Articles on health in india

The Unmet need for Contraception in India!

Dr. Neelam Nath Bhatia, General Physician
26th September Is World Contraceptive Day & India Needs More Awareness.We were 1 billion in 1999 and we are 1.3 billion now in 2016. Why is one billion figure is worth its might- to cause a scare or to remind us about our depleting resources like water, food, and polluted air?Also because Dev Anand made a movie around same time titled 100 Crore to remind us about our might to Fight Corruption!If a qualified doctor happens to work in a one amongst thousands of rural villages right within Delhi/ NCR ,the harsh reality of numbers stares at us. No family has less than 4- 5 children and women are married at less than 18,the official age ,they have kids one after another every year in a row,by the time they are 25 , they are anemic mothers along with malnourished kids hanging around them but not willing to go to school despite education being made free.Still, it is our duty to guide these people, being visited by Government Vans to give them advice for free.Nobody offers them a Cafeteria approach to choose.Every contraceptive does not suit all women. It cannot be robotic.Why I wrote women here? Do men share no responsibility about family planning matters? The harsh reality is Yes.There are Myths associated with Male sterilizations, though medically it is the Safest for man and his family as Abdomen is Not involved. It is No Cut Vasectomy and the man walks out of clinic as if no procedure has been done, ready to go to work the same very day ,including lifting weights etc.Compare this with keyhole surgery of tubal ligation (safest choice for a woman who has completed her family) It looks like 1 stitch operation , but without sounding scary about the surgery, local anesthesia is given and abdomen is bloated up with gas to see tubes through a machine and bands are tied on both tubes one after another. Like any abdominal surgery, there is pain afterward , the woman is advised Not to Lift heavy weights for about 2 weeks lest the bands come out and Operation is a Failure.For temporary contraception, Pills, Condoms ( protection against STDs also ) are suggested but side effects are - Condoms have 20% failure rate,pills have side effects associated with hormones ( more on that later in another article)IUCD-Intrauterine Contraceptive Device is fairly good provided it is inserted to women under hygienic conditions & she does not suffer from heavy periods.I-pill means Only Emergency pill, it is loaded with hormones and can make regular cycle as erratic.Some girls have become habitual of taking it as a routine.Similarly, OCs should Not be given for more than 6 months at a stretch.A recent introduction is an injection for 5 years. This injection is the one being given every 3 months to avoid pregnancy. It is for women who forget to take a pill every day.Injection has hormone Progesterone. The woman is loaded with a dose for 3 months instead of a low dose to be taken daily. These women tend to get an Early Menopause & other conditions related to high doses of hormones. Motivate as many women as possible for safer procedures like Laprascopic Ligation / IUCD after asking them the details about their complex problems.One Happy woman may Not Share her Experience but another unhappy woman with wrongly fitted IUCD in a Van by Inexperienced Nurse/Health Worker is going to badmouth to entire Mohalla about bad effects of IUCD/Ligations.

Eight Important Things About Audiologist, Speech Therapist & Quacks

SLP Sanjay Kumar, Audiologist
Audiologist And Speech Language Pathologist will be registered with Rehabilitation Council  of India (RCI) not by any medical council .You can google after writing “Rehabilitation Council of India” to know more.The College from where they studied will be affiliated by RCI Also.Their online profile will be having information about the college and University both  not only University .The confident professional with valid degree will also mention the degrees/training from  bachelor (BASLP/B.Sc Speech & Hearing) with other higher qualification. Professional with valid degree if they have PhD they will mention the subject also in which they did PhD instead of writing only PhD.Quacks will never display their degree in Audiology and Speech language Pathology at their Clinic.Most of the time they will also scared to put their profile picture at online portal or any other places.In google search quack specially claiming cure for stammering  will mention they are Speech Pathologist/Speech Hearing Specialist with their business name but once you explore in details about them you will find they are quacks . Few quacks will tell that they are Ex-Stammerer who developed his own techniques and cured himself his stammering and now curing others. Also they will not hesitate to write with their business name Speech Hearing Specialist/Speech Language Pathologist to attract innocent people with stammering. Many quacks will say they are ex-stammerer and without having training in speech language pathology they will write about themselves speech pathologist/speech therapist/doctor designation in India and run stammering cure center, speech therapy center ,stammering care center and conduct stammering correction classes/Communication Workshop due to lack of awareness. Some of this quack will take guarantee for stammering cure/therapy. Truth is different. There is no 100% cure for stammering. Scientific research published by American Speech Language Hearing Association  based on more than 100 studies on adults who stutter concluded that significant improvement typically occurs as a result of treatment/Speech therapy in 60to 80% of cases. You can find  the original article by  putting "treatment efficacy stuttering" in google search also. Do you know? DHLS is diploma course in the field of speech and hearing and these professional are trained to work as speech therapist assistant/audiologist assistant. Note: The above information are just to get an idea. There may be acception also. 

Good Sleep for Good Health

Ms. Swati Kapoor, Dietitian/Nutritionist
Nothing makes you feel more refreshed than a good sleep in night. It is a natural cyclic state of resting for mind and body. There’s more to an ideal 7-8 hrs of sleep than just preparing our bodies for the next day. Adequate sleep is an essential part of good health and plays an important role in all body functions hence ensuring a better mental and physical fitness.The National Sleep Foundation (NSF) reported that good sleep is essential for a person’s health and well being.Lord Chesterfield very well said that “A light supper, a good night's sleep and a fine morning have often made a hero out of the same man, who, by indigestion, a restless night and a rainy morning would have proved a coward."Now, the question is “Can good sleep make good health?”Yes, sleep makes you feel better. Adequate sleep is a key part of a healthy lifestyle. Without it, one becomes more susceptible to health problems, such as heart disease, obesity, depression and many more. Some facts of sleep which lead to a healthy life are -Good Sleep Keeps Heart Healthy: Lack of sleep has been associated with worsening of blood pressure and cholesterol so some experts say that heart will be healthier if one gets between( 7 -9 hours) of sleep each night.Sleep Helps to Make Body Repairs: Sleep is a time for your body to repair damage caused by stress, ultraviolet rays and other harmful exposures. Your cells produce more protein while you are sleeping. These protein molecules form the building blocks for cells, allowing them to repair damage. This is the time when the cells undergo wear and tear and that’s what makes you feel refreshed in the morning.Good Sleep Reduces Stress: When your body is sleeping deficient, it goes into a state of stress. Therefore it is recommended to have good sleep in order to allow your body to cope with day’s stress and manage it in a better way with a relaxed mind. It is found that any amount of sleep deprivation reduces mental performance.Sleep & Weight Loss: Lack of sufficient sleep affects the appetite regulating hormones. It also aggravates cravings for high-fat and carbohydrate rich foods, making a route to weight gain. It also affects the body’s ability to regulate blood sugar levels, a key factor in weight management. So, if you want to be on a healthy weight, make sure you get a good sleep every night.Good Sleep Reduces Depression: Lack of proper sleep and depression is inter-linked. Depression may lead to insomnia and lack of sleep increases depression. Sleep impacts serotonin levels (feel-good hormone) which affect the mood of an individual.Sleep Prevents Cancer: People working for long hours have a higher risk for breast and colon cancer. There is evidence stating that good sleep can alter the balance of hormones in the body which may influence cancer progression.As very well said by Benjamin Franklin, “Early to bed and early to rise, makes a man healthy, wealthy & wise.”

Essential Baby Care Tips

Dr. Yogesh Kumar, Ayurveda
Baby care is an area which could be very intimidating for the first timer parents. This article has been written to help mothers learn about their babies. It gives a lot of information on how a baby grows, how to breastfeed, and helpful hints on caring for babies through infancy. Breastfeeding:Breastfeeding is the normal way to feed babies. Breast milk provides all the nutrition the baby needs. It has hundreds of antibodies, enzymes and other factors that protect babies from infections and diseases. Breast milk is easy for the baby to digest, it is always at the right temperature, easy to provide and always handy. Breastfeeding is also good for the mothers because it helps them to return more quickly to pre-pregnancy weight, gives stronger bones in later life, helps to bond more closely to the baby and lowers the risk of breast cancer, ovarian cancer and diabetes.The World Health Organization, and many other National and international organizations recommend that no other foods besides Breast milk be given to the babies until they are six months old. They also recommend that one continues to breastfeed after starting solid foods at six months. Reflexes :Babies do some things automatically without knowing they are doing them. These are called reflexes. For example, if something is put in their mouth they suck on it (sucking reflex) and if something is put in their hands they hold on tight (grasp reflex). If they are startled or upset they fling their arms out and throw their heads back (Startle Reflex) Breast Bud Babies are often born with large genitals and breasts and sometimes 'milk' comes from their breasts. This swelling is due to the mother's hormones, it is normal (even for boys) and it does not last long. Don’t try to squeeze and milk out of the breasts, as too much pressure can sometimes cause an infection. If the breasts become larger, firm and tender, and your baby seems unwell, there could be an infection, and you would need to take your baby to your doctor.Umbilicus: The baby's umbilicus (belly button) may take several days to heal fully, and many babies have umbilical hernias. An umbilical hernia is a lump underneath their belly button (umbilicus); it may swell if the baby is crying. This is a small gap in the tummy muscles and will nearly always go away in time. It does not cause health problems. Cradle cap :Cradle cap is a yellowish, patchy, greasy, scaly and crusty skin rash that occurs on the scalp or recently born babies. You can put olive oil or baby oil to soften the scales and wash the oil off the next day. Gently lift off the softened scales with a soft brush, if some of the scales are sticking to the surface of the scalp, use the oil again the next night. Do not use much pressure to scrape off the scales, as this could cause wound on the underlying skin. Rashes: Most babies have spots on their faces and often on parts of the body in the first few weeks. They are called milia and can look like acne -red spots with white centers. They are not acne and they do not need any treatment. They seem to be a reaction to the skin being exposed to air rather than to fluid in the womb (uterus) before birth, Sometimes the spots come when the baby gets hot or has been lying on that side. Some may also be reactions of the skin to Baby’s cream, lotions etc. Diaper rash: This is a red and painful rash on the diaper area. Rashes can be caused by irritation from dampness of urine or bowel movement on the skin. To prevent Diaper rash, wash your hands before and after changing diapers. Keep the skin dry by changing diapers as soon as they are wet or soiled. Wash the diaper area with warm water and dry well or preferably use a baby wipe. Take the diaper off and expose the area to the air for 10 to 15 minutes, three times a day. You can lay your baby on an absorbent towel and play with her during this time. When the diaper area is clean and dry, rub on a thin Layer of zinc-based cream. Oral Thrush (candidiasis): Thrush is a common infection in infants. Thrush appears as a whitish gray coating on the tongue and on the inside of the cheeks and gums. This coating is not easily wiped off. Babies may also develop thrush on their skin. Most babies do not have any pain or complications with thrush .Regurgitation :Lots of babies have hiccups after feeds. This is normal. Some babies spill some milk after feeds. If they are growing well and happy this is nothing to worry about. If the baby is bringing up milk in big spurts much of the time and not putting on weight or is miserable a lot of the time; you need to see the doctor.Stomach pain or Colic: Many babies cry for up to three hours, or sometimes more, a day in the early weeks. Most babies like being held and comforted. Some babies still cry when they are being held. Remember that every baby isdifferent. While babies usually follow similar patterns with their development, your baby might do things faster or slower or differently from other babies and this is usually fine. If the baby is doing things much more slowly or not doing some things at all. It is a good idea to check with your doctor to make sure that all is going well. Teething :Most babies get their first teeth between 6-9 months. Once teething starts, it continues almost uninterrupted for about two years. Some babies have no difficulty with teething while others may become fussy and uncomfortable. Some things you can do to relieve sore or tender gums: Give the baby a clean teething ring (Teether). Clean and massage the gums regularly to ease discomfort. Baby's stools: Very young breastfed babies usually do several 'poos' a day. Even if your baby, seems to be pushing hard, the poo is usually very soft. After a few weeks some breastfed babies only have a poo every few days and it will still be soft. All this is normal. Bottle fed babies might have firmer poos. If the poos seem very hard, water may be given to the baby to help the poo be soft again. Some may also have constipation for days, they may need to be assisted with the bowel movement. Baby‘s urine: A little light pink or orange stain from urine on the nappy is common and is nothing to worry about. It is caused by a reaction between chemicals in the baby's urine (urates) and chemicals in the fibres of the nappy. It is more likely, in boys because their stream of wee (urine) is more likely to all be on the same place on the diaper. If it is red or leaves a brown stain, that is, if it looks at all like blood or your baby seems unwell and is not feeding normally you need to have it checked by a doctor. Sometimes there can be small ‘crystals’ on the inner surface of a disposable nappy. These come from the inside of the nappy not from the baby. Vaginal blood loss :Some female babies have small vaginal blood loss a few days after birth. This loss is due to the change in hormone levels after birth causing a brief menstrual period. This bleeding stops after a day or two. There will not be any more vaginal blood loss until the girl reaches puberty and starts to have periods. Developmental milestones: The child developmental milestones are briefly analyzed below: Six Weeks:  He can smile at you when you smile at him. Two Months: Neck Control i.e he can hold up his head when you are holding him upright and lift his head up if he is lying on his tummy. Three Months:He will enjoy hitting toys that make noise and he can hold a rattle for a short time. Four Months:He may be able to roll from his front to his back, but it may be another couple of months, or more, before he can roll from his back to his front. Six Months:He may be able to sit without support .Seven Months: He will be sitting up and might be starting to crawl Nine Months:Many babies can pull themselves up to stand. Some babies take longer. It takes another two or three months or so before he can stand without holding onto something and then a few more weeks before he can actually walk. Twelve Months: Babies will talk to you in their own language and expect you to understand. They may say one or two clear words- Hello, No etc. They can understand some sounds. The baby will be able to hold something with his thumb and forefinger and play little games like wave goodbye. Jaundice: Jaundice appears in about half of full term babies and most of preterm babies. Babies have extra red blood cells. As the blood cells breakdown, a yellow colored substance called bilirubin is released. The yellow coloured substance in the baby’s blood causes the skin and the whites of the eyes to take on a yellowish tinge called jaundice. In most infants, Jaundice is mild. It comes on during the first three to five days and lasts only a few days. The only treatment needed initially is lots of breastfeeding and later phototherapy. Do not give water by bottle as bilirubin is better eliminated through stools than urine. Untreated severe jaundice can lead to brain damage and deafness. Immunization: Immunizations help to protect children from many diseases. Other words for immunizations are inoculations, vaccinations, boosters and shots. Immunizations help the baby’s immune system make substances called antibodies that fight diseases. The baby then develops protection against these diseases. Some vaccines are only given once or twice, and some need to be given over a period of time in a series of properly spaced immunizations. By immunizing your baby, you give him the best possible protection against many serious diseases. Always take your child's record with you when he gets his immunizations. Keep it with other important papers, because your child will need his immunization record when he is older. Sometimes immunizations may cause minor side effects, but these are temporary. These side effects might be soreness or swelling where the needle went into the arm or leg, or a slight fever. These do not usually last long. Serious side effects from immunizations are very rare. Vitamin K Injection :All newborns should have an injection or vitamin K within 6 hours after birth. This injection helps prevent hemorrhagic disease of the newborn. Hemorrhagic disease of the newborn is a bleeding problem that occurs during the first few days of life. Eye Treatment: Pediatricians recommend that all newborns receive treatment to prevent an infection of gonorrhea or Chlamydia. These infections can get into the baby’s eyes during birth. Today, an eye ointment is usually used to treat a baby’s eyes if the discharge is copious. If not treated, these infections are severe and can cause blindness. Ear Infection : Middle ear infections are called Otitis Media. Children can also get infections in the ear canal (called Otitis Externa). It causes pain, fever and distress to children and is one of the reasons why they may wake at night. Ear infections can also affect children's hearing. Fever: Fever is usually caused by infections. The source of the infection can be bacteria or a virus. Fever is the normal process of fighting an infection. Babies less than six months old should be taken to their health care provider if they have a fever. Let the baby breast feed more, or offer more to drink, take off extra clothes that the baby is wearing. Give medicine to help bring down the fever and make him more comfortable. Give your baby a tepid sponging or lukewarm bath. Not every sick baby will have a fever, especially if they are less than 1 month old. Some signs of a sick baby may be poor feeding, excessive crying or being irritable. Temperature range Your baby’s body temperature changes throughout the day. It is lowest in the early morning and highest in the early evening. Normal temperature taken under the armpit is 36.5°C to 37.4°C (97.7F to 99.3F). Put the tip of the thermometer in the centre of the armpit. Tuck the arm snugly against the body, then comfort and distract your baby. After about 1 minute the thermometer will beep if it is digital. Mothers are advised to get their own digital thermometer for home use. Paracetamol or Ibuprofen Paracetamol (which in some countries is called acetaminophen/tyelenol) has been safely used for many years to help with mild to moderate pain and fever for babies, young children and older children, But if too much paracetamol is given to a child, especially a sick child, for too long, it can harm the child. Ibuprofen is a newer drug than paracetamol, but it has also been used for fever and mild to moderate pain in children and adults for some years. It is not suitable for children under six months of age. If the fever persists for 1-2 days, it is advisable the child is seen by the doctor. Circumcision  :Circumcision is the removal of the flap or skin which naturally covers the tip of the penis. Circumcision can be painful for the child, both at the time of the operation and some days after. Male Circumcision reduces risks or urinary tract infection in infancy and reduces the risk of HIV/AIDs later in life. The babies are placed on paracetamol after the procedure. Female circumcision: is harmful and is not done due to the various complications it exposes the female child to. Preterm babies: Preterm babies or preemies are those who are born before 37 weeks gestation. Preemies may have immature organ systems. Generally, the younger the baby’s age at birth, the more health problems she may have. A preterm baby may need to be separated from the mother at birth if special care is required. When the preterm baby is well enough, she may be encouraged to have skin-to-skin contact with the mother; this is called Kangaroo care. The baby is unwrapped and placed on the chest where he can hear the heart beat, feel the breathing, and breastfeed. The babies may have problems with feeding. They may be fed via pedal tubes or pump to give breast milk for feedings. Remember - Never shake a baby or throw a baby up! It can lead to seizure, brain damage and death.

Health Feed!! (Snacks Worth Rupees Nine Crores)

Dr. Shreya, Dietitian/Nutritionist
Earlier this month, Hindustan Times gave me a big shock when I read that MLAs of Uttar Pradesh have spent Rs. 9 Crore on their tea time snacks. They have eaten up samosas, tea and gulab jamuns in 4 years. Or I should say they have eaten up 9 crores and have destroyed their health. As a medical nutritionist my concern is health more than the money. In India, samosa is considered as the best and the only option which comes in mind of every one when they have to serve the snacks.I would recommend that India need to change their eating habits and the canteens of offices, schools and even the government buildings have to undergo this change for a healthy future. Here are some healthy options which one should opt for. They are:Vegetable Poha: It can be prepared very easily and is very nutritious if veggies get added into it. Different households in India make it in different ways and are considered as staple food of the country. Eating poha regularly can prevent iron deficiency or anaemia as it contains 20 mg iron in every 100gram raw rice flakes. Children as well as pregnant and lactating women can have poha because of the health benefits it contains. To make iron absorption easy, you can squeeze a lemon in it. Oats Idli: Oats have a lot many number of health benefits. It has a high nutrition value and is rich in fibber. It has a minimal amount of saturated fat and cholesterol and thus considered as one of the best options for weight management and maintenance of health. It contains soluble fibber which reduced bad cholesterol and increases good cholesterol level in the blood.Dhokla:  this is a very renowned Gujarati dish and has many health benefits. The fermentation of dal adds its nutritive value of dhoklas make them rich in fibre and protein. It releases glucose at a more sustained rate and this makes it good for diabetics. Being steamed and oil free makes it low in calories.So, instead of buying ill health choose the healthy way of living and give a worth to your hard earned money. For knowing healthy diets, you should consult a nutritionist.

Why We Fall Sick – as Explained in Ayurveda

Dr. Richa Agarwal, Ayurveda
According to Ayurveda, taking wrong diet which is NOT according to the “Ritu” (the season) & leading a lifestyle which is against the “Prakriti” of a person (various prakriti of a person is categorized as Vaataj, Pittaj, Kaphaj and  Dwandaj in ayurveda) are the two main causes for  any disease in our body.   Ayurveda believes that a different season of a year aggravates different types of “Doshas” (Vaata, Pitta and Kapha) in human body. So, type of food should be chosen according to the season and body type so that it does not attract and aggravate the related “Doshas” in our body.A person with Pittaj property is susceptible to diseases such as skin problems, hyper acidity, conjunctivitis, gout etc.Different Body Types and Dosha aggravation according to the seasonsExampleIt has been observed that all types of skin diseases usually appears or aggravates the most in rainy season (Varsha Ritu). According to Ayurveda, rainy season is the time of “Pitta” aggravation because heat accumulated in summer is aggravated in rainy seasons. The property of Pitta Ras is hot in nature. If some one has a predominant pitta dosha, any food which is spicy and hot in nature should be avoided because it aggravates pitta dosha in our body. Vegetarian dishes and salads (uncooked food) are good choice over deep fried food. The following food should be avoided -food rich in garlic and tomatofermented food items such as idli, doshas, Jalebis etccitrus fruits such as orange, lemon,Chinese foods as it usually contains sauces which has vinagerTea, coffee and alcoholA person with Pittaj property should also avoid sun bath which will aggravate the Pitta further.

Cheer for Team India, Play Like Team India- Let Us Help You Avoid Injuries!

Dr. Meeta Nanda (P.T.), Physiotherapist
As they say, “Cricket is a religion in India” which makes World Cup a mega festival. Looking at Team India’s such a Brilliant and hard working performance, lets talk about the probable injuries that may occur as a side effect of this hard work-Top 5 Cricket InjuriesHamstring StrainWhat is a Hamstring Strain?A Hamstring Strain is a tear in the muscle tissue. Hamstring strains tend to affect all cricketers regardless of position and account for around 15% of all cricket injuries. Hamstring strains occur during explosive sprinting activities such as bowling, taking a quick single or fielding a ball.What should you do if you suffer a Hamstring Strain?If you have a Hamstring Strain follow the RICE protocol - rest, ice and compression and elevation (never apply ice directly to the skin). If you have to apply ice at home, an Ice Bag is recommended. This is a safe method of ice application to avoid the risk of an ice burn.Seek advice from a doctor or Chartered Physiotherapist regarding rehabilitation . Most Hamstring Strains will be fully healed by 6 weeks, but recurrent problems can occur when a return to play is attempted too early.Low Back PainWhat can you do to prevent Low Back Pain?Fast bowling in cricket requires a combination of bending backwards together with rotation and side bending of the trunk. When repeated continuously this puts excessive stress on an area of the vertebra called the Pars Interarticularis and this is where a stress fracture develops.What should you do if you suffer Low Back Pain?A soothing Heat pack can reduce back pain and back muscle spasm. Once diagnosed, stress fractures of the lower back usually require 6 weeks of rest to allow the bone to heal. During this period, an exercise programme under the supervision of a Chartered Physiotherapist can be started . This focuses on exercises to increase the muscular stability in the lower back.Research has shown that poor muscular stability in the lumbar region can lead to low back pain. Core stability exercises target certain specific muscles which give the spine much better support. This prevents postural faults which can cause low back pain.Side StrainWhat is a Side Strain?A Side Strain is fairly common in cricket, where it typically occurs in bowlers. A Side Strain refers to a tear of the Internal Oblique, the External Oblique, or the Transversalis fascia at the point where they attach to the four bottom ribs.In cricket the bowlers suffer the Side Strain on the non bowling arm side as a result of a forcible contraction of the muscle on that side while they are fully stretched as the bowling arm is cocked for bowling.What can you do to prevent a Side Strain?Core strength exercises on an Exercise Mat using a Swiss Ball and Resistance Bands can improve muscle function across the trunk and pelvis and this can help to reduce the risk of a Side Strain.The number of overs bowled per session should be increased gradually and adequate rest periods should be provided to prevent fatigue.What should you do if you suffer a Side Strain?In the early stages an Ice Pack can be applied for twenty minutes every two hours. A Cohesive Compression Bandage can be applied to help to limit bleeding in the tissues. More active rehabilitation can be started under the supervision of a Chartered Physiotherapist, once the immediate pain resolvesShoulder PainWhat is Shoulder Pain?Shoulder pain is common in cricket because of the repeated actions of throwing and bowling. The Rotator Cuff muscles are small muscles situated around the shoulder joint, which can become damaged due to overuse during cricket.Rotator Cuff injuries often begin as inflammation caused by repeated irritation. If the cause of the inflammation is not addressed, partial tears may develop in the cuff that could eventually become a tear all the way through one or more of the Rotator Cuff muscles.What can you do to prevent Shoulder Pain?Correct throwing and bowling technique can help to reduce injury risk. Shoulder stabilization exercises under the supervision of a Chartered Physiotherapist can also help prevent damage to the Rotator Cuff tendons.It is important that any increase in the amount of training or competition must be gradual in order to prevent overload of the Rotator Cuff muscles. In particular, bowling and fielding practice should be increased gradually to allow the Rotator Cuff tendons to adapt.What should you do if you suffer Shoulder Pain?Physiotherapy treatment can reduce acute (short-term) inflammation and chronic (long-term) degeneration of the cuff where a tear is not present. The objective of physiotherapy treatment is to limit inflammation using Ice Therapy. Anti-inflammatory medication prescribed by a doctor is often helpful.Sprained AnkleWhat is a Sprained Ankle?A Sprained Ankle is damage to the ligaments and soft tissues around the ankle, usually as a result of the ankle being twisted inwards. The ankle ligament and soft tissue damage produces bleeding within the tissues and an extremely painful, swollen ankle.What can you do to prevent a Sprained Ankle?Research has shown that bracing or taping the ankle can help to reduce the risk of a Sprained Ankle.What should you do if you suffer a Sprained Ankle?Immediately following a Sprained Ankle you can follow the PRICE protocol - Protection with an Aircast Walker, Rest, Ice Therapy, Compression with a Cohesive Bandage and Elevation of the ankle to reduce swelling.Rehabilitation with a Chartered Physiotherapist significantly improves the outcome following a Sprained Ankle. Wobble Board training improves balance and proprioception.

How Is Tuberculosis Diagnosed?

Dr. Madhukar Pai
Dr Madhukar Pai, MD, PhDDirector, McGill GlobalHealth Programs, McGill University, Montreal, CanadaAssociate Director,McGill International TB CentreIndia alone accounts for a quarter of all TB cases in the world. Over 2.2 million new TB cases occur every year and TB kills nearly 900 people every day in India. The emergence of severe forms of drug-resistant TB has worsened the situation, especially in cities like Mumbai.TB is a bacterial infection caused by Mycobacterium tuberculosis. While TB most affects the lungs, it can affect other parts of the body as well (e.g. lymph nodes, skin, bones, abdomen,urinary tract, nervous system).When should we worry about TB?All persons with otherwise unexplained productive cough lasting two weeks or more, or with unexplained chronic fever and/or weight loss should be tested for TB. Apart from chronic cough and fever, TB causes weight loss, loss of appetite, and tiredness. Night sweats can also occur.What tests are acceptable for TB diagnosis and what samples should be collected?Sputum is the ideal specimen to collect for pulmonary TB. All patients suspected of having pulmonary TB should have at least two sputum specimens submitted for microscopic examination and/or a World Health Organization (WHO) approved molecular test such as Xpert MTB/RIF (also called GeneXpert). Liquid culture is very useful in diagnosing smear-negative TB,and drug-resistant TB.Where are these TB tests available?In the public sector,sputum smears are widely available in designated microscopy centers and DOTS centers. GeneXpert is also available in the public sector, at the district level. Cultures are only available at reference hospitals and medical colleges.All TB tests are free in the public sector.In the private sector,tests such as GeneXpert, liquid cultures and line probe assays are available atmore affordable prices via the Initiative  for Promoting Affordable, Quality TBtests ( More than 115 accredited labs are part of the IPAQTnetwork.What about chest X-rays?Chest radiography is useful but cannot provide a conclusive diagnosis on its own, and needs to be followed by sputum testing. Abnormal X-rays do suggest TB, but other lung conditions can also produce abnormalities on radiography. So, only relying on chest x-ray can result in over-diagnosis. Tuberculosis can only be confirmed by microbiological tests such as sputum smear microscopy, GeneXpert, and cultures.So, it is very important to order sputum tests that can directly detect Mycobacterium tuberculosis.What about blood test sand skin tests?There is no accurate blood test for active TB at this time.  There is no clinical role for blood-based antibody tests (e.g. IgG/IgM ELISA or rapid tests) and interferon-gamma release assays (e.g. TB Gold). They are not accurate and should not be used for pulmonary TB diagnosis.The Mantoux (tuberculin)skin test cannot distinguish latent TB infection from active TB disease, and has no utility for diagnosing pulmonary TB in adults. It has clinical utility in children, along with other tests such as chest x-ray, smears, and clinical history. Tests like Mantoux and TB Gold were designed to detect latent infection, and cannot separate latency from active disease.How is drug-resistant TB diagnosed?Drug-resistance testing can be done using two methods: genotypic and phenotypic. Genotypic methods are based on molecular tests that detect mutations in TB bacteria that confer drug-resistance. For example, mutations in the rpoB gene of Mycobacterium tuberculosis is strongly associated with rifampicin resistance. Examples of genotypic tests include Xpert MTB/RIF (GeneXpert), and Hain Genotype MTBDRplus (a commercial line probe assay). Phenotypic methods are based on detection of culture growth with and without TB drugs added to the culture media. Phenotypic methods include solid and liquid cultures. While solid cultures can take up to 2 months, liquid cultures (e.g. MGIT culture) can produce useful results within 2 weeks. All of these tests are available via the IPAQT network of private laboratories. They can also be accessed for free in the public/government TB program.