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Bronchoscopy

Management Team

Bronchoscopy

Overview

Bronchoscopy is a procedure that lets doctors look at your lungs and air passages. It is usually performed by a doctor who specialises in lung disorders (a pulmonologist). During bronchoscopy, a thin tube (bronchoscope) is passed through the nose or mouth, down the throat, and into the lungs.

Common reasons for needing bronchoscopy are a persistent cough, infection, or some unusual findings on a chest X-ray or other tests.

Bronchoscopy can also be used to obtain samples of mucus or tissue, to remove foreign bodies or other blockages from the airways or lungs, or to provide treatment for lung problems.

  • Diagnosis of a lung problem
  • Identification of a lung infection
  • Biopsy of lung tissue
  • Removal of mucus, a foreign body, or other obstructions in the airways or lungs, such as a tumour
  • Placement of a small tube to hold open an airway (stent)
  • Treatment of a lung problem (interventional bronchoscopy), such as bleeding, an abnormal narrowing of the airway (stricture), or a collapsed lung (pneumothorax)1
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Benign Adrenal Tumours

Management Team

Benign Adrenal Tumours

Overview

Benign adrenal tumours are non-cancerous growths in the adrenal glands. They can sometimes produce excess hormones.

High blood pressure, weight gain, or changes in hair growth.

Blood and urine tests to evaluate hormone levels and imaging studies like CT or MRI.

Depends on the tumour type and whether it is causing symptoms. Some tumours may only require regular monitoring, while others may need surgical removal if they produce excess hormones or are at a risk of becoming cancerous. Management of benign adrenal tumours involves regular follow-up to ensure that they do not cause complications.

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Bronchiectasis

Management Team

Bronchiectasis

Overview

Bronchiectasis is a chronic lung condition characterised by the permanent dilation and damage of the bronchi, which are large to medium-sized airway passages leading to the lungs. This condition results from repeated infections and inflammation.

The causes of bronchiectasis are varied. It is usually a consequence of severe lung infections, such as tuberculosis, pneumonia, or whooping cough, or it can arise from conditions like cystic fibrosis, immunodeficiency disorders, and primary ciliary dyskinesia. Additionally, conditions like allergic bronchopulmonary aspergillosis and inhalation of toxic substances can also contribute to the development of bronchiectasis.

Patients with bronchiectasis experience persistent cough, often producing large amounts of sputum (mucus), and may suffer from recurrent respiratory infections, wheezing and shortness of breath. Fatigue and chest pain are also common, affecting the overall quality of life.

Diagnosis

High-resolution computed tomography (HRCT) of the chest, i.e., HRCT Chest is the gold standard for diagnosis. Other investigations are done to know the cause of bronchiectasis; these include but are not limited to sputum examination, nasal nitric oxide level analysis, sweat chloride test, immunoglobulin level analysis and Aspergillus-specific immunoglobulin analysis.

Treatment

Only a specialist can identify the underlying cause of bronchiectasis for its effective management. Treatment is focused on managing the symptoms and preventing complications. This requires a multidisciplinary approach that includes airway clearance techniques, such as chest physiotherapy and postural drainage, medications like antibiotics to treat infections, bronchodilators, and sometimes surgical intervention.

Pulmonary rehabilitation also plays a significant role in maintaining lung function.

Regular follow-ups with healthcare providers are essential to monitor the condition and adjust treatment plans as needed for maintaining lung health.

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Brainstem Auditory-evoked Response (BAER)

Management Team

Brainstem Auditory-evoked Response (BAER)

Overview

The brainstem auditory evoked response is a non-invasive test used to assess the function of auditory nerve and brainstem. It measures the electrical activity generated in response to an auditory stimulus.

  • Electrodes are placed on the scalp and ears
  • Patient listens to sounds generated in the form of clicks and tones
  • The brain activity generated in response to the sound is recorded

  • New-born screening for hearing disorders
  • Diagnosing auditory nerve damage
  • Monitoring brain stem function in comatose patients
  • Diagnosing hearing loss or deafness
  • Diagnostic tools in acoustic neuroma or multiple sclerosis
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Bone Marrow

Management Team

Bone Marrow

Overview

The bone marrow is the factory where all your blood is made. It produces: 

  • Platelets that stop you from bleeding when you get a cut or fall over and hurt yourself.
  • White blood cells that help your body to fight infections.
  • Red blood cells that give you energy to help you run around and play.

