Stretch Marks

Management Team

Stretch Marks

Overview

Stretch marks, or striae, are long, narrow streaks or lines that develop due to rapid stretching of the skin.

  • Striae rubrae: New, red, or purple stretch marks.
  • Striae albae: Old, white, or silver stretch marks.

 Indented streaks on the abdomen, breasts, hips, buttocks, or other areas.

  • Pregnancy
  • Rapid weight gain or loss
  • Growth spurts
  • Corticosteroid use

Physical examination by a dermatologist.

  • Topical treatments (retinoids)
  • Laser therapy (Harmony XL Pro)
  • Microneedling, or PRP therapy as deemed suitable. 
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Solar Ageing (Photoaging)

Management Team

Solar Ageing (Photoaging)

Overview

Solar ageing, or photoaging, is the premature ageing of the skin caused by prolonged exposure to UV radiation.

  • Mild photoaging: It is marked by fine lines and pigmentation.
  • Severe photoaging: It is marked by deep wrinkles and leathery skin.

  • Wrinkles
  • Pigmentation
  • Rough skin texture

Prolonged exposure to sunlight which can also include visible (HEV) and infrared light apart from UV light.

Visual examination by a dermatologist.

  • Antioxidants
  • Laser treatments (Clear + Brilliant)
  • Topical retinoids, based on the severity of the symptoms. 
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Substance-related Disorders

Management Team

Substance-related Disorders

Overview

Substance related disorders encompass mental disorders related to addictions caused by certain substances. Common substances linked to addiction include alcohol, tobacco, caffeine, opioid, cannabis, hallucinogens, stimulants, sedatives, sleeping aids, anxiolytics, and inhalants. Addiction involves psychological and physical dependence, where an individual feels compelled to use a substance to manage or prevent withdrawal symptoms driven by an intense cravings. These substances can negatively impact various organ systems, increasing the risk of serious illnesses. Additionally, pathological gambling, a form of non-substance addiction, may also occur in some individuals.

Substance use disorder can run in families. Risk factors include:

  • Stress
  • Environmental factors
  • Trauma

The symptoms include: 

  • Feeling elevated
  • Hallucinations
  • Increased heart rate
  • Anxious
  • Altered visual and auditory perceptions

Substance abuse is diagnosed through:

  • Medical history
  • Observation
  • Physical examination

Substance abuse treatment includes:

  • Medications
  • Behavioural therapies.
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Specific Learning Disorders (SLD)

Management Team

Specific Learning Disorders (SLD)

Overview

Specific learning disorders (SLD) are a type of neurodevelopmental disorders characterised by difficulty in acquiring and implementing academic skills such as difficulty in reading, writing, mastering numbers, calculations and mathematical reasoning. When identified, a certificate from authorised government centres can enable individuals to access special accommodations during board and university examinations.

Causes of learning disorders include:

  • Malnutrition
  • Trauma
  • Prenatal and neonatal factors

Types of learning disorders include:

  • Dyslexia
  • Dysgraphia
  • Dyscalculia

The symptoms of learning disorders are as follows:

  • Difficulty understanding concepts
  • Difficulty in reading and writing
  • Difficulty spelling words

Diagnosis is made through 

  • Series of observation
  • Criteria checklist

Since there is no cure for SLD and no approved medications from FDA to manage the illness. Treatment involves: 

  • Early intervention
  • Special education services
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Sleep-related Disorders

Management Team

Sleep-related Disorders

Overview

Sleep is a vital physiological function crucial for growth, rejuvenation, restoration and overall well-being. Disturbance in sleep can disturb the body’s homeostasis (its natural balance and equilibrium). Sleep-related disorders can either be symptoms of medical and psychiatric conditions or increase the risk of developing such disorders.

The causes of sleep deprivation include:

  • Depression or anxiety
  • Genetics
  • Working late night
  • Substance use
  • Side effects of certain medications

Common sleep related disorders are as follows:

  • Insomnia: Difficulty falling asleep or staying asleep
  • Hypersomnolence: Excessive sleep or persistent feeling of sleepiness.
  • Parasomnia: Unusual or unwanted behaviours and perceptions occurring during sleep
  • Narcolepsy: Episodes of excessive daytime sleepiness and brief involuntary sleep episodes
  • Obstructive sleep apnoea (OSA): Repeated temporary interruptions in breathing during sleep, often associated with snoring.

Symptoms depend on the type, but commonly include

  • Unable to fall asleep
  • Trouble continuing sleep throughout the night
  • Snoring or gasping
  • Unable to move on waking up
  • Mood irritability
  • Sleepiness during daytime

Diagnosis is made by

  • Physical examination
  • Sleep study
  • Blood tests
  • Imaging tests

Sleep disorders are managed by

  • Changing sleep routine
  • Medications (sleeping pills)
  • Light therapy
  • Cognitive behavioural therapy.
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Sexual Dysfunction

Management Team

Sexual Dysfunction

Overview

Sexual dysfunction refers to certain disorders that prevents an individual or couple to feel satisfied after physical intimacy. Both men and women are affected by this disorder. It is fairly common and can be treated.

The causes may be physical or psychological.

  • Physical causes
    • Diabetes
    • Heart diseases
    • Neurological disorders
    • Hormonal imbalance
  • Psychological causes
    • Stress
    • Depression
    • Concerned of sexual performance
    • Trauma or abuse
    • Relationship issues.
  • Medications

Common presentations of sexual dysfunctions are as follows.

  • Delayed ejaculation: Significant delay in ejaculation, infrequency, or absence of ejaculation during sexual activity.
  • Premature ejaculation: Ejaculation that occurs too early during sexual activity or before the individual desires it.
  • Difficulty with sexual interest and arousal: A noticeable decrease or lack of interest in sexual activity and/or diminished arousal response to sexual cues.
  • Female orgasmic disorder: Significant delay, infrequency, absence of orgasm, or a marked reduction in the intensity of orgasmic sensations.

Diagnosis is based on :

  • Physical examination
  • History of symptoms
  • Diagnostic tests to rule out other symptoms.

Sexual dysfunction is treated through:

  • Medications
  • Behavioural therapy
  • Psychotherapy
  • Communication
  • Mechanical aids
  • Sex therapy.
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Schizophrenia

Management Team

Schizophrenia

Overview

Schizophrenia is a neurodevelopmental disorder of brain characterised by a range of symptoms that include delusions (false, firmly held unshakeable beliefs or thoughts), hallucinations (perception of having heard, seen, touched, tasted or smelled when no such stimuli exist), cognitive difficulties, avolition (no desire to work), anhedonia (inability to feel pleasure), withdrawal along with disturbance in speech and behaviour. Schizophrenia is usually a chronic illness and requires long-term management.

The exact cause is unknown. It might be due to a combination of

  • Genetics
  • Psychological factors
  • Environmental factors

The symptoms of Schizophrenia are as follows:

  • Hallucinations
  • Pessimistic thinking
  • Delusions
  • Disorganised behaviour
  • Illogical speech

Schizophrenia is usually diagnosed through:

  • Physical examination
  • Mental health evaluation
  • Alcohol and drug use screening

Management of schizophrenia involves:

  • Medications (anti-psychotic drugs)
  • Cognitive behavioural therapy
  • Brain stimulation therapy
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Scleroderma Oesophagus

Management Team

Scleroderma Oesophagus

Overview

Scleroderma can cause hardening and thickening of the internal organs, including the oesophagus. In scleroderma, the smooth muscles of the oesophagus become weakened, leading to impaired peristalsis.

  • Immune dysregulation: This is the primary cause of scleroderma as it is an autoimmune disease, wherein the autoimmune reaction results in oesophageal fibrosis (scarring).
  • Atrophy of oesophageal smooth muscles: In scleroderma, the smooth muscle fibres of the oesophagus undergo atrophy and fibrosis, impairing the ability of the oesophagus to contract effectively. This leads to a loss of normal peristalsis (the coordinated wave-like contractions that move food down the oesophagus).
  • Decreased lower oesophageal sphincter (LES) tone: One of the most significant features of scleroderma oesophagus is a reduction in LES pressure. This can lead to gastroesophageal reflux disease (GERD), as the weakened LES cannot effectively prevent stomach contents from refluxing into the oesophagus. This is often exacerbated by the loss of oesophageal motility.
  • Neuropathy (nerve problem that causes pain): The vagus nerve (which controls oesophageal motility) can be affected by the autoimmune reaction, leading to neuropathy or damage to the neural pathways that control smooth muscle contraction and relaxation. This results in the loss of coordination between muscle layers, leading to disordered motility. This can cause a phenomenon called "hypomotility", where the oesophagus has decreased or absent peristalsis, or "aperistalsis", where the normal peristaltic waves are either absent or ineffective.

  • Dysphagia (difficulty swallowing)
  • Heartburn (burning sensation in the upper abdomen)
  • Regurgitation
  • Acid reflux (backflow of stomach acid into the oesophagus)
  • Aspiration can occur in severe cases, i.e., food or liquid can be aspirated into the lungs due to the dysfunction of the swallowing mechanism, which can lead to aspiration pneumonia.

  • Oesophageal manometry: In this test, scleroderma oesophagus may manifest as reduced peristalsis and lower oesophageal sphincter (LES) relaxation.
  • Barium swallow: In this test, the LES may exhibit a bird-beak appearance.

Treatment modalities for scleroderma oesophagus include:

  • Medications:
    • Proton pump inhibitors and H2 receptor blockers: These are used to manage acid reflux.
    • Prokinetic agents: Agents like metoclopramide and domperidone are used to improve oesophageal motility.
  • Stricture dilation: In some cases, stricture dilation may be performed to reduce the pressure on the oesophagus.
  • Oesophageal surgery: This may be necessary in some cases.
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Stomach Pain

Management Team

Stomach Pain

Overview

Stomach pain or abdominal pain can arise because of various causes and can range from mild to serious. Understanding the type, location, and accompanying symptoms can help determine the underlying issue.

Stomach pain can have a range of accompanying symptoms, including nausea or vomiting, bloating, diarrhoea or constipation, some more symptoms are listed below.

  • Common gastrointestinal issues:
    • Indigestion
    • Gastritis: Inflammation of the stomach lining, which can be caused by infection, alcohol, or certain medications.
    • Ulcers on the stomach or intestinal lining.
    • Gastroenteritis: gastroenteritis is the inflammation of the stomach and intestines, usually due to infection (viral or bacterial).
    • Painful IBS: IBS is a common disorder affecting the large intestine, characterised by cramping, abdominal pain, and changes in bowel habits.
  • Gastrointestinal organ-related issues:
    • Appendicitis: Inflammation of the appendix.
    • Gallstones
    • Bile duct stones
    • Pancreatitis: Inflammation of the pancreas, resulting in severe pain in the upper abdomen usually radiating to the back.
    • Enteritis: small intestinal inflammation is known as enteritis, which can cause colicky or crampy pain in the central abdomen.
    • Any tumour affecting any organ of the abdomen
    • Intestinal obstruction
  • Reproductive system issues:
    • Menstrual cramps: Commonly seen among young women
    • Ovarian cysts or ectopic pregnancy: This may lead to unilateral abdominal pain in those who menstruate.
  • Urinary tract issues:
    • Kidney stones: kidney stones can cause severe, radiating pain from the back to the lower abdomen.
    • Urinary tract infection: urinary tract infection may result in lower abdominal discomfort and other urinary symptoms.

  • Nausea or vomiting
  • Bloating
  • Diarrhoea or constipation
  • Fever
  • