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Hernias are rather usual and can confound anyone. However, how can you know that you have developed one? There are various causes of hernia such as straining of muscles due to heavy weight lifting, multiple pregnancies, congenital reasons or you can get one even from a recent accident. Additionally, lifestyle variables such as obesity, smoking, and not having a nutritious diet can cause a hernia.

The abdomen is the most common area for developing a hernia, however, it can also be seen in the upper thigh or chest. A hernia can take time to show symptoms and sometimes those symptoms can lead to intense pain thus leading to surgery. The conventional symptom of a hernia is the appearance of a bulge in the groin area. You may observe a lump in the pubic region if you have an inguinal hernia whereas hiatal hernia has more characteristic symptoms such as heartburn, chest pain, breathing, and swallowing problems etc. In many cases, a person may not complain of any symptom at all and it may be accidentally detected during a routine examination. As your hernia grows, discomfort may grow as well.

Early signs of a hernia may include:

  • A bulge in the groin area or scrotum or swelling in the scrotum.
  • Pain or discomfort in the affected area which worsens during bending or heavy lifting.
  • Heaviness in the abdomen and burning or aching sensation in the bulge.
  • Pain or aching sensation while passing stools or urinating.
  • Pain in the abdomen, typically during evenings after you have remained standing for most of your day.
  • In case of a strangulated hernia, you may also have a fever, vomiting, nausea, and severe abdominal cramps.

While a hernia may begin as an innocuous lump, it can get bigger and begin to trouble with time. In some cases, it can even be perilous. So regardless of whether it doesn’t appear to be a serious deal, it’s ideal to see your primary care physician in case you have indications of a hernia, similar to a bump or lump you can’t clarify.

Seek medical attention immediately if you have a hernia and these symptoms:

  • The bulge appears to be dark, purple, or red.
  • You can’t pass stools.
  • You have a high fever.
  • The pain quickly worsens.
  • You’re throwing up or have an upset stomach.

The diagnosis of a hernia is generally a clinical one, which implies that your doctor will go through a history of your symptoms followed by a brief physical examination. In the great majority of cases, where there is a conspicuous swelling in the groin/abdominal area, which increases in size on standing, straining or coughing, a clinical diagnosis of hernia is made and no tests are needed. More challenging diagnoses are best performed by hernia specialists.

Usually, your doctor can determine if you have a hernia with just physical examination. They may ask you a variety of questions along with cross-checking your medical history. During this diagnosis of a hernia, your doctor may ask you to perform activities like standing and coughing to confirm the possibility of a hernia.

Furthermore, your doctor will confirm that you have a hernia by prescribing some tests such as ultrasound of your abdomen, A CT or MRI scan which is like X-rays. Your doctor may also ask you to undergo an endoscopy; a non-surgical procedure used to examine a person’s digestive tract. Using an endoscope, a flexible tube with a light and camera attached to it, your doctor can view pictures of your digestive tract on a colour TV monitor.

For adults, particularly if the medical procedure could be dangerous for you, your primary care physician may propose simply watching out for it as long as the hernia’s small and not creating any serious issues for you. However, in some cases, you can always lower your odds of getting a hernia by following simple steps such as following a well-balanced diet and staying at a healthy weight, quitting smoking, talking to your doctor if your cough won’t go away, and using the correct form while doing any physical activity (bend from your knees instead of the waist while weight lifting).

Wearing face masks is just a part of an inclusive strategy for preventing and controlling the spread of viral infectious diseases, including COVID-19. Masks can be worn by healthy persons (for self-protection while accidentally coming in contact with an infected patient) or by an already infected patient for preventing further spread of the infection (source control). But, solely using a mask cannot provide optimum protection or source control. The WHO advises people to wear masks when unable to maintain social distancing. Compliance to other infection prevention and control (IPC) measures, such as maintaining social distancing and practicing hand hygiene are imperative to prevent human transmission of the viral disease.

Guideline for using masks in the health care settings

A) Use of medical masks (surgical or procedure masks) and respirators (N95 masks) for caring suspected or confirmed COVID-19 patients

It is recommended that health workers who directly provide care or come in direct contact with COVID-19 patients, should wear a medical mask (along with other PPE components that are a part of aerosol and contact precautions), in the absence of aerosol-generating procedures (AGPs).

In areas where AGPs are being performed, it is recommended to health care personnel that they should wear a N95 or FFP2 or FFP3 or equivalent standard respirator.

B) Targeted continuous use of medical mask by health workers in locations of known or suspected COVID-19 community transmission.

In the context of areas, where community spread of COVID-19 is suspected or an intense COVID-19 outbreak exists, following recommendations are provided:

Health workers practicing in clinical area should always wear a medical mask during their routine activities throughout the entire shift; apart from the duration when they are having their meals and changing their medical mask after caring for a patient who requires droplet/contact precautions for other reasons

It is particularly vital to adopt the strategy of continuous use of masks in areas with a potentially higher risk of transmission such as triage, waiting lounges of family physicians or OPDs, designated COVID-19 hospitals, cancer units, transplant units etc.

While continuously using medical masks, it is also vital to:

  • Change the mask if it gets wet, soiled or damaged.
  • Not touch the mask to adjust it.
  • If you have touched it, safely remove it, perform the hand hygiene procedure and use a fresh mask.
  • Discard the mask and the PPE and use a new set after coming in contact with a patient for contact or droplet precautions.
  • Personnel not working in clinical areas need not wear a medical mask during routine activities.
  • PPEs including masks should not be shared between workers and be suitably disposed after use and not to be re-used.
  • In addition to above recommendations, precautions of social distancing and hand hygiene practices should not be avoided as they are equally important.
Table 1: Recommended type of mask for use by health workers

Considerations for using non-medical masks

The utility of medical masks by the non-affected population may lead to a shortage of this extremely important supply to the health workers, who need them the most. In settings where medical masks are in short supply, medical masks should be reserved for use by only health workers and at-risk population when need arises.

Non-medical or fabric masks are prepared from varied woven and non-woven fabrics like polypropylene. Non-medical masks may be composed from differing fabric compositions, sequences or layers and shapes. However, a non-medical mask is neither a medical or surgical device nor a PPE.

Usage Considerations

The use of non-medical masks, prepared from woven fabrics such as cloth, and/or non-woven fabrics, should only be considered for used by infected persons in unrestricted settings and not for prevention. They can be used temporarily for activities such as travelling on public transport when social distancing cannot be maintained, and their use should without fail go with frequent hand hygiene and physical distancing.

Table 2: Recommended material, source and structure of non-medical masks

Elastic materials are not preferred to prepare masks as they get stretched after each use, causing increased pore size and lower effectiveness of the mask to filter droplets.

Layers

A minimum of three layers is needed for a non-medical mask, as per the used fabric. However, cotton handkerchief masks should consist of a minimum of 4 layers. Cotton gauze is found to be very porous with a filtration efficiency of only 3%.

The ideal material combination for non-medical masks should include three layers as follows: 1) an innermost layer of a material which absorbs water (e.g. cotton or cotton blends); 2) an outermost layer made of non-water absorbing material (e.g., polypropylene, polyester, or their blends) which may restrict external impurity from penetration through to the wearer’s nose and mouth; 3) a middle non-water absorbing layer of synthetic non-woven material such as polyproplylene or a cotton layer which may enhance filtration or retain droplets.

Shape

Shape of the non-medical mask should be flat-fold, fitting closely over the nose, cheeks and chin of the wearer. If the mask’s edges are not close to the face and shift, during activities like  speaking, air penetrates through the mask’s edges rather than getting filtered through the fabric. The mask should be equipped to be held in place by the use of elastic bands or ties.

Coating

Coating the mask with materials like wax may raise the barrier and make the mask liquid-resistant, but too much coating may cause difficulty in breathing through the mask due to complete blocking of pores.

Maintenance

  • Mask should be used only by a single person and not shared by multiple individuals
  • All masks should be changed immediately, if they get wet or are visibly soiled
  • When required, masks should be removed without touching the front portion of the mask and after mask removal, do not touch the eyes and mouth
  • Discard the mask, if you wish or keep it in a sealable bag until you wash it. After washing, immediately perform hand hygiene
  • Cloth masks should be frequently washed as per the cloth’s recommended washing temperatures
  • Wash in warm hot water, 60°C, with soap or laundry detergent.
  • Non-woven polypropylene (PP) may be washed at high temperatures, up to 125°C.
  • Natural fibres may resist high temperature washes and ironing.
  • Wash the mask delicately (without too much friction, stretching or wringing) if non-woven materials are used.
  • The combination of non-woven PP and cotton can tolerate high temperatures; masks made of these combinations may be steamed or boiled.
  • Where hot water is not available, wash mask with soap/detergent at room temperature water, followed by either i) boiling mask for one minute OR ii) soak mask in 0.1% chlorine for one minute then thoroughly rinse mask with room temperature water, to avoid any toxic residual of chlorine.
Table 3: Recommendations of areas where the general public should be advised to use masks in established or suspected community transmission areas

Wearing a face mask is not a substitute for physical distancing and basic hand hygiene but in some situations where you can’t follow social distancing and other preventive measures, wearing a mask can give you some layer of protection. It is important to follow the Government’s latest guidance on safeguarding yourself during the coronavirus pandemic, including travel advice within and outside the country.

If you think getting your surgery done is the last piece of the puzzle then you may be wrong because you might still have to show some resilience till the time your stitches or sutures don’t come off or are dissolved as instructed by your surgeon. Though getting done with the surgery covers the majority of the procedure, adequate post-operative care of your stitches or sutures is still an important aspect that needs to be managed well to avoid any future problems. Before moving on to the post-operative management of the wound, let us first understand more about sutures or stitching.

Sutures and stitches are used for the same purpose – to close wounds or surgical incisions. For sutures, professionals use a thread or strand of material to perform wound closure. The term ‘stitches’ refers to the surgical procedure of closing a wound with the help of sutures. There are basically two types of sutures, absorbable and non-absorbable. Absorbable sutures don’t require your doctor to remove them, while the Non-absorbable sutures will have to be removed at some point in time by your doctor. The kind of material to be used for sutures will completely depend on your doctor’s observation and analysis of the wound and the material type that’s appropriate for the wound or procedure. From piles to bariatric surgery to a hernia repair surgery, suturing is a part of most of the surgeries with incisional cuts and has to be performed with utmost precision and accuracy. Sutures are used for maintaining tissue contact until optimal healing is achieved to provide internal wound strength. When it comes to hernias, the selection of suture and suturing technique is based on the type of underlying hernia, its dimensions and the operative technique used for a hernia repair.

Though there’s no clear evidence that says one particular type of suture is better than others, it is important to care for your sutures irrespective of the material type so that it helps the healing process. Any negligence can slow down the recovery process and cause a lot of pain to the patients.

Below are some of the common symptoms that indicate that your wound has split or is damaged.

  • Inflammation
  • Bleeding from the wound
  • Broken suture
  • Pain near the wounded site
  • Swelling
  • Fever
  • Puss formation

Open wounds often require immediate attention and doctors usually opt for antibiotics or debridement (removal of dead tissue from the wound). It is always advisable to get in touch with your doctor in case any such symptoms are observed. Classically, your sutures require to stay in play for some days to even 1-2 weeks, as per the severity of the incision and its location. Usually, as your sutured wound starts to heal, your doctor will instruct you to take proper care of your sutures, which includes cleaning, dressing and drying your wound.

How to care for your sutures/stitches

Moisturise: Applying moisturizing creams with high Vitamin and Aloe vera content can help the wound’s faster recovery

Massage: Massaging the wound gently over time can help in reducing the scar and also increases the blood flow near the wound which can help in faster recovery. However, the pressure applied should be moderate and should not initiate any pain or discomfort near the operated area.

Avoid activities that expose the wound:It is advisable to avoid exposing the wound to any physical activity that adds pressure on the wound or makes it dirty, increasing the chances of an infection.

During the removal of your stitches, your doctor will analyze, observe the state of your wound and then only give a go-ahead. Removing sutures is a much quicker procedure than applying one. You might simply experience a minor pulling sensation and some pain which is due to your body trying to guard itself against organisms trying to enter inside through the cut. As a protective mechanism, the body releases chemicals for aiding your WBCs to fight against infections. As a result of this mechanism, you will feel pain and inflammation due to your nerve stimulation in the area.

If the pain is intense and you are not able to tolerate it, you can take paracetamol as a pain-killer. Avoid take aspirin, ibuprofen or any NSAID to relieve pain, as they may make it difficult for your blood to clot during wound healing. Or else, you may place an ice pack to decrease your pain and inflammation at the affected area for 15 to 20 minutes every hour. This procedure can also reduce bruising. Also, remember that removing stitches on your own is not a good idea. When doctors remove stitches, they look for multiple signs such as infection, state of healing, and wound closure. But when you try to do it on your own, you skip this final observation step which could be lethal for you in the coming future. 

Patients who get completely recovered from the fatal COVID-19 disease possess chemicals (antibodies) in their blood plasma that their bodies have produced to counter the infection in their blood and get cured of the infection. The blood of recovered COVID-19 patients is termed as Convalescent Plasma. In easier terms, plasma is the yellowish liquid part of the whole blood in which the blood cells (RBC, WBC and platelets) stay suspended. It is believed that this convalescent plasma of recovered patients can be transfused into severely ill COVID-19 patients, for boosting their immunity and enabling them to fight off their infection.

Certain blood cells function as “memory cells”, remembering the pathogen against whom they have produced antibiotics. When such blood plasma possessing the antibodies against COVID-19 is isolated from the recovered patient and transfused in the existing patient, the donor’s plasma immediately recognizes the COVID-19 viral pathogen and again produces the antibiotics to fight off the organism in the transfused patient’s body to improve their condition. This therapy is known as “Convalescent Plasma Therapy” (CPT) or simply, “Plasma Therapy”. Experts believe that this therapy can also prevent moderately ill COVID-19 patients from experiencing severe symptoms and complications related to the infection. Development of passive immunity is the basis of this therapy.

Where is this therapy used?

CPT is believed to aid COVID-19 patients who do not respond expectedly to other experimental drug therapies. Such patients may develop a severe lung complication called “Acute Respiratory Distress Syndrome”, necessitating mechanical ventilation to breathe, or else their organs begin to fail.

CPT may also help patients having chronic co-morbid conditions such as diabetes or cardiovascular diseases, whose immunity is already impaired and are COVID-19 infected of becoming severely ill.

CPT might also be considered for family members of COVID-19 patients or medical staff, who get exposed to potential patients, for preventing them from getting the infection.

Probable Risks of CPT:

Blood and plasma transfusions have been used to treat multiple diseases with exceptional safety. However, CPT does carry a risk of complications such as:

  • Allergies
  • Damage to the lungs and impaired breathing
  • Infections from the donor’s plasma such as hepatitis or HIV

Although the risk of above-mentioned problems is very low, they can occur. Also, the therapy is still in the experimental phase and its effectiveness is not well-established in large clinical trials.

Who all can donate plasma?

  • People between the age of 18 to 60 years.
  • You weigh above 50 kgs.
  • You are not suffering from any transmissible or chronic diseased condition.
  • Your heart rate should be normal.
  • Your hemoglobin level is ≥ 12.5 g/dl.
  • Your blood pressure is normal.
  • You should not have got any piercing done in the last 6 months.
  • Above all, you should be completely free of COVID-19.

What is the procedure for donating plasma?