Before your child’s transplant, they will undergo several tests to ensure they are ready for the procedure. These may include:

  • X‑ray
  • Ultrasound Scan
  • Blood Tests
  • Breathing Tests
  • Height
  • Kidney Test
  • Weight
  • Any other test as per doctor discretion

To prepare for the transplant, your child will need a central line inserted, which will stay in place for several months. This line is used for administering blood tests, treatments, and medications. While it won't interfere with your child’s daily activities like attending school, swimming will be restricted.

Your child will receive preparatory treatment before the transplant. This treatment can range from a few days to two weeks and may include chemotherapy, radiotherapy, or both.

  • Chemotherapy involves special medications that are either administered through the central line or taken orally to target and destroy any malfunctioning cells in the body, including the bone marrow cells, to make way for the new, healthy bone marrow cells.
  • Radiotherapy is not given to all children who have a bone marrow transplant. Radiotherapy is a special kind of X‑ray whose job it is to kill any cells in your body that don't work properly and to destroy your bone marrow. Having radiotherapy does not hurt. It is very important that your child keeps still for his / her radiotherapy which will last about 20 minutes. No one else can stay in the room with your child while he / she has his / her radiotherapy but they can usually see and hear you on a special television screen.

The need for chemotherapy and radiotherapy will be decided by your doctor and will be discussed with you in detail.

Chemotherapy and radiotherapy can cause temporary hair loss about 2 weeks later, including eyebrows and eyelashes. Many children choose to have their hair cut short before treatment or wear a wig, cap, or hat until their hair grows back, which typically takes 3-6 months. Sometimes hair can be a bit darker or a bit lighter when it grows back.

Chemotherapy and radiotherapy can make your child's mouth sore and may cause nausea. To help manage this:

  • Encourage your child to drink small sips of water or suck on ice cubes.
  • Maintain good oral hygiene. We would like your child to clean your teeth 3‑4 times a day with a soft toothbrush and toothpaste. If mouth sores make brushing difficult, special sponges can be used instead.
  • Inform the nurses if your child feels sick or has mouth pain so they can provide the necessary treatments to ease discomfort.

If your child has trouble eating, they may require a feeding tube to get the nutrition they need. The tube could also be used for medicines which can really help your child. If the feeds make your child too sick, special feeds (TPN) may be administered through a Hickman line. A feeding tube is essential during recovery to keep your child strong.

During the recovery phase, your child’s bone marrow will be destroyed, leading to a lower white blood cell count and a weakened immune system. To protect against infections:

  • Your child will stay in a private room, rather than sharing with other children, to minimize exposure to germs. 
  • A family member will be able to stay with your child to help with care.
  • Daily Seitz baths (sitting in a tub for 15-20 minutes) are recommended for hygiene and comfort.
  • Your child's hair will start growing back after a few months. 

Certain foods may not be allowed during the transplant period, as they could cause digestive upset. Your child will probably not be able to eat the skin on fruit, a half boiled egg, etc. A list of recommended foods will be provided by the hospital’s dietitians, and the nurse will guide you on which foods are safe for your child.

As your child’s new bone marrow begins to function, they will gradually be able to interact more and leave their room. The doctors and nurses will monitor blood counts to determine when it is safe for your child to have visitors or leave their room. If an infection is present, your child may need to stay in isolation for longer.

At home, your child will need to continue taking medications. You may be able to choose between liquid or tablet forms. Please ask if the options aren’t provided.

After leaving the hospital, your child will have regular check-ups to monitor recovery and prevent complications. Your child may need to stay on special medications if they experience side effects such as rashes or digestive issues. Sometimes you may have to come back into hospital for a few days in case of any problem.

Once your child leaves the hospital, it’s important to limit exposure to germs:

  • Keep visits to a few close friends who are healthy and free of infections.
  • Avoid crowded places like shopping malls for the time being.
  • Short walks outside in fresh air are encouraged if your child feels strong enough.
  • School attendance may be delayed for a few months. Initially, your child may return for half-days or a few hours at a time.
  • Your child will likely feel tired, especially if they have undergone radiotherapy. This is normal, and with time, their energy levels will improve.

Once your child no longer needs the central line for blood tests or treatments (usually around 3-6 months after the transplant), it will be removed. At that point, your child can resume swimming and enjoy regular baths.

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Blepharitis

Management Team

Blepharitis

Overview

Blepharitis refers to the inflammation of the eyelids. This condition causes irritation and itchiness in the eyelids. Patients with blepharitis often exhibit greasy and crusted eyelids with scales sticking to the eyelashes. Blepharitis commonly occurs as a result of the clogging of the Meibomian glands (tiny oil glands near the base of the eyelashes). Some patients with blepharitis wake up with their eyelids stuck together, while others may experience dried tears and/or the feeling of something being stuck in their eyes. Although blepharitis is a chronic difficult-to-treat condition and can cause discomfort, it does not permanently damage eyesight and is not contagious.

The exact cause of blepharitis is unclear. However, one or more of the following factors are usually associated with this condition:

  • Dry eyes.
  • Seborrheic dermatitis (eyebrow and scalp dandruff).
  • Other types of eye infections.
  • Meibomian gland clogging or dysfunction.
  • Rosacea (a skin condition characterised by facial redness).
  • Allergies, including those to eye makeup, contact lens solutions, or eye medications.
  • Lice or eyelash mites.

Typically, the symptoms of blepharitis are worse in the morning. Such symptoms include:

  • Red and/or watery eyes.
  • Red, itchy, and/or swollen eyelids.
  • Sticky eyelids that often appear greasy.
  • Crusted eyelashes.
  • Flaking of the skin around the eyes.
  • Burning, gritty, or stinging sensations (eye irritation).
  • Frequent blinking.
  • Heightened light sensitivity.
  • Blurred vision (usually improves with blinking).

Blepharitis is typically diagnosed through a comprehensive eye examination performed by an ophthalmologist. The steps involved in diagnosing blepharitis include:

  • Collection of medical history to assess the history of skin conditions (like rosacea or seborrheic dermatitis) or allergies.
  • Physical examination of the eyelids, eyelashes, and tear film. This includes looking for signs of inflammation, crusting at the base of the eyelashes, or abnormal oil gland function in the eyelids.
  • Slit-lamp (a specialised microscope) examination to magnify and light up the eyelid and eye surface for a detailed view of the eyelid margins, meibomian glands (which can become blocked), and the overall condition of the tear film.
  • Tear sample or swab (if necessary) to rule out bacterial or fungal infections or to check for demodex mites (which cause blepharitis).

In most cases, self-care measures, such as regular eye washes and the use of warm compresses, are adequate for treating blepharitis. If these measures do not help, certain medications may be prescribed:

  • Infection-targeting medications: Antibiotics are useful in alleviating the symptoms and treating bacterial infections in the eyelids. These are available as eyedrops, creams, and ointments. Oral antibiotics may be prescribed if no response is observed with topical antibiotics.
  • Anti-inflammatory medications: Steroid-based eyedrops or ointments are used for patients who do not respond to other treatments. These may be prescribed together with antibiotics.
  • Immunomodulatory medications: Topical cyclosporine (Restasis) has been reported to ameliorate some symptoms of blepharitis.
  • Medications for treating underlying conditions: In cases where blepharitis is caused by conditions, such as rosacea, seborrheic dermatitis, or other diseases, treating the underlying disease may help alleviate the signs and symptoms of blepharitis.
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Brain Death

Management Team

Brain Death

Overview

Brain death is the permanent and irreversible cessation of arousal, wakefulness, accompanied by total and irreversible loss of brain stem reflexes, including breathing, coughing, eye movement, and swallowing.

