Erythrocyte Sedimentation Rate (ESR) is a time-honored, simple, inexpensive, most widely used laboratory test for monitoring the course of infections, inflammatory diseases, and some types of cancer.
Just to get more clarity on the method for testing: There are several test methods developed recently, and as a result the safety and reliability of ESR testing procedures have improved. The International Council for Standardization in Hematology and the National Committee for Clinical Laboratory Standards for ESR measurement have approved the test which is based on the traditional Westergren method, using EDTA-anticoagulated samples without dilution.
Whenever ESR is raised there could be several interpretations:
- The most frequently thought about are infection, especially Tuberculosis ,chronic bronchitis, rheumatoid arthritis and renal failure.
- In cases ofmyocardial infarctions, ankylosing spondylitis, inflammatory bowel disease, psoriasis also raised ESR’s are observed.
- ESR may be useful in establishing a “sickness index” in elderly persons who have nonspecific changes in health status and a moderate probability of underlying disease; in screening for infection in specific settings.
- An ESR value exceeding 100 mm/hr has a 90% predictive value for serious underlying disease, most often infection, collagen vascular disease, or metastatic tumor.
- Raised erythrocyte sedimentation rates are observed in patients without an acute phase reaction, in cases when hematological disorders including anemia are present.
- Many a times it is raised in obesity and ageing individuals too.
- Female sex is associated with higher erythrocyte sedimentation rates than men.
ESR should not be used to screen asymptomatic persons for disease. If an increased ESR is encountered and no explanation is immediately apparent, one need not pursue an exhaustive search for occult disease. The test can be repeated after several months.
DEVADOSS MULTI SPECIALITY HOSPITAL
WHAT IS POLYCYSTIC OVARIAN SYNDROME (PCOS)
PCOS is a condition that can affect.
- Your periods.
- Your fertility.
- Aspects of your appearance.
- Long term health.
HOW COMMON IS THE CONDITION?
Estimates vary from 2 to 26 in every 100 women.
Symptoms of PCOS
- Irregular periods.
- An increase in facial or body hair.
- Loss of hair on your head.
- Being overweight/experiences a rapid increase in weight /having difficulty losing weight.
- Oily skin, Acne.
- Infertility (difficulty in conceiving).
- Depression and psychological problems can also result from having PCOS.
- Symptoms vary from women to women from mild to severe.
What causes PCOS ?
The cause of PCOS is not yet known. There is a proven insulin resistance.
It often runs in families.
The symptoms are related to abnormal hormone levels.
- Testosterone is a hormone that is produced in small amounts by the ovaries in all women. Women with PCOS have slightly higher than normal levels of testosterone and this is associated with many of the symptoms to the condition.
- Insulin is a hormone that controls the level of glucose in the blood. If you have PCOS, your body may not respond to insulin (this is known as insulin resistance) so the level of glucose is higher.
- To try to prevent the glucose levels becoming higher, your body produces even more insulin.
- High levels of insulin can lead to weight gain, irregular periods, fertility problem and higher levels of testosterone.
How is PCOS diagnosed?
A diagnosis is made when you have any two of the following.
- Irregular, infrequent periods or no periods at all.
- An increase in facial or body hair and/or blood tests that show higher testosterone levels than normal.
- An ultrasound scan that shows polycystic ovaries.
Management of PCOS
The principal components of management
- Eat a healthy balanced diet this should include fruit and vegetables and whole foods (such as brown rice, whole wheat bread, lean meat, fish and chicken.)
- You should cut down the amount of sugar, salt and caffeine that you eat and drink.
- Take exercise regularly(30 mts at least 3 times a week)
- If you are overweight it would be helpful to lose weight and maintain body mass index (BMI)between 19 and 25.
(BMI is the measurement of weight in relation to height.)
The benefit of reducing weight include
- A lower risk of insulin resistance and avoid develop diabetes.
- A lower risk of heart problems.
- A lower risk cancer of the womb.
- More regular periods.
- An increased chance of becoming pregnant.
- A reduction in acne and decrease in excess hair growth over time.
- Improve mood and self esteem.
- To regularize irregular periods, consult your gynaecologist.
- Management of infertility needs specialist intervention.
- Skin specialist/dermatologist can help managing acne excess facial/ body hair growth and oily skin.
Management of PCOS control
- HAVE REGULAR HEALTH CHECKS: Once you have a diagnosis of PCOS, you need to be monitored for long term health problems.
- DIABETES: Women with PCOS over the age of 40 should be offered a blood sugar test once a year to check for signs of diabetes.
- CANCER OF THE WOMB: If you have not had periods for a long time (over 4 months) or have irregular bleeding, it is advisable to see your doctor.
- High blood pressure, routine health checks with your physician should keep it under check.
- Depression and psychological problems can occur due to various factors and needs to be handled.
IS THERE A CURE?
There is no cure for PCOS
Medical treatments aim to manage and reduce the symptoms or consequences of having PCOS.
Medication alone has not been shown to be any better than healthy lifestyle changes.
All of us at times are sad or feel blue or down n out and dull. All of us feel sad but we also know it will change. When the sadness is overwhelming and you seem stuck in sadness for days without relief! When feeling sad extends for days and crosses two weeks then it is termed depression.
- Anhedonia: When you don’t feel any pleasure or happiness from the things that you usually enjoy doing. For example when music fails to move you or cannot get involved in a movie.
- Easy fatigability. When normal every day chores like bathing and climbing a single flight of stairs leaves u tired and wanting to rest.
- Crying spells.. Tearing up often and for trivial issues
- Anger outbursts and irritable mood, wanting to break the remote or smash the plates and bang the door
- Frequent thoughts of ending it all- suicide.. Harming yourself, hurting yourself, wishing you were never born and didn’t have to live. Talking of leaving everyone behind and being free
- Severe disturbances in sleep, waking up two hours earlier than usual, fitful sleep, unrefreshing quality of sleep.
- Anorexia or rather lack of interest in food, Poor appetite, significant weight loss.
- Slowing down of mental abilities, difficulty in concentration, and apparent loss of memory.
- Feeling guilty and a burden to others feelings of helplessness, hopelessness and worthlessness. Feeling that the future is bleak and grey.
- In severe depression called psychotic depression there can be additional symptoms of delusions /hallucinations where there is loss of touch with reality.
- In auditory hallucinations people hear voices from nowhere telling them messages or ordering them or commenting on their appearance.
- Some people can have strong false beliefs called delusions. Where they believe they have been infected with HIV virus or have become paupers or that the police will come and arrest them.
- Lack of concentration, poor self esteem, feeling unloved and unwanted for days on end! See the psychiatrist please! Hope is at hand!
Depression is not a sign of weakness or a taboo! Please ask for help if you or a loved one is suffering from depression. Seek the psychiatrist as soon as possible! Help is available!
Dr.Kavitha Arun MD.Psychiatric
Whenever there is a injury there is a Scar formation, the wound healing process is a natural consequence which occurs whenever tissues in the body are damaged by a physical injury. A fresh is usually reddish, sometimes itchy and slightly elevated. Over a period of time it flattens and at times depigmented (loss of pigment) and within a period of days to months becomes normal. Scars could be pathological in nature too, due to abnormal responses to trauma and can be itchy and painful, causing serious functional and cosmetic disability. These scars are described as Hypertrophic scars or keloids. Few factors that promote hypertrophic scar/keloid include mechanical forces on the wound, wound infection, and foreign body reactions. Severity of inflammation and the type of immune response (in the individual) predisposes to excess scar formation.
Hypertrophic scars (HTSs) are visible and elevated scars which usually do not spread into surrounding tissues and very often regress spontaneously. These scars develop due to ploriferation of the dermal tissue, with excessive deposition of fibroblast and collagen. This occurs over a long period and by persistent inflammation and fibrosis.
Keloids are benign fibrous growths that are caused because of abnormal connective tissue response in certain predisposed individuals. Dark skin individuals develop keloids more often than whites. Keloids are difficult to treat and need multimodal therapies to relieve symptoms.
The most successful non-surgical treatment of an HTS or keloid is achieved when the scar is immature and the overlying skin is intact.
Treatments for Hypertrophic scars and Keloids includes:
- Intralesional corticosteroid injections: The scar tissue is injected directly with steroids mostly Triamcilonone Acetonide. Injected once in every 3-4 weeks. In case the keloid or the HTS is older than combination therapy is required.
- Pressure Therapy: This has been quite prevalent since the 1970’s . In cases of burn scars this proves very effective. Pressure garments decreases the collagen synthesis by limiting capillary perfusion(blood flow), thus decreased oxygen supply to the scar tissue. Continuous pressure of 15–40 mmHg for at least 23 hours per day for more than 6 months while the scar is still active is what is recommended.
- Laser Treatments: Pulsed dye laser (PDL) 585-nm, was first described as promising for the treatment of younger hypertrophic scars and keloids. Two to six treatment sessions are recommended to successfully improve scar color, height, pliability, and texture. Few other lasers Like Long Pulsed and Pulsed Nd Yag are also useful to a certain extent. Conventional CO2or Erbium: YAG lasers may be recommended for the ablation of inactive hyper-trophic scars with good results.
- Radiotherapy: Superficial X-rays, electron beam and low- or high-dose-rate brachytherapy are few which have been employed primarily as an adjunct to surgical removal of keloids. The with overall benefits is reduction in recurrence.
- Botulinium Toxoid(BTA): This is one of the emerging treatments in the treatment of scars. BTA immobilizes local muscles, reduces skin tension caused by muscle pull, and thus, decreases micro trauma and subsequent inflammation. These are injected once in 3 months for a period of 9 months at least.
- Slicone based products: These products have gained a lot of popularity as they have good results and easy to use. Pressure is not the action which brings in the effects. Silicone sheets increases the hydration status of the scar by decreasing the water vapor transmission loss . A buildup of moisture on the skin surface under the silicone sheet improves the scar tissue. Silicones sheets proves effective when used for 12–24 hours per day over a period of 12–24 weeks.
- Bleomycin and 5 Flurouracil: These are injected into the scar tissue and lot of reduction in the redness and pain caused after a few injections have been administered.
- Onion extract ad Heparin Gel: Heparin and onion extract affect scar development via their inhibitory effects on inflammatory processes and the synthesizing capacity of fibroblasts (cells which form scar). Heparin interacts with the collagen. A small difference is seen in cases of HTS and Keloids which are old.
Several treatments are available for scars, HTS and Keloids .
We have discussed the medical managements and minimal invasive treatments available .There is a wide array of surgical treatments available too. The ultimate challenge is which treatment is effective and worth the time and this needs expertise!!
Dr. HEMA SATHISH M.B.B.S., (UK)
Cosmetic Dermatologist | Sanche Cosmetic Centre
DEVADOSS MULTI SPECIALITY HOSPITAL