Tuesday, December 25

Health - Pregnancy-related pelvic girdle pain

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Nutrition, Health & Wellness

Pregnancy-related pelvic girdle pain
Home > Coping with Pregnancy-related pelvic girdle pain
Pregnancy-related pelvic girdle pain (PPGP) is a very common and universal problem. About 16% to 25% of women experience it at some point during pregnancy. In about five percent of women, PPGP is found to persist after childbirth up to two years. The pain and discomfort may start as early as the first trimester of pregnancy and gradually become severe as the trimesters progress. In some women it may begin as late as the last few days before giving birth. Informing the midwife, or obstetrician about the condition and early treatment can alleviate it.

The pelvic girdle is the largest part of our skeleton containing the pubic symphysis, and two sacroiliac joints. A net work of ligaments join these three joints giving them strength. We have to note that pregnancy-related low-back pain, sciatica, visceral or vascular origin syndromes are distinct entities which needs to be excluded before the diagnosis of PPGP is made. European guidelines recommended MRI scan for the differential diagnosis of PPGP in all stages.

Signs and symptoms during pregnancy

PPGP is associated with dull, stabbing, shooting or burning pain in pelvic girdle area during pregnancy. It may be spread over the general area of the girdle. It may also be localized either posteriorly close to the sacroiliac joints (hips and buttocks) or anteriorly to the symphysis pubis area (groin). Some of the symptoms are:
  • Inflammation of the joints in the pelvic girdle.
  • Tenderness in the pubic bone area.
  • Difficulty in standing on one leg.
  • Difficulty in lifting leg.
  • Difficulty keeping legs or knees apart.
  • Stooping backward when standing.
  • Difficulty in twisting, bending or squatting.
  • Pain may radiate to the legs.
  • Alteration of gait patterns.
  • Clicking sound or sensation from the pelvic girdle during movement. 
Depending upon stage of pregnancy and the severity of the condition, the symptoms may vary from individual to individual.

Pelvic girdle pain in pregnancy - possible causes

The exact causes leading to the development of this syndrome are unclear. Etiological implications may be multifactorial conditions during pregnancy like hormonal changes, bio-mechanical factors, trauma, metabolic changes and genetic factors. The release of pregnancy hormones, structural and postural changes in pregnancy, gait changes, weight of the growing baby and changes in the center of gravity can all add to the development of PPGP. Having PPGP in a previous pregnancy predisposes the person to have pelvic girdle pain in subsequent pregnancy.

Any change during pregnancy in the activity of the muscles in pelvic girdle, hips (hip abductor and hip extensor), lower back, abdomen, ankle (ankle plantar flexor) and pelvic floor can cause this condition. Remodeling of soft tissues, cartilage and ligaments over time or due to pregnancy by bio-mechanical and hormonal factors can also contribute to development of this discomfort.

Treatment for pregnancy related pelvic girdle pain

Many treatment options like exercises, exercises in water, physiotherapy, chiropractic manipulations, medication, educational interventions, acupuncture, use of mobility aids, and intensive multidisciplinary bio-psycho-social rehabilitation treatment are available. For very severe debilitating cases during pregnancy surgical treatment (fusion surgery) is considered. The available treatment options during pregnancy are limited by the presence and the potential hazards to the fetus.

Coping with pelvic girdle pain in pregnancy

Self care and management can to a great extend contribute in the alleviation of the distressing condition.
  • Take care to have sufficient rest.
  • Avoid lying on your back.
  • Lie on your side with a pillow between your knees to keep hip joints aligned.
  • Avoid sitting slumped.
  • Be active within the pain limits.
  • Avoid strenuous activities.
  • Avoid weight bearing activities.
  • Avoid climbing stairs.
  • Wear flat shoes.
  • Avoid twisting, bending or squatting.
  • Take small steps while walking.
  • Avoid any action or movement with knees apart.
  • As far as possible Keep the knees together.
  • Avoid stressing the joints.
  • For getting into bed, sit on the edge keeping the knees close together and lie down on your side by simultaneously lifting your feet.
  • Do the reverse of it when getting out of bed.
  • While shifting position in the bed keep the knees together.
  • Avoid moving your knees apart.
  • Avoid standing on one leg.
  • Avoid carrying a baby on one hip during pregnancy.
  • Consider wearing hip support.

With the increase in clinical awareness of pregnancy related hip girdle pain syndrome and multidisciplinary medical approach there are significant improvements in the treatment and management of this multifactorial syndrome.

1. Wu W, Meyer O, Uegaki K et al. 2004. Pregnancy-related pelvic girdle pain, 1: terminology, clinical presentation and prevalence. Eur Spine Journal Epub 13: 575-589 
2. Vleeming A, Vries HJD, Mens JMA et al. 2002. Possible role of the long dorsal sacroiliac ligament in women with peripartum pelvic pain. Acta Obstetrica Gynecologica Scandinavica 81: 430-436 
3. Nikolaos K Kanakaris, Craig S Roberts and Peter V Giannoudis. Pregnancy-related pelvic girdle pain: an update BMC Med. 2011; 9: 15. Published online 2011 February 15.

Image source: http://en.wikipedia.org/wiki/File:Illu_pelvic_girdle.jpg
License: Public domain.
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Coping with pelvic girdle pain during pregnancy.

Wednesday, December 12

Back pain - Chronic low back pain - Treatment and management

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Chronic low back pain
Home > Back pain - Chronic low back pain - Treatment and management
Lower back pain is a common health problem and nearly 80% of adults experience it at some point in their life. Low back pain is a skeletomuscular disorder and it is considered chronic if it persists for more than twelve weeks. Without proper treatment the pain tends to become chronic.

Most of the causes of chronic low back pain (CLBP) are neuromusculoskeletal disorders like wrong posture, sprain in the lower back muscles, strain of soft tissues, slipped disc (herniated, or ruptured disc), sciatica ( sciatic neuritis) degenerative discs, spinal stenosis, fractures, trauma, skeletal irregularities, scoliosis, kyphosis, lordosis, osteoarthritis and osteoporosis.

Chronic lower back pain treatment options

The options are physical, medical, and surgical methods. The focus is on causative factors, relevant pathoanatomy and pain generators and their alleviation and removal. Generally the options are non-invasive methods like initial rest, medication and exercise. In the case of traumatic injury, structural damage or structural irregularities surgical options may be resorted to.

Bed rest for chronic LBP

Immediate bed rest for less than two days helps in the lessening of chronic pain and inflammation. However bed rest for longer period does not have increased benefits. Prolonged bed rest can be counterproductive. In fact prolonged bed rest can have deleterious effects by weakening the supportive muscles and leading to progressive hypo mobility of joints and prolonged recovery.

Physio-therapeutic treatments

Physiotherapy comprises a mixture of any of the methods like interferential treatment, laser, lumbar supports, shortwave diathermy, therapeutic ultrasound, hot/cold packs, traction, transcutaneous electrical nerve stimulation (TENS), massage and mobilization Though there may be marginal momentary reduction in low back pain there are no long term positive effects and advantages.

Exercise treatment

Exercises aimed at strengthening, endurance and flexibility
show lasting improvement in chronic low back pain reduction and function. These exercises do not require expensive training equipment. Muscle strengthening, muscle conditioning, aerobic, flexion, Alexander Technique and McKenzie exercises may be tried as per the preference of both the patient and therapist.

Chiropractic spinal manipulation and spinal mobilization

Manual treatment comprises spinal manipulation and spinal mobilization  The spinal manipulation is small amplitude high velocity thrust technique. It is usually a rapid movement beyond the movement range of the affected back joint. The patient has no control over the manipulation and the technique is prone to complications if done by persons lacking expertise.

Spinal mobilization is use of passive low-velocity movements to give mobility to a joint. Excluding movements that would further strain the lower back, mobilization within the limits of low back pain aids recovery. Mobilization techniques show improvement in pain reduction, motor activity and sympathetic nervous system activity. As the patient has control over the movement, this technique is considered as far safer to manipulation technique.

Pharmacological treatments for chronic LBP

Non Steroidal Anti Inflammatory Drugs (NSAIDs) are widely prescribed for their pain-killing potential and also for their anti-inflammatory action. The side-effects of NSAIDs are gastrointestinal complications like irritation, gastric ulcers and intestinal bleeding. Some NASIDs like rofecoxib have serious long-term effects like increases cardiovascular risk. Hence for long term use individual case has to be monitored.

Noradrenergic and noradrenergic-serotonergic antidepressants have been found to be moderately effective in reducing chronic pain in CLBP patients and quite effective when used as co-medication with NSAIDs. In patients with kidney diseases, glaucoma, chronic obstructive pulmonary disease and heart failure antidepressants should be avoided. Pregnant patients with chronic pain should not be given antidepressants without closely monitoring their health.

Opioid are short-term treatment for pain and disability in chronic low back pain. Weak opioid are prescribed only for short-term treatment as there is the risk of development of dependence and addiction. To avoid addiction, slow release opioid can be given.

Muscle relaxants like benzodiazepines are used for the short-term reduction from pain. However they have the side effects like allergy, addiction, drowsiness, dizziness and impaired liver function in the long run.

Capsicum pain plasters have capsaicin from chilli peppers which reduces low back pain. Hence application of capsicum pain plasters is an effective short-term treatment for CLBP.

Surgical treatments

Surgery for pain reduction is resorted to when all other conservative treatments have become ineffective in reducing of pain.
Surgical treatments for chronic low back pain include lumbar microdiscectomy, discectomy (involving partial or complete excision of an intervertebral disk), laminectomy (removal of portion of the vertebral bone called the lamina), foraminotomy (performed to reduce the symptoms of nerve root compression), disc replacement surgery or spinal fusion.

Spinal fusion surgery is considered in case of degenerative disc disease, facet joint degeneration or spinal instability and it aims at obtaining solid fusion of two or more affected vertebrae to give stability. As spinal fusion surgery has high rate of complications it may be performed only if the CLBP persists for more than two years and also in case of failed conservative treatments and severe pain.

Other alternative treatments

Back school is a combination of education and skill program aimed to lower the chronic LBP. There are some short-term positive results. However there may not be any long-term benefit.
Brief educational interventions to promote self treatment by the patient can be given by the physiotherapist or physician to reduce disability and sickness. Brief educational interventions should provide reassurance and positive messages that encourage the patient to return to normal activities.
Cognitive-behavioral treatment methods are effective for chronic pain, functional status and behavioral outcomes.
Intensive multidisciplinary biopsychosocial rehabilitation treatment program consisting of combination of physical, pharmacological, vocational, and behavioral components are very effective in alleviating the chronic LBP and improving the functionality, especially in patients who have failed mono-disciplinary treatment options.
Neuro-Reflexotherapy has been effective in the treatment of chronic low back pain. Short-term treatment can be taken up to lower chronic pain.
Percutaneous electrical nerve stimulation (PENS) are effective in reduction of chronic low back pain.

Image source:
Image author: LadyofHats Mariana Ruiz Villarreal
License: public domain

2.Karjalainen K, Malmivaara A, van Tulder M, et al. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults. Cochrane Database Syst Rev. 2003;(2):CD002193.

Current topic in Daily Health News & Tips:
Chronic low back pain - Treatment

Saturday, December 1

Skin care in winter - Coping with dry skin in winter

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Nutrition, Health & Wellness

Coping with dry skin in winter
Home > Winter skin care - Coping with dry winter skin
Skin becomes dry in winter months and if proper care is not taken it may lead to painful cracks, bleeding and infections. The primary cause of dry skin in the winter is the dehydration of the stratum corneum layer of epidermis and the decrease in the production of sebum. In winter conditions even people with healthy skin can develop dry dermal conditions and as for persons already having dry skin, eczema, dermatitis, contact dermatitis, seborrhea and psoriasis the problems will aggravate.

In winter weather the humidity (moisture in the air) tends to be low and moisture from the skin is removed at a faster rate leading to dry condition. In cold weather people tend to use room heaters which further dry up the low-moisture air in the room. To address this problem sufficient care must be taken to prevent loss of moisture from the skin as well as to additionally moisturize it. Following a regular skin care regimen we can tide over the winter months smoothly.

Hydration by drinking fluids in winter

Fulfilling our body's water requirement takes care of skin moisturizing to a great extend. A normal individual requires up to one liter of water per day for every twenty kilos of body weight. Persons consuming insufficient water tend to become chronically dehydrated. In such situation they are likely to have dry skin. In winter, even if we do not feel thirsty, we must drink sufficient water and fluids to hydrate our body, to avoid constipation and to remove toxic wastes from the system. Fruit juices give nutrients required for care of healthy body and skin.

