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Editorial Note
Dr. Biji GeorgeEditor
Editorial Team
P.O. Box 198,PC 101, As SeebSultanate of Oman
Tel: +968 24557200, Email: [email protected]
Web: www.starcarehospital.com
Issue: 09
Starcare Hospital welcomes our esteemed readers to our ninth
volume of our e-magazine “Health Splash”. It is heartening to note
that we are getting good feedback about our articles in the maga-
zine. We invite further constructive criticisms on our articles and
the magazine as a whole.
We can all remember the old days when our grandmothers used to
cook fresh food with freshly grown vegetables and locally available
produce. Now our diets are changed and wholesome food has been
replaced with oily and calorie rich food and fizzy beverages, result-
ing in multitude of physical ailments. Hyperacidity, Stomach Ulcers,
High blood pressure, Diabetes to name just a few. An ailment seen
especially in Oman is GERD (Gastro-Esophageal Reflux Disease). Dr
Grezl, our Senior Gastroenterologist, gives us a well written article
on the causes and diagnosis of GERD and how to manage this
common problem.
The “Red Days” are an innate part of the life of every woman. But
those suffering from excessive bleeding during menstruation suffer
a great deal more. Dr Visalakshi, our Gynecologist enlightens us on
the causes, diagnosis and treatment of heavy menstrual bleeding.
Excessive bleeding often requires blood transfusions to replace all
the lost blood. Blood comes from Blood banks obviously. But the
Blood banks depend a great deal on voluntary donors. Blood donation
does not require any education or skills and the satisfaction of having
done something good for others by donating regularly is one to be
experienced personally.
Our complement of other features including the quiz and updates
from the Starcare family will also interest you, as always.
Keep caring…
Editor:Dr. Biji Thomas George
Associate Editor:Dr. Yousef Abdel Mohsin El Qabbany
Issue Manager:Shyju Joseph
Magazine Coordinator:Anu Joseph
Design & LayoutDantis Mathew
Dr. VishalakshiMBBS, MDObstetrician & Gynaecologist
Heavy menstrual bleeding (HMB) is the excessive menstrual blood loss which interferes with women’s physical, social, emotional or material quality of life. Normal menstrual bleeding generally lasts for 5 – 7 days. If bleeding occurs for more than 7 days and you tend to pass clots the size of a quarter or larger, that is heavy bleeding or HMB.Usually, the cause is a hormonal imbalance between the hormones estrogen and progesterone. These hormones regulate the buildup of the lining of the uterus (endometrium), which is shed during menstruation. If a hormonal imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding. Here the woman may have a brief period of absent periods followed by heavy flow. Usually the bleeding is painless. Uterine fibroids: This is the commonest tumor arising from uterine muscle cells. These noncancerous tumors of the uterus appear during the childbearing years. They may be asymptomatic or result in HMB, which may be accompanied with pain. Uterine fibroids may cause heavier than normal or prolonged menstrual bleeding. Pelvic inflammatory disease (PID) is an infection of one or more organs that affects the uterus, fallopian tubes, and cervix.Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus (endometrial implant). Endometriosis most commonly involves your ovaries, bowel or the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond your pelvic region. Pelvic Endometriosis can be painful with excessive bleeding.Functional cyst (a fluid filled bag which releases hormones) of the ovary can also give rise to HMB.Endometrial polyps are typically non-cancerous, growths that protrude from the lining of the uterus and results in HMB.Intrauterine Contraceptive devices, especially copper
containing devices sometimes act as a foreign body and prompts heavier bleeding. This usually settles by 2 – 3 months unless complicated with infection.Complications of Pregnancy can also cause HMB and should be excluded in all women of reproductive age.Women who are nearing menopause may have thickening of the lining of uterus and cancer of the uterus has to be ruled out. Sometimes thyroid disorders especially Hypothyroidism can cause HM bleeding. In some cases, the cause of heavy menstrual bleeding is unknown. Tests: Common Blood Profile is done to detect the cause and extent of resulting anemia. Tests are done to rule out genetic blood clotting or bleeding disorders in younger women with HMB. Ultrasound Scanning is done to detect fibroids, polyps, ovarian masses and also to see if any endometrial thickening is present. Treatment: Management of HMB depends on the cause. In earlier days, HMB was the main reason for the removal of the uterus. Most of the patients with HMB due to hormonal variations are started with simple analgesics like Mefanamic Acid, which helps in controlling the bleeding by 50% in most of the cases. The recommended treatment for pelvic inflam-matory disease is antibiotic therapy. Drugs which help to increase clotting of blood can decrease the bleeding but have to be used with caution. Hormone treatments where proges-terones are given from 5th – 15th or 5th – 25th day for 3 – 6 months have been used successfully, again with caution.Alternatively Oral Contraceptive Pills are given to those who are currently using contraceptives. Other choices like intra uterine hormonal devices give good control over HMB especially in women who are around the age of meno-pause. Minor surgical procedures like removal of polyps in the endometrium, D&C (Cleaning of the inside of the uterus) and hysteroscopy (using a camera to visualize the inside of the uterus) may be required in some patients. More major procedures include removal of the lining of the uterus and removal of the uterus itself as a last resort in severe cases.
