HEALTH & FITNESS

Hernia in children: don’t avoid surgery
Dr Nandini K Bedi
T
HERE are a few misconceptions regarding medical problems in children which can be easily removed through surgery. These myths, if not cleared, can lead to a delay in therapy and this can be detrimental to the health of the child. Inguinal hernia is the commonest surgical problem seen in the paediatric age group. About 1-3 per cent of children have a hernia.

Homoeopathy & you
Autism — your child’s behaviour tells a lot
Dr Vikas Sharma
Autism is a disorder that begins in early childhood (typically during the first three years of life). It affects the child’s communication skills and social interactions, and causes restricted, repetitive and stereotyped patterns of behaviour in varying degrees. It can range from severe to a very milder form. The actual cause for autism is not clear.

eYESIGHT
Femtosecond in ophthalmology
Dr Mahipal Sachdev
F
OR many patients, the biggest fear for any surgery remains “the fear of the blade”. Laser offers a blade-free treatment and minimises mechanical contact with the tissue. There are various lasers already in use in ophthalmology. These are used for diabetic retinopathy, glaucoma, after cataract and various other conditions of the eye.

Health Notes
Boffins map new areas of chicken brains
Sydney: Australian researchers have compiled the atlas for the brain of a chicken, showing 11 different units of the Rhombomeres area of the brain. Professor George Paxinos of the University of New South Wales and Professor Charles Watson from Curtin University of Technology have mapped more than 100 new areas.





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Hernia in children: don’t avoid surgery
Dr Nandini K Bedi

THERE are a few misconceptions regarding medical problems in children which can be easily removed through surgery. These myths, if not cleared, can lead to a delay in therapy and this can be detrimental to the health of the child.

Inguinal hernia is the commonest surgical problem seen in the paediatric age group. About 1-3 per cent of children have a hernia. It is higher in infants born prematurely. It is present at the time of birth, even though it may or may not be noticed immediately. It can be identified as an intermittent lump or bulge or swelling which comes and goes from time to time in the groin region on either side of the midline above the scrotum in boys and the labia in girls. A hernia literally means the pushing out of the abdominal contents through a defect in the abdominal wall or musculature.

The gonads (testes and ovaries) develop near the kidneys in the abdomen and gradually descend into the scrotum in boys and stop in the pelvis in girls. This process of descent is completed just before birth. During descent a passage is created between the abdominal cavity (peritoneal cavity) and the scrotum in boys and ending blindly in the labia in girls. This passage normally closes just before birth. In the event of non-closure of this passage, the baby will present with an inguinal hernia at the time of birth or some time later.The hernia may be on one or the other side or even both sides .

An inguinal hernia may contain only abdominal fluid in which case it is called hydrocele. It may contain intestine, appendix, urinary bladder and in girls ovary or fallopian tubes.

Hernia becomes large and tense with a rise in intra-abdominal pressure which can be caused by crying, running, coughing, straining, etc. It can usually be reduced or may spontaneously disappear when the child is sleeping or relaxed.

An inguinal hernia is always in the danger of getting obstructed and this means that it does not reduce spontaneously and cannot be reduced manually. On obstruction, it soon starts to swell and become red, hot and painful. The patient cries, complains of pain and often vomits. If not treated soon there is the danger of the contents becoming gangrenous. There is a threat to the baby’s life. Such an event requires an urgent surgical intervention.

It is advisable to operate a hernia within 10 days of its diagnosis by the doctor. The age of the baby is never a contraindication for surgery. On the other hand, the neonate is actually at a higher risk of obstruction than the older child. There is no evidence at all that a hernia will close by itself. Also there is no logic in the reasoning that “let the child get old enough to be operated upon”.

The writer, a Ludhiana-based senior consultant in paediatric surgery, earlier worked at a hospital for children in Australia and Mool Chand Hospital, New Delhi.

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Homoeopathy & you
Autism — your child’s behaviour tells a lot
Dr Vikas Sharma

Autism is a disorder that begins in early childhood (typically during the first three years of life). It affects the child’s communication skills and social interactions, and causes restricted, repetitive and stereotyped patterns of behaviour in varying degrees. It can range from severe to a very milder form. The actual cause for autism is not clear.

Autism in the first two years of life is slightly difficult to diagnose. Parents are usually the first ones to notice the symptoms, which in the first two years of life are otherwise slightly difficult to find out. Usually, it is the nonresponsive behaviour in the first two years that may make the parents feel concerned. In cases where the child has been growing normally, his sudden withdrawal from social interactions, nonresponsive behaviour along with losing that little amount of speech that he had gained initially may lead the parents to get their toddler screened for this disorder.

By the age of three, autism can be clearly diagnosed. Children with ASD (autism spectrum disorder) may not follow a regular developmental pattern like others of their age.

Key features that should help parents in identifying this disorder are a child’s inability to babble or make meaningful gestures (like social smile, pointing to objects like fan, etc) by 18 months of age. Inability to speak even a single word by the age of two, having a poor or no eye contact, giving the impression as if he is hard of hearing when being called out to are the other symptoms. The ‘not in tune’ behaviour of child is the most important differentiating symptom although it is not very easy for a lay person to identify it.

Homoeopathy for treating autism is gaining popularity all over the world. Clinical experience shows that results are much better when the treatment is started at an earlier age, even though at higher ages like six or seven some kids do show remarkable improvements. But homoeopathic intervention at an early age (before much behavioural and emotional issues come up) has distinct advantages.

One important aspect is the fact that results with homoeopathy in treating autism are selective. This means that where one segment of kids may respond extremely favourably to the treatment, others may fail to yield any relief. Even while treating with homoeopathy, the child needs to be rated on an autism rating scale. Periodical assessments on the autism rating scale are a must to gauge the improvements in the child.

Homoeopathy is a holistic system of medicine; it takes into consideration the constitutional picture (complete physical and mental make-up of the child) along with the necessary details of the disease.

Medicines that are very effective in treating autism are Carcinocin, Thuja, and Secretin. The role of carcinocin in treating autism requires a special mention. This also does not mean that every child who has autism should be put on it; even for carcinocin to be prescribed, the child has to fall within the drug’s constitutional picture.

The writer is a Chandigarh-based homoeopath.

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eYESIGHT
Femtosecond in ophthalmology
Dr Mahipal Sachdev

FOR many patients, the biggest fear for any surgery remains “the fear of the blade”. Laser offers a blade-free treatment and minimises mechanical contact with the tissue.

There are various lasers already in use in ophthalmology. These are used for diabetic retinopathy, glaucoma, after cataract and various other conditions of the eye. The IntraLase FS laser is the first femtosecond laser cleared to create a flap for use in refractive and corneal surgeries, including LASIK, intrastromal incisions used with ring implants, lamellar keratoplasty, penetrating keratoplasty and the preparation of the donor tissue used in corneal transplants.

LASIK is generally safe and widely popular. However, the initial lamellar resection used to create the flap remains the leading cause of intra- and-post-operative complications.

A non-mechanical alternative is now available to create the LASIK flap and may avoid many of the risks associated with using the microkeratome. The technology uses an ultrashort-pulse duration laser - measured in femtoseconds, or 1x10-15 seconds - to create a flap. Ophthalmic photodisruption is not a new concept; it has been performed since the 1980s and is the technology behind the Nd:YAG laser. The ultra-short duration of the femtosecond laser minimises the shock and collateral tissue damage, making it ideally suited to cut a lamellar flap by contiguous photodisruption.

Similarly, there is “Fugo Blade” which is used in the place of scissors and knifes in various ophthalmic procedures. The Fugo Blade, which was invented by Richard Fugo, is a lightweight, handheld, radio-frequency electrosurgical device that generates a cloud of plasma particles around a tiny filament (about as thick as a human hair) at the end of the hand piece. The plasma particles dissolve the molecular bonds of the material they come in contact with, creating an incision 20 to 40 times sharper than an incision made with a diamond blade. In India Dr. Daljit Singh is using Fugo Blade for filtration surgery for glaucoma and anterior capsulotomy.

The remarkable cutting ability of the Fugo Blade has prompted researchers to adapt this technology to a number of different applications. This is commonly used in different situations like.

Retinal surgery. The Fugo Blade cuts through dense fibro-vascular membranes easily, with no traction on tissue and little or no bleeding. The device has been used on proliferative diabetic retinopathy patients to quickly ablate fibrovascular bands without traction and bleeding.

Glaucoma surgery: Surgeons are using the blade to place 150-micron filtration tracks in both the pre-iris area and in the pars plana.

Corneal surgery: The blade’s energy field can be used to “erase” corneal scarring. This technique is extremely helpful when treating aggressive, recurrent pterygium cases.

Other surgeries: In performing and enlarging capsulotomies in Marfan’s patients without dislocating the lens.

In paediatric cataract cases the Fugo Blade is used to form strong, reliable anterior capsulotomy that can be repaired and enlarged quickly and safely.

The Laser has changed the surgical scenario totally. It is more safe and reliable. Bladeless surgery is a reality now!

The writer is Chairman and Medical Director, Centre for Sight, New Delhi. Email: msachdev@bol.net.in

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Health Notes

Boffins map new areas of chicken brains

Sydney: Australian researchers have compiled the atlas for the brain of a chicken, showing 11 different units of the Rhombomeres area of the brain.

Professor George Paxinos of the University of New South Wales and Professor Charles Watson from Curtin University of Technology have mapped more than 100 new areas.

“Knowing where each of those units are is useful in analysing things like breathing disorders, and perhaps even autism, which is suspected to be related to the Hox genes,” ABC quoted Watson, as saying.

“The research they do with the spinal cord in chickens is amazing and it simply couldn’t be done on mice. Because there’s been no anatomy of the chicken bits, there have been fewer studies on the connections in the chicken brain. Now, with accurate coordinates, we’re hoping that more can be done,” he added. — ANI

A vaccine that could keep all types of flu away

London: British scientists are developing a flu vaccine that will give lifelong benefit to patients and it is also expected to fight anything from winter flu to bird flu.

Compared to traditional jabs, the new FLU-v vaccine is easier to make and can also be stocked for a global epidemic.

“We expect one course of injections — probably of two a week apart — to give life-long immunity,” the Daily Mail quoted Dr Stuart Robinson of the Buckinghamshire company PepTcell, which developed the vaccine, as saying.

The new vaccine is based on proteins that are common to all strains of the virus, which have not altered for about 60 years.

The new vaccine makes immune system cells cytotoxic T cells to fight the virus, rather in bringing in antibodies. — ANI

Alzheimer’s-associated enzyme linked to seizures

London: Boffins have found that an enzyme beta-secretase or BACE, involved in the formation of the amyloid-beta protein linked with Alzheimer’s disease can also alter neural activity in the brain, whose disruption might lead to seizures.

The study might put light on the high occurrence of seizures in Alzheimer’s patients and suggests that treatments that might block this enzyme could lessen the incidences of seizures.

Alzheimer’s disease is marked by toxic amyloid-beta protein plaques in the brain which are formed when the larger amyloid precursor protein (APP) is clipped by two enzymes, BACE and gamma-secretase, which release the amyloid-beta fragment.

The study was conducted by a team of researchers led by Dora Kovacs at the MassGeneral Institute for Neurodegenerative Disorders (MGH-MIND).

Earliers studies have shown that the BACE and gamma-secretase enzymes also work on the beta2 subunit of neuronal sodium channels. — ANI

Kids once assaulted are at risk of becoming serial victims

London: Children who experience a crime or assault once are at risk of becoming serial victims, a study shows.

The study was conducted by a team of researchers led by Professor David Finkelhor at the Crimes Against Children Research Centre at the University of New Hampshire.

As part of the study, researchers examined 1,500 children between the age-group 2 and 17 for two years to see the effect of any kind of exposure to crime.

The study found that 59 per cent of the children became victims again within the next year.

Kids who are assaulted often live in an unsafe environment like in an abusive family or a high crime rate area.

The findings of the study which were published in the Journal of Child Abuse and Neglect last month, indicated that any assaulted kid gets traumatized and might ‘feel powerless’. — ANI

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