Knee Replacement Implant Materials:

The replacement knee joint is comprised of a flat metal plate and stem implanted in your tibia, a polyethylene bearing surface and a contoured metal implant fit around the end of the femur. The use of components made from metals and polyethylene allow for optimum articulation (or joint mobility) between the joint surfaces with little wear. Because the knee implant has a flatter bearing, wear is less of a problem than in a hip implant which has a very deep bearing.

Materials which can be used in knee implants are:

Stainless Steel

Due to limited ability to withstand corrosion in the human body in the long term, stainless steel is not often used in knee replacement implants. It is more suited to being used as temporary implants such as fracture plates and screws.
Cobalt-chromium Alloys

Cobalt-chromium alloys are hard, tough, corrosion resistant, bio-compatible metals. Along with titanium, cobalt chrome is one of the most widely used metals in knee implants. There is no consensus as to which material is better and more suitable.

Although the percentage of patients having allergic reactions related to the use of cobalt-chromium alloys to is very low, one area of concern is the issue of tiny particles (metal ions) that may be released into the body as a result of joint movement. These particles can sometimes cause reactions in the human body, especially in case of those patients who have allergy to special metals like nickel.
Titanium and Titanium Alloys

Pure titanium is generally used in implants where high strength is not necessary. For example, pure titanium is sometimes used to create fiber metal, a layer of metal fibers bonded to the surface of an implant which allows bone to grow into the implant or allows cement to better bond to the implant for stronger fixation.

Titanium alloys are bio-compatible in nature. They commonly contain amounts of vanadium and aluminum in addition to titanium. The most used titanium alloy in knee implants is Ti6Al4V. Titanium and titanium alloys have great corrosion resistance, making them inert biomaterial (which means they will not change after being implanted in the body).

Titanium and its alloys have a lower density compared to other metals used in knee implants. Additionally, the elastic nature of titanium and titanium alloys is lower than that of the other metals used in knee implants. Because of this, the titanium implant acts more like the natural joint, and as a result, the risk of some complications like bone resorption and atrophy are reduced.

Uncemented implants

Knee implants may be “cemented” or “cementless” depending on the type of fixation used to hold the implant in place. The majority of knee replacements are generally cemented into place. There are also implants designed to attach directly to the bone without the use of cement.

These cementless designs rely on bone growth into the surface of the implant for fixation. Most implant surfaces are textured or coated so that the new bone actually grows into the surface of the implant.

For this, surface of the titanium is modified by coating the implant with hydroxyapatite, a bioactive surfacing agent that will ultimately bond as the bone grows into it.
Tantalum

Tantalum is a type of pure metal, which has excellent biological and physical properties, namely flexibility, corrosion resistant, and biocompatibility. Recently, a new porous substance has been made of tantalum named Trabecular Metal. It contains pores, the size of which makes this material very good for bone in-growth. In addition, Trabecular Metal has an elastic nature which aids bone remodeling.
Polyethylene

The tibial and patellar components in knee replacements are made of polyethylene. Though standard polyethylene surfaces traditionally suffered from wear in hip implants, wear is less of a problem in knee implants as the bearing surfaces are flatter and do not result in the same kind of wear. The use of Ultra Highly Cross Linked PolyEthylene (UHXLPE) or Ultra High Molecular Weight PolyEthylene (UHMWPE) reduces even the minimal wear enabling the knee implants to last for a much longer time.
Zirconium

Zirconium alloy and all plastic tibial component:

Zirconium alloy is used in a new ceramic knee implant. The zirconium alloy is combined with an all-plastic tibial component, replacing the metal tray and plastic insert used in other knee replacements. It is believed that this new knee could last for 20-25 years, substantially more than the 15-20 years that cobalt chromium alloy and polyethylene implants are effective. The new combination can be lubricated, which results in a smoother and easier articulation through plastic.

Another important characteristic of this material is that it is biocompatible, meaning that people who have nickel allergies and cannot have knee implants made of cobalt chromium alloy (because nickel is an ingredient of cobalt chromium alloy). Zirconium alloy implants eliminate the risk to nickel-allergic patients because this new material contains no nickel.

Hair Care Tips For Healthy And Beautiful Hair
All said and done, the hair forms an important part of our appearance. We are biologically programmed to view this as a marker in finding suitable partners as it is an important indicator of a person’s youth, health and beauty. With a perfect hairstyle that matches your face shape and figure, you can you can make an individual style statement. But the point is that you can experiment with your looks and locks only if you have thick and luscious hair! Long hair can be called beautiful only if you pay adequate attention to it. There is definitely hard work involved, but the results could astonish you! In addition to being fun and trendy, the hair serves a valuable biological purpose i.e. it keeps your head warm and helps regulate body temperature. Read below to know more about tips to maintain healthy and beautiful hair, some ideas about the myths and facts about hair and how to handle hair breakage.

Hair Myths And Facts

Hair Facts:

A combination of hormones and genetic factors are responsible for hair loss in both males and females. A typical scalp contains 100,000 to 150,000 hair follicles before any serious cases of hair loss.
Blondes have the greatest number of scalp follicles followed by brunettes. Redheads are said to have the fewest number of hair follicles!
The hair is the fastest growing tissue in the body, second only to bone marrow. It is normal to lose approximately 100 hairs per day from the scalp.
Your hair turns gray because pigment cells known as melanin become dysfunctional. The hair bulb usually degrades in production, with increasing age or stress.
When your hair is wet, you can increase its length by up to 30% and it will still return to normal length after it has dried. But, if you try this too often then it can damage the hair shafts too.

Hair Myths:

Washing your hair too much can cause hair loss. The only way this is possible is if you conduct this operation vigorously.
Cutting your hair makes it stronger and it tends to grow faster. Let’s bust this myth with one question – how?!
Split ends can be repaired. This is a myth that needs to be broken because split ends cannot be mended and should be trimmed off immediately.
Dandruff causes you to lose hair. This is a very common belief amongst women.
Hair loss does not affect young people. Although most statistics show that older men tend to lose their hair, it can also be possible with teenagers and adults too.
Lack of sex causes hair to thin. Untrue!
Pluck one gray hair and two grow back. When you pluck gray hair out, there is a chance you’re looking for more and hence see more!

How To Handle Hair Breakage And Loss

After a hair wash, try not to use a comb directly on the hair. Make it a point to run your fingers through your hair and ensure that it is not subjected to any jerks.
Make sure that you let your hair free once in a while. Tying your hair back in a ponytail or wearing a hat all the time will only add to stress on the hair follicles which results in hair breakage or hair loss.
Minimize the use of hair dryer. Try not using it directly over the scalp instead use it only on the hair. Again, do not use it on freshly washed locks. You could replace this by draining off the water with the help of a thick towel. Let your hair be semi-dry before you use the hair dryer again.
Use a high quality shampoo and conditioner that is designed for dry and fragile hair. Perform weekly deep conditioning treatments. Wear a swimming cap when you enter a pool to avoid exposing your hair to chlorine.
Wash your hair only once or twice a week. The more you wash your hair, the more it gets stripped of oil and it further dries up.

How To Enjoy Hair Care

Long or short, consult an expert who can suggest different looks. It is truly enjoyable to experiment with various hairstyles.
Learn to handle your hair length. This way you will give it more attention. There are many books and videos which can help you learn the basics of braiding.
There are certain remedies to help you take care of your problems such as dandruff, baldness etc. Adhere to the tips in case of hair loss problems, hair implant procedures, general hair care tips, hair coloring and hair styling and braids.

Hair care is an integral part of daily living. Thus, take care of your hair the way it should be done!

Hair Care Tips And Ayurveda
An individual with beautiful hair often makes a lasting impression. Don’t you think? Thick luscious hair and a fine hairstyle can infact make any average-looking face look ravishing. But, it all comes at a price- the price of paying heed! This article gives you the right tips to get glossy

Anti Aging Cosmetic Surgery Options:

Age is one factor which worries all and surely even you think the same, so, this article will help you with all the information on how you can reverse the signs of ageing. Along with age, many problems such as wrinkles, scars, loose skin and many other unwelcome things come on your way making you worried and tensed. In the present beauty conscious world, nobody wants to look aged and dull. That is why everyone strives hard to maintain the perfect figure and a healthy skin. But age is one factor which can never be hidden without the help proper care and maintenance. But, nowadays, help is at hand, with the progress of science and technology, nothing is impossible, thus, if you are ready, all your age and beauty related problems can be cured by anti-aging cosmetic surgery. So, now you know how to get that youthful appearance. Know more on various anti-aging surgeries by following the writing below.

Skin Resurfacing, Peeling And Lifts:

Anti aging Laser Skin Resurfacing:

Laser resurfacing is a method to give individuals, magically softened, healthier looking skin by smoothing the wrinkles and removing scars and other blemishes. It is a relatively new technology, which is proving to be less abrasive to the skin than traditional treatments. Noticeably, the results of laser resurfacing are immediate, especially when used to remove fine to moderate wrinkles.

Chemical Peel:

Chemical peel, also called derma peeling or chemexfoliation, is one of the techniques to make you look younger. This technique makes a person look years younger by removing and softening wrinkles and blemishes caused by over exposure to the sun. Depending on the degree of wrinkling, a light, medium or deep peel may be recommended. Although chemical peel is most commonly used on face, the treatment can also be used to improve the skin on legs, neck and hands.

Neck, Forehead And Eyelid Lift:

Forehead Lift:

A forehead lift is performed in conjunction with a facelift to achieve a more harmonious and complete facial enhancement. A forehead lift is also appropriate for the treatment of certain inherited traits. Young people, who have a low brow or who already have deep frown lines due to stress or over activity of the forehead muscles, can benefit from this procedure. A forehead lift can improve rigidity of the skin. Another facelifting procedure, ‘endoscopic facelift’ is the medical name for an improved plastic surgical technique that provides facial enhancement with minimal scars. This technique allows faster healing, and results in fewer side effects than traditional techniques.

Eyelids lift:

After the face, it is the eyelids that show signs of aging. Blepharoplasty or eyelid cosmetic surgery can return youthful elegance to an individual’s face, making the eyes appear brighter and more refreshed. Browpexy is another procedure used to lift the brow without surgery. Some individuals experience an accumulation of fat in the lower eyelids, creating persistent bags under the eyes. These bags, however, are not always related to aging. This tendency may be inherited and may appear in early life before the aging process becomes noticeable. In other individuals, the skin of the upper eyelids may become lax and impart a hooded appearance to the upper eyelids and, in severe instances, even obscure vision. These can be corrected with eyelid cosmetic surgery.

Face lift:

Compared to any other parts of your body, it is the face which shows the sign of ageing very prominently. So, when you think of anti-ageing surgery, face lift or rhytidectomy can be your best bet. This surgery removes the loose skin from your face, thereby, making you look fresh and younger.

Neck lift:

Neck is also another region in the body where the age factors like wrinkles and dark spots can be seen prominently. In most cases, patients are asked to undergo only neck lift rather than the entire facelift. The neck lift can be considered as a part of the facelift, as the surgery takes place behind the ear and down into the neck. This procedure tightens the neck skin, upward behind the ears.

General Foot Conditions And Treatment
As our feet are spent in closed footwear all day long, bacteria and fungi tend to thrive and survive. Occurrence of any microbial infection causes dehydration, redness, blisters, itching and peeling of the skin. If these are not treated properly then there is a chance of a relapsed infectivity. Some of the tips that you could follow are to maintain your feet, especially the area between your toes, dirt free and to keep them dry so as to avoid any sort of contamination. There are 26 bones, 33 joints and more than 100 muscles in the foot that require attending to! These are responsible for keeping you mobile and active throughout the day. Read the following article for an insight on tips to cure foot diseases, burning foot cures and foot care for diabetics.

Tips To Cure Foot Problems

Avoid residing in footwear such as boots, high heels and cleats. Wear shoes that make room for movement around the toe area. Shoes that confine your feet prevent proper blood flow properly and can lead to foot problems such as calluses and improper balance.
Give your feet a daily massage and watch how they serve you after that! Excessive walking can cause knots or can even strained tendons on the feet. For this reason, massaging the soles of your feet will help in increasing circulation.
Place your feet in warm water to help alleviate any pain or swellings that can be caused by bunions. Wear a protective covering, which can be purchased at a drug store, to pad the area and reduce inflammation.
Keep your feet hydrated (with cream/oil and not water) and skin moist to cure any sort of cracks. Massage foot oil onto the soles and heels of your feet every day.
Remember to wash your feet daily and scrub between the toes to cure any itching and fungal infection to prevent athlete’s foot. If the infection is chronic, visit a doctor and get a prescribed topical antifungal medication.

Burning Feet Cures

Burning feet are a sign of a serious health condition such as peripheral neuropathy. Peripheral neuropathy is the damage to nerves on your feet. If you suspect this condition, a health-care provider will screen you for diseases like diabetes and nerve damages. Closely follow your doctor’s advice.
Another way to cure burning feet is to use shoes and socks that are adequately ventilated. Synthetic shoes are not as well aired as the ones made from genuine leather. Socks that are made from nylon do not allow the skin to breathe; shift to materials such as cotton or linen.

Foot Care For Diabetes

Check your feet and toes every day by carefully looking at the top, sides, soles, heels and toes. Wash them in lukewarm water with mild soap as use of strong detergents may damage your skin.
Test the temperature of the water with your fingers or elbows before putting your feet in warm or hot water. This is because as a diabetic, you may not be able to sense if the water is too hot and burns can easily occur
Make sure that you gently and thoroughly dry your feet, particularly areas between your toes as infections are prone to develop in moist areas.
Your feet may also crack causing rough heels and possibly even sores. After bathing your feet, soften the dry skin with lotion, petroleum jelly, lanolin or oil.
Wear comfortable, well-fitting shoes that have plenty of room. Never buy shoes with the notion that it will stretch over time. Nerve damage is sure to kill the sensation on your feet! If you are diabetic, you may need special shoes that are custom-made for you. At this point, do not opt for footwear with pointed or open toes, high heels, flip-flops or sandals.