As drinking aerated soft drinks is found to dehydrate our body, it better to reduce their consumption. Alcohol and caffeine present in alcoholic beverages and coffee have diuretic effect and remove water from the body. Hence their consumption must be avoided for care of dry skin. Alcohol and nicotine (smoking) are found to constrict capillaries and cut down blood supply to body organs, including skin.

Nutritional care of dry skin in winter

To have a healthy body and skin we should take care to eat healthy balanced food. During the winter when the skin has to face the dry conditions, any nutritional deficiency will have adverse effect on stratum corneum hydration, sebum secretion and desquamation process.

The food we eat must be balanced containing all the required nutrients. Our food must contain complete protein having all the essential amino acids. To achieve this we have to include protein rich food of both plant and animal origin. To stop aggravation of dry winter conditions, sugar, sugar preparations, sweets and soft drinks must be avoided. Take care to avoid saturated fats. Polyunsaturated and monounsaturated fats must be consumed in moderation.

However our food must contain sufficient quantities of essential fatty acids like omega-3 fatty acid and omega-6 fatty acid available in olive oil, vegetable oils, fish and fish oil. Sufficient soluble and non-soluble fiber containing food must be consumed to ease bowl movement and avoid constipation. Constipated material in the bowl release toxins which can affect the skin causing it to become dry and acne prone. Our food must also contain micro nutrients like dietary minerals and vitamins. Any deficiencies can cause dermal problems especially during dry winter.

Skin cleaning and bathing in winter

For protection from dry winter conditions use chlorine free water for bath. Do not have more than one bath a day and make the bath as short as possible. Do not use hot or cold water for bath as it will cause dry skin; use lukewarm water. You can think of massage with olive oil or body oil before bath to lock in moisture.

Take care not spend more time in bathing. Long exposure to water removes the protective natural sebum layer. Use mild soap of PH 7 or less. Alkaline soaps remove the acidic protective layer and dehydrate the skin. After bath dab the skin dry and apply moisturizer to lock-in moisture.

Cleansing, moisturizing and exfoliating dry winter skin

Prefer cosmetics containing natural, organic and herbal ingredients like aloe vera, olive oil, honey, jojoba oil, calendula, oatmeal, tea tree oil, beeswax, and almond oil.

Clean your skin daily preferably before going to bed with alcohol free cosmetic milk, cleaning lotion or cleansers to remove the accumulation of grime, stratum corneum debris and remnants of makeup. Cleansing also opens up and cleans the pores.

Take care to apply moisturizer twice a day to lock in moisture. It is preferable to apply moisturizer soon after cleansing. Please note that your hands, feet and nails require moisturizer as they often come in contact with water. Try wearing hand gloves, when prolonged contact with water is required.

Hair also requires protection from being getting dry and suitable moisturizer and conditioner like olive oil can be used. Chapped lips are common in dry winter conditions and moisturizing lip balm can be applied regularly to protect them. Licking the chapped lips must be avoided as this aggravates the condition.

Exfoliating once a week helps in skin rejuvenation. The skin debris get removed of their own in younger persons during desquamation process. As one ages the desquamation may not be complete and exfoliation will help in removal of dead skin and grime clinging on.

Careless use of cosmetics can flare up the dry winter skin condition. Take care not to use any skin care product containing harsh chemicals. Avoid using chlorinated water for cleaning as chlorine will make the skin further dry by removing the natural moisturizing oils and moisture.

Protection and care of skin from environment in winter

Even if it is winter take care to protect yourself from exposure sun by using umbrella, sun protective clothing and wide brimmed hat. Take care to use sunscreen of SPF 20 or more on exposed parts of the body when going out or getting exposed to sun. In longer exposures take care to apply sunscreen every two hours. Take care to avoid exposure to cold winds and rain. Cold winds dehydrate the skin. Drenching in rain and using swimming pool also removes the protective natural oil from the skin. If room heaters are used in winter take care to install a room humidifier to counter dry conditions.

Treatment and care of skin ailments

If you are affected by skin ailments like itch, rash, eczema, dermatitis, seborrhea and psoriasis consult a dermatologist to treat them. In dry winter the conditions if proper care is not taken the ailments can worsen and lead to many complications.

Current topic in Daily Health News & Tips:
Coping with winter dry skin and skin care for winter

Friday, November 30

Pneumonia in elderly people - Causes, symptoms & treatment

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Pneumonia in elderly people
Home > Pneumonia in children and infants - Signs, symptoms & causes > Causes, symptoms and treatment of pneumonia in elderly people
Pneumonia in elderly people, unlike younger patients, may have very subtle symptoms and by the time diagnosis is done and treatment is commenced the situation may become very serious and life threatening. Pneumonia is an inflammation of the lungs followed by fluid accumulation in alveoli air sacs and is usually caused by viruses, bacteria, fungi, parasites and other organisms. The inflammation and fluid accumulation in alveoli causes reduced blood flow to the affected part as well as reduced oxygen uptake.

In general elderly patients have feeble organ level and body level responses to any infection. Unfortunately, most of the elderly people and their caregivers are unable to understand the symptoms of pneumonia and by the time action is taken the condition turns serious.

Causes of pneumonia in elderly people

Though pneumonia is caused by viruses, bacteria, fungi and other organisms, in elderly, Streptococcus pneumoniae bacteria account for most of the infections and are the major cause of death. The infection can start with flue like symptoms of the upper respiratory tract and can spread fast to the lower respiratory tract and the lungs. Damage of lung tissue can occur and the infection may spread to the blood causing bacteremia. If most areas of the lungs are involved acute respiratory distress syndrome (ARDS) may be caused.

The complications of pneumonia in the elderly can be life-threatening, apart from the possibility of bacteremia, meningitis, kidney failure and heart failure can occur. The lung infections triggered by viruses are generally milder but there is always the risk of opportunistic bacterial infections including Streptococcus pneumoniae.

In elderly people, aspiration pneumonia is caused by difficulties in swallowing leading to mouth secretions and food going to the lungs and causing infection and pneumonia. Issues with swallowing are common in elderly patients which require treatment.