The procedure of donating plasma differs from that of donating blood. Though the initial process of blood collection is the same i.e. through the IV route, the whole blood collected from your arm for plasma donation has to pass through a dedicated machine for separating plasma and the blood components. Then, just the plasma is stored and the remaining portions are transfused back to the body with some saline. Hence, the procedure of plasma donation takes more time (approx. 90 minutes) than blood donation (which is 30 minutes).

In preliminary treatment, numerous individuals have benefited from CPT. Researchers keep on assessing the outcomes of individuals who got the treatment done. By considering the consequences of this treatment for COVID-19, specialists are drawing nearer to finding a treatment. Likewise, getting familiar with the utilization of CPT currently will assist healthcare workers to be better prepared to provide optimal patient care.

Considering a hernia surgery? Let’s take you through this article that will help you explore different treatment options for a hernia surgery.

Hernias do not heal on their own. Though they can remain asymptomatic for a long time and cause no trouble, they also have high possibilities of getting worse with time. Usually surgical repair is recommended for treating hernias but your doctor may prescribe OTC (Over-the-Counter) antacid medicines at times to reduce the risk of your hernia or may ask you to wear a supporting truss. It is important to understand that hernias in most cases are not immediately life-threatening but it does require treatment as they normally do not get better on their own. Apart from an umbilical hernia in infants, the nature of treating a hernia normally depends on symptom presence. If an adult has the same, surgery is usually recommended because the complications are most likely to increase with time.

As per available evidence, surgical repair is the only current effective way to treat a hernia. To prevent the hernia surgery is performed to return bulging tissue to its proper place, and then repair the defect in the abdomen with stitches or a mesh patch. There are generally two types of a hernia surgery- open repair and laparoscopic repair.

1) Open Hernia Repair

A single long incision is made in the groin area for this kind of repair. The weak spot in the muscle wall is then fixed by sewing the edges of healthy muscle tissues collectively for the contents to be pushed back into the abdominal cavity. This approach is suitable for more diminutive hernias that may have been present since birth, and for healthy tissues without addressing stress on the tissue. This type of surgery can be performed under general, spinal, and local anesthesia.

What to expect after the open hernia surgery?

  • In most of the cases, patients are able to go home the same day. However, recovery time is usually about 3-4 weeks.
  • You can most likely return to performing light activities after 3 weeks.
  • Strenuous tasks must wait until after 6 months of recovery.
  • Avoid tasks that may cause severe pain.

2) Laparoscopic Hernia Repair

Laparoscopic hernia repair uses a laparoscope, a thin, telescope-like instrument that is inserted through a small incision at the umbilicus (belly button). This procedure is usually performed under general anesthesia and before the surgery, you will have an evaluation of your general state of health and an electrocardiogram (EKG). The laparoscope is connected to a tiny video camera that projects an “inside view” of your body onto television screens in the operating room. After the procedure is completed, the small abdominal incisions are closed with the help of stitches or surgical tapes.

What to expect after a laparoscopic hernia surgery?

  • In most of the cases, patients are able to go home the same day itself however, recovery time is usually about 1-2 weeks.
  • You can most likely return to performing light activities after 1-2 weeks.
  • Strenuous tasks must wait until after 4 months of recovery.
  • Avoid tasks that may cause severe pain.

Recent studies have revealed that in the short term, laparoscopic repair is superior to open repair in terms of less blood loss, fewer operative complications, and shorter hospital stay. Long-term outcomes such as recurrence rates are yet unexplained. However, a hernia can reoccur even after the surgery. And, which is why patients are advised to adapt a healthy lifestyle post a hernia surgery. While not much can be done to prevent muscle weakness, one can reduce pressure on the abdomen, and thus reduce the risk of incurring a hernia. Maintaining a healthy body weight can reduce the risk of getting a hernia as your extra body fat can put pressure on your abdomen. Likewise quitting smoking, avoiding lifting of heavy objects can also help in reducing the risk of getting a hernia. Also, staying aware of any symptoms is the key to identifying and treating a hernia on time. It is important to keep in mind that hernias do not go away on their own and will need medical attention at some point of time.