Total Knee Replacement

What is a total knee replacement?

A total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with artificial material. The knee is a hinge joint which provides motion at the point where the thigh meets the lower leg. The thighbone (or femur) abuts the large bone of the lower leg (tibia) at the knee joint. During a total knee replacement, the end of the femur bone is removed and replaced with a metal shell. The end of the lower leg bone (tibia) is also removed and replaced with a channelled plastic piece with a metal stem. Depending on the condition of the kneecap portion of the knee joint, a plastic “button” may also be added under the kneecap surface. The artificial components of a total knee replacement are referred to as the prosthesis.

 

 

The posterior cruciate ligament is a tissue that normally stabilizes each side of the knee joint so that the lower leg cannot slide backward in relation to the thighbone. In total knee replacement surgery, this ligament is retained, sacrificed, or substituted by a polyethylene post. Each of these various designs of total knee replacement has its benefits and risks.

 

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Jet Lag

What is jet lag?

 

Jet lag, also called desynchronosis and flight fatigue, is a temporary disorder that causes fatigue, insomnia, and other symptoms as a result of air travel across time zones. It is considered a circadian rhythm sleep disorder, which is a disruption of the internal body clock.

 

 

What are other symptoms and signs of jet lag?

 

Besides fatigue and insomnia, a jet lag sufferer may experience a number of physical and emotional symptoms including anxiety, constipation, diarrhea, confusion, dehydration, headache, irritability, nausea, sweating, coordination problems, dizziness, and even memory loss. Some individuals report additional symptoms, such as heartbeat irregularities and increased susceptibility to illness.

 

Children can also suffer the same jet lag symptoms as adults.

 

 

What is a time zone?

 

A time zone is a geographical region which has the same time everywhere within it. The world has 24 time zones, one for each hour in the day. Each zone runs from north to south in strips that are approximately 1,000 miles (1,600 kilometers) wide. (The actual width of each zone varies to accommodate political and geographical boundaries.) As the earth rotates, dawn occurs at a set hour in one time zone, then an hour later in the time zone immediately to the west and so on through the 24-hour cycle. Thus, in the U.S., when it is 6 a.m. in the Eastern Time zone, it is 5 a.m. in the central zone, 4 a.m. in the mountain zone, and 3 a.m. in the Pacific zone.

 

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Pancreatitis

 

What is pancreatitis?

 

Pancreatitis is inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum – the first part of the small intestine. The pancreas secretes digestive juices, or enzymes, into the duodenum through a tube called the pancreatic duct. Pancreatic enzymes join with bile – a liquid produced in the liver and stored in the gallbladder – to digest food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body regulate the glucose it takes from food for energy.

 

Normally, digestive enzymes secreted by the pancreas do not become active until they reach the small intestine. But when the pancreas is inflamed, the enzymes inside it attack and damage the tissues that produce them.

 

Pancreatitis can be acute or chronic. Either form is serious and can lead to complications. In severe cases, bleeding, infection, and permanent tissue damage may occur.

 

Both forms of pancreatitis occur more often in men than women.

 

What are the causes of acute pancreatitis?

 

Acute pancreatitis is inflammation of the pancreas that occurs suddenly and usually resolves in a few days with treatment. Acute pancreatitis can be a life-threatening illness with severe complications. The most common cause of acute pancreatitis is the presence of gallstones – small, pebble-like substances made of hardened bile – that cause inflammation in the pancreas as they pass through the common bile duct. Chronic, heavy alcohol use is also a common cause. Acute pancreatitis can occur within hours or as long as 2 days after consuming alcohol. Other causes of acute pancreatitis include abdominal trauma, medications, infections, tumors, and genetic abnormalities of the pancreas.

 

 

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Orthostatic Hypotension

What is orthostatic hypotension?

 

When a person stands up from sitting or lying down, the body must work to adjust to that change in position. It is especially important for the body to push blood upward and supply the brain with oxygen. If the body fails to do this adequately, blood pressure falls, and a person may feel lightheaded or even pass out. Orthostatic hypotension is the term used to describe the fall in blood pressure when a person stands (orthostatic= upright posture of the body; hypo= less + tension=pressure).

 

Adequate blood supply to the body’s organs depends upon three factors:

 

1. a heart strong enough to pump,

2. arteries and veins that are able to constrict or squeeze, and

3. enough blood and fluid within the vessels.

When the body changes position, a variety of actions occur involving all parts of the cardiovascular system as well as the autonomic nervous system that helps regulate their function.

 

The autonomic nervous system can be considered to “run in the background” of the body, regulating body processes that we take for granted. There is a balance between the sympathetic system (adrenergic nerves), that speed things up, and the parasympathetic system (cholinergic nerves) that slow things down. These names are based on the type of chemical that is used to transmit signals at the nerve endings.

 

* Adrenaline (from the sympathetic nervous system) allows the body to respond to stress. Imagine seeing a bear in the woods; your heart beats faster, your palms get sweaty, your eyes dilate, and your hair stands on end.

 

* Acetylcholine is the chemical that is the anti-adrenaline and is involved in the parasympathetic nervous system.

 

These two systems are in balance, and yet need to respond to routine changes in the body that happens throughout the day.

 

* When the body moves to a standing position, pressure monitors (baroreceptor cells) located in the carotid arteries and the aorta sense a subtle drop in blood pressure because of gravity, which causes blood to flow towards the legs.

 

* Almost immediately, the sympathetic system is stimulated, causing the heart rate to increase, the heart muscle to contract or squeeze more forcefully, and blood vessels to constrict or narrow.

 

* All of these actions serve to increase the blood pressure so that an adequate amount of blood can still be pumped to the brain and other organs.

 

* Without these changes, gravity would cause the blood to remain in the lowest part of the body and away from the brain, causing symptoms of light headedness or even passing out.

 

Orthostatic hypotension is not a disease or a complaint from an individual; it is an abnormal change in blood pressure and heart rate associated with an illness.

 

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Ultrasound

Introduction

While the patient’s history and physical examination are the building blocks of making a medical diagnosis, the ability to peer inside the body can be a powerful tool. Ultrasound is an imaging technique that provides that ability to medical practitioners.

 

What is an ultrasound?

Ultrasound produces sound waves that are beamed into the body causing return echoes that are recorded to “visualize” structures beneath the skin. The ability to measure different echoes reflected from a variety of tissues allows a shadow picture to be constructed. The technology is especially accurate at seeing the interface between solid and fluid filled spaces. These are actually the same principles that allow SONAR on boats to see the bottom of the ocean.

 

What is ultrasonography?

Ultrasonography is body imaging using ultrasound in medical diagnosis. A skilled ultrasound technician is able to see inside the body using ultrasonography to answer questions that may be asked by the medical practitioner caring for the patient. Usually, a radiologist will oversee the ultrasound test and report on the results, but other types of physicians may use ultrasound as a diagnostic tool. For example, obstetricians use ultrasound to assess the fetus during pregnancy. Surgeons and emergency physicians use ultrasound at the bedside to assess abdominal pain or other concerns.

 

A transducer, or probe, is used to project and receive the sound waves and the return signals. A gel is wiped onto the patient’s skin so that the sound waves are not distorted as they cross through the skin. Using their understanding of human anatomy and the machine, the technician can evaluate specific structures and try to answer the question asked by the patient’s physician. This may take a fair amount of time and require the probe to be repositioned and pointed in different directions. As well, the technician may need to vary the amount of pressure used to push the probe into the skin. The goal will be to “paint” a shadow picture of the inner organ that the health care practitioner has asked to be visualized.

 

The physics of sound can place limits on the test. The quality of the picture depends on many factors.

  • Sound waves cannot penetrate deeply, and an obese patient may be imaged poorly.
  • Ultrasound does poorly when gas is present between the probe and the target organ. Should the intestine be distended with bowel gas, organs behind it may not be easily seen. Similarly, ultrasound works poorly in the chest, where the lungs are filled with air.
  • Ultrasound does not penetrate bone easily.
  • The accuracy of the test is very much operator dependent. This means that the key to a good test is the ultrasound technician.

Ultrasound can be enhanced by using Doppler technology which can measure whether an object is moving towards or away from the probe. This can allow the technician to measure blood flow in organs such as the heart or liver, or within specific blood vessels.

 

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Sleep

What is sleep?

 

There are over 20 definitions of “sleep” in several dictionaries. The first, a verb, seems most appropriate:

 

to take the rest afforded by a suspension of voluntary bodily functions and the natural suspension, complete or partial, of consciousness; cease being awake.

 

Physiologically, sleep is a complex process of restoration and renewal for the body. Scientists still do not have a definitive explanation for why humans have a need for sleep. We do know that sleep is not a passive process or “switching off” of body functions; sleep is believed to be important in many physiologic processes including the processing of experiences and the consolidation of memories. It is also clear that sleep is essential, not only for humans but for almost all animals.

 

The importance of sleep is underscored by the symptoms experienced by those suffering from sleep problems. People suffering from sleep disorders do not get adequate or restorative sleep, and sleep deprivation is associated with a number of both physical and emotional disturbances. In addition, sleep is influenced by the circadian rhythms (regular body changes in mental and physical characteristics that occur in the course of about 24 hours). These are controlled by brain neurons that respond to light, temperature and hormones and other signals and comprise the body’s biological clock. This clock helps regulate the “normal” awake and sleep cycles. Disruption of these cycles can make people sleepy at times people want to be awake. For example, travelers experience “jet lag” when they cross time zones. When a New Yorker arrives in Paris at midnight Paris time, his or her body continues to operate (their biological clock) on New York time. It may take some time (about 1-3 days) to reset a person’s biologic clock, depending on how much it has been altered by the time change.