Symptoms of pneumonia in elderly people

General symptoms of pneumonia are:
  • week feeling
  • lethargy
  • productive cough
  • greenish or yellowish sputum
  • chills
  • difficulty in breathing
  • symptoms of shallow breathing
  • chest pain
  • muscle pain
  • fever
  • symptoms of skin and nails turning bluish
  • confusion
  • nausea
  • abdominal pain and diarrhea
  • decreased level of consciousness.
In elderly persons the pneumonia symptoms may be fewer and fever may not be present. Symptoms like Chest pain, shallow breathing, decreased appetite, feeling cold and difficulty in breathing may be observed. All the symptoms may not be present and observed symptoms can be pieced together to get a clearer picture of the situation. Symptoms like slightly confused state of mind together with changes in their behavior and appearance can also indicate the underlying problem.

Pneumonia - Tests and diagnosis
Simple diagnosis by listening to the patient's lungs can confirm pneumonia. Typical rales (clicking, rattling, or crackling noises) and rhonchus ( coarse rattling sound) can be picked up by a stethoscope signalling lung infection and inflammation. A chest x-ray or CT scan can confirm the disease and give us the location of inflammation. Blood and sputum analysis can tell us about the pathogen involved in pneumonia so that it can be treated.

Treatment of pneumonia in elderly people

Medical care must be sought for treatment if in the elderly person symptoms like have breathing problem or lung infection is suspected.
The cause of the pneumonia has to be found out for the treatment. Bacterial pneumonia is treated with antibiotics. Antibiotic treatment should carried out as per the advice of the doctor.

In rare cases antiviral medication is given for viral pneumonia. For the treatment of aspiration pneumonia corticosteroids may be prescribed. To reduce the fever antipyretic medicine may be prescribed. Unless necessary cough suppressants are avoided in the treatment.

Sufficient rest can help in alleviating the symptoms and also help in the treatment of pneumonia. Drinking plenty of fluids helps in loosening the lung secretions and their removal by coughing. With proper treatment the patient will recover in about two weeks.

Pneumonia - Risk factors in elderly people

Many habits and health conditions increase the risk of lung infections and pneumonia. Some of the risk factors are:
  • chronic obstructive pulmonary disease (COPD), cystic fibrosis, asthma, bronchiectasis
  • heart, lung, spleen or kidney diseases
  • health conditions like stroke, diabetes, dementia and Alzheimer's, amyotrophic lateral sclerosis (ALS)
  • untreated illness
  • decreased ability to cough
  • decreased productive cough
  • bad oral hygiene
  • inactivity
  • spending too much time in bed
  • malnutrition
  • use of narcotics, antihistamines
  • intoxication
  • alcohol
  • weakened immune systems
  • long-term use of immunosuppressant drugs
  • chemotherapy treatment for cancer
  • smoking
  • using inhaled corticosteroids
  • exposure to air pollution or toxic fumes

Pneumonia - Prevention with vaccination

Yearly vaccination for seasonal flu can go a long way in the prevention of pneumonia in elderly. Influenza virus can predispose an elderly person for developing bacterial pneumonia. Influenza itself can move on to the lungs and cause viral pneumonia.

As for bacterial lung infection, doctors recommend a one-time shot of pneumococcal polysaccharide vaccine (PPSV) against Streptococcus pneumoniae for elderly people above 65 years. The prevention vaccination may have to be repeated after 5-6 years.

In the United States, PPSV is recommended for elderly people above 65 years of age as a prevention. Adults having symptoms of poor health and also long-term serious health problems are also advised to get vaccinated with PPSV as prevention. PPSV is recommended as prevention for smokers and children above two years of age having serious health problems. Adults and elderly people suffering from  asthma, COPD, congestive heart failure, Severe renal problems,  liver diseases, diabetes requiring medication, HIV/AIDS and asplenia do require vaccination as prevention and protection against pneumonia.

Very important: If an elderly person under your care appears to have symptoms like difficulty in breathing, cough, chest pain or lethargy immediately seek medical help without delay for proper treatment to prevent complications and save life.

Related topics in Daily Health News & Tips:
Pneumonia in children and infants - Signs, symptoms & causes.

1. Höffken G, Halank M, Gillissen A. Treatment of severe pneumonia--community-acquired and "early onset" nosocomial Med Klin (Munich). 2004 Jul 15;99(7):362-71.
2. Schmidt-Ioanas M, Lode H. Treatment of pneumonia in elderly patients. Expert Opin Pharmacother. 2006 Apr;7(5):499-507.

Current topic: Causes, symptoms and treatment of pneumonia in elderly people

Thursday, November 29

Pneumonia in children and infants - Signs, symptoms & causes

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Nutrition, Health & Wellness

Pneumonia in children and infants
Home > Pneumonia - Signs and symptoms and causes of pneumonia in children and infants
Pneumonia in children and infants is a very debilitating medical condition and is sometimes fatal. The symptoms of pneumonia depend on the causes and the age of the affected child. The common origin of pneumonia in children are lung infections and inflammations caused by viruses, bacteria or fungi.

According to WHO, pneumonia kills an estimated 1.2 million infants and children under the age of five years, accounting for 18% deaths among this age group. It is estimated that one in three newborn infant die due to this disease. Of these deaths 85% occur in South Asia and sub-Saharan Africa. Simple interventions and timely treatment, care and preventive measures can stop loss of life.

Causes of pneumonia in infants and children

Pneumonia is inflammation of the lungs. Often, it begins as an upper respiratory tract infection affecting nose and throat which subsequently affects lower respiratory tract (lungs). The microscopic air sacs (alveoli) in the lungs bring about gas exchange, resulting in exhalation of CO2 and absorption of oxygen. In lung inflammation/infection primarily alveoli get affected. The inflammation causes alveoli to accumulate fluids and the surface area for gas exchange gets reduced. This results in respiratory distress and connected symptoms.

The lung inflammation and infection is usually caused by a variety of microorganisms, including bacteria, viruses, parasites or fungi. Bacterial lung infection in children and infants is usually caused by Streptococcus pneumoniae (or pneumococcus). Other common pneumonia causing bacteria are Haemophilus influenzae, Chlamydophila pneumoniae, and Mycoplasma pneumoniae, Staphylococcus aureus, Moraxella catarrhalis, Legionella pneumophila and Gram-negative bacilli. In infants and children affected by HIV, the incidence of this disease caused by Pneumocystis jiroveci is high and 25% of pneumonia deaths are due to P.jiroveci.

The viral lung infection in infants is commonly caused by Influenza virus A and B, Respiratory syncytial virus (RSV),Human parainfluenza viruses, rhinoviruses, human metapneumovirus and human bocavirus.