Make it a point to take medication for your feet whenever required. Pamper them as you might be extremely dependent on them in the years to come!

Eyelid Surgery Tips:
Belpharoplasty, medical term for eyelid surgery, is a blessing in disguise for those who are born with droopy eyelids and sagging eye lines. This surgical modification of the eyelid not only makes your eyes look attractive but also adds a fresh new dimension to your personality. The increasing stress and work pressure, along with improper diet and incomplete sleep, can cause wrinkles and puffiness around the eyes making you look older than your actual age. Eyelid surgery, which can be done along with other facial surgeries, can help correct flabby eyelids. Generally, belpharoplasty is conducted after the patient is a given local anesthesia or put under sedation. In this surgical procedure, the price generally depends on various factors such as age, health risks, and location of the place. The surgery can take anywhere from two to four hours to complete. Scroll down the article to know more on how to prepare for an eyelid surgery and tips for recovery from eyelid surgery.

How To Prepare For Eyelid Surgery

Before undergoing eyelid surgery, visit the surgeon’s office for a series of tests, usually performed to evaluate your eyesight and capability to produce tears. Also, give a copy of your previous eye exam records to your plastic surgeon to give him/her a fair idea. During the consultation, don’t hesitate to ask questions and clear all your doubts related to the surgical procedure.
The doctor will not only tell about the operation in detail but will also give tell you what all preparation you need to do for the eyelid surgery, the kind of medications you should take post surgery, after-care, foods to avoid, etc. Those who smoke are generally advised to kick the habit weeks before the surgery, as smoking tends to slow the process of healing.
It’s worthwhile to make prior arrangements when it comes to accommodation and staying over. If you don’t want to rely on your immediate friends or relatives, then you can directly approach your surgeon’s office and ask for post-surgery nursing services, which are usually offered at a reasonable price.

Tips For Recovery From Eyelid Surgery

Post surgery, it’s necessary to take plenty of rest and not do any kind of strenuous work like washing clothes, cleaning, etc, especially, for the first few days. Though you may watch television and read books for some time, overdoing it may increase swelling and blur your vision.
Make sure that friends or family members are always there around you, so that they can help you during any emergency or when you need their assistance. For the first three days, avoid bending over and or indulging in physical activities that can strain you.
If you feel irritation in the eyes, you can apply lubricating drops or cold / warm compresses. Take a clean cloth and dip it in cold or warm water and then apply it on your eyes. Doing this several times a day will not only reduce swelling and bruising but also relax your eyes.
The surgeon will usually prescribe ointments or creams to be applied on the eye lids and the surrounding areas. Apply the ointments with a clean finger, during the initial. Wash your hands properly before and after the application.
Women should avoid wearing any kind of heavy make-up during the first ten days.
Patience is an important weapon you must possess if you want to banish post-surgery problems like swelling, bruising, and redness among others. Sometimes, patients may face a little bleeding, which is completely normal and disappears within a couple of weeks.

Hepatitis A

Key facts:

Hepatitis A is a viral liver disease that can cause mild to severe illness.
The hepatitis A virus is transmitted through ingestion of contaminated food and water or through direct contact with an infectious person.
Almost everyone recovers fully from hepatitis A, but very small proportions die from fulminant hepatitis.
Hepatitis A infection risk is associated with a lack of safe water and poor sanitation.
Epidemics can be explosive and cause significant economic loss.
Improved sanitation and the hepatitis A vaccine are the most effective ways to combat the disease.

Hepatitis A is a liver disease caused by the hepatitis A virus. The virus is primarily spread when an uninfected (and unvaccinated) person ingests food or water that is contaminated with the faces of an infected person. The disease is closely associated with unsafe water, inadequate sanitation and poor personal hygiene.

Unlike hepatitis B and C, hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and fulminant hepatitis (acute liver failure), which is associated with high mortality.

Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic recurrences. The hepatitis A virus is one of the most frequent causes of foodborne infection. Epidemics related to contaminated food or water can erupt explosively, such as the epidemic in Shanghai in 1988 that affected about 300 000 people1. Hepatitis A viruses persist in the environment and can withstand food-production processes routinely used to inactivate and/or control bacterial pathogens.

The disease can lead to significant economic and social consequences in communities. It can take weeks or months for people recovering from the illness to return to work, school or daily life. The impact on food establishments identified with the virus, and local productivity in general, can be substantial.
Geographical distribution

Geographical distribution areas can be characterized as having high, intermediate or low levels of hepatitis A infection.
Areas with high levels of infection

In developing countries with very poor sanitary conditions and hygienic practices, most children (90%) have been infected with the hepatitis A virus before the age of 10 years2. Those infected in childhood do not experience any noticeable symptoms. Epidemics are uncommon because older children and adults are generally immune. Symptomatic disease rates in these areas are low and outbreaks are rare.
Areas with intermediate levels of infection

In developing countries, countries with transitional economies and regions where sanitary conditions are variable, children often escape infection in early childhood. Ironically, these improved economic and sanitary conditions may lead to a higher susceptibility in older age groups and higher disease rates, as infections occur in adolescents and adults, and large outbreaks can occur.
Areas with low levels of infection

In developed countries with good sanitary and hygienic conditions, infection rates are low. Disease may occur among adolescents and adults in high-risk groups, such as injecting-drug users, men who have sex with men, people travelling to areas of high endemicity, and in isolated populations, such as closed religious communities.
Transmission

The hepatitis A virus is transmitted primarily by the faecal-oral route; that is when an uninfected person ingests food or water that has been contaminated with the faeces of an infected person. Waterborne outbreaks, though infrequent, are usually associated with sewage-contaminated or inadequately treated water.

The virus can also be transmitted through close physical contact with an infectious person, although casual contact among people does not spread the virus.
Symptoms

The incubation period of hepatitis A is usually 14–28 days.

Symptoms of hepatitis A range from mild to severe, and can include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-coloured urine and jaundice (a yellowing of the skin and whites of the eyes). Not everyone who is infected will have all of the symptoms.

Adults have signs and symptoms of illness more often than children, and the severity of disease and mortality increases in older age groups. Infected children under 6 years of age do not usually experience noticeable symptoms, and only 10% develop jaundice. Among older children and adults, infection usually causes more severe symptoms, with jaundice occurring in more than 70% of cases.
Who is at risk?

Anyone who has not been vaccinated or previously infected can contract hepatitis A. In areas where the virus is widespread (high endemicity), most hepatitis A infections occur during early childhood. Risk factors include:

poor sanitation;
lack of safe water;
injecting drugs;
living in a household with an infected person;
being a sexual partner of someone with acute hepatitis A infection; and
travelling to areas of high endemicity without being immunized.

Diagnosis

Cases of hepatitis A are not clinically distinguishable from other types of acute viral hepatitis. Specific diagnosis is made by the detection of HAV-specific IgM and IgG antibodies in the blood. Additional tests include reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA, but may require specialised laboratory facilities.
Treatment

There is no specific treatment for hepatitis A. Recovery from symptoms following infection may be slow and may take several weeks or months. Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.
Prevention

Improved sanitation, food safety and immunization are the most effective ways to combat hepatitis A.

The spread of hepatitis A can be reduced by:

adequate supplies of safe drinking water;
proper disposal of sewage within communities; and
personal hygiene practices such as regular hand-washing with safe water.

Several hepatitis A vaccines are available internationally. All are similar in terms of how well they protect people from the virus and their side-effects. No vaccine is licensed for children younger than 1 year of age.

Nearly 100% of people develop protective levels of antibodies to the virus within 1 month after a single dose of the vaccine. Even after exposure to the virus, a single dose of the vaccine within 2 weeks of contact with the virus has protective effects. Still, manufacturers recommend two vaccine doses to ensure a longer-term protection of about 5 to 8 years after vaccination.

Millions of people have been immunized worldwide with no serious adverse events. The vaccine can be given as part of regular childhood immunizations programmes and also with other vaccines for travelers.
Immunization efforts

Vaccination against hepatitis A should be part of a comprehensive plan for the prevention and control of viral hepatitis. Planning for large-scale immunization programmes should involve careful economic evaluations and consider alternative or additional prevention methods, such as improved sanitation, and health education for improved hygiene practices.

Whether or not to include the vaccine in routine childhood immunizations depends on the local context. The proportion of susceptible people in the population and the level of exposure to the virus should be considered. Several countries, including Argentina, China, Israel, Turkey, and the United States of America have introduced the vaccine in routine childhood immunizations.

While the 2 dose regimen of inactivated hepatitis A vaccine is used in many countries, other countries may consider inclusion of a single-dose inactivated hepatitis A vaccine in their immunization schedules. Some countries also recommend the vaccine for people at increased risk of hepatitis A, including:

travellers to countries where the virus is endemic;
men who have sex with men; and
people with chronic liver disease (because of their increased risk of serious complications if they acquire hepatitis A infection).

Regarding immunization for outbreak response, recommendations for hepatitis A vaccination should also be site-specific. The feasibility of rapidly implementing a widespread immunization campaign needs to be included.

Vaccination to control community-wide outbreaks is most successful in small communities, when the campaign is started early and when high coverage of multiple age groups is achieved. Vaccination efforts should be supplemented by health education to improve sanitation, hygiene practices and food safety.
WHO response

WHO is working in the following areas to prevent and control viral hepatitis:

raising awareness, promoting partnerships and mobilizing resources;
formulating evidence-based policy and data for action;
preventing transmission; and
executing screening, care and treatment.