  • Hypoxic brain damage
  • Trauma
  • Vascular- ischemic / haemorrhagic stroke
  • Fulminant systemic/ brain infections
  • Inflammatory conditions- vasculitis
  • Autoimmune conditions- neurosarcoidosis

  • Cardiopulmonary arrest
  • Traumatic brain injury
  • Subarachnoid haemorrhage
  • Intracerebral haemorrhage
  • Other causes of brain death include heart attack, stroke, blood clot, infections like encephalitis or meningitis, and brain tumour

  • Fixed pupils with no response to light
  • Absence of corneal or conjunctival reflex
  • No response on caloric testing
  • Absence of spontaneous breathing
  • Absence of gag reflex
  • No motor response to painful stimulus
  • No respiratory movements on disconnection from ventilator, even after increase in CO2 in blood

  • The aetiology for irreversible brain damage should be confirmed.
  • The causes of coma such as sedative medications, hypothermia, metabolic and endocrine causes should be excluded
  • The Patient should be hemodynamically stable on ventilator
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Botulism

Management Team

Botulism

Overview

Botulism is a a severe and potentially life-threatening disease caused by the botulinum toxin, which is produced by the bacterium Clostridium botulinum.

  • Ingestion of contaminated food or water
  • Infected wounds
  • Inhalation of toxin used in biological warfare

  • Injecting illicit drugs such as black tar heroin
  • Drinking certain kinds of homemade alcohol, such as “pruno” or “hooch”
  • Eating improperly canned, preserved, or fermented foods, Foods commonly linked to botulism include home-canned foods and Alaska Native foods.
  • Being injected with too much botulinum toxin for medical or cosmetic reasons

  • Drooping of eyelids
  • Muscle weakness or paralysis
  • Slurring of speech
  • Difficulty in swallowing
  • Diarrhoea or vomiting
  • Difficulty in breathing

Neurologist

  • Antitoxin (if given early)
  • Supportive care (mechanical ventilation)
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Benign Positional Paroxysmal Vertigo (BPPV)

Management Team

Benign Positional Paroxysmal Vertigo (BPPV)

Overview

Benign positional paroxysmal vertigo refers to brief intermittent attacks of rotatory vertigo, that is a sudden spinning sensation. It is precipitated by rapid change in head position. Posterior semicircular canal is affected the most followed by anterior semicircular canal in the ear.

It is caused by movements of canalith (calcium crystals in inner ear) in endolymph (fluid in inner ear)

  • Age: Most common in people aged >50 years but can occur at anytime
  • Gender: BPPV is common in women
  • Vitamin D deficiency
  • Head trauma
  • Other disorders including:
    • Labyrinthitis
    • Vestibular neuronitis
    • Meniere disease
    • Migraine
    • Inner ear surgery
  • Other conditions including:
    • Hypertension
    • Diabetes mellitus
    • Hyperlipidaemia
    • Osteoporosis
    • Non-apnoea sleep disorders

  • Vertigo (spinning sensation of head) on turning head, while sitting up or lying down, and looking up or bending down
  • May be associated with nausea or vomiting
  • Imbalance
  • Usually comes in episodes
  • Relieved by resting in one position

Neurologist

  • Clinical examination using head impulse test or Dix Hallpike manoeuvre
  • MRI brain to detect unusual features

  • Repositing manoeuvres - Epley’s, Semont’s, Brandt-Daroff exercises
  • Regular vestibular rehabilitation exercises
  • Medicines for symptomatic treatment
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Body Image Concerns

Management Team

Body Image Concerns

Overview

Body image concerns refer to aesthetic concerns about one’s body shape, such as having loose skin or being fat, skinny, or overall contour.

  • Fat-related concerns: Excess fat deposits that are resistant to diet and exercise.
  • Skin-related concerns: Loose or sagging skin resulting from weight changes or ageing.

Excess fat deposits, and loose or sagging skin.

Genetics, hormonal, ageing, dietary, and other lifestyle factors. 

Physical examination and consultation by a physician. 

  • Nonsurgical: Laser lipolysis, radiofrequency lipolysis (EmSculpt), injection lipolysis (aqualix), Morpheus8, Clear + Brilliant, and Regenera Activa, based on need.
  • Surgical: Liposuction, tummy tuck, and body lifts, based on need.
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