Fungal pneumonia in children is rarer and is mostly caused by Histoplasma capsulatum, blastomyces, Cryptococcus neoformans, Pneumocystis jiroveci, and Coccidioides immitis.
Parasites in human, which can affect the lungs, like Toxoplasma gondii, Strongyloides stercoralis, Ascaris lumbricoides, and Plasmodium malariae some times lead to fluid accumulation in lungs and pneumonia.

Pneumonia - Symptoms in infants and children

Viral and bacterial infections have similar symptoms and the viral infections are more numerous.
The common symptoms of pneumonia in infants and children include:
  • productive cough
  • nasal congestion
  • fever 
  • chills 
  • shortness of breath and difficult breathing
  • rapid breathing
  • increased respiratory rate
  • loss and lack of appetite
  • decreased activity and lethargy
  • wheezing
  • sharp or stabbing chest pain during deep breaths
  • abdominal pain
  • conjunctivitis due to chlamydia in infants

Symptoms of severity of pneumonia include:
  • lower chest wall in-drawing during inhalation in children
  • skin and nails becoming bluish,
  • inability to feed or drink in infants
  • decreased thirst
  • convulsions
  • nausea or persistent vomiting
  • Extremes of body temperature (fever or hypothermia)
  • decreased level of consciousness.
In children and infants with bacterial infections set in fairly quickly whereas the viral infections set in gradually.
Malnutrition or undernourishment, compromised immune systems and pre-existing illnesses increase susceptibility of infants and children and can cause pneumonia. Environmental factors like air pollution, crowded homes and parental smoking also increase the risks.

Treatment of bacterial lung infection involves administration of antibiotics and patient care. Viral infection may resolve after some time as the patient develops immunity. For severe cases and young infants hospitalization is necessary. According to WHO, vaccinations against Haemophilus Influenzae Type b (Hib), pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia in infants and children.

Related topics in Daily Health News & Tips:
Pneumonia in elderly - causes, symptoms, prognosis and treatment.


1.Image source:
Image author: James Heilman, MD
License: CC BY-SA 3.0
2.Image source:
Image author: Mikael Häggström
License: Public domain

Current topic: Symptoms and causes of pneumonia in children and infants

Monday, October 29

Tear ducts - Blocked tear ducts in newborn - Dacryostenosis

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Nutrition, Health & Wellness

Blocked tear ducts in newborn
Home > Tears in newborn > Blocked tear ducts in newborn
Tear ducts in newborns are quite often under developed or clogged at the time of birth. In most of the newborns, these blocked ducts open up after several weeks and the natural drainage of lacrimal fluids is established.

Tears are secretions by lacrimal gland, meibomian glands (or tarsal glands) and conjunctival goblet cells in the eyes. Tears are for cleaning, protecting, moisturizing and lubricating the eyes. Production of tears is a continuous process and newborns also have functional lacrimation.
When we blink these secretions are smeared on the eye and the excess is pushed towards the tear ducts in the inner corners of the eyes. There, these secretions get collected in the nasolacrimal sac and are emptied into nose through nasolacrimal tubes.

Causes of blocked tear ducts in newborns

As the lacrimation is a continuous process, the excess fluids have to find a way out and it is usually through the tear ducts. About 20-30% of the newborns have blocked or under developed tear drain ducts.

The condition of blocked tear drain tubes at birth is known as congenital nasolacrimal duct obstruction (congenital dacryostenosis). This condition can affect just one eye or both and in most of the cases it is due to a small thin membrane obstructing the opening. With the growth of the youngster there is spontaneous natural remission of the blocked condition in about 9-12 months in 90% of the cases.

In the case of under developed nasolacrimal tubules, with the growth of youngster, the nasolacrimal tubes also extend and grow to establish connection with the nasal cavity.

Certain other blocked conditions are encountered in a few newborns. They may occur in the following situations.
  • Blocked lacrimal gland or nasolacrimal tube due to infections.
  • Injuries to bone and tissues around the nasolacrimal tube.
  • Thickening or inflammation of the nasolacrimal tube lining.
  • Inflammation of the nasal cavity lining.
  • Sinusitis.
  • Conjunctivitis.
  • Polyps and tumors in the nasal cavity.
  • Abnormal growth of nasal bone putting pressure on the nasolacrimal tube.
  • Closed, undeveloped or undeveloped holes (puncta) in the inner corners of the eyes.

Symptoms of blocked tear ducts in newborns

If the nasolacrimal tubule is not fully developed, not yet connected or blocked the excess fluid make the eyes appear flooded and newborn tears may trickle down the cheeks. This may happen even when the s/he is not crying. In the first four weeks as the secretions are minimal, flooding of eyes may not be apparent.

Crusty eyes and sticky and matted eyelashes are tell-tale signs of blocked tear ducts. Mucin produced by the glands gets deposited at the corner of the eyes and also makes the eyelids sticky. Bacteria start growing on these deposits and cause eye infection leading to irritation and reddening of the eyes. The stagnated tears in the nasolacrimal sacs may also become a focal point for bacterial growth and lead to swollen sacs. Infection of nasolacrimal sac is known as dacryocystitis. Fever with tenderness and swelling near the nose bridge on the affected side may be experienced.

Remedies for blocked tear ducts in newborns

Usually the conditions with blocked tear ducts do not require treatment as in most of the cases they open up by their first birthday.
However they must be continuously Observed with no intervention to avoid possibilities of complications.
The pediatrician may advise nasolacrimal massage to be repeated a number times in a day.
The pediatrician may also advise cleaning the discharge and crust with clean, soft, wet and warm cloth.
If infection is suspected, antibiotic eye drops may be prescribed.
If the infection spreads and involves nasolacrimal sacs or conjunctiva, oral antibiotics may also be prescribed.
If the blocked condition persists beyond nine months, pediatric ophthalmologist may resort to probing procedure for clearing and opening up tear drain tubes.
Surgical procedures may be resorted to, if there are structural anomalies or abnormal growths.

As there are possibilities of medical complications in blocked tear duct in newborns, it is necessary that if you suspect this condition, bring it to the notice of your pediatrician for medical evaluation.

Related topics in Daily Health News & Tips:
Newborn tears.

Sunday, October 28

Newborn tears - Newborns usually do not shed tears while crying

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Newborns usually do not shed tears while crying
Home > Newborn tears
A newborn rarely sheds tears while crying. The nervous control and emotional responses in the newborn are still under development. However the basal tears production is functional in newborns to keep the eyes functioning properly.

Crying by newborns is the only way of telling that they are hungry, uncomfortable, sleepy, feeling cold or bored. Crying is the only way to communicate their myriad of problems.

After a few months of growth, with the development of the emotional responses and nervous control, they start shedding tears (lacrimation) while crying. To understand its physiology, we have to know the types of these eye secretions and the process of their formation.
What are tears?
They are secretions from lacrimal gland, meibomian glands (or tarsal glands) and conjunctival goblet cells found in the eyes. Lacrimal gland secrete aqueous lacrimal fluid containing water, lipocalin, lactoferrin, lysozyme and lacritin. Meibomian glands secrete lipids and oils. Conjunctival goblet cells secrete mucin. Lacrimal secretions are produced continuously. With the blinking of eye, lacrimal fluid is spread over the eye surface.

Types of lacrimation
Lacrimation in humans, including newborns, is to clean, moisturize and lubricate eyes. There are three types of lacrimations namely basal, reflex and psychic lacrimation. The lacrimal gland is mainly responsible for producing emotional or reflexive lacrimation.

Basal tears in newborn

In newborns, basal lacrimal production is functional, to keep the eyes moist, clean, lubricated and protected from bacteria. Lysozyme present in the lacrimal fluid helps in the destruction of certain bacteria. If s/he has crusted or sticky eyelids it is an indication of eye infection. Up to one ml of lacrimal fluid is secreted in twenty four hours. With old age the amount secreted may come down.

Reflex tears in newborn

Reflex lacrimal secretion results from irritation of the eyes by any foreign objects. The presence of any irritating fumes or vapors in the atmosphere may also induce the lacrimal secretion. Bright light and hot or peppery taste also induces reflex secretion in the eyes. Certain reflex functions like yawning, coughing and vomiting may also induce lacrimal secretions. In a newborn reflex lacrimal secretion due to all the above mentioned causes is present.

Psychic tears in newborn

Emotional and physical stress like anger, hurt feeling, mourning and pain and intense spasmodic cramps can increase the lacrimation and maintain a copious flow. Limbic system controls  the basic emotional drives and via autonomic parasympathetic nervous system it controls the lacrimal glands. As the emotions and the connected nervous controls are still under development in a newborn, copious flow of psychic lacrimation is absent and hence s/he does not weep while crying.

Newborn lacrimation problems
If a youngster, having started shedding lacrimal fluid while crying, persistently cries without lacrimal fluid with reddened eyes, it could be a sign of something more serious, like eye infection, problem with the function of lacrimal gland or dehydration.
If the eyes are watering without actual crying, it is the problem of blocked or infected nasolacrimal ducts.
An eye specialist will be able to evaluate the situation. If the blockage is due to infection, he may prescribe antibiotic drops.
In newborns, tears ducts blocking is common and in most of the cases the ducts open up naturally after a few months.

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Newborn tears - Newborns rarely shed tears while crying.

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Sunday, September 30

Social anxiety depression - Social anxiety disorder causes

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Nutrition, Health & Wellness

Social anxiety depression disorder
Home > Mental health definition > Causes of social anxiety disorder and depression.
Social anxiety is a persistent and intense fear of being judged in social situations and the disorder causes depression and a sense of embarrassment. In this type of anxiety disorder, the affected individuals have the constant fear and anxiety of being observed, scrutinized, evaluated and judged. This disorder causes feelings of inferiority, self-blame, nonperformance, incompetence, ineffectiveness, ineptness and unfitness and leads to mental depression.

This disorder and related depression has become a common behavioral problem. Millions of people all over the world are going through this agonising psychological trauma of this disorder and related depression every day. Epidemiological studies have shown that 7-8% of the population of the United States suffer from some form of social anxiety. It is the third largest psychological disorder in the country.

The causes of the disorder and depression may be generalized or specific to certain situations. In the generalized form all life situations can give rise to anxiety. The affected people may experience psychological stress at one or many of the following situations.
  • Requiring to make a speech
  • On being introduced to people
  • On being criticized
  • Discomfort with co-travellers
  • Eating or drinking in front of others
  • Becoming a center of attraction
  • Doing something when somebody is looking on
  • The thought that somebody is observing
  • Meeting people considered very important
  • Requiring to lead a group
The anxiety depression causes manifestation of many physical symptoms like, stuttering, trembling, nausea, urge to use toilet, racing heart, sweating, stammering or rapid speech, blushing and muscle twitches. Behavioral symptoms caused by depression are cognitive distortions, excessive social avoidance, avoidance behaviors, compulsive lying behavior, avoidance of eye contact, fight-or-flight response and cringing.
Though the affected persons know that their behavior is irrational and abnormal, they are unable to overcome the thoughts and feelings of anxiety and connected depression.

Possible causes of social anxiety disorder
  • Causes of social anxiety are wide-ranging and the onset is typically between 10 to 13 years.
  • The most common cause is emotional or physical abuse by peers or parents in the young age.
  • There may be a genetic cause, as a child has greater chances for developing anxiety disorder if one of the immediate family member is affected.
  • The genetic association as one of the causes is further strengthened by studies of twins adopted into different families. If one of them developed social anxiety disorder, the other child has 30-50% chances for developing the condition.
  • If a family member is affected, a child may acquiring anxiety depression through the processes of observational learning.
  • Insecure attachment with their mother as infants can cause children developing the condition in their adolescence.
  • 'Behavioural inhibition' in infants can cause them to have inhibited or fearful nature as they grow up.
  • Negative social experiences of self and observed or heard negative experiences of others may have a negative impact and lead to anxiety depression.
  • Excessive use of other's opinions and also shame as a disciplinary strategy by the parents can affect a child.
  • Living in thinly populated places reduces social contacts and this can cause behavioral problems.
  • Some studies have related these conditions are caused by hyperactivity in some areas of the brain and also imbalances in some neurochemicals.
Treatment for social anxiety depression
Cognitive-behavioral therapy is found to be very effective in treating social anxiety and related depression. Getting over anxiety problems is very difficult, but not impossible. Many people have overcome it. A psychologist who investigates and understands the individual situations of his patients can help them to get over it. Along with cognitive behavior therapy, antidepressants may be prescribed to overcome depression.

Untreated social anxiety can cause related psychological disorders like, major depressive disorder (MDD), Personality disorders, alcohol dependence, bulimia nervosa, anorexia nervosa, binge eating and substance abuse.

Interesting topics in Daily Health News & Tips:
Research reference:
1. Franklin R. Schneier, M.D., Anissa Abi-Dargham, M.D., Diana Martinez, M.D., Mark Slifstein, Ph.D., Dah-Ren Hwang, Ph.D., Michael R. Liebowitz, M.D., and Marc Laruelle, M.D. (2009). "Dopamine Transporters, D2 Receptors, and Dopamine Release in Generalized Social Anxiety Disorder". Depression and Anxiety. 2009; 26(5): 411–418.

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Causes of social anxiety disorder - Social anxiety depression

Friday, September 28

Horseradish roots - Horseradish juice - Health benefits

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Nutrition, Health & Wellness

Horseradish juice - Health benefits
Home > Celery nutrients - Celery juice health benefits > Horseradish root juice health benefits
Horseradish roots and their juice have high nutritional value and immense health benefits. The horseradish plant belongs to Brassicaceae family, and species Armoracia rusticana. Horseradish is a perennial plant. It grows up to five feet (1.5 meters) and has long, white, tapered roots. Its edible medicinal roots and their juice are traditionally known for many health benefits. It is one among the cruciferous vegetables (broccoli, cabbage and Brussels sprouts) known to contain glucosinolates. Glucosinolates are precursors to antimicrobial and antitumor compounds like allyl isothiocyanate and indoles.

Intact horseradish roots do not have any aroma. When the roots are cut or grated, a glucosinolate (sinigrin) present in the juices from the damaged cells is degraded by the enzyme myrosinase into a mustard oil (allyl isothiocyanate). Allyl isothiocyanate has a typical pungent odor. On exposure to air and heat, the cut roots loose their pungency and become dark with unpleasant bitter taste. They are mixed with vinegar to keep their quality and health benefits.

Health benefits of horseradish
  • Traditionally horseradish roots and their juice are being used as medicine for treating a number of health conditions and ailments.
  • In herbal medicine, horseradish juice is used for treating sinusitis, bronchitis and urinary tract infections.
  • Its juice is used as rubefacient and rubbed on skin to stimulate blood circulation below the skin for relieving pains.
  • Another health benefit is that its juice is a diuretic.
  • Culinary benefits include use in sauce, salad and soup preparations.
  • Horseradish is rich in vitamin C and also contains selenium, potassium, calcium, magnesium and phosphorus.
  • It also has dietary fibers, particularly soluble fibers.
  • Glucosinolates, sinigrin and gluconasturtiin (phenethylglucosinolate), present in root juice impart many medicinal health benefits to horseradish.
  • The extracted glucosinolates in fully developed roots contain 83%  sinigrin and 11% gluconasturtiin.

Antimicrobial health benefits of horseradish
Research studies have substantiated the use in herbal medicine for antimicrobial health benefits. Goos KH, Albrecht U and Schneider B. in their research studies compared treatment benefits of the herbal drug containing horseradish root juice with standard antibiotics. They found that herbal drug containing horseradish displayed a clear advantageous safety profile and benefits when compared with standard antibiotics in treating acute sinusitis, acute bronchitis and acute urinary tract infection.

Further it is found that horseradish root juice inhibits the development of antibiotic resistance by bacterial biofilms and multidrug-resistant bacteria. Jakobsen TH et al (Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.) found in their research studies that iberin, an isothiocyanate produced by horseradish exhibited the highest activity in blocking the bacterial communication, also known as quorum sensing (QS), which is essential for development of drug resistance in bacteria.

Antitumor effects and health benefits
Allyl isothiocyanate (AITC) present in horseradish roots and its juice has antitumor properties. Zhang Y. (Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY 14263, USA) in his research studies "Allyl isothiocyanate as a cancer chemopreventive phytochemical" concluded that "Bioavailability of Allyl isothiocyanate is extremely high, as nearly 90% of orally administered AITC is absorbed.  Overall, Allyl isothiocyanate exhibits many desirable attributes of a cancer chemopreventive agent, and further studies are warranted in order to elucidate its mechanism of action and to assess its protective activity in humans." Hence there is a great possibility of horseradish roots juice having a greater role as a cancer preventive agent.

Horseradish should not be consumed in excess as it can irritate the gastrointestinal tract. People with peptic ulcers and children below four years should avoid horseradish juice.

The enzyme horseradish peroxidase, present in the root juice has extensive research benefits in molecular biology and biochemical research fields.

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Research references:
1. Jakobsen TH, Bragason SK, Phipps RK, Christensen LD, van Gennip M, Alhede M, Skindersoe M, Larsen TO, Høiby N, Bjarnsholt T, Givskov M. Food as a source for quorum sensing inhibitors: iberin from horseradish revealed as a quorum sensing inhibitor of Pseudomonas aeruginosa. Appl Environ Microbiol. 2012 Apr;78(7):2410-21. Epub 2012 Jan 27. PMID: 22286987
2. Zhang Y. Allyl isothiocyanate as a cancer chemopreventive phytochemical. Mol Nutr Food Res. 2010 Jan;54(1):127-35.
3. Goos KH, Albrecht U, Schneider B. (Repha GmbH, Biologische Arzneimittel, Langenhagen.)Efficacy and safety profile of a herbal drug containing nasturtium herb and horseradish root in acute sinusitis, acute bronchitis and acute urinary tract infection in comparison with other treatments in the daily practice/results of a prospective cohort study. Arzneimittelforschung. 2006;56(3):249-57. PMID: 16618018

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Horseradish roots juice health benefits.

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Wednesday, September 26

Side effects of hypothyroidism - Severe hypothyroidism

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Nutrition, Health & Wellness

Side effects of hypothyroidism
Home > MRI scans uses, benefits and risks > Severe hypothyroidism and side effects.
Severe hypothyroidism can give rise to serious side effects like life threatening myxedema coma. When properly diagnosed severe hypothyroidism can be completely treated and the symptoms and the side effects can be totally alleviated. The basic cause of hypothyroidism is low levels of thyroxine hormone. Hormone replacement therapy with synthetic or natural hormone sources can completely control the condition. However the treatment may have to be continued life long.