WHO also organizes World Hepatitis Day on July 28 every year to increase awareness and understanding of viral hepatitis.

What is Dengue?

Dengue is a mosquito-borne infectious disease caused by the dengue virus, which is mainly found in the tropical regions. The disease may produce such body pains as one feels when his/ her bones break; it is hence known as Dengue fever, or ‘Breakbone’ fever.

The major symptoms of dengue include fever, headache, muscle and joint pain and a typical skin rash that occurs all over the body, similar to measles. Rarely dengue may develop into a more life threatening form known as dengue hemorrhagic fever, which results in bleeding, decreased blood platelet count or thrombocytopenia, blood plasma leakage or the more fatal dengue shock syndrome, which causes dangerously low blood pressure.

Dengue and Dengue fever
How is it Caused and Spread?
Dengue is a serious infection especially among children; about two-fifths of the world’s population is at risk. Dengue and dengue haemorrhagic fever are spread from human-to-human by the bite of mosquitoes carrying the dengue virus. The dengue virus belongs to a group known as Flavivirus and can be typically divided into four viral serotypes, DEN-1, DEN-2, DEN-3, and DEN-4, which are closely related but differ in their antigens. Many species of mosquito under the genus Aedes transmit dengue; especially the Aedes aegypti species is involved in spreading the infection and is considered as the main cause of dengue. This species of mosquito breeds in stagnant water and usually bites during daylight hours. The virus circulates in the blood for 2-7 days after the human is affected, during which the mosquito may acquire the virus by biting the infected human and spread it to another unsuspecting victim.

The symptoms typically develop anywhere between 2 to 4 days from the time of the mosquito bite and may last up to a week. The dengue virus doesn’t have any detrimental effect on the mosquito, that carries it, and the mosquito remains infected for life. Dengue is rarely spread through person-to-person contact. Usually the disease is spread when a mosquito bites an infected person and becomes a carrier of the dengue virus. The mosquito then bites another healthy person and thus spreads the disease causing a possible epidemic breakout. A person infected with a single type of dengue virus serotype out of the four, develops resistant to that particular virus. However, they become much more susceptible to infection by other three serotypes.

Dengue Infection Cycle
Complications Involved with Dengue
Dengue causes the dengue fever, which sometimes may develop into more dangerous forms such as dengue hemorrhagic fever or dengue shock syndrome, which may lead to the development of life-threatening symptoms. Some of the complications caused due to the disease are:

Severe dehydration

Continuous bleeding

Low platelets, due to which clotting of blood doesn’t occur

Blood pressure may go dangerously low

Enlargement of liver and damage to it

Bradycardia (heart beating less than 60 counts per minute)

Damage to brain due to bleeding, seizures or encephalitis

Damage to the immune system

Diagnosis of Dengue
Diagnosis of dengue is considered when fever is accompanied by severe body pain. It is important to be evaluated when a person develops fever within two weeks of being in the tropics or sub-tropics. Dengue often causes symptoms that are similar to other diseases such as flu, measles, and typhoid fever etc. Hence investigations are always performed to exclude other disease conditions. Usually the blood of the patient is tested for the presence of antibodies and virus. Diagnosis of dengue infection can be done by the following methods:

Isolating the virus by collecting serum sample from patients within 5 days of appearance of symptoms

Detection of specific antibodies can be done by collecting serum within 6 days after onset of symptoms. The serum is tested for specific anti-dengue antibodies by Enzyme-linked Immunosorbent assay (ELISA). Titres of IgM and IgG antibodies increase four-fold in serum sample

Using Polymerase Chain Reaction (PCR) for detecting viral genomic sequence from Serum or Cerebro Spinal Fluid (CSF) samples collected from the patient, which is more expensive and complicated

Polymerase Chain Reaction (PCR)

In the case of more serious complications such as dengue hemorrhagic fever, the following diagnosis must be performed:

A tourniquet test is to be conducted, where a tourniquet is tied to the arm and if blood blotches tend to appear beyond the tourniquet, the patient may be suffering from increased bleeding, which may indicate Dengue Hemorrhagic Fever

Decreased in platelet count also known as Thrombocytopenia occurs when platelets are found to be 100 000 cells or less and this may be due to disease condition

Increase in hematocrit i.e., the volume percentage of Red Blood Cells (RBS), by 20% should be a caution as it occurs due to rise in the vascular permeability of the plasma. Signs of plasma leakage appears as increased fluid accumulation in the chest and abdominal cavity known as pleural effusion or ascites respectively

Treatment for Dengue:

There are actually no known antiviral drugs or injections available for the cure of dengue. However, the disease can be treated with plenty of supportive care and treatment that would eventually help save the patient’s life. Dengue is characterized by fever and intense body ache. The fever can be treated with antipyretic drugs such as paracetamol and the body ache can be treated with analgesics that help relieve the pain. Drugs such as aspirin and ibuprofen should be avoided as they may increase the risk of hemorrhage. The patient can also be treated with natural home remedies such as papaya leaves, kiwi and other food items that have been proven to help in the increase of platelet count, which gets affected during dengue.

In the case of more severe forms of dengue, such as dengue hemorrhagic disease or dengue shock syndrome, it a must for the patient to be admitted to a hospital and given proper care. The mortality rate of a dengue patient without hospitalisation increases about 50 percent. Treatments such as intra-venous fluid replacements should be administered to these patients to prevent shock. Patients should drink plenty of fluids, as dehydration is prevalent among those affected with Dengue. Vaccines for all of the serotypes are being developed, which will be the most effective way to cure the disease.
Prevention of Dengue
As there are no injections or vaccines available to cure dengue, prevention by following certain basic steps will be the most effective way to fight against the dreadful disease. Some of the ways to prevent the onset of dengue are stated as follows:

It is better to avoid stagnant water in flowerpots, buckets, barrels etc., in and around the house, as these are the favorite places for mosquitoes to lay eggs. Water should be stored in closed containers

Bleaching powder may be used in water sources that are not meant for drinking, as it prevents the development of mosquito eggs

The female mosquito feeds on blood as it requires the blood protein to produce eggs, hence it is better to use mosquito repellents, even when indoors

It is advised to reside in a well screened or air conditioned house. If not, mosquito nets may be attached to the windows

Usage of long-sleeved shirts, boots, socks and long pants is advised when outdoors

It is healthier to avoid being outdoors during dawn, dusk or early evenings when mosquitoes tend to roam around in the open

Mosquitoes are attracted to dark colored clothing hence it is better to wear bright and light colored clothes

Avoid strong perfumes, as mosquitoes are drawn towards strong body odours

Pediatric Onco Surgery:

Surgery in children with cancer has a major role in same tumors like Wilms Tumor, Neuroblastoma, Bone Tumor, Soft Tissue Sarcoma, Gonadal Malignancies, Brain Tumor etc and it has a supportive role in Leukemias and Lymphomas where mainstay of treatment is Chemotherapy. All surgical procedures are performed by surgeons who are specifically trained in the field of Pediatric Oncosurgery. Pediatric Cancers are potentially curable and in the modern era. The focus is to formulate treatment plans with minimum complication and suffering. Pediatric Oncosurgery plays a major role in decreasing the morbidities of cancer treatment.

Initially the treatment of long bone tumors was amputation of the limb but now most of the tumors can be resected without sacrificing limb especially if tumor is detected in early stage. We want to cure, but not by performing mutilating surgery. This is made possible by multimodality approach and working in close association with Pediatric Oncologist, Orthopedic Surgeons and Radiation Therapist.

While treating a pediatric cancer patient a lot of stress is laid down on maintaining the reproductive abilities of these patients. Pelvic tumor like PNET, Rhabdmyosarcomas which require Radiation Therapy to pelvis, may impair the ovarian functions and minimally invasive surgery can be undertaken, to move the ovaries out of the radiation field and thereby saving the ovaries from radiation.

Most of the pediatric patients are afraid of needle sticks. We deal with this problem by placement of central vascular access devices like PICC line, Hickman Line and Portacath. These devices make the oncology treatment acceptable and to a great extent painless. All the blood sampling can be done through these devices and all the IV medications can be given through these devices.

We work as a team throughout the treatment. Whenever the patient goes to operation theatre, an experienced Anesthesiologist provides Anesthesia to the patient. One of the parents is allowed to come with the patient to Operation Theatre, after wearing OT clothes. This process alleviated the anxiety of the patient to a great extent.

Category based treatment of tuberculosis in children:

Abstract:

Childhood tuberculosis is treated with multiple regimens for different clinical manifestations. World Health Organization has suggested a category-based treatment of tuberculosis that focuses on adult type of illness. To include children as DOTS beneficiaries, there is a need to assess the feasibility of classification and treatment of various types of childhood tuberculosis in different categories.

