HEALTH & FITNESS

Antibiotics: alarming misuse
Dr J.D. Wig

All over the world more than 50 per cent of all medicines are prescribed, dispensed or sold inappropriately, while 50 per cent of the patients fail to take them correctly. Antibiotics are among the most frequently prescribed medicines and over 50 per cent may be unnecessary. These drugs are administered in keeping with the recommendations for rational therapy in only 10 per cent cases. The main reason is that it still takes two days to identify the bacteria responsible for infections.

Rotator cuff injury needs early attention
Dr Ravinder Chadha

Rotator cuff injury occurs due to a fall in a sports event as a result of repetitive movement and high-velocity overhead motion (throwing). The symptoms are:

Health Notes
Double dose of anti-clotting drug halves heart attack, death risk
WASHINGTON: A pre-treatment with double-dose of an anti-clotting drug just before percutaneous coronary intervention (PCI) may halve the combined risk of heart attack and cardiac death, according to a new collaborative study.

Homoeopathy & you
Back pain? It could be spondylitis
Dr Vikas Sharma
As the symptoms of ankylosing spondylitis (As) — low back pain worse in the morning or after periods of rest — is similar to that of an ordinary back pain, it is often (by mistake) thought to be a simple back problem. Although the symptoms are similar, AS is not a simple back pain. It is a kind of arthritis that affects the vertebrae of the spine and the pelvis bone.

 

 

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Antibiotics: alarming misuse
Dr J.D. Wig

All over the world more than 50 per cent of all medicines are prescribed, dispensed or sold inappropriately, while 50 per cent of the patients fail to take them correctly. Antibiotics are among the most frequently prescribed medicines and over 50 per cent may be unnecessary. These drugs are administered in keeping with the recommendations for rational therapy in only 10 per cent cases. The main reason is that it still takes two days to identify the bacteria responsible for infections.

Anti-infective agents have made a huge impact on humankind in the face of relentless attack from micro-organisms. Antibiotics cure diseases by killing bacteria. It is important to realise that antiobiotics only treat bacterial infections and are useless against viral or fungal infections.

The factors kept in view while using an antibiotic include the likely cause of infections, medication cost, dosing schedule and common side-effects. Laboratory support, special techniques and cultures also help to determine antibiotic sensitivity. Only a clinician can choose the best antibiotic for individual need. Lack of rapid tests to identify microbes results in imprecise diagnosis, inappropriate therapy, overuse of antibiotics, development of drug resistance and high health care costs. Newer techniques may revolutionise the clinical practice and give tools in the near future to better control infections.

It is important to take antibiotics correctly. Taking antibiotics incorrectly may affect their absorption, reducing or eliminating their effectiveness. The entire course of antibiotics needs to be taken even if the patient feels better before the full course. If the drug is stopped in the midcourse, the bacteria may not be completely killed; they may grow resistant to the antibiotic. This can lead to a serious problem if these resistant bacteria grow enough to cause a reinfection. Antibiotics should not be overused or over-prescribed; avoided in viral or fungal infections.

An inadequate and delayed antibiotic therapy increases the mortality chances in critically ill persons. The period from the beginning of an infection to the administration of antibiotics is a critical factor to reduce mortality in sepsis treatment. An ideal antimicrobial agent should cover the infection — inducing pathogens, minimising the development of resistant strains and being available at reasonable costs. Currently, the established empiric antibiotic strategies for patients with sepsis include single-and-multiple-agent regimens.

Anti-infective agents have made a huge impact on mankind in the face of relentless attack from micro-organisms. However, such beneficial effects are counter-balanced by rampart irrational use. Antibiotic resistance is one of the most important culprits of antibiotic treatment and one of the foremost concerns in modern medicine. The existence of antibiotic resistant bacteria creates the danger of life-threatening infections that do not respond to antibiotics.

Newer antibiotics are being developed which have broad activity, once daily dosing, simplified administration, low resistance and excellent clinical efficacy. Antimicrobial resistance is a serious problem world-wide. This increase is occurring in the face of dearth of new antibiotics for use and even fewer for treating resistance species. The growing challenge of resistance and the paucity of novel antibiotics underscore the importance of developing novel therapeutic agents. Bacterial cell-to-cell signalling constitutes a novel drug target. Quorum-sensing blockade is a strategy for enhancing host defences against bacterial pathogens.

Strategies for minimising antimicrobial resistance include the following:

  • Prudent and appropriate use of antimicrobials.
  • Avoiding therapeutic failure by considering pharmacokinetic and pharmacodynamic factors when selecting an antibiotic.
  • Sufficient dose and an appropriate administration interval to ensure that antibiotic concentration at the site of infection is high enough to kill or inhibit the growth of the pathogen.
  • Implementation of infection control practices to prevent or stem the outbreaks of infection caused by resistant micro-organisms.
  • Public education initiatives about appropriate use of antibiotics and to be used only if needed, and to limit their overuse.

A national organisation for the rational use of antimicrobial agents and surveillance of resistance needs to be initiated.

The writer is Professor and Head Department of General Surgery, PGI, Chandigarh.

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Rotator cuff injury needs early attention
Dr Ravinder Chadha

Rotator cuff injury occurs due to a fall in a sports event as a result of repetitive movement and high-velocity overhead motion (throwing). The symptoms are:

lPain (night pain) at the anterior, the lateral aspect of the shoulder. The patient complains of pain while lifting the arms overhead; sometimes he/she gets up from the sleep and does not feel as strong as before.

  • Weakness.
  • Limitation of active motion, especially overhead activities.
  • MRI examination confirms the tear, its size, etc.
  • Non-operative management is often effective for the treatment of rotator cuff injuries; a supervised programme of physical therapy is the mainstay.
  • Avoid overloading of the rotator cuff muscles too rapidly, increase the workload to less than 10 per cent per week.

Treatment at an acute stage:

  • Rest from aggravating activities.
  • Anti-inflammatory medication/ ICE
  • Electrotherapies — TENS/ ultrasound.
  • Local massage — digital ischaemic pressure.
  • Injection of corticosteroid

Rehabilitation: The main aim of rehabilitation is to re-establish the full range of motion of the shoulder joint, improve muscle strength, etc.

Acute phase:

  • Wall walking.
  • Pendulum exercises
  • Passive joint/scapular mobilisation/manipulation relieves pain and increases the range of motion.

Second phase:

Rope and pulley exercises.

Isometric exercises against a wall.

Scapular stabilisation exercises — Scapular punch, scapular elevation/retraction against a wall and on a table.

  • Push-ups — Knee push-up/wall push-up.
  • Posterior capsule stretching, i.e. by moving the hand towards the opposite shoulder and pressing backwards through the elbow.
  • Isolated rotator cuff exercises with weights
  • Side-lying external/internal rotation.
  • Rowing (with a stretch band)

Forearm/biceps/ deltoid (up to 90 degree)

  • Stretch band — external/ internal rotation — elbow at a side, full internal rotation and 30 deg.

Closed chain strengthening exercises:

Walk on the arms while the trunk is supported by a Swiss ball or a low stool

  • Ball exercises (throwing & catching a ball against a wall with a bend arm)
  • The throwing technique should be evaluated by the coach and appropriate changes should be integrated into the rehabilitation programme.

Whenever the symptom of a shoulder injury is noticed, early evaluation and treatment can prevent mild inflammation from becoming a rotator cuff tear.

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Health Notes
Double dose of anti-clotting drug halves heart attack, death risk

WASHINGTON: A pre-treatment with double-dose of an anti-clotting drug just before percutaneous coronary intervention (PCI) may halve the combined risk of heart attack and cardiac death, according to a new collaborative study.

University of Turin researchers say that during the study, the administration of at least 600-mg of clopidogrel before stenting, rather than the standard 300-mg dose, halved the risk of major complications associated with blood clotting, or thrombosis.

The researchers also said that the higher dose did not increase the risk of serious bleeding.