Early symptoms
The common early symptoms are listed below:
  • Cold intolerance
  • Heavier menstrual periods
  • Severe constipation
  • Depression
  • Dry hair
  • Dry skin
  • Fatigue and weakness
  • Sleepiness
  • Weight gain
  • Body-ache
  • Depression
  • Brittle finger nails

Hypothyroidism as a side effect of certain health conditions and medications.
Following health conditions and medications have been found to cause the deficiency in the hormone production:
  • Adrenal insufficiency
  • Congenital hypothyroidism
  • Environmental stress
  • Excess estrogen
  • Auto-immunity
  • Destruction of the pituitary gland
  • Homeostatic stress
  • Iodine deficiency
  • Radiation treatments
  • Cancer and cancer treatments
  • Treatment of hyperthyroidism
  • Surgical removal the gland
  • Cold
  • Respiratory infection
  • Viral infections of the glands
  • Lithium-based mood stabilizers
  • Amiodarone
  • Interferon alpha
  • Interleukin-2
  • Thalidomide.

Symptoms of severe hypothyroidism are:
  • Hoarse voice
  • Puffiness of face, hands and feet
  • Slow speech
  • Thick skin
  • Thinning outer eyebrows.

Severe hypothyroidism and myxedema
In this situation of severe hypothyroidism, symptoms like low body temperature, decreased rate of breathing, low blood pressure and low blood glucose are seen.
Myxedema coma is the serious side effect of very low levels of the hormone. This is a medical emergency requiring hospitalization and intensive care treatment.

Side effects of hypothyroidism medication.
Thyroxine, triiodothyronine or desiccated gland extract are prescribed for treatment and control the hormone deficiency. One of the side effects is over-treatment resulting in hyperthyroidism. Side effects like palpitations, tremor, restlessness and severe profuse sweating are encountered when the dosage of the medication is high.

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Severe hypothyroidism and its side effects.

Tuesday, September 25

Chronic Sinusitis Treatments - Balloon Sinuplasty

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Nutrition, Health & Wellness

Chronic Sinusitis Treatments
Home > MRI uses, benefits and health risks > Balloon sinuplasty treatment for chronic sinusitis
Chronic sinusitis refers to persisting inflammation of the sinuses and its treatment with recently developed balloon sinuplasty appears promising. Endoscopic balloon sinuplasty procedure is similar to angioplasty and is less invasive than conventional surgical treatments for chronic sinusitis aka chronic rhinosinusitis (CRS).

Balloon sinuplasty procedure for sinusitis treatment helps in improving the normal drainage of the sinus cavities. drainage passages are widened and enlarged  with a small, flexible endoscopic balloon catheter. Unlike the conventional surgical treatment for chronic sinusitis, balloon sinuplasty procedure does not involve bone and tissue removal and has a shorter recovery period.

What is chronic sinusitis?
  • There are small paranasal cavities in the skull on the facial region and they are lined by mucus membrane and are filled with air. 
  • Mucus is discharged from these cavities into the nasal passage through ostia (opening). 
  • Sinusitis is the chronic inflammation of these cavities. 
  • The primary cause of chronic sinusitis is nasal inflammation blocking the mucus drainage, leading to infection, inflammation and pain in these cavities. 
  • If the sinusitis persists for more than twelve weeks, it is considered chronic.
  • Untreated acute sinusitis can become chronic.

Triggers and predisposing factors for chronic sinusitis.

The predisposing factors and triggers of sinusitis are:
  • allergies to environmental pollutants,
  • common cold,
  • Cystic fibrosis,
  • asthma,
  • inflammatory disorders,
  • seasonal temperature changes,
  • viral, bacterial and fungal infections, 
  • defective structure of nasal passage like deviated septum,
  • nasal polyps blocking the mucus drainage and
  • gastroesophageal reflux disease (GERD).

Conventional treatments for chronic sinusitis

Sinusitis is a much prevalent illness, affecting individuals of all age groups. Treatment with anti-inflammatory medicine, painkillers and antibiotics are considered for sinusitis.

Nasal sprays and drops: Saline nasal sprays, corticosteroid nasal sprays or corticosteroid nasal drops are recommended by physicians to clear the blocks of ostia and also to reduce inflammation in the early stages of chronic sinusitis.
Though nasal sprays containing Zinc compounds have been used successfully for sinusitis, FDA has advised against their use. The zinc nasal compounds can damage the sense of smell by permanently damaging the smell nerve endings.

Steam inhalation treatment: Breathing steam has been found useful in treatment of sinusitis controlling inflammation and opening up the blocked ostia.

Antimicrobial treatment: The physician may consider treatment with antibacterial (amoxicillin, doxycycline or trimethoprim-sulfamethoxazole) or antifungal preparations (amphotericin B) if an infection is the cause of chronic sinusitis.

Nasal irrigation: Flushing out the nasal passage with sterile saline water with the help of bulb syringes or neti pots help in relieving the pressure, blockage and pain.

Surgical options

For patients with chronic sinusitis if the response to conventional treatment is not satisfactory, there are two surgical options available.

Functional endoscopic sinus surgery (FESS): FESS is the conventional surgical treatment involving removal of bone and/or tissues to make wide passage for the cavity to drain. This surgical procedure requires hospitalization, rest and a long recovery period.

Balloon sinus dilation (BSD) or balloon sinuplasty: This procedure introduced in 2005 is the latest non invasive method for the treatment of chronic sinusitis. The advantage of BSD lies in minimal anesthetic use, short procedure time and fast return to normal activities.

Equipment for balloon sinuplasty: A flexible endoscope (Rhinoscope or Nasoscope), guide catheter, balloon catheter and irrigation catheter are used while performing this procedure.

Balloon sinuplasty procedure

Ct scan and endoscopic visualization is done prior to sinuplasty.
With endoscopic visualization a guide catheter is introduced into sinus opening.
Once access to the ostium of the cavity under treatment is located, a balloon catheter is positioned into the blocked ostium.
Balloon sinuplasty catheter is inflated for short duration with predetermined pressure.
The sinuplasty balloon is deflated and the catheter is removed after treatment.
If irrigation system incorporated into the balloon sinuplasty catheter, irrigation is activated to flush out the mucus and pus, if any.
If the balloon sinuplasty catheter is not equipped with irrigation system, a separate irrigation catheter has to be inserted to flush out the cavity of its accumulated mucus.

When sinusitis becomes chronic, it is very difficult to avoid recurrences. Taking preventive measures and also early treatment with balloon sinuplasty will go a long way in alleviating the severity of chronic sinusitis.

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Treatment of chronic sinusitis with balloon sinuplasty.