics work only when the bacteria are actively dividing, and the bacteria that cause TB grow very slowly. While latent TB infection can be treated with only one antibiotic, active TB disease is treated with several antibiotics at one time, to decrease the chances that the bacteria will evolve resistance to the drugs. Active TB disease must be treated aggressively, and patients may have to start treatment with a hospital stay to keep them from spreading the disease. After a few weeks, they will feel better and will no longer be infectious.

The biggest danger in TB treatment is that the patient will not take antibiotics on schedule. This gives the bacteria the opportunity to develop resistance to the drugs, rebound, and become much more difficult to treat. Therefore, it is crucial to take all of your drugs as instructed. Most treatment programs require that a health care professional watch you take every dose.

Your doctor may monitor you during treatment with blood tests to check your liver, sputum tests to see if the bacteria are susceptible to the antibiotics you are taking, and chest X-rays to look for signs of disease.

Extrapulmonary TB is active TB disease in any part of the body other than the lungs (for example, the kidney, spine, brain, or lymph nodes). Treatment for extrapulmonary disease is basically the same as for TB in the lungs except that TB involving the brain or bones is treated longer.

NICU

NICU is a special unit in a hospital where ill and premature newborn are often admitted to. NICU stands for Neonatal Intensive Care Unit. Here the babies are provided with around the clock care by a team of specially trained experts. NICU is known in many names like a special care nursery, an intensive care nursery or a newborn intensive care nursery.

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The different medical equipments at NICU are
● Incubators: These are small beds enclosed by transparent hard plastic. It provides controlled temperature for the baby inside. It has side holes through which babies are nursed by the caregivers.
● Infant warmers: These are open beds with heaters over them to help babies stay warm
while being monitored.
● Photo-therapy: It treats babies with jaundice by lying them on special light therapy blankets.
● Monitors: They are used to keep track of the baby’s temperature, heart rate, and breathing etc. It includes
1.Chest heads : Painless stickers on baby’s chest that connects to monitors to track the heart
rate and monitor the number of breathing.
2.Pulse oximetry (or pulse ox): This machine is used to measure baby’s blood oxygen levels. It is connected to baby’s fingers or toes and it emits a soft red light.
3.Temperature probe : It records baby’s temperature and displays it on the monitor.
4.An arterial lining or blood pressure cuff is used to measure baby’s blood pressure.
5.Feeding tubes: These are used to feed the babies with formula milk or breast milk.
6.IVs: These are thin bendable tubes used to drip the baby with medicine and fluids through the baby’s veins.
7.Ventilators: These provide extra breathing assistance for the baby as and when required.
8.Oxygen hood or nasal cannula: These provides extra oxygen for babies who are in need of it.
Babies who require NICU are

● Premature babies born before 37 weeks of pregnancy.
● Babies who have low birth weight (less than 2500 g or more than 4000 g
● Babies who have a medical condition that requires special care.
● Twins, triplets, and other multiple babies
● Babies born with heart problems, infections, or birth defects
● Babies who requires blood transfusion treatments.
● If the baby’s first stool(meconium) passed during pregnancy into the amniotic fluid.
● Breech delivery presentation during delivery.
● Too little or too much amniotic fluid during fetal stage.
● Babies whose mother have Diabetes and hypertension.

NICU usually have specially trained team of medical professionals including neonatologists,
pediatricians, lactation consultants, respiratory therapists, dietitians etc.

SCOLIOSIS

Scoliosis is a “S ”  or “C” shaped curve of the spine that mostly occurs during the growth spurt just before puberty. Though the actual cause is unknown scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy.  In severe cases it  can lead to reduced amount of space within the chest, making it difficult for the lungs to function properly and thus interfere with breathing . In some cases, the degree of curve remains stable, while in others, it increases over time. A person with scoliosis may have an uneven shoulder or waist, a shoulder blade that appears prominent than the other, one leg being longer than the other etc. This curves can be structural curves or non structural curves.  In structural scoliosis, the curve of the spine can’t be reversed as it is rigid where as in the case of non structural type ,though the spine looks curved it functions normally. Scoliosis can cause complications like heart and lung damage making it difficult to breath, chronic back pains and noticeable changes in appearances.

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 TREATMENT

In mild cases scoliosis won’t require surgery. In case of mild scoliosis , braces are recommended.  In severe cases surgery may be suggested  to prevent it from getting worse.

  1. Braces:  They are plastic made close fitting invisible tighteners worn under the dress to prevent further progression of the curve. A brace won’t cure scoliosis or reverse the curve. It can be removed as and when required.
  2. Surgery: The surgery  for scoliosis involves the spinal fusion wherein  patient will be examined by an anesthesiologist, to manage the pain both during and after the operation prior to the surgery.  A thin flexible tube (epidural catheter) may be inserted in the back at the conclusion of the operation to help control pain. Pre operation procedures also involves collection of blood samples to examine the blood count of the patient.The surgery takes  five to six hours of time depending on the patient. During the surgery
  •  An incision is made in the middle of the back.
  • The spine is exposed by moving the muscles to side.
  • The joints between the vertebrae are removed to loosen them up. The new bone produced when the vertebrae  get roughened eventually bridges the gaps between the vertebrae and makes them fuse together.
  • Metal rods are used to hold the spine in place until fusion happens  which are attached to the spine by screws, hooks, and/or wires.

A bone graft is used to stimulate bone healing  which helps to increase bone production and the vertebrae heal together into a solid bone. A bone graft is either taken from the patients hip or from a donor through bone bank. The possible complications of the surgery are bleeding, infection, nerve injury etc.

 

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