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Sunday, 18 March 2018 14:50

Care of Elderly

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Each patient carries his own doctor within him.Hecomes to us not knowing that truth.We are at our
best when we give the doctor who resides within each patient the chance to go to work."Albert

Mrs Paroma Mitra just turned seventy two three days back.She considerd herself reasonably fit and in
fact needed to be,as her husband had a stroke recently and was bedridden.However that night ,while
proceeding to the bathroom she slipped on the water lying on the floor.After the fall she could get not
getup an had severe hip pain.Somehow she managed to to alert her servant who fortunately had not
departed till then.She was taken to the hospital where she was diagnosed to have a osteoporosis hip

Osteoporosis is a condition where
bones become brittle
resulting in reduced bone
strength and increased risk of
fracture.It has been established
that the incidence of
increases with age and by 80 years of age 100 percent women have osteoporosis.The danger of
osteoporosis is directly related to the risk of developing fracture of the spine,wrist and most serious of
all,hip fractures.
A hip fracture occurring in an elderly leads to death in upto 30 percent of patients within one
yeayr.Of the survivors only 37 percent regain normal mobility and walking ability
It is therefore essential to detect osteoporosis in the elderly at the earliest and take suitabless
preventive measures so that hip fractures do not occur .
Detecting osteoporosis

At the age of 65 years all women should undergo DEXA scan(dual energy xray absorptiometry)to detect
Below 65 years of age DEXA scan is indicated in patients with thyroid
disorders,hyperparathyroidism,chronic liver or kidney disease as they have high incidence of
Osteoporosis.It may also be indicated in individuals who are chronic smokers,alcoholics,caffeine use,low
physical activity,and use of certain medications.
Preventing osteoporosis progression

Currently a class of drugs called biphosphonates(allendronate) given daily(5mg) orweekly(75mg) taken
orally in empty stomach half hour before breakfast with a glass of water, continued upto two years
reduces hip fractures by 49 percent and spine fracture by 48 percent.other medications used are
calcitonin,oestrogen,parathyroid hormone,strontium ran elate.
Preventing patient falls

Elderly patients tend to have an increased risk of falls which often leads to fractures.If the risk factors
which lead to falls in the elderly can be detected and removed the risk of osteoporosis fractures
The risk factors for increased falls are medications such as antidepressants and benzodiazepene ,gait
impairment due to previous stroke,poor vision due to cataract and retinopathy and home hazards.
Falls can be prevented by reducing or discontinuing medications that cause drowsiness and postural
hypotension.Regular exercise improves balance,mobility.Steps should be taken to correct visual
impairment and have adequate night lighting.Correct home hazards by using shoes rather than
slippers,avoiding carpets,not using highly polished floor tiles ,wiping water spills in bathrooms and
kitchen,controlling pets to avoid collisions .
Many of my patients get confused by the two terms osteoporosis and osteoarthritisas they resemble
each other.However whereas osteoporosis is a disease of the bones osteoarthritis is a disease of joints
specifically joint cartilage which undergoes degeneration with age.
Osteoarthritis is common after fifty years of age and leads to pain in hips or knees on weight
bearing.Later the pain becomes continous and the individual has constant unremitting pain.
The greatest advancement in treatment of osteoarthritis knee has been total knee replacement surgery
where an artificial joint is placed where the previous joint existed.After the surgery the individual is able
to walk pain free .Snhe is able to carry out domestic actibi ties as well as moderate outdoor activities.
The frequently asked question of a patient before TKR is whether it will be successfull ?The in knee
replacement surgery is of premature failure due to loosening of the artificial joint .While a well
performed TKR should last for 15 to 20 years a poorly done TKR can loosen (fail) in two years.While
selecting a competent surgeon for your TKR look for someone who has trained in a reputed institution

,the volume of surgery he perfofrms(low volume surgeons operate infrequently while high volume
surgeons delegate)and personal philosophy(whether using evidence based protocols).

Sunday, 18 March 2018 05:53

Preventing injuries in football

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Preventing  injuries in football

"The most dangerous part of soccer game is tackling"
If a player or coach knows how an injury occurs then maybe that player can avoid that injury when such a situation occurs.The top three locations for injuries in soccer are the ankle,knee and shin.Knee injuries can occur from either direct contact or from cutting or landing.Ankle injuries can occur as a result on another players foot or from unequal forces  iduring a tackle.Shin injuries can occur after a hard kick to the shin during tackling and can result in tibia fracture.Foot injuries result when a player reaches for a ball during tackle and the opponent steps on the foot.
       As  it is obvious from above the most serious injuries occur in soccer during tackling.Studies have shown that injuries during tackling are more if the skills are mismatched ,the better player could be injured by the worst player.Since as a team the priority is to protect penetrative of a player or ball or both as a defender steps can be taken to place tackling at a minimum.
1.Cover the player in your area so well so that his teammates won't think of passing the ball to that player.
2.If a pass is made step up and intercept that pass.
3.If the pass can't be intercepted ,pressure the player so that he cannot turn around forcing a back pass.
 4.If the player does turn,keep the player and the ball in front of you.Force the player to less dangerous part of the field.
5.Finally go for a tackle.
In this way the tackle comes as a tactics of last resort and the most dangerous part of the game is brought down along with the associated injuries.
ACL injury of knee and arthroscopic ACL reconstruction


The most serious knee injury occurring in soccer is a tear of a ligament inside the knee joint called the anterior cruciate ligament.Mostly this injury occurs indirectly while changing direction or landing from a jump and then twisting the knee joint.After an ACL injury the knee swells and becomes very painful.In case of an ACL tear the treatment of choice is to create a new ligament inside the knee with the help of an arthroscopy.
Today the evaluation ,treatment and rehabilitation of an ACL injury is a standard procedure and most athletes recover completely to return to active participation in his sporting field.In this surgery a tendon is taken out from the patients own leg and placed in bone tunnels in femur and tibia bone and fixed with bioscrews.The most important technique to ensure a success in this surgery is the accurate placement of the femoral tunnel in the femoral bone and the surgeon  has to ensure this.


Monday, 13 July 2015 00:00

Securely Uranium (PL)

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