METHODS:

The study was conducted in the Pediatric Tuberculosis (TB) Clinic of a tertiary care hospital in North India. All children registered in the TB clinic were classified in four categories, similar to the categorization in World Health Organization’s guidelines for treatment of tuberculosis in adults. All children with freshly diagnosed serious form of tuberculosis were included in category I. Category II included patients who had treatment failure, had interrupted treatment, relapse cases and those who were suspected to have drug resistant tuberculosis. Patients with primary pulmonary complex (PPC), single lymph node tuberculosis, minimal pleural effusion and isolated skin tuberculosis were included in category III. Category IV included patients who did not improve or deteriorated despite administration of 5 drugs (as per Category II) for at least 2 months.
RESULTS:

A total of 459 patients were started on antituberculosis drugs and were available for analysis. Pulmonary tuberculosis was the commonest followed by lymph node tuberculosis. Identification of AFB was possible only in 52 (11 percent) of the patients and was more commonly seen in lymph node tuberculosis. The mean age of the children was 93 months and sex distribution was almost equal. 323 patients were in category I, 12 in category II, 120 in category III and 4 in category IV. 365 (80 percent) children completed the treatment. Of these, 302 (82.7 percent) were cured with the primary regimen assigned to them in the beginning, 54 (14.8 percent) required extension of treatment for 3 months and 9 (2.5 percent) patients required change in the treatment regimen. Side effect in form of hepatotoxicity was observed in 12 (2.6 percent) patients and was significantly more in patients who were getting category IV treatment.
CONCLUSION:

It is feasible to classify and manage various types of tuberculosis in children in different categories similar to WHO guidelines for adult tuberculosis.

Glaucoma :

Glaucoma is a group of eye diseases in which the normal fluid pressure inside the eyes slowly rises, leading to damage to the eye’s optic nerve resulting in vision loss or even blindness.

What causes Glaucoma?

At the front of the eye, there is a small space called the anterior chamber. Clear fluid flows in and out of the chamber to bathe and nourish nearby tissues. In Glaucoma, for still unknown reasons, the fluid drains too slowly out of the eye. As the fluid builds up, the pressure inside the eye rises. Unless this pressure is controlled, it may cause damage to the optic nerve and other parts of the eye and loss of vision.

How is it detected?

To detect Glaucoma the following tests are done:

Tonometry: This standard test determines the fluid pressure inside the eye. There are many types of Tonometry. One type is the “air puff,” test, which measures the resistance of the eye to a puff of air.

Visual Field: This test measures your side (peripheral) vision. It helps your doctor to find out if you have lost side vision, a sign of Glaucoma.

Pupil dilation: This examination provides your doctor with a better view of the optic nerve to check for signs of damage. To do this, drops are placed in the eye to dilate (widen) the pupil.

Optical Coherence Tomography: This is a newer diagnosis imaging technique which does high resolution cross sectional or tomographic imaging of biological tissues and hence helps in the early detection of glaucomatous optic nerve damage

SYMPTOMS:

Most types of Glaucoma cause no symptoms. Vision stays normal, and there is no pain. If Glaucoma remains untreated, people may notice that although they see things clearly in front of them, they miss objects to the side and out of the corner of their eye. Without treatment, people with Glaucoma may find that they suddenly have no side vision. It seems as though they are looking through tunnel. Over time, the remaining forward vision may decrease until there is no vision left. Some forms however cause pain, redness, vomiting, decrease in vision and colored rings around bulbs.

Treatments:

Patients benefit from our state-of-the-art Glaucoma testing capabilities and specially trained Glaucoma staff who have expertise in the diagnosis and the medical and surgical management of primary, secondary and complicated Glaucoma.

Although Glaucoma cannot be cured, it can usually be controlled. The loss of vision that already exists cannot be recovered. This makes early diagnosis and treatment important to protect vision.

Glaucoma treatments include:

Medications: These may be either in the form of eye drops or pills. For most people with Glaucoma, regular use of medications will control the increased fluid pressure. But, these drugs may stop working overtime. Or they may cause side effects. If a problem occurs, your doctor may select other drugs, change the dose, or suggest other ways to deal with the problem.

Laser Surgery: During laser surgery, a strong beam of light is focused on the part of the interior chamber where the fluid leaves the eye. This results in a series of small changes, which makes it easier for fluid to exist the eye. Overtime, the effect of laser surgery may wear off. Patients who have this form of surgery may need to keep taking Glaucoma drugs.

Surgery: Surgery can also help fluid escape from the eye and thereby reduce the pressure. However, surgery is usually reserved for patients whose pressure cannot be controlled with eye drops, pills or laser surgery.

FAQs:

Who is most likely to get it?

Glaucoma is one of the leading causes of blindness in India. Although anyone can get Glaucoma, some people are at higher risk. They include:

People over age of 45: While Glaucoma can develop in younger patients, it occurs more frequently as we get older.

People who have a family history of Glaucoma: Glaucoma appears to ‘run’ in families. The tendency for developing Glaucoma may be inherited. However, just because someone in your family has Glaucoma does not mean that you will necessarily develop the disease.

People with abnormally high intraocular pressure (IOP): High IOP is the most important risk factor for Glaucomatous damage.

People who have Diabetes, Myopia, Regular, long-term Steroid/Cortisone use and a previous eye injury.

Article by

Sankara Eye care.