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Colonoscopy

Management Team

Colonoscopy

Overview

Colonoscopy is a medical procedure used to examine the inner lining of the colon (large intestine) and rectum. During the procedure, a flexible tube called a colonoscope, equipped with a light and camera, is inserted into the rectum to provide a detailed view of the entire colon. This allows doctors to detect abnormalities, remove polyps, or take tissue samples for further analysis.

Your doctor may recommend a colonoscopy in the following cases:

  • Routine Screening: Individuals aged 45 or older are advised to undergo routine screening to detect early signs of colorectal cancer.
  • Rectal Bleeding: Unexplained rectal bleeding could indicate haemorrhoids, polyps, or other conditions requiring further evaluation.
  • Chronic Diarrhoea: Persistent diarrhoea may point to underlying gastrointestinal issues such as infection or inflammatory bowel disease (IBD).
  • Abdominal Pain: Unexplained abdominal pain could be a sign of conditions like diverticulosis, IBS, or colorectal cancer.
  • Family History: Those with a personal or family history of colorectal cancer or polyps need regular surveillance.
  • Inflammatory Bowel Conditions: Monitoring diseases like Crohn’s disease, ulcerative colitis, or IBS for progression or complications.

Proper preparation is critical for a successful colonoscopy. As a part of preparation, patients are required to follow a clear liquid diet (e.g., water, clear broths) for 24 hours before the procedure. For bowel cleansing, Polyethylene glycol (PEG)-based laxatives are administered to empty the colon. These osmotic laxatives, taken with large amounts of water, ensure thorough cleaning while maintaining electrolyte balance. All solid food should be avoided to ensure a clear view of the colon during the procedure.

Colonoscopy is an outpatient procedure and it usually lasts for only 15–30 minutes. The steps for performing colonoscopy include:

  • Patients are typically given mild sedatives or anaesthesia to ensure comfort.
  • The colonoscope is gently inserted through the rectum and advanced through the colon. Air is inflated into the colon to ensure expansion of colon.
  • The entire colon is examined for abnormalities. If necessary, polyps can be removed, and tissue samples may be taken for biopsy.

Benefits of colonoscopy include:

  • Early detection and prevention of colorectal cancer.
  • Removal of precancerous polyps.
  • Monitoring and managing gastrointestinal conditions like irritable bowel syndrome.

  • Sigmoidoscopy: A similar procedure which examines only the lower colon but may miss abnormalities in the upper colon.
  • CT Colonography: A procedure that uses imaging to visualize the colon but cannot perform biopsies or remove polyps.
  • Stool Tests: Useful for initial screening but lack detailed diagnostic capabilities.

While colonoscopy is generally safe, potential side effects include:

  • Bloating or Cramps: Temporary discomfort caused by air introduced during the procedure.
  • Bleeding: Minor bleeding may occur if polyps are removed or biopsies are taken.
  • Rare Complications: Perforation of the colon or adverse reactions to sedation are extremely rare.
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Carcinoid Tumours

Management Team

Carcinoid Tumours

Overview

Carcinoid tumours refer to slow-growing neuroendocrine tumours typically developing in the gastrointestinal tract or lungs.

Tumours can produce hormones that cause symptoms like flushing, diarrhoea, and wheezing.

Blood and urine tests to measure hormone levels, imaging studies like CT or MRI, and biopsy to confirm the tumour type.

Surgery to remove the tumour, medications to manage symptoms, and sometimes radiation or chemotherapy for advanced cases. Regular monitoring is essential to manage symptoms and detect any tumour recurrence. Early diagnosis and treatment of disease enhance outcomes and quality of life for patients with carcinoid tumours.

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Congenital Adrenal Hyperplasia

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Congenital Adrenal Hyperplasia

Overview

Congenital adrenal hyperplasia refers to a group of inherited conditions affecting the adrenal glands, leading to abnormal hormone production.

Deficiency of enzymes needed for cortisol and aldosterone production.

Vary but can include ambiguous genitalia, early puberty, and severe electrolyte imbalances.

Newborn screening, genetic testing, and hormone level assessments.

Hormone replacement therapy for correction of deficiencies and management of symptoms. Regular monitoring and adjusting hormone doses are essential for optimal management. Early diagnosis and treatment improve outcomes, and genetic counselling can help families understand the condition and its inheritance patterns.

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Cushing’s Syndrome

Management Team

Cushing’s Syndrome

Overview

Cushing’s syndrome refers to a condition wherein there is excessive cortisol production (produced by the adrenal glands) in the body.

Prolonged use of corticosteroid medications or tumours that produce excess cortisol.

Weight gain, especially around the abdomen and face; high blood pressure; and mood changes.

Blood, urine, and saliva tests to measure cortisol levels as well as imaging studies to identify the cause.

Depends on causative factors and may include gradually reducing corticosteroid use, surgery to remove tumours, radiation therapy, or medications to control cortisol production. Managing Cushing’s syndrome requires regular monitoring to prevent complications.

If you are experiencing symptoms of Cushing’s syndrome, particularly while using glucocorticoid medications for conditions like arthritis, asthma, or inflammatory bowel disease, contact your healthcare provider for an evaluation.

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Charcot Foot

Management Team

Charcot Foot

Overview

Charcot foot, also known as Charcot arthropathy, is a condition affecting people with significant nerve damage (neuropathy), causing weakening of the bones in the foot. Initially, you may not notice any symptoms; however, as the condition advances, the bones become fragile enough to fracture. Continued weight-bearing can cause the foot to change shape over time. As the disorder progresses further, the joints may collapse, resulting in an abnormal shape of the foot characterised by a rocker-bottom foot deformity.

It is a common condition for people with diabetes. However, other causes, including spinal cord disease or injuries, alcohol abuse, Parkinson’s disease, infection, and HIV infection, can also cause nerve damage.

  • Swelling
  • Warmth (the affected foot often feels warmer than the unaffected)
  • Changes in foot colour.
  • Changes in foot shape.

Consists of two types: nonsurgical & surgical treatment. Nonsurgical treatment comprises:

  1. Immobilisation
  2. Custom shoes and bracing
  3. Activity modification

Successful treatment can be achieved by early diagnosis of Charcot foot. Doctors will examine the foot X-rays and other imaging scans. Charcot foot can be prevented by controlling blood sugar levels and undergoing regular checkups with a foot and ankle surgeon.

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Continuous Glucose Monitoring System (CGMS) Technology

Management Team

Continuous Glucose Monitoring System (CGMS) Technology

Overview

CGMS is a device used to track levels of glucose in the interstitial fluid throughout the day, offering real-time data and trends. This helps individuals with diabetes regulate their blood sugar levels more efficiently.

CGMS includes:

  • A sensor that is inserted under the skin
  • A transmitter
  • A receiver or smartphone app for displaying data

  • Better glucose control
  • Reduced hypoglycaemia risk
  • Improved quality of life.

CGMS can alert users to high or low blood sugar levels, providing timely interventions. Regular use and proper calibration are important for getting accurate readings. CGMS is a valuable tool for diabetes management, particularly for those using insulin therapy.

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Cystic Fibrosis

Management Team

Cystic Fibrosis

Overview

Cystic fibrosis (CF) is a genetic (inherited) disorder that is characterised by the build-up of thick phlegm (mucus) and other fluids in different parts of the body, including the lungs and the digestive system (pancreas, liver and intestine). This mucus clogs the airways, making it difficult to breathe. Because of these issues, many people consider CF a lung disease, but it is called “cystic fibrosis” as it is also characterised by cysts and scarring in the pancreas.

CF is caused by a mutation (abnormality) in the CFTR gene. To inherit the disease, a person needs to inherit the mutated gene from both the parents. An individual’s parents do not have to have CF for them to have CF. Individuals with just one copy of the CFTR mutant are called carriers.

The thick mucus in the lungs causes people with CF to get frequent lung infections. Over time, these infections damage and destroy the lung architecture and functioning. The thick fluids in the pancreas and liver keep the intestine from absorbing certain nutrients from food. This affects a person’s growth and causes problems with bowel movements.

CF signs and symptoms vary, depending on the severity of the disease. Even in the same person, symptoms may worsen or improve as time passes. Some people may not exhibit symptoms until their teenage years or adulthood. People who are not diagnosed until adulthood usually have milder disease and are more likely to have atypical symptoms.

Common symptoms of CF include:

  • No weight gain
  • Long-lasting cough: The cough usually brings up mucus and sounds "wet." Some people cough up blood.
  • Trouble breathing or breathing that sounds like whistling (wheezing).
  • Frequent infections of the lungs or sinuses (i.e., pneumonia, bronchitis, sinusitis).
  • Salty skin, i.e., if your child has CF, you might taste salt when you kiss them.
  • Belly pain, diarrhoea, or constipation (trouble having bowel movements).
  • Loose, oily or bad-smelling stool.
  • Infertility.

Although CF is progressive and requires daily care, people with CF are usually able to attend school and go to work. Individuals with CF, in the present era, usually have a better quality of life than those in the previous decades.

The tests for CF include:

  • Newborn screening: This test is done soon after birth.
  • “Sweat test”: During this test, the doctor makes a person sweat and then measures the amount of salt in the sweat.
  • Blood tests to check for the abnormal gene.
  • Pulmonary function tests: These tests evaluate lung performance.
  • Sputum culture: Mucus coughed up by the lungs is tested for bacteria as certain bacteria, like Pseudomonas, are commonly found in people with CF.

  • Medicines called “CFTR modulators” help manage symptoms arising because of abnormal genes. Usually provided after genetic tests.
  • Antibiotics to help prevent or treat infections.
  • Bronchodilators are given through inhalers or nebulisers to open up the airways.
  • Chest physiotherapy: This includes exercises designed to help break and loosen the mucus in the lungs and make it easier for the patient to cough it out and clear the airways to reduce infections in the future.
  • Lung transplant: In cystic lung disease surgery, a surgeon replaces a person's diseased lungs with healthy lungs. A lung transplant is done only an individual has severe disease and meets certain conditions.
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Coronavirus Disease-19

Management Team

Coronavirus Disease-19

Overview

COVID-19 is caused by the novel coronavirus SARS-CoV-2 belonging to the coronavirus family, which also includes viruses responsible for common cold and more severe diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The virus mainly targets the respiratory system, but its effects can be systemic, i.e., impacting multiple organs.

The infection spreads mainly when an infected person coughs, sneezes, or talks and spreads the respiratory droplets. Aerosol (liquid particles suspended in air) transmission is possible in poorly ventilated spaces. Further, indirect transmission can also occur through contaminated surfaces.

Patients usually present generalised symptoms, such as fever, chills, cough, fatigue, and loss of taste or smell; however, severe symptoms, such as difficulty in breathing and chest pain are also observed in some cases. Older adults or individuals who already have underlying medical conditions such as diabetes or high blood pressure are at greater risk of serious illness.

Individuals who do not present any symptoms but test positive for COVID-19 are termed asymptomatic. Individuals who go on to develop symptoms are considered presymptomatic. Both types of individuals are capable of spreading COVID-19 to others.

COVID-19 may be subdivided into mild, moderate, severe, or critical illness:

  • Mild COVID-19: The ability of lungs to transport oxygen to the body is not affected.
  • Moderate COVID-19: The lungs work properly but there are indications that the infection has deeply penetrated them.
  • Severe COVID-19: The lungs don't work correctly, and the affected individual needs oxygen and medical help.
  • Critical COVID-19: The lungs and the respiratory system have failed and the whole body has been affected as a result.

Get emergency help right away for any of these symptoms:

  • Inability to catch your breath or there are problems in breathing
  • Skin, lips or nail beds turn pale, grey or blue
  • Trouble staying awake or waking up
  • Constant chest pain
  • New confusion

Diagnostic tests include:

  • PCR test: the gold standard due to its high sensitivity in detecting viral RNA
  • Antigen test: offers faster results but are less accurate

Healthcare systems play a pivotal role through preparedness and developing protocols for handling such patients. This ensures effective communication and education to combat misinformation and promote health guidelines.

Treatment for COVID-19 varies based on the severity of the case. Mild cases often require self-isolation and symptomatic treatment. Moderate to severe cases may require isolation and treatment with antiviral medications like remdesivir, monoclonal antibodies for high-risk patients, anti-inflammatory drugs like dexamethasone for severe inflammation, and oxygen therapy for those with low blood oxygen levels. Critical cases might need mechanical ventilation.

