Editorial Team Editor: Dr. Biji Thomas George Associate Editor: Dr. Yousef Abdel Mohsin El Qabbany Issue Manager: Shyju Joseph Magazine Coordinator: Anu Joseph Design & Layout Dantis Mathew
Issue: 09 P.O. Box 198,PC 101, As Seeb Sultanate of Oman Tel: +968 24557200, Email: firstname.lastname@example.org
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 magazine. 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, resulting 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…
Dr. Biji George Editor
Blood Disorders in Women The red days Dr. Vishalakshi
MBBS, MD Obstetrician & 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 inﬂammatory 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 progesterones 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 menopause. 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.
Dr. L. Grezl
MD Consultant 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 damaging 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 esophagus 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 beverages 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 beverages 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
Gastro-Esophageal Reflux Disease - GERD • 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 chronic The Gastroscopy procedure: A doctor places a ﬂexible tube with a camera at the end through the mouth into the esophagus, stomach and duodenum, 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 inﬂammation of the esophagus (esophagitis) and detect complications 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, esomeprazole 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 complications, it is rarely life-threatening. With proper treatment most people will ﬁnd relief and prevent possible complications.
HEALTH& WELLNESS Donate Blood Blood donation is a voluntary procedure. Millions of people
several weeks, your body replaces the lost red blood
need blood transfusions each year. Some may need blood
cells.After donating you sit in an observation area, where you
during surgery. Others depend on it after an accident or
rest and eat a light snack. After 10 to 15 minutes, you can
because they have a disease that requires blood components.
Blood donation makes all of this possible.There are several
• Drink extra ﬂuids for the next day or two.
types of blood donation:
• Avoid strenuous physical activity or heavy lifting for the next
• Whole blood. This is the most common type of blood
donation, during which approximately a pint of whole blood
• If you feel lightheaded, lie down with your feet up until the
is given. The blood is then separated into its components —
red cells, plasma, platelets.
• Keep the bandage on your arm for at least four hours.
• Platelets. This type of donation uses a process called apher-
• If bleeding or bruising occurs under the skin, apply a cold
esis. During apheresis, the donor is hooked up to a machine
pack to the area periodically during the ﬁrst 24 hours.
that collects the platelets and some of the plasma, and then
• If your arm is sore, take a pain reliever such as acetamino-
returns the rest of the blood to the donor.
phen. Avoid taking aspirin or ibuprofen (Advil, Motrin,
• Plasma. Plasma may be collected simultaneously with a
platelet donation or it may be collected without collecting
Contact the blood donor center or your doctor if you:
platelets during an apheresis donation.
• Continue to feel nauseated, lightheaded or dizzy after
• Double red cells. Double red cell donation is also done
resting, eating and drinking.
using apheresis. In this case, only the red cells are collected.
• Notice a raised bump, continued bleeding or pain at the
To be eligible to donate whole blood, platelets or plasma, you
needle-stick site when you remove the bandage.
• Become ill with signs and symptoms of a cold or ﬂu, such as
• an age between 18-65 years
fever, headache or sore throat, within four days after your
• In good health
blood donation. Bacterial infections can be transmitted by
• At least 50 Kilograms weight
your blood to a potential donor via transfusion, so it's impor-
• Blood pressure - 70-140 mm.Hg
tant to let the blood donor center know if you become ill so
• Pulse - 50-100 per mm., regular ments
that your blood won't be used. Results • Your blood will be tested to determine your blood type —
• not have donated blood in the last 56 days – ideal time is
classiﬁed as A, B, AB or O — and your Rh factor. The Rh factor
after 90 days.
refers to the presence or absence of a speciﬁc antigen, a
The eligibility requirements are slightly diﬀerent for double
substance capable of stimulating an immune response, in the
red cell donation.
blood. So you're either Rh positive or Rh negative, meaning
you carry the antigen or you don't.
Blood donation is safe. New, sterile disposable equipment is
• Your blood will also be tested for blood borne diseases, such
used for each donor, so there's no risk of contracting a blood
as hepatitis, HIV and syphilis. If these tests are negative, the
borne infection by donating blood.
blood is distributed for use in hospitals and clinics. If any of
If you're a healthy adult, you can usually donate a pint of
these tests are positive, the blood bank notiﬁes you, and your
blood without endangering your health. Within 24 hours of a
blood is discarded and not used.
• Able to pass the other physical and health history assess-
blood donation, your body replaces the lost ﬂuids. And after
Contributed by Mayo Clinic Ref: http://www.moh.gov.om/en/mgl/Manual/TechnicalManualonBloodTransfusion/index.htm
NEWS Our new doctor
2013 Sept 29 Dr. Adnan Jamil MBBS General Practitioner
A fit healthy body gives a healthy heart !!! 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.
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Oman Special 1. 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 Sultanâ€™s date of birth C) the date the Omani civil war ended
Answers to Quiz in September issue: 1. The ďŹ reman 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
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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.
2013 Sept 29 MBBS
+968- 98088771 Emailfirstname.lastname@example.org
Organization Accredited by Joint Commission International
Tel: +968 24557200, Fax: +968 2455720, P.O. Box 198, PC 101, As Seeb, Sultanate of Oman, Web: www.starcarehospital.com, Emailemail@example.com
Published on Oct 5, 2013
Starcare online health magazine "HEALTH SPLASH" featuring articles on women and on the common Gastro-Esophageal Reflux Disease - GERD. We...