 

There is evidence that some aspects of sleep are under genetic influence; a gene termed DEC2 is being investigated as causing people that possess it to require only about 6 hours of sleep. Researchers have only begun to examine the genetics involved in sleep.

 

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Healthcare boost for Sabah folk

Monday December 24, 2012

 

KOTA KINABALU: All five 1Malaysia clinics in Sabah will be open by the end of the week, bringing the total number to 23 statewide.

 

Assistant State Resource Development and Information Technology Minister Datuk Jainab Ahmad said the clinics located in Kampung Likas, Tanjung Aru, Kepayan and Telipok here and in southwestern Sipitang were in the final stages of completion.

 

She said this after officially opening the Kampung Likas 1Malaysia clinic yesterday.

 

“More 1Malaysia clinics will be built next year, including in Beau-fort, Kinabatangan, Kota Belud, Lahad Datu, Pitas, Sandakan and Tenom.”

 

Jainab said 1Malaysia clinics were not just being built in rural areas but also urban locations as many people there need access to affordable healthcare, too.

 

“Many are in the low-income group and they need help because of the higher cost of living.

 

“Such clinics will help reduce the financial burden of these people who include the disabled and single mothers,” she said.

 

Sabah Health Department deputy director Dr Jamail Muhi said that people would receive quality healthcare for a minimal fee of RM1, including medication.

 

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Dr Yee: Healthy social activities a good way to reduce rising number of suicide cases

Friday, December 28, 2012

Stories by R.S.N. MURALI
murali@thestar.com.my

 

MALACCA: Suicide rates in Malaysia are on the rise. According to the National Suicide Registry Malaysia’s (NSRM), there were 445 suicides as reported.

 

Out of that figure, 347 were men and 98 women while the highest number of suicides occurred by those between 30 and 39 years old (109), followed by those between 20 and 29 age bracket (108).

 

Dr Yee Kok Wah was speaking at the Happy Line Dancing Christmas celebration here at the main stage of Jonker Walk, said the Health Ministry also reported that an average of seven people, mainly youths and young adults, end their own lives on a daily basis that tabulates to an estimated 140 people attempting suicide each day.

 

“National statistics also show that men outnumber women by three to one, while the Chinese had the highest number of suicides at 48%, followed by Indians (21%), Malays (18%) and other races (13%).

 

“I believe there are lot more people in despair and in need of emotional support,” Dr Yee said.

 

He said there is a great need to create awareness and healthy activities and line dancing is indeed a good avenue for such people to release tension and mix about socially to eradicate or reduce their personal problems.

 

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Don: More youngsters suffering from diabetes

Sunday December 23, 2012

 

UALA LUMPUR: Some 300,000 young people in the country are suffering from Type 2 Diabetes Mellitus (T2DM), according to Universiti Sains Malaysia endocrinologist Prof Datuk Dr Wan Mohamad Bebakar.

 

He said the number was expected to increase as the number of T2DM patients worldwide was expected to almost double from the current 230 million to 440 million by 2030.

 

He said this meant the risks were higher for more young people to suffer from diabetes complications.

 

“The fact is 20.8% of the Malaysians are suffering from T2DM right now, 5% of whom are young people aged between 20 and 25.

 

“The percentage is clearly bigger than in the United States which only recorded 2% of young people suffering from T2DM,” he said .

 

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Nonsteroidal Antiinflammatory Drugs (NSAIDs)

What are NSAIDs and how do they work?

 

Prostaglandins are a family of chemicals that are produced by the cells of the body and have several important functions. They promote inflammation, pain, and fever; support the blood clotting function of platelets; and protect the lining of the stomach from the damaging effects of acid.

 

Prostaglandins are produced within the body’s cells by the enzyme cyclooxygenase (COX). There are two COX enzymes, COX-1 and COX-2. Both enzymes produce prostaglandins that promote inflammation, pain, and fever. However, only COX-1 produces prostaglandins that support platelets and protect the stomach. Nonsteroidal antiinflammatory drugs (NSAIDs) block the COX enzymes and reduce prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced. Since the prostaglandins that protect the stomach and support platelets and blood clotting also are reduced, NSAIDs can cause ulcers in the stomach and promote bleeding.

 

 

For what conditions are NSAIDs used?

 

NSAIDs are used primarily to treat inflammation, mild to moderate pain, and fever. Specific uses include the treatment of headaches, arthritis, sports injuries, and menstrual cramps. Ketorolac (Toradol) is only used for short-term treatment of moderately severe acute pain that otherwise would be treated with opioids. Aspirin (also an NSAID) is used to inhibit the clotting of blood and prevent strokes and heart attacks in individuals at high risk. NSAIDs also are included in many cold and allergy preparations.

 

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