The issue of patient safety has been gaining increased traction year on year and the issue is in right direction. Hospitals, doctors and administration need to vigorously address shortcomings and strive toward minimum errors and desired goals of safety. Patient safety is of paramount importance; therefore it is an serious issue. It should be achieved by good ground work and not by sensationalizing and mischaracterizing the real basic issues, transparent safety culture, adequate number of staff and resources.
There is a recurrent old argument and temptation to ask about why healthcare can’t be as safe as airline travel. There can be many apt comparisons that may be possible between aviation and health care especially taking into account the risk involved. But the doctors who treat critical emergencies, have insight looking at life and death situations directly, know that comparing both would be just an oversimplification of the real basic issues.
At most of the points, the comparison is a complete fallacy; and like comparing apples to musk-melons.
It is beyond doubt that air-industry maintains truly an impressive system which is well-designed to achieve the safety results that it does. But , the kind of comparison that some health care safety leaders make in which they compare the mortality data of acute hospital care and airline fatal accident rates is more of a word play and not so appropriate. This comparison is dangerous because it misses the key points for improvement. Such comparisons merely present over-simplified and convenient tool for the health quality experts, who themselves have never been a front line health workers at any point of time, but still pretend to pioneer the quality in health industry. For the quality improvement the leaders need to be grounded in the reality of emergency front line medicine to be really effective.
Aircrafts are engineered to be in the best possible shape before they fly. Patients, on the other hand, patients are in the worst shape when they enter the emergency of the hospital.
Medicine is by nature, a much more risky work than flying along with vulnerability to death always.
The aircrafts are required to regularly demonstrate that the performance of their critical systems meets or exceeds strict standards. If systems are not operating well the plane will not be allowed to fly.
But all the patients, (aeroplane metaphor) are already sick; doctors are expected to fly such aeroplanes, who are in crashed condition universally. Doctors do not have the luxury to replace any part. For example, when doctors treat an elderly with heart failure, chronic kidney failure and pneumonia, they try to keep them “flying” despite multiple sub optimally functioning critical systems.
In other words, doctors have to fly crashed planes always on every day basis,something that never happens even once in aviation industry.
Has any Pilot ever tried to fly a plane in which engine power is only 25 percent of normal with other systems are functioning sub optimally and the fuel tank is leaking? What will be standard procedure (SOP) for Pilot to fly this plane? But everyday doctors try to fly such planes and they have to fly it no matter how many systems are non-functional. Moreover, doctors can be sued on some flimsy grounds in case they fail or an accident happens in an effort to keep this plane in the air. Treating a critical illness is like an effort to keep such planes in air with suboptimal functioning systems.
Obviously the comparison is a bit overzealous.
What would be chances that a fully checked plane with a trained pilot will crash after flight takes off. Now compare the chances of patient who lands in emergency, and treatment is started.
By a simple common sense, are two situations comparable?
Former has no chance (almost Zero percent) of crash whereas in a critical emergency patient, the chances of crash are 100 % to start with.
Communication of passengers to the pilot about what he should do and what he should not while flying the plane is nil. Whereas doctors are continuously bombarded with google knowledge of patients and interference by relatives and questioned about every action.
Doctors are expected to make future prediction about what can happen, how he will be able to keep the crashed plane in the air and take consent, based on few assumptions. Doctors can be harassed and dragged to courts if such predictions fail.
Airlines will always have full staff to serve promptly during a flight. The pilot will be totally dedicated to flying the plane, and will not fly without the co-pilot and crew. On the other hand, front line healthcare workers know it well the fact that patient safety incidents and errors tend to occur when they are struggling with staffing levels and feel grossly overworked.
Fatigue and overwork is too common scenario among front line healthcare staff in clinical settings.
A pilot is also only ever going to fly one plane at a time. It is not realistic for a doctor or nurse to be allocated to just one patient, but the workflow is very different, with healthcare tasks frequently interrupted with new clinical issues and emergency situations. Consequently, insufficient staffing can have an acute effect on outcomes and the ability to perform safely.
Aviation industry is too predictable and on the contrary, health care is combination of uncountable unpredictable risk factors, be it allocation of staff or risk of death or resource prediction and complexity of communication.
Aviation is more of mechanical milieu, whereas health care deals with emotion and compassion. The two industries are vastly heterogeneous, and to say that safety in medicine should follow in the path of flying airplanes, grossly oversimplifies a complex problem.
Last but not the least; health care involves lot of financial uncertainties and arrangements. Needless to say, doctors carry the blame for financial hardship of the patients, even if they are not responsible for costs. The mammoth industry remains hidden and doctors are blamed as they are the only front man visible.
Basic difference lies in the fact that patients are real living people, whereas airplanes are simply machines, whose codes and protocols are well defined and limited to within human capabilities. The importance of human contact, empathy, compassion, interact and listen to concerns, and the ability to spend adequate time with patients, should be always be the first pillar of promoting a culture of safety.
Exhortations by armchair preachers to learn oversimplified improvement examples from aviation can provoke considerable frustration and skepticism among clinicians exposed to the unique challenges, difficult working conditions and everyday complexities. Patients are not aeroplanes, and hospitals are not production lines.
Most unfortunate part is the assumption that every sick person who dies in a hospital from an adverse event is an example of a truly preventable death rather than clinicians trying their best to keep someone alive and eventually failing.
Checklists and documentation to improve systems are wonderful in mechanical areas like operative care and inserting central lines, but have limited role and can only go so far without the most important virtues of being a doctor or nurse. It means more than mechanically following protocols and doing paper work in real sense.
In health care merely providing check list and doing extra- paper work may be counterproductive for many reasons. Increase in time for voluminous documentations will consume time and forces health care workers to focus on paper work and takes them away from patient’s real issues.
Completed paper work and excessive documentation provides a false assurance of quality work, which may or may not reflect true picture of patient care. Even after full documentation, still it will be required to be carried out in a diligent manner, a task which is different from mechanical task of mere check list of other industries . Learning from other industries seems to offer a simple shortcut to anyone trying to improve healthcare, but its utility is limited only for documentation purposes and not real quality. Caring for patients is radically different from flying aeroplanes. Healthcare is unique in the intimacy, complexity, and sensitivity of the services it provides as well as the trust, compassion, and empathy that underpin it.
Merely completing protocols mechanically and excessive documentation will result in decline in quality actually. Simply importing and applying a ready-made tool will lead to situation, where quality will exist only on papers and merely reduced to a number to the satisfaction of so called ‘pioneers’ of quality.
A frightening scenario is emerging as there seems to be an epidemic about fake or substandard medicines, spurious drugs and heightened belief in marketed therapies by advertisements. An epidemic of ignorance that causes people to believe in pseudoscience or merely in projected promise of cure. A hope of miracle is flashed to patients, who have been given a ‘no hope’ by scientific medicine. Such patients are an easy prey for such fraudsters. It is not uncommon that lethal substances like steroids, hormones and heavy metals are given in dangerous doses.
In the absence of strict Government control, all kinds of dubious assertions are available about curing all types of ailments. These alleged remedies, and the belief systems they are based on, are based on the facts that can neither be proved nor disapproved. They are dangerous to life of patients, which is why it is necessary to fight them and refute them. But who should fight? Patients themselves are blinded by a projected faith and false belief about definite cure.
New Delhi: In its latest drug safety alert, the apex drug regulatory body, Central Drugs Standard Control Organization (CDSCO) has flagged 50 medicine batches for failing to qualify for a random drug sample test for the month of October,2022.
These drugs samples which are declared not of standard quality include Levocetirizine tablets manufactured by Hindustan antibiotics, Onkam (ondansetron Oral solution) manufactured by Gujarat Pharmalab, Pantop-DSR (Pantoprazole Sodium Gastro-resistant & Domperidone Prolonged release Capsules IP) manufactured by Aristo pharmaceuticals, Diacowin-plus Capsules (prebiotic & probiotics capsules) manufactured by Zee Laboratories and others.
In addition, other popular drug sample that is declared not of standard quality include Montek LC (Montelukast Sodium & Levocetirizine Hydrochloride Tablets IP) manufactured by Sun pharma laboratories due to failure of Identification and assay of Montelukast.
This came after analysis and tests conducted by the CDSCO, Drugs Control Department on 1280 samples. Out of these, 1230 samples were found to be of standard quality while 50 of them were declared as Not of Standard Quality (NSQ).
A few of the reasons why the drug samples tested failed were the failure of the assay, failure of the disintegration test, failure of the dissolution test, failure of sterility test, etc. The samples collected were tested in five laboratories, namely CDL Kolkata, CDTL Mumbai, RDTL Chandigarh, RDTL Guwahati, and CDTL Hyderabad.
The rise in “falsified and substandard medicines” has become a “public health emergency”. A surge in counterfeit and poor quality medicines means that thousands of patient a year are thought to die after receiving shoddy or outright fake drugs intended to treat ailments. Most of the deaths are in countries where a high demand for drugs combines with poor surveillance, quality control and regulations to make it easy for criminal gangs and cartels to infiltrate the market.
More are thought to die from poor or counterfeit vaccines and antibiotics used to treat or prevent acute infections and diseases. Beyond the fakes that are made and sold by criminal gangs are poor-quality medicines that lack sufficient active ingredients to work properly, or fail to dissolve correctly when taken. Sloppy manufacturing is often to blame, but others are sold past their shelf life or have degraded in poor storage conditions.
There is an urgent need for effort to combat a “pandemic of bad drugs” that is thought to kill hundreds of thousands of people globally every year.
The rise in “falsified and substandard medicines” has become a “public health emergency”. A surge in counterfeit and poor quality medicines means that thousands of patient a year are thought to die after receiving shoddy or outright fake drugs intended to treat ailments. Most of the deaths are in countries where a high demand for drugs combines with poor surveillance, quality control and regulations to make it easy for criminal gangs and cartels to infiltrate the market.
There is an urgent need for effort to combat a “pandemic of bad drugs” that is thought to kill hundreds of thousands of people globally every year.
More are thought to die from poor or counterfeit vaccines and antibiotics used to treat or prevent acute infections and diseases. Beyond the fakes that are made and sold by criminal gangs are poor-quality medicines that lack sufficient active ingredients to work properly, or fail to dissolve correctly when taken. Sloppy manufacturing is often to blame, but others are sold past their shelf life or have degraded in poor storage conditions.
Governments and pharmaceutical companies had to improve the security of the drug supply chain in all countries from the point of manufacture to the patient. Regarding online pharmacies, there is poor public understanding of how to differentiate between a legitimate online pharmacy and an illegal one. Illegal online pharmacies and the sale of medicines via social media platforms pose the greatest risk to the public.
To make big money, Pradhan got his cousin Shubham Manna and Ram Kumar involved in his plan and started making spurious cancer drugs. “He had been providing spurious medicines at a discounted 50% of market prices. He was manufacturing and supplying more than 21 spurious cancer medicines of various companies of different countries,” special commissioner (crime) Ravindra Yadav said. The syndicate comprised highly-qualified and well-earning individuals. Manna had completed his BTech and served in MNCs before joining hands with Pradhan. Police said his job was to generate barcodes, emboss batch numbers and expiry dates on medicines. He also looked after overall packaging of the spurious medicines. International syndicate used to procure capsules and manufactured fake medicines by filling them with starch.
Burning the bodies of the dead was an ancient rite and practice in India. It was observed among Buddhists, Hindus and Jains from well before the start of the Common Era, and was later adopted by Sikhs. Burning the dead historically helped demarcate these religious communities from Muslims and Christians, for whom burial was the norm, and from India’s Parsi community who exposed their dead on Towers of Silence. Burning bodies after death, originating at a time when India was still heavily forested, cremation may also have been environmentally more appropriate and sustainable than, for instance, the mummification practised in the dry desert air of ancient Egypt.
In India, one estimate reveals that funeral pyres consume 6 crore trees annually and play a huge role in deforesting the country. Air pollution and deforestation are not the only environmental threats of cremation. They also generate large quantities of ash – around 50 lakh tonnes each year – which is later thrown into rivers, adding to their waters’ toxicity. The prolonged burning of fossil fuels for cremation results in around 80 lakh tonnes of carbon dioxide or greenhouse gas emissions per year, according to one estimate. It creates different hazardous gases, including dental mercury, which is vaporised and released into the environment leading to health hazards in the surrounding area. Many of these toxins can bio-accumulate in humans, including mercury – often from dental amalgams, but also from general bioaccumulation in the body. Cremation results in various other toxic emissions including persistent pollutants such as volatile organic compounds, particulate matter, sulphur dioxide, nitrogen oxides and heavy metals. An IIT Kanpur study in 2016 found that open-air cremations contribute 4% of Delhi’s carbon monoxide emissions. There are concerns for crematorium workers as well, who may be exposed to nuclear medicine treatments (chemotherapeutics/radiation), orthopaedic (implants) and pacemaker explosions, and nanoparticles.
. In order to tackle the environmental problems stemming from these sites, the Indian government and environmental groups have over the years tried to promote the use of electric crematoriums as an alternative way of cremation. Electric crematoriums largely unsuccessful, are expensive to run, and crucially, traditional rituals are made impossible.
Carbon Cost estimation -When people are cremated after death, the burning releases carbon into the air. Alkaline hydrolysis, in which the body is dissolved, has about a seventh of the carbon footprint of cremation, and the resulting fluid can be used as fertiliser. A Dutch study of the disposal of bodies found that the lowest amount of money that it would theoretically cost to compensate in terms of the carbon footprint per body was €63·66 for traditional burial, €48·47 for cremation, and €2·59 for alkaline hydrolysis. Composting or natural burial are alternatives.
Keeping in mind the growing level of pollution, the NGT said that there was a need to adopt environment-friendly methods like electric crematoriums and use of CNG and change the ‘mindset of the people’.
The NGT bench headed by Justice UD Salvi also directed the Union Environment Ministry and the Delhi government to initiate programmes to provide alternative modes of cremation of human remains, saying the traditional emitted hazardous pollutants in the environment.
“It is also the responsibility of the government to facilitate the making of the mindset of the citizens as well as to provide environment-friendly alternatives for cremation to its citizenry,” the bench further said.
The green panel said the traditional means of cremation caused adverse impact on environment and dispersal of ashes in the river led to water pollution.
If we are to survive the climate crisis then almost everything will have to change, including health care, end-of-life care, and how we dispose of the dead.
The Demons of social media and online gaming has rewired the people’s mind to live life and remain in virtual world. The chaos and turmoil in the society can be linked to social media that exploits the deep wired craving of masses to know more about the “realities”. Once a curiosity is fired, each one at social media starts feeding something or other. In the mad game of TRP’s, clouts and engagements, these players cross ethical lines and create rifts. They literally hunt and scavenge news items that suit their narrative. They embellish it with more provocative words and share it with their name hoping to drive more engagement Conspiratorial and alarmist thinking is likely to keep people glued to social media.
Covid-19 pandemic worsened addiction to the internet among children. The footfall at psychiatric out-patient departments in hospitals, especially those offering help to kids hooked to the net, be it for online gaming, chatting with friends or sharing videos, offers a glimpse of the problem.
Freedom, Cold Turkey, RescueTime, Toggl, StayFocusd, FocusMe, SelfControl, AntiSocial… They are not random words pulsed together in a blender, but names of some of the top apps that, ironically, help you stay away from your digital addictions. As Thakur said in Sholay, “loha lohe ko kaat-ta hai”, so now we need apps to stay away from apps. This farcical situation hides a deeper reality – too many of us are spending too much time online. So, amid the launch of 5G and other high-speed tech, a growing army of people doesn’t want to be addicted to social media and googling. They aspire to live frugal, almost ascetic, digital lives without completely switching off from the internet. It’s a trend called ‘digital minimalism’, and it is different from a ‘digital detox’ where you unplug completely. To illustrate, detox is what Mohityanche Vadgaon village in Maharashtra’s Sangli district does. A siren goes off at 7pm, and residents put their electronic devices away for 90 minutes. Children are encouraged to read while the older people meet and chat.
Digital minimalism, however, does not require complete withdrawal. Coined by author Cal Newport, it is a way of using technology in which you focus your online time on a few carefully selected tasks that strongly support the things you value. It advises against excessive use of gadgets.
Digital minimalism is based on three tenets: clutter is expensive, optimization is critical, and intention is satisfying. The objective is that the usage should be intentional and controlled for a limited period of time. And the apps mentioned above are meant to stop you from jumping from one attention-diverting push notification to another. They can block other apps from operating, create blocklists, schedule apps to run only during a specific time of the day, and alert you about the excessive time spent online.
This philosophy is being discussed now, especially after the pandemic when people began spending more time online, adding that children aged 13-18 years have become more prone to digital addiction since the pandemic. The parents are taking their children to counsellors as they have become addicted to screens and feel isolated and tense when they have to interact with people in the real world. For them, online networking is secure and simple.” He advised gradually introducing such children to digital minimalism, to reduce their reliance and time spent on digital platforms. He also said it is critical for parents and adults to see if those who are addicted to digital devices have any anxiety issues. Because digital addiction has been observed in people who already have anxiety issues, these issues must be addressed first. WHO has classified excessive use of the internet and mobile phones as screen addiction, and provided a set of guidelines. There is certainly a 50% increase in screen time addiction cases post-pandemic, we should be more concerned about the changes that will occur with advancements, like the metaverse. Need to first introduce minimalistic practices, and then, in some cases, recommend mild medication to help people break free from their “internet compulsions”.
Blowin’ In The Wind Yes, and how many times can a man turn his head
And pretend that he just doesn’t see?
The answer, my friend, is blowin’ in the wind
The answer is blowin’ in the wind
Yes, and how many times must a man look up
Before he can see the sky?
And how many ears must one man have
Before he can hear people cry?
Yes, and how many deaths will it take ’til he knows
That too many people have died?
The answer, my friend, is blowin’ in the wind
The answer is blowin’ in the wind
An eight year old child –scared, sitting terrified in mother’s lap, feeling breathless and feeling a bit dizzy. News about rising levels of smog and pollution send shivers down her spine every year. Her mother closing all the doors of house and trying to avoid the fumes entering the room like ghosts from every small crevices, peepholes and slits. The mother prays for the smooth sail through these days as she knows very well that the season has come when the environment will be full of pollutants. The child will writhe with suffocation due to air pollution in the same proportion. The reasons for dangerous levels of air pollution can be multiple like vehicles, crackers or farm waste burning, but accumulate near the some cities due to geographical distribution and environmental factors.
Irony is that it is someone else’s problem like farm waste burning and ball of a time with polluting crackers adds to child’s suffering. Here the sufferer is not the real cause pollution. Unlike if someone smokes or drinks alcohol, it is the doer who is sufferer. But here the root cause of her trouble emanates from poor governance and administrative failure to control the irresponsible behaviour of few.
Every year, many factors collectively add to enormous pollution and air becomes thick with smog and suspended particulate matter at a predictable time. It is a cause of breathlessness in children and adults and vulnerable to asthmatic attacks.
Like this one child, there are thousands of them and people from all ages suffer during this season because of mistakes and thrill of others. These sufferers, who are frustrated due to their plight, with no fault of theirs, have to undergo treatment and visit emergencies of the hospitals. This irresponsible behaviour of people puts burden on the medical services and the doctors, who are already overstretched due to workload. But it is only the doctors and nurses, who are visible round the clock, whereas people who have polluted the air and the administrators remain invisible. For many, it is very hard to understand the complexity of the situation. Patients many a times will rather tend to blame the doctors for their sufferings, poor treatment and difficulty in treatment, without realizing that constant pollution is the reason for poor response to treatment.
Why all of us cannot keep in mind the plight of such patients? Why the administrators wake up and come out of their slumber every year when AQI is more than 500 already?
There are no punishments for repeated administrative failures.
But inconsequential pleasure and poor governance should not be allowed to inflict health and life of others.
Delhi Air Pollution: AQI more than 500. Apart from climate change, air pollution is just another biggest environmental threat to human health at present. And with pollution levels worsening in the national capital and neighbouring regions, residents of Delhi have started complaining of several health problems like difficulty in breathing, tightness of chest, asthmatic symptoms, runny nose, sore throat, itchy and watery eyes. As the city has been waking up to a thick blanket of hazardous smog every morning since Diwali, Delhi hospitals are also witnessing a surge in the number of patients coming to OPDs with health issues. And it’s the elders and children, who have lower immunity levels, complained of breathing issues. The hazardous level of air pollution towards the end of October triggered a series of official measures such as shutting down construction work across Delhi and smoke-emitting factories.
It requires sincere administrative will and not merely tokenism to control such hazardous pollution.
Depending on the travel destination, travellers may be exposed to a number of infectious diseases; exposure depends on the presence of infectious agents in the area to be visited. The risk of becoming infected will vary according to the purpose of the trip and the itinerary within the area, the standards of accommodation, hygiene and sanitation, as well as the behaviour of the traveller. In some instances, disease can be prevented by vaccination, but there are some infectious diseases, including some of the most important and most dangerous, for which no vaccines exist.
As many of such diseases are infections, general precautions can greatly reduce the risk of exposure to infectious agents and should always be taken for visits to any destination where there is a significant risk of exposure, regardless of whether any vaccinations or medication have been administered.
Modes of transmission and general precautions
The modes of transmission for different infectious diseases are diverse:
Foodborne and waterborne diseases transmitted by consumption of contaminated food and drink.
Vector-borne diseases transmitted by insects such as mosquitoes and other vectors such as ticks.
Diseases transmitted to humans by animals (zoonoses), more particularly through animal bites or contact with animals, contaminated body fluids or faeces, or by consumption of foods of animal origin, particularly meat and milk products.
Sexually transmitted diseases passed from person to person through unsafe sexual practices.
Bloodborne diseases transmitted by direct contact with infected blood or other body fluids
Airborne diseases involving droplets and droplets nuclei. Droplet nuclei <5 µm in size are disseminated in the air and breathed in. These droplet nuclei can remain suspended in the air for some time. Droplet nuclei are the residuals of evaporated droplets. Droplet transmission occurs when larger particles (>5 µm) contact the mucous membranes of the nose and mouth or conjunctivae of a susceptible individual. Droplets are usually generated by the infected individual during coughing, sneezing or talking.
Diseases transmitted via soil include those caused by dormant forms (spores) of infectious agents, which can cause infection by contact with broken skin (minor cuts, scratches, etc).
The main infectious diseases to which travellers may be exposed, and precautions for each, are detailed in the Chapter 5 of the International travel and health situation publication. The most common infectious illness to affect travellers, namely travellers’ diarrhoea, is covered in Chapter 3 of the International travel and health situation publication (WHO). Because travellers’ diarrhoea can be caused by many different foodborne and waterborne infectious agents, for which treatment and precautions are essentially the same, the illness is not included with the specific infectious diseases.
Information on malaria, one of the most important infectious disease threats for travellers, is provided separately (WHO).
The infectious diseases listed below have been selected on the basis of the following criteria:
Diseases that have a sufficiently high global or regional prevalence to constitute a significant risk for travellers;
Diseases that are severe and life-threatening, even though the risk of exposure may be low for most travellers;
Diseases for which the perceived risk may be much greater than the real risk, and which may therefore cause anxiety to travellers;
Diseases that involve a public health risk due to transmission of infection to others by the infected traveller.
Amoebiasis
Angiostrongyliasis
Anthrax
Brucellosis
Chikungunya
Coccidioidomycosis
Dengue
Giardiasis
Haemorrhagic fevers
Hantavirus diseases
Hepatitis C
Hepatitis E
Histoplasmosis
HIV/AIDS and other sexually transmitted infections
Legionellosis
Leishmaniasis (cutaneous, mucosal and visceral forms)
Leptospirosis (including Weil disease)
Listeriosis
Lyme Borreliosis (Lyme disease)
Lymphatic filariasis
Malaria
Onchocerciasis
Plague
SARS (Severe Acute Respiratory Syndrome)
Schistosomiasis (Bilharziasis)
Trypanosomiasis
Typhus fever (Epidemic louse-borne typhus)
Zoonotic influenza
Some of the diseases included in this chapter, such as brucellosis, HIV/AIDS, leishmaniasis and TB, have prolonged and variable incubation periods. Clinical manifestations of these diseases may appear long after the return from travel, so that the link with the travel destination where the infection was acquired may not be readily apparent.
Special feature
Vaccine-preventable diseases
Vaccine-preventable diseases
Cholera
Hepatitis A
Hepatitis E
Japanese encephalitis
Meningococcal disease
Rabies
Tick-borne encephalitis
Typhoid fever
Yellow fever
Information about available vaccines and indications for their use by travellers is provided in the pdf entitled vaccine-preventable diseases and vaccines beside. Advice concerning the diseases for which vaccination is routinely administered in childhood, i.e. diphtheria, measles, mumps and rubella, pertussis, poliomyelitis and tetanus, and the use of the corresponding vaccines later in life and for travel, is also given in the section Vaccines.
Brucellosis is a common zoonotic infection caused by bacterial genus Brucella. Brucellosis is an old disease known by various names including undulant fever or Mediterranean fever. This is one of the infectious diseases transmissible between animals and humans.
Global distribution of Brucellosis-
This infection is more common in Mediterranean areas, the south and the center of America, Africa, Asia, Arab peninsula, Indian subcontinent and the Middle East. The maximum incidence in the world had been reported in Syria.
Other names:
Brucellosis, undulant fever, Mediterranean fever, Cyprus fever, and goat fever.
Summary:
‘Malta fever’ is a bacterial disease caused by various brucella species, which mainly infect cattle, swine, goats, sheep and dogs.
Malta fever is transmitted to humans through direct and indirect contact with infected animals.
Infection is most likely caused by ingesting unpasteurized milk or cheese from infected goats or sheep.
It causes flu-like symptoms, including fever and lethargy.
There is no human vaccine to prevent Malta fever, but it is important to take precautions to avoid it.
Overview:
Malta fever is a bacterial disease caused by various brucella species. Infection is transmitted to humans through direct and indirect contact with infected animals. It mostly affects individuals who work in the livestock sector. The consumption of raw milk and cheese made from raw milk (fresh cheese) is the major source of infection in man; however, human-to-human transmission is very rare. On the other hand, Malta fever remains a problem globally, because it is the most common bacterial infection spread from animals to humans around the world, as animals may be carrying the bacteria without showing any symptoms of illness.
Types of Brucella bacteria:
Types of brucella bacteria:
There are 8 known species of the brucella bacteria, but only four of them cause brucellosis in humans:
Maltese Brucellosis (B. melitensis): This type is the most common and most severe, and is found in lambs.
Pig Brucellosis (B. suis): This type infects individuals who come in contact with animals. It has a severe impact on humans.
Brucella abortus (B. abortus): It infects cows and is moderately severe.
Canine Brucellosis (B. canis): It infects individuals who come in contact with dogs and is moderately severe.
Other animals are also considered a primary source of the Brucella bacteria, including wild animals.
Cause:
Brucellosis is the result of being infected with the brucella bacteria.
Transmission:
Humans contract brucellosis by consuming unpasteurized dairy products and undercooked or raw meat of infected animals.
Direct contact with an infected animal or its bodily discharge (such as tissues, blood, urine, vaginal discharge, aborted fetuses, and placentas), via cracked skin, can also occur.
The disease can also be transmitted to humans through inhaling airborne agents in barns, stables, and sometimes laboratory and slaughterhouse.
Rare Means of Transmission:
From mother to fetus through the placenta
Sexual contact
Blood transfusion or marrow transplant from a person infected with Brucella
Few cases result from accidental pollination of an animal with brucellosis.
Incubation Period:
Symptoms usually appear within 5 to 60 days, and sometimes they takes several months to appear.
Who is at risk?
Vets
Livestock farmers
Slaughterhouse workers
Hunters
Microbiologists
Medical lab workers
Symptoms:
Malta fever can cause several symptoms. Some of them last for a long period of time. Initial symptoms include:
Fever
Sweating
Chills
Loss of appetite
Headache
Muscle, joint, and back pain
Fatigue and lethargy
When to see a doctor?
When a rapid rise in temperature, muscle pain or unusual weakness and persistent fever occurs. It is also crucial to see your doctor if you are among the groups at a higher risk of contracting the disease.
Complications:
Endocarditis (an infection of the endocardium, which is the inner lining of the heart or valves)
Arthritis
Orchitis (inflammation of the testicles)
Spleen or liver inflammation
Central nervous system inflammation.
Diagnosis:
Clinical examination
Laboratory tests: They involve searching for the bacteria in samples of blood, bone marrow, or other body fluids.
Treatment:
Treatment aims to relieve symptoms and prevent complications. It depends on the timing and severity of the disease. The disease may take a few weeks to several months to be cured. Patients take antibiotics for at least six weeks.
Prevention:
There is no human vaccine that can prevent Malta fever, so it is important to take precautions to prevent it with the following steps:
Make sure to cook meat well at a temperature of 63-74°C.
Do not drink or eat unpasteurized dairy products, including milk and cheese.
Take safety precautions at workplaces (e.g. during handling samples in laboratories).
Wash your hands before and after handling animals.
Wear rubber gloves and protective clothing and glasses if you work in a field where you come in contact with animals.
Ensure that wounds are covered with a bandage.
FAQs:
How long do brucella bacteria live outside the body?
Brucella bacteria are resistant to natural conditions, and they can survive for several hours up to over 60 days if the surrounding environment is moist.
How long should meat be cooked?
Meat and liver should be well cooked at 63°C for half an hour.
Women who are pregnant and have been exposed to Brucella should consult with their obstetricians/healthcare provider for evaluation. Prompt diagnosis and treatment of brucellosis in pregnant women can prevent complications including miscarriage.
Anne Heche, 53, had spent several days in a coma at the Grossman Burn Center at West Hills (California) Hospital and Medical Center after her Mini Cooper ran off the road Aug. 5 and smashed into a two-story home.
On Friday- Anne Heche (Hollywood actress ) had been declared brain dead, although she remained on life support for organ donation, a rep for the actress told The Hollywood Reporter on Friday. According to the actress’ publicist Holly Baird, Heche is “legally dead according to California law.” However, her heart is still beating and she has not been taken off of life support so that “OneLegacy can see if she is a match for organ donation.”
The actress’ team had previously shared an update on her health Thursday, stating that she suffered a severe anoxic brain injury and wasn’t expected to survive following an Aug. 5 car crash.
According to Baird, the star had been hospitalized in a coma and in critical condition since the accident. The actress crashed her car into a two-story home in L.A.’s Mar Vista neighborhood, sparking a fire, according to a Los Angeles Fire Department report.
In the statement Thursday from Heche’s rep, it “has long been her choice to donate her organs” and she was being kept on life support to determine whether her organs were viable.
The shortage of organs is virtually a universal problem but Asia lags behind much of the rest of the world. India lags far behind other countries even in Asia. It is not that there aren’t enough organs to transplant. Nearly every person who dies naturally, or in an accident, is a potential donor. Even then, innumerable patients cannot find a donor.
Situation of shortage of organs in India
There is a wide gap between patients who need transplants and the organs that are available in India. An estimated around 1.8 lakh persons suffer from renal failure every year, however the number of renal transplants done is around 6000 only. An estimated 2 lac patients die of liver failure or liver cancer annually in India, about 10-15% of which can be saved with a timely liver transplant. Hence about 25-30 thousand liver transplants are needed annually in India but only about one thousand five hundred are being performed. Similarly about 50000 persons suffer from Heart failures annually but only about 10 to 15 heart transplants are performed every year in India. In case of Cornea, about 25000 transplants are done every year against a requirement of 1 lakh.
The legal Framework in India
Transplantation of Human Organs Act (THOA) 1994 was enacted to provide a system of removal, storage and transplantation of human organs for therapeutic purposes and for the prevention of commercial dealings in human organs. THOA is now adopted by all States except Andhra and J&K, who have their own similar laws. Under THOA, source of the organ may be:
Near Relative donor (mother, father, son, daughter, brother, sister, spouse)
Other than near relative donor: Such a donor can donate only out of affection and attachment or for any other special reason and that too with the approval of the authorisation committee.
Deceased donor, especially after Brain stem death e.g. a victim of road traffic accident etc. where the brain stem is dead and person cannot breathe on his own but can be maintained through ventilator, oxygen, fluids etc. to keep the heart and other organs working and functional. Other type of deceased donor could be donor after cardiac death.
Brain Stem death is recognized as a legal death in India under the Transplantation of Human Organs Act, like many other countries, which has revolutionized the concept of organ donation after death. After natural cardiac death only a few organs/tissues can be donated (like cornea, bone, skin and blood vessels) whereas after brain stem death almost 37 different organs and tissues can be donated including vital organs such as kidneys, heart, liver and lungs.
Despite a facilitatory law, organ donation from deceased persons continues to be very poor. In India there is a need to promote deceased organ donation as donation from living persons cannot take care of the organ requirement of the country. Also there is risk to the living donor and proper follow up of donor is also required. There is also an element of commercial transaction associated with living organ donation, which is violation of Law. In such a situation of organ shortage, rich can exploit the poor by indulging in organ trading.
Government of India initiated the process of amending and reforming the THOA 1994 and consequently, the Transplantation of Human Organs (Amendment) Act 2011 was enacted. Some of the important amendments under the (Amendment) Act 2011 are as under:-
Tissues have been included along with the Organs.
‘Near relative’ definition has been expanded to include grandchildren, grandparents.
Provision of ‘Retrieval Centres’ and their registration for retrieval of organs from deceased donors. Tissue Banks shall also be registered.
Provision of Swap Donation included.
There is provision of mandatory inquiry from the attendants of potential donors admitted in ICU and informing them about the option to donate – if they consent to donate, inform retrieval centre.
Provision of Mandatory ‘Transplant Coordinator’ in all hospitals registered under the Act
To protect vulnerable and poor there is provision of higher penalties has been made for trading in organs.
Constitution of Brain death certification board has been simplified- wherever Neurophysician or Neurosurgeon is not available, then an anaesthetist or intensivist can be a member of board in his place, subject to the condition that he is not a member of the transplant team.
National Human Organs and Tissues Removal and Storage Network and National Registry for Transplant are to be established.
There is provision of Advisory committee to aid and advise Appropriate Authority.
Enucleation of corneas has been permitted by a trained technician.
Act has made provision of greater caution in case of minors and foreign nationals and prohibition of organ donation from mentally challenged persons
In pursuance to the amendment Act, Transplantation of Human Organs and Tissues Rules 2014 have been notified on 27-3-2014
Directorate General of Health Services, Government of India is implementing National Organ Transplant Programme for carrying out the activities as per amendment Act, training of manpower and promotion organ donation from deceased persons.
National Organ Transplant Programme with a budget of Rs. 149.5 Crore for 12th Five year Plan aims to improve access to the life transforming transplantation for needy citizens of our country by promoting deceased organ donation.
Issues and Challenges
High Burden (Demand Versus Supply gap)
Poor Infrastructure especially in Govt. sector hospitals
Lack of Awareness of concept of Brain Stem Death among stakeholders
Poor rate of Brain Stem Death Certification by Hospitals
Poor Awareness and attitude towards organ donation— Poor Deceased Organ donation rate
Lack of Organized systems for organ procurement from deceased donor
Maintenance of Standards in Transplantation, Retrieval and Tissue Banking
Prevention and Control of Organ trading
High Cost (especially for uninsured and poor patients)
Regulation of Non- Govt. Sector
Objectives of National Organ Transplant Programme:
To organize a system of organ and Tissue procurement & distribution for transplantation.
To promote deceased organ and Tissue donation.
To train required manpower.
To protect vulnerable poor from organ trafficking.
To monitor organ and tissue transplant services and bring about policy and programme corrections/ changes whenever needed.
NOTTO: National Organ and Tissue Transplant Organization
National Network division of NOTTO would function as apex centre for all India activities of coordination and networking for procurement and distribution of organs and tissues and registry of Organs and Tissues Donation and Transplantation in country. The following activities would be undertaken to facilitate Organ Transplantation in safest way in shortest possible time and to collect data and develop and publish National registry.
At National Level:
Lay down policy guidelines and protocols for various functions.
Network with similar regional and state level organizations.
All registry data from States and regions would be compiled and published.
Creating awareness, promotion of deceased organ donation and transplantation activities.
Co-ordination from procurement of organs and tissues to transplantation when organ is allocated outside region.
Dissemination of information to all concerned organizations, hospitals and individuals.
Monitoring of transplantation activities in the regions and States and maintaining data-bank in this regard.
To assist the states in data management, organ transplant surveillance & Organ transplant and Organ Donor registry.
Consultancy support on the legal and non-legal aspects of donation and transplantation
Coordinate and Organize trainings for various cadre of workers.
For Delhi and NCR
Maintaining the waiting list of terminally ill patients requiring transplants
Networking with transplant centres, retrieval centres and tissue Banks
Co-ordination for all activities required for procurement of organs and tissues including medico legal aspects.
NOTTO will assign the Retrieval Team for Organ retrieval and make Transport Arrangement for transporting the organs to the allocated locations.
NOTTO will maintain the waitlist of patients. needing transplantation in terms of the following:-
Hospital wise
Organ wise
Blood group wise
Age of the patient
Urgency ( on ventilator, can wait etc.)
Seniority in the waitlist (First in First Out)
Matching of recipients with donors.
Allocation, transportation, storage and Distribution of organs and tissues within Delhi and National Capital Territory region.
Post-transplant patients & living donor follow-up for assessment of graft rejection, survival rates etc.
Awareness, Advocacy and training workshops and other activities for promotion of organ donation
ROTTO: Regional Organ and Tissue Transplant Organization
Name of ROTTO
States covered
Seth GS medical college and KEM Hospital, Mumbai (Maharashtra)
Maharashtra, Gujarat, Goa, UTs of DNH, Daman, Diu, M.P., Chhattisgarh
Govt. Multispecialty Hospital, Omnadurar, Chennai (Tamil Nadu)
TN, Kerala, Telangana, Seem Andhra, Karnataka, Pondicherry, A & N Islands, Lakshadweep
Institute of PG Medical Education and Research, Kolkata (West Bengal)
SOTTO: State Organ and Tissue Transplant Organization
It is envisaged to make 5 SOTTOs in new AIIMS like institutions.
Govt. supported Online system of Networking
A website by the name www.notto.nic.in has been hosted where information with regards to the organ transplantation can be obtained. An online system through website is being developed for establishing network for Removal and Storage of Organs and Tissues from deceased donors and their allocation and distribution in a transparent manner. A computerized system of State/Regional and National Registry of donors and recipients is also going to be put in place.
Sciatica pain is caused by an irritation, inflammation, pinching or compression of a nerve in the lower back. The most common cause is a herniated or slipped disk that causes pressure on the nerve root. Most people with sciatica get better on their own with time and self-care treatments.
True sciatica is an injury or irritation to the sciatic nerve, which starts in your buttock/gluteal area.
What is sciatica?
Sciatica is nerve pain from an injury or irritation to the sciatic nerve, which originates in your buttock/gluteal area. The sciatic nerve is the longest and thickest (almost finger-width) nerve in the body. It’s actually made up of five nerve roots: two from the lower back region called the lumbar spine and three from the final section of the spine called the sacrum. The five nerve roots come together to form a right and left sciatic nerve. On each side of your body, one sciatic nerve runs through your hips, buttocks and down a leg, ending just below the knee. The sciatic nerve then branches into other nerves, which continue down your leg and into your foot and toes.
True injury to the sciatic nerve “sciatica” is actually rare, but the term “sciatica” is commonly used to describe any pain that originates in the lower back and radiates down the leg. What this pain shares in common is an injury to a nerve — an irritation, inflammation, pinching or compression of a nerve in your lower back.
If you have “sciatica,” you experience mild to severe pain anywhere along the path of the sciatic nerve – that is, anywhere from the lower back, through the hips, buttocks and/or down your legs. It can also cause muscle weakness in your leg and foot, numbness in your leg, and an unpleasant tingling pins-and-needles sensation in your leg, foot and toes.
What does sciatica pain feel like?
People describe sciatica pain in different ways, depending on its cause. Some people describe the pain as sharp, shooting, or jolts of pain. Others describe this pain as “burning,” “electric” or “stabbing.”
The pain may be constant or may come and go. Also, the pain is usually more severe in your leg compared to your lower back. The pain may feel worse if you sit or stand for long periods of time, when you stand up and when your twist your upper body. A forced and sudden body movement, like a cough or sneeze, can also make the pain worse.
Can sciatica occur down both legs?
Sciatica usually affects only one leg at a time. However, it’s possible for sciatica to occur in both legs. It’s simply a matter of where the nerve is being pinched along the spinal column.
Does sciatica occur suddenly or does it take time to develop?
Sciatica can come on suddenly or gradually. It depends on the cause. A disk herniation can cause sudden pain. Arthritis in the spine develops slowly over time.
How common is sciatica?
Sciatica is a very common complaint. About 40% of people in the U.S. experience sciatica sometime during their life. Back pain is the third most common reason people visit their healthcare provider.
What are the risk factors for sciatica?
You are at greater risk of sciatica if you:
Have an injury/previous injury: An injury to your lower back or spine puts you at greater risk for sciatica.
Live life: With normal aging comes a natural wearing down of bone tissue and disks in your spine. Normal aging can put your nerves at risk of being injured or pinched by the changes and shifts in bone, disks and ligaments.
Are overweight: Your spine is like a vertical crane. Your muscles are the counterweights. The weight you carry in the front of your body is what your spine (crane) has to lift. The more weight you have, the more your back muscles (counterweights) have to work. This can lead to back strains, pains and other back issues.
Lack a strong core: Your “core” are the muscles of your back and abdomen. The stronger your core, the more support you’ll have for your lower back. Unlike your chest area, where your rib cage provides support, the only support for your lower back is your muscles.
Have an active, physical job: Jobs that require heavy lifting may increase your risk of low back problems and use of your back, or jobs with prolonged sitting may increase your risk of low back problems.
Lack proper posture in the weight room: Even if you are physically fit and active, you can still be prone to sciatica if you don’t follow proper body form during weight lifting or other strength training exercises.
Have diabetes: Diabetes increases your chance of nerve damage, which increases your chance of sciatica.
Have osteoarthritis: Osteoarthritis can cause damage to your spine and put nerves at risk of injury.
Lead an inactive lifestyle: Sitting for long period of time and not exercising and keeping your muscles moving, flexible and toned can increase your risk of sciatica.
Smoke: The nicotine in tobacco can damage spinal tissue, weaken bones, and speed the wearing down of vertebral disks.
Is the weight of pregnancy the reason why so many pregnant women get sciatica?
It’s true that sciatica is common in pregnancy but increased weight is not the main reason why pregnant women get sciatica. A better explanation is that certain hormones of pregnancy cause a loosening of their ligaments. Ligaments hold the vertebrae together, protect the disks and keep the spine stable. Loosened ligaments can cause the spine to become unstable and might cause disks to slip, which leads to nerves being pinched and the development of sciatica. The baby’s weight and position can also add pressure to the nerve.
The good news is there are ways to ease sciatic pain during pregnancy, and the pain goes away after birth. Physical therapy and massage therapy, warm showers, heat, medications and other measures can help. If you are pregnant, be sure to follow good posture techniques during pregnancy to also ease your pain.
SYMPTOMS AND CAUSES
What causes sciatica?
Sciatica can be caused by several different medical conditions including:
A herniated or slipped disk that causes pressure on a nerve root. This is the most common cause of sciatica. Disks are the cushioning pads between each vertebrae of the spine. Pressure from vertebrae can cause the gel-like center of a disk to bulge (herniate) through a weakness in its outer wall. When a herniated disk happens to a vertebrae in your lower back, it can press on the sciatic nerve.
Degenerative disk disease is the natural wear down of the disks between vertebrae of the spine. The wearing down of the disks shortens their height and leads to the nerve passageways becoming narrower (spinal stenosis). Spinal stenosis can pinch the sciatic nerve roots as they leave the spine.
Spinal stenosis is the abnormal narrowing of the spinal canal. This narrowing reduces the available space for the spinal cord and nerves.
Spondylolisthesis is a slippage of one vertebra so that it is out of line with the one above it, narrowing the opening through which the nerve exits. The extended spinal bone can pinch the sciatic nerve.
Osteoarthritis. Bone spurs (jagged edges of bone) can form in aging spines and compress lower back nerves.
Trauma injury to the lumbar spine or sciatic nerve.
Tumors in the lumbar spinal canal that compress the sciatic nerve.
Piriformis syndrome is a condition that develops when the piriformis muscle, a small muscle that lies deep in the buttocks, becomes tight or spasms. This can put pressure on and irritate the sciatic nerve. Piriformis syndrome is an uncommon neuromuscular disorder.
Cauda equina syndrome is a rare but serious condition that affects the bundle of nerves at the end of the spinal cord called the cauda equina. This syndrome causes pain down the leg, numbness around the anus and loss of bowel and bladder control.
What are the symptoms of sciatica?
The symptoms of sciatica include:
Moderate to severe pain in lower back, buttock and down your leg.
Numbness or weakness in your lower back, buttock, leg or feet.
Pain that worsens with movement; loss of movement.
“Pins and needles” feeling in your legs, toes or feet.
Loss of bowel and bladder control (due to cauda equina).
DIAGNOSIS AND TESTS
Straight leg raise test helps spot your point of pain. This test helps identify a disk problem.
How is sciatica diagnosed?
First, your healthcare provider will review your medical history. Next, they’ll ask about your symptoms.
During your physical exam, you will be asked to walk so your healthcare provider can see how your spine carries your weight. You may be asked to walk on your toes and heels to check the strength of your calf muscles. Your provider may also do a straight leg raise test. For this test, you’ll lie on your back with your legs straight. Your provider will slowly raise each leg and note the point at which your pain begins. This test helps pinpoint the affected nerves and determines if there is a problem with one of your disks. You will also be asked to do other stretches and motions to pinpoint pain and check muscle flexibility and strength.
Depending on what your healthcare provider discovers during your physical exam, imaging and other tests might be done. These may include:
Spinal X-rays to look for spinal fractures, disk problems, infections, tumors and bone spurs.
Magnetic resonance imaging (MRI) or computed tomography (CT) scans to see detailed images of bone and soft tissues of the back. An MRI can show pressure on a nerve, disk herniation and any arthritic condition that might be pressing on a nerve. MRIs are usually ordered to confirm the diagnosis of sciatica.
Nerve conduction velocity studies/electromyography to examine how well electrical impulses travel through the sciatic nerve and the response of muscles.
Myelogram to determine if a vertebrae or disk is causing the pain.
MANAGEMENT AND TREATMENT
How is sciatica treated?
The goal of treatment is to decrease your pain and increase your mobility. Depending on the cause, many cases of sciatica go away over time with some simple self-care treatments.
Self-care treatments include:
Appling ice and/or hot packs: First, use ice packs to reduce pain and swelling. Apply ice packs or bag of frozen vegetables wrapped in a towel to the affected area. Apply for 20 minutes, several times a day. Switch to a hot pack or a heating pad after the first several days. Apply for 20 minutes at a time. If you’re still in pain, switch between hot and cold packs – whichever best relieves your discomfort.
Taking over-the-counter medicines: Take medicines to reduce pain, inflammation and swelling. The many common over-the-counter medicines in this category, called non-steroidal anti-inflammatory drugs (NSAIDs), include aspirin, ibuprofen and naproxen. Be watchful if you choose to take aspirin. Aspirin can cause ulcers and bleeding in some people. If you’re unable to take NSAIDS, acetaminophen may be taken instead.
Performing gentle stretches: Learn proper stretches from an instructor with experience with low back pain. Work up to other general strengthening, core muscle strengthening and aerobic exercises.
How long should I try self-care treatments for my sciatica before seeing my healthcare professional?
Every person with sciatic pain is different. The type of pain can be different, the intensity of pain is different and the cause of the pain can be different. In some patients, a more aggressive treatment may be tried first. However, generally speaking, if a six-week trial of conservative, self-care treatments – like ice, heat, stretching, over-the-counter medicines – has not provided relief, it’s time to return to a healthcare professional and try other treatment options.
Other treatment options include:
Prescription medications: Your healthcare provider may prescribe muscle relaxants, such as cyclobenzaprine. to relieve the discomfort associated with muscle spasms. Other medications with pain-relieving action that may be tried include tricyclic antidepressants and anti-seizure medications. Depending on your level of pain, prescription pain medicines might be used early in your treatment plan.
Physical therapy: The goal of physical therapy is to find exercise movements that decrease sciatica by reducing pressure on the nerve. An exercise program should include stretching exercises to improve muscle flexibility and aerobic exercises (such as walking, swimming, water aerobics). Your healthcare provider can refer you to a physical therapist who’ll work with you to customize your own stretching and aerobic exercise program and recommend other exercises to strengthen the muscles of your back, abdomen and legs.
Spinal injections: An injection of a corticosteroid, an anti-inflammatory medicine, into the lower back might help reduce the pain and swelling around the affected nerve roots. Injections provide short-time (typically up to three months) pain relief and is given under local anesthesia as an outpatient treatment. You may feel some pressure and burning or stinging sensation as the injection is being given. Ask your healthcare provider about how many injections you might be able to receive and the risks of injections.
Alternative therapies: Alternative therapies are increasingly popular and are used to treat and manage all kinds of pain. Alternative methods to improve sciatic pain include spine manipulation by a licensed chiropractor, yoga or acupuncture. Massage might help muscle spasms that often occur along with sciatica. Biofeedback is an option to help manage pain and relieve stress.
When is surgery considered?
Spinal surgery is usually not recommended unless you have not improved with other treatment methods such as stretching and medication, your pain is worsening, you have severe weakness in the muscles in your lower extremities or you have lost bladder or bowel control.
How soon surgery would be considered depends on the cause of your sciatica. Surgery is typically considered within a year of ongoing symptoms. Pain that is severe and unrelenting and is preventing you from standing or working and you’ve been admitted to a hospital would require more aggressive treatment and a shorter timeline to surgery. Loss of bladder or bowel control could require emergency surgery if determined to be cauda equine syndrome.
The goal of spinal surgery for sciatic pain is to remove the pressure on the nerves that are being pinched and to make sure the spine is stable.
Surgical options to relieve sciatica include:
Microdiscectomy: This is a minimally invasive procedure used to remove fragments of a herniated disk that are pressing on a nerve.
Laminectomy: In this procedure, the lamina (part of the vertebral bone; the roof of the spinal canal) that is causing pressure on the sciatic nerve is removed.
How long does it take to perform spine surgery and what’s the typical recovery time?
Discectomy and laminectomy generally take one to two hours to perform. Recovery time depends on your situation; your surgeon will tell you when you can get back to full activities. Generally the time needed to recover is six weeks to three months.
What are the risks of spinal surgery?
Though these procedures are considered very safe and effective, all surgeries have risks. Spinal surgery risks include:
Bleeding.
Infection.
Blood clots.
Nerve damage.
Spinal fluid leak.
Loss of bladder or bowel control.
What complications are associated with sciatica?
Most people recover fully from sciatica. However, chronic (ongoing and lasting) pain can be a complication of sciatica. If the pinched nerve is seriously injured, chronic muscle weakness, such as a “drop foot,” might occur, when numbness in the foot makes normal walking impossible. Sciatica can potentially cause permanent nerve damage, resulting in a loss of feeling in the affected legs. Call your provider right away if you lose feeling in your legs or feet, or have any concerns during your recovery time.
PREVENTION
Can sciatica be prevented?
Some sources of sciatica may not be preventable, such as degenerative disk disease, sciatica due to pregnancy or accidental falls. Although it might not be possible to prevent all cases of sciatica, taking the following steps can help protect your back and reduce your risk:
Maintain good posture: Following good posture techniques while you’re sitting, standing, lifting objects and sleeping helps relieve pressure on your lower back. Pain can be an early warning sign that you are not properly aligned. If you start to feel sore or stiff, adjust your posture.
Don’t smoke: Nicotine reduces the blood supply to bones. It weakens the spine and the vertebral disks, which puts more stress on the spine and disks and causes back and spine problems.
Maintain a healthy weight: Extra weight and a poor diet are associated with inflammation and pain throughout your body. To lose weight or learn healthier eating habits, look into the Mediterranean diet. The closer you are to your ideal body weight the less strain you put on your spine.
Exercise regularly: Exercise includes stretching to keep your joints flexible and exercises to strengthen your core – the muscles of your lower back and abdomen. These muscles work to support your spine. Also, do not sit for long periods of time.
Choose physical activities least likely to hurt your back: Consider low-impact activities such as swimming, walking, yoga or tai chi.
Keep yourself safe from falls: Wear shoes that fit and keep stairs and walkways free of clutter to reduce your chance of a fall. Make sure rooms are well-lighted and there are grab bars in bathrooms and rails on stairways.
OUTLOOK / PROGNOSIS
What can I expect if I have been diagnosed with sciatica?
The good news about sciatic pain is that it usually goes away on its own with time and some self-care treatments. Most people (80% to 90%) with sciatica get better without surgery, and about half of these recover from an episode fully within six weeks.
Be sure to contact your healthcare provider if your sciatica pain is not improving and you have concerns that you aren’t recovering as quickly as hoped.
LIVING WITH
When should I contact my healthcare provider?
Get immediate medical attention if you experience:
Severe leg pain lasting more than a few hours that is unbearable.
Numbness or muscle weakness in the same leg.
Bowel or bladder control loss. This could be due to a condition called cauda equina syndrome, which affects bundles of nerves at the end of the spinal cord.
Sudden and severe pain from a traffic accident or some other trauma.
Even if your visit doesn’t turn out to be an emergency situation, it’s best to get it checked out.
Is the sciatic nerve the only source of “sciatica” pain?
No, the sciatic nerve is not the only source of what is generally called “sciatica” or sciatica pain. Sometimes the source of pain is higher up in the lumbar spine and causes pain in front of the thigh or in the hip area. This pain is still called sciatica.
How can I tell if pain in my hip is a hip issue or sciatica?
Hip problems, such as arthritis in the hip, usually cause groin pain, pain when you put weight on your leg, or when the leg is moved around.
If your pain starts in the back and moves or radiates towards the hip or down the leg and you have numbness, tingling or weakness in the leg, sciatica is the most likely cause.
Is radiculopathy the same as sciatica?
Radiculopathy is a broader term that describes the symptoms caused by a pinched nerve in the spinal column. Sciatica is a specific type, and the most common type, of radiculopathy.
Should I rest if I have sciatica?
Some rest and change in your activities and activity level may be needed. However, too much rest, bed rest, and physical inactivity can make your pain worse and slow the healing process. It’s important to maintain as much activity as possible to keep muscles flexible and strong.
Before beginning your own exercise program, see your healthcare provider or spine specialist first to get a proper diagnosis. This healthcare professional will refer you to the proper physical therapist or other trained exercise or body mechanics specialist to devise an exercise and muscle strengthening program that’s best for you.
Can sciatica cause my leg and/or ankle to swell?
Sciatica that is caused by a herniated disk, spinal stenosis, or bone spur that compresses the sciatic nerve can cause inflammation – or swelling – in the affected leg. Complications of piriformis syndrome can also cause swelling in the leg.
Are restless leg syndrome, multiple sclerosis, carpal tunnel syndrome, plantar fasciitis, shingles or bursitis related to sciatica?
While all these conditions affect either the spinal cord, nerves, muscles, ligaments or joints and all can cause pain, none are directly related to sciatica. The main causes of these conditions are different. Sciatica only involves the sciatic nerve. That being said, the most similar condition would be carpal tunnel syndrome, which also involves a compression of a nerve.
A final word about sciatica
Most cases of sciatica do not require surgery. Time and self-care treatment are usually all that’s needed. However, if simple self-care treatments do not relieve your pain, see your healthcare provider. Your healthcare provider can confirm the cause of your pain, suggest other treatment options and/or refer you to other spine health specialists if needed.
Evolution of Medical profession-Extinction of good doctors 