Post-COVID/Long COVID:

Post-COVID care addresses long-term symptoms known as Long COVID, which can include fatigue, respiratory issues, and cognitive difficulties. This requires a multidisciplinary approach involving pulmonologist as centre point with good supportive care and dedicated physiotherapy department all under one roof, to provide the best possible care making a complete recovery seemingly possible.

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Chronic Obstructive Pulmonary Disease (COPD)

Management Team

Chronic Obstructive Pulmonary Disease (COPD)

Overview

COPD is a common lung disease that is associated with restricted airflow and breathing problems. Even though it is a well-known pulmonary disease, it also affects other organ systems leading to unintentional weight loss, skeletal muscle dysfunction, increased risk of cardiovascular disease, osteoporosis and depression.

COPD has two major phenotypes, emphysema and chronic bronchitis.

People with COPD are at a higher risk of developing other health issues, including:

  • lung infections (flu or pneumonia)
  • lung cancer
  • weak muscles and brittle bones
  • heart problems
  • depression and anxiety

COPD is mainly caused by long-term exposure to irritating gases or particulate matter (mix of solid and liquid in air, which includes dust, dirt, soot, and smoke; most often from cigarette smoke). Nowadays, air pollution is also a significant risk factor. Genetic factors, such as a deficiency of a protein called alpha-1 antitrypsin, are responsible for the development of COPD at a young age.

COPD-associated changes in lungs and airways include:

  • Loss of elasticity in the airways and air sacs of the lungs (alveoli)
  • Inflammation, scarring and narrowing of the airways
  • Thick mucus in the airways
  • Destruction of the walls between the alveoli, resulting in their enlargement and trapping of air

Common symptoms include breathing difficulty, cough, mucus (sputum) production, and wheezing. These symptoms often don't appear until significant lung damage has occurred, and they usually worsen over time.

COPD is typically diagnosed based on a combination of patient history, physical examinations, and lung function tests like spirometry, which measure the amount of air a person can exhale and the rapidity with which they can do so. CT Chest is also used for diagnosis.

Though COPD is not curable, its progression can be controlled with various treatments. These include lifestyle changes (like quitting smoking), medications (such as bronchodilators and inhaled steroids), pulmonary rehabilitation, vaccinations, and in severe cases, oxygen therapy, BiPAP (Bi-level Positive Airway Pressure), or surgery.

The most effective way to prevent COPD is to never start smoking or to quit smoking if you already do. Avoiding exposure to other lung irritants can also help reduce the risk of developing COPD. 

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Conjunctivitis

Management Team

Conjunctivitis

Overview

The conjunctiva is the transparent membrane that lines the eyelids and eyeballs and protects the white part of the eye and the areas under the eyelids. Conjunctivitis, also known as pink eye, refers to the inflammation of the conjunctiva.

Based on the causative agents, there are different types of conjunctivitis:

  • Viral conjunctivitis: Acute (short-term) conjunctivitis is most commonly caused by viruses, especially those belonging to the adenovirus family. Several other viruses, such as the measles or mumps viruses, viruses that cause eye herpes, enteroviruses or coxsackieviruses (cause hand, foot, and mouth disease) (uncommon), or SARS-CoV-2 (causes COVID-19) (uncommon), can also cause pink eye. Viral conjunctivitis tends to cause watering and redness of the eyes and can persist for two to three weeks even after appropriate treatment. Usually, viral conjunctivitis does not affect vision. In rare cases, it may cause the blurring of vision or a glares when looking directly at bright objects. This is due to an inflammatory reaction that results in the formation of small white dots on the cornea (the transparent front layer of the eye). These spots usually go away after a few weeks or sometimes, a few months.
  • Bacterial conjunctivitis: Bacteria are the second most common causes of infectious conjunctivitis. The most common bacteria that cause conjunctivitis are Staphylococcus species (which cause staph infections), Streptococcus species (which cause strep throat and pneumococcal disease), Haemophilus influenzae (which causes meningitis in young children), and bacteria that cause sexually transmitted infections, such as chlamydia, gonorrhoea, and syphilis. Moreover, these conditions may also be passed from the mother to child, leading to neonatal conjunctivitis, a condition that can cause permanent blindness and/or permanent eye damage. Bacterial conjunctivitis is associated with redness in the eyes along with a sticky yellow discharge.
  • Allergic conjunctivitis: Sometimes, the immune system reacts to usually harmless substances like pollen, dust, or grass, causing a non-infectious type of conjunctivitis. This is common in patients with pre-existing allergies or a family history of allergies. The occurrence of seasonal allergic conjunctivitis varies depending on the season and weather conditions. Individuals with pre-existing allergies (e.g., allergies to dust mites, dander (animal fur), and pollen) may display symptoms throughout the year.
  • Other types of non-infectious conjunctivitis: Apart from allergens, other factors/substances may cause conjunctivitis, such as toxic substances or eye irritants (including contact lenses or contact solution, cosmetics or eye products (shampoos and eye makeup), chlorine in swimming pools, smoke, and certain types of medications), injuries that cause conjunctival damage, immune disorders that affect the eye, and conjunctival tumours or cancers.