“This research has important clinical and cost implications. The goal of antithrombotic management for PCI is to maximise protection from thrombotic complications during and shortly after PCI, while minimising bleeding and costs,” said Dr Giuseppe G. Biondi-Zoccai, Assistant Professor of Cardiology. — ANI

3-D model of cancer-preventing enzyme

WASHINGTON: Scientists at the University of Missouri (MU) have created a three-dimensional model of cancer- preventing enzyme Proline dehydrogenase to study how the protein works.

It is well known that Prolien dehydrogenase plays a very significant role in apoptosis, the process of cell death, by enabling the creation of a highly reactive electron-rich oxygen species called superoxide.

Professor John J. Tanner and doctoral student Tommi A. White say that their model has revealed the process by which proline dehydrogenase creates superoxides. They say that for the purpose, the protein “opens up to allow oxygen to ‘steal’ electrons”.

As the human form of proline dehydrogenase is difficult to work with, the scientists studied it from the bacteria Thermus thermophilus. They involved bioinformatics and biochemical studies in their project so as to ensure that the enzyme is functionally similar to its human version. — ANI

Health & happiness among midlife women

WASHINGTON: According to a new study by University of Florida, whether a woman has children or not seems less critical than other important factors that shape her life, including education, work and earnings, and relationships with family and friends.

Lead author and a UF sociology professor, Tanya Koropeckyj-Cox, whose study of nearly 6,000 women between the ages of 51 and 61, found that being in good health and having a husband or partner gave the biggest boost to older women’s psychological 
well-being.

“Contrary to warnings we hear about being lonely if you don’t have children, our study finds that childless women and mothers generally report similar levels of psychological well-being in their 50s,” said Koropeckyj-Cox. — ANI

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Homoeopathy & you
Back pain? It could be spondylitis
Dr Vikas Sharma

As the symptoms of ankylosing spondylitis (As) — low back pain worse in the morning or after periods of rest — is similar to that of an ordinary back pain, it is often (by mistake) thought to be a simple back problem. Although the symptoms are similar, AS is not a simple back pain. It is a kind of arthritis that affects the vertebrae of the spine and the pelvis bone.

Usually low back pain and stiffness, which get worse during the morning or night time or after periods of rest, are typical symptoms of this disease. Pain in the hip and the cervical area is also common. Loss of flexibility in the lower spine is an early sign of AS. Homeopathy provides an excellent solution for controlling this disease. In the initial stages, it can completely cure the disease.

AS affects mainly the vertebrae and the joints between the spine and the pelvis (which is also called as the sacroiliac joint). It leads to inflammation where tendons and ligaments are attached to the joint. This ultimately results in new bony material being formed in the joint, causing the joints to fuse with each other. There is severe or complete loss of mobility of the joint.

AS is usually a progressive disorder and can slowly involve the hip joint and the complete spine. It can also involve other areas in the body.

Symptoms include morning stiffness lasting more than 30 minutes, which becomes better after exercise or movement. One symptom that differentiates AS-related pain from that of any other back problem is the stiffness and pain during the second half of the night. With time and as the disease worsens, back pain progresses up the spine and affects the rib cage.

Chest expansion can become restricted with the involvement of the vertebral joints of the upper spine, including the cervical area. The best way to diagnose ankylosing spondylitis is a simple x-ray of the sacroiliac joint.

As it is an autoimmune disorder, homoeopathy can provide an excellent solution in controlling its progression. It can be of great help in the initial stages where inflammation in the joints has not progressed to the stage of fusion of the joints. At this stage, the disease can be completely controlled and the changes can be reversed.

In stages beyond this when new bone formation has occurred in the joints (where the fusion has taken place) further progression of the disease can be controlled and symptomatic relief can be given. Fusion of the joints cannot be reversed back. Homeopathy works by optimising our immune system. It gradually desensitises the overactive immune system, thereby stopping the progression of ankylosing spondylitis.

The writers is a Chandigarh-based homoeopath.

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