Blood Disordersin WomenThe red days
Dr. L. GrezlMDConsultant Gastroenterologist
What is it ?GERD is the most common and costly disease of the digestive system and its prevalence seems to be increasing. Men and women are affected equally. Gastro-esophageal reflux is a back flow of stomach acid and contents into the esophagus. Over time, the backwash of acid irritates and can inflame and damage the lining of the esophagus. GERD is when reflux of gastric contents into the esophagus produce symptoms like heartburn and regurgitation and/or complications due to the acid damag-ing the esophageal lining. Gastric reflux may damage the esophagus causing inflammation with tiny ulcers - called reflux esophagitis. This is called erosive type GERD. When the esopha-gus is normal it is called non-corrosive type GERD.Cause: A muscular valve called the lower esophageal sphincter (LES) usually stops the backflow of stomach contents while allowing food from the esophagus to go into the stomach. So, to prevent backflow of stomach contents, it normally stays tightly shut if there is no food in the esophagus on the way to the stomach. But when there is temporary relaxation of this valve (LES) at this time or when it stays loose or open all the time, it causes GERD. Factors that decrease LES pressure and contribute to reflux are lifestyle factors like weight gain, smoking, eating immediately prior to bedtime, certain food and beverages like fatty and spicy food, coffee, chocolate, peppermint, alcohol, carbonated bever-ages like cola, tomato based products, citrus fruits and juices, vinegar and certain medicines.Symptoms: Typical esophageal symptoms of GERD are heartburn and acid regurgitation. Heartburn is defined as a burning discomfort in upper abdomen that radiates up toward the chest and throat and occurs after a high-fat or large volume meal. It can also be aggravated by ingestion of food and bever-ages mentioned above. Other symptoms associated with GERD include difficulty in swallowing, water brash, excessive salivation, feeling of a lump in the throat, nausea, vomiting and chest pain.GERD can also manifest with symptoms not related to the digestive system like involving ear, nose, throat and lungs due to micro-aspiration of gastric acid. These include bronchial asthma, recurrent upper respiratory infections, hoarseness, laryngitis and bad breath. A newly recognized manifestation is middle ear infection in children.Additional tests before starting treatment are not necessary when:• Patient experiences common symptoms of reflux like heartburn• Which is only episodic • Patient is younger than 45 years
• Alarming symptoms like weight loss, bleeding, anemia, difficult or painful swallowing are absent. Diagnosis, when all the above are true, is based on symptoms and when there is complete response for acid suppression by medications.Upper Endoscopy (Gastroscopy) is indicated when:• If symptoms do not respond to treatment• If alarming symptoms described above are present• Patient is older than 45 years• Symptoms are chronicThe Gastroscopy procedure:A doctor places a flexible tube with a camera at the end through the mouth into the esophagus, stomach and duode-num, under medication to lessen discomfort. Gastroscopy allows the doctor directly visualize the interior of these parts of the digestive system.
Gastroscopy helps to detect and grade severity of the inflam-mation of the esophagus (esophagitis) and detect complica-tions like ulcers, narrowing and pre-cancerous or cancerous lesions. It also allows the doctor to take a biopsy from suspicious areas.Antacids and Ranitidine are used to treat accidental heartburn, but are not used any longer to treat GERD.
First line treatment involves a class of drugs called Proton Pump
Inhibitors (like omeprazole, lansoprazole, pantoprazole, esome-
prazole and rabeprazole.) They are all highly effective and act by
blocking the final step of acid production in the stomach. They
should be taken a half an hour before breakfast. If symptoms
continue, the same dose can be added before dinner.
Standard treatment for acute symptoms involves 8-12 weeks
trial of a PPI.
Long term maintenance therapy can involve long term use of
PPI at the lowest effective dose or they may be also taken only
when symptoms occur along with lifestyle modification.
Although GERD can limit daily activities and may cause compli-
cations, it is rarely life-threatening. With proper treatment most
people will find relief and prevent possible complications.
Gastro-Esophageal Reflux Disease - GERD
Blood donation is a voluntary procedure. Millions of people
need blood transfusions each year. Some may need blood
during surgery. Others depend on it after an accident or
because they have a disease that requires blood components.
Blood donation makes all of this possible.There are several
types of blood donation:
• Whole blood. This is the most common type of blood
donation, during which approximately a pint of whole blood
is given. The blood is then separated into its components —
red cells, plasma, platelets.
• Platelets. This type of donation uses a process called apher-
esis. During apheresis, the donor is hooked up to a machine
that collects the platelets and some of the plasma, and then
returns the rest of the blood to the donor.
• Plasma. Plasma may be collected simultaneously with a
platelet donation or it may be collected without collecting
platelets during an apheresis donation.
• Double red cells. Double red cell donation is also done
using apheresis. In this case, only the red cells are collected.
To be eligible to donate whole blood, platelets or plasma, you
must be:
• an age between 18-65 years
• In good health
• At least 50 Kilograms weight
• Blood pressure - 70-140 mm.Hg
• Pulse - 50-100 per mm., regular
• Able to pass the other physical and health history assess-
ments
• not have donated blood in the last 56 days – ideal time is
after 90 days.
The eligibility requirements are slightly different for double
red cell donation.
Risks
Blood donation is safe. New, sterile disposable equipment is
used for each donor, so there's no risk of contracting a blood
borne infection by donating blood.
If you're a healthy adult, you can usually donate a pint of
blood without endangering your health. Within 24 hours of a
blood donation, your body replaces the lost fluids. And after
several weeks, your body replaces the lost red blood
cells.After donating you sit in an observation area, where you
rest and eat a light snack. After 10 to 15 minutes, you can
leave.
• Drink extra fluids for the next day or two.
• Avoid strenuous physical activity or heavy lifting for the next
five hours.
• If you feel lightheaded, lie down with your feet up until the
feeling passes.
• Keep the bandage on your arm for at least four hours.
• If bleeding or bruising occurs under the skin, apply a cold
pack to the area periodically during the first 24 hours.
• If your arm is sore, take a pain reliever such as acetamino-
phen. Avoid taking aspirin or ibuprofen (Advil, Motrin,
others).
Contact the blood donor center or your doctor if you:
• Continue to feel nauseated, lightheaded or dizzy after
resting, eating and drinking.
• Notice a raised bump, continued bleeding or pain at the
needle-stick site when you remove the bandage.
• Become ill with signs and symptoms of a cold or flu, such as
fever, headache or sore throat, within four days after your
blood donation. Bacterial infections can be transmitted by
your blood to a potential donor via transfusion, so it's impor-
tant to let the blood donor center know if you become ill so
that your blood won't be used.Results• Your blood will be tested to determine your blood type —
classified as A, B, AB or O — and your Rh factor. The Rh factor
refers to the presence or absence of a specific antigen, a
substance capable of stimulating an immune response, in the
blood. So you're either Rh positive or Rh negative, meaning
you carry the antigen or you don't.
• Your blood will also be tested for blood borne diseases, such
as hepatitis, HIV and syphilis. If these tests are negative, the
blood is distributed for use in hospitals and clinics. If any of
these tests are positive, the blood bank notifies you, and your
blood is discarded and not used.
Contributed by Mayo ClinicRef: http://www.moh.gov.om/en/mgl/Manual/TechnicalManualonBloodTransfusion/index.htm
HEALTH WELLNESS
&Donate Blood
Starcare in
NEWS
Call us: 98088705 / 24557200
2013
Organization Accreditedby Joint Commission International
Tel: +968 24557200, Fax: +968 2455720, P.O. Box 198, PC 101, As Seeb, Sultanate of Oman, Web: www.starcarehospital.com,
Sept 29
Heart Diseases can affect people of all ages and population groups, including women and children.
However, their risk can be controlled, treated or modified through everyday heart-healthy behaviours, such as eating a healthy diet, taking regular exercise and avoiding tobacco use.
A fit healthy body gives a healthy heart !!!
Special discounts on Cardiac Consultations, Investigations & Cardiac Check ups
Take the roadto a healthy heartwww.worldheartday.com, theme:2013
Register at: +968 98088771From 29th Sept- 31st Oct 2013
Starcare Antenatal Classes on child birth & parenting
Register at: 98252030
Dr. Adnan JamilMBBS
General Practitioner
Our new doctor
For more details e- mail us: [email protected]
Disclaimer
This magazine does not attempt to endorse or promote any information presented. Please keep in mind that information about health matters changes constantly as new studies are performed and new treatments are discovered. Consult your physician or other health professional for your health related advice.
Send in your answers at [email protected] and the winner willget a GIFT VOUCHER. *Conditions apply
Win yourGift
QUIZ CORNER
For more information on our hospitalVisit: www.starcarehospital.com, E-mail: [email protected]
Contact: +968 24557200, GSM: +968 98252030, P.O.Box: 198, PC 101, As Seeb, Sultanate of Oman
Your feedback and opinions are important to us. Kindly write to [email protected]
Answer the below questions
Oman Special1. To the south east of Oman is which waterway ?
2. The Arabian Oryx Sanctuary in Oman is a UN World Heritage Site, an Oryx is
3. In the past, Oman was known by the name Majan. What does Majan mean? A) the land of copper B) the land of sand C) the land of gold
4. The Omani National Day which falls on November 18th marks:
A) the day when the Sultan came to power
B) the Sultan’s date of birth
C) the date the Omani civil war ended
Answers to Quiz in September issue:1. The fireman is the only man in the room. The rest of the poker players are women.
2. Pick from the one labeled "Apples & Oranges". This box must contain either only apples or only oranges.
3. 12
2013
Organization Accreditedby Joint Commission International
Tel: +968 24557200, Fax: +968 2455720, P.O. Box 198, PC 101, As Seeb, Sultanate of Oman, Web: www.starcarehospital.com, [email protected]
Sept 29
www.worldheartday.com, theme:2013
+968- 98088771
MBBS