Infective conjunctivitis can affect one eye or both eyes. Its symptoms include:

  • Inflammation and redness of the whites of the eyes.
  • Gritty, watery, or sticky eyes, especially in the mornings.
  • Blurred vision due to tears or the formation of a sticky discharge.
  • Flu-like symptoms, such as general malaise, sore throat, muscle aches, and fever.

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

  • Collection of medical history to rule out conjunctivitis (the ophthalmologist asks questions about symptoms, any close contact with other people with conjunctivitis, and possible contact with eye irritants).
  • Slit-lamp examination (to examine various parts of the eye, including the sclera, conjunctiva, iris, and cornea). 
  • Visual acuity tests to ascertain whether conjunctivitis has affected the vision.

Eye culture (sampling of the cells from underneath the eyelids with a cotton swab for further examination by a pathologist to ascertain the causative pathogen).

Bacterial and viral conjunctivitis are highly contagious. They spread very easily via droplets (coughing or sneezing) or contact with fomites, such as tissues, towels, or pillowcases. To avoid the spread of infection, it is important to:  

  • Wash hands frequently.
  • Cover mouth while coughing or sneezing.
  • Dispose of tissues after use.
  • Avoid sharing contagious belongings. 

The following measures may be used to prevent allergic and other forms of non-contagious conjunctivitis: 

  • Allergy testing to identify potential triggers. 
  • Wash your face after being exposed to allergens like dust or pollen.
  • Keep windows closed during seasons when pollen or fungal spores are abundant. 
  • Wash your hands after petting animals.
  • Frequently cleaning the house.
  • Washing bedding/pillows using detergents and hot water.
  • Careful use of medications, cosmetics, and apparatus along with regular consultation with the physician.
  • Monitoring exposure to different activities (such as swimming) and environments (such as polluted areas). 

Most cases of infective conjunctivitis require no treatment as the infections are self-limiting and will clear up on their own within a few days to a few weeks. However, if the condition persists, treatment options for infective conjunctivitis include:

  • Antibiotic ointments or eye drops: These may be helpful in managing bacterial conjunctivitis. However, viral infections do not respond to antibiotics and may last for two to three weeks until the natural immunity of the host eliminates the virus.
  • Lubricating ointments, eye drops, or gels: These may help reduce discomfort and grittiness but not the duration of the illness.
  • Over-the-counter and prescription painkillers, such as paracetamol or ibuprofen (provided no medical reason prevents their use) can help alleviate the discomfort and flu-like symptoms associated with conjunctivitis.
  • Warm-water washes: This can be performed routinely to clean the sticky discharge from the eyes.
  • Steroidal eye drops: These are used to reduce inflammation in severe cases.

Treatment options include:

  • Avoiding rubbing of the eyes as it worsens symptoms.
  • Cold compress to help reduce eyelid swelling.
  • Application of lubricating ointments or eye drops may help reduce discomfort but will not treat the allergy.
  • Over-the-counter anti-allergy drops need to be used daily. These may require up to two weeks to work. While some people need to use these drops for only a few weeks in the summer, others may have to do so throughout the spring and summer months. However, depending on the severity of symptoms, some patients may also need to use these drop throughout the year.
  • Antihistamine tablets.
  • Steroid eye drops (used in severe cases).

Occasionally, viral conjunctivitis can cause keratitis (corneal inflammation) or conjunctival scarring, both of which can affect vision. However, these complications are usually manageable with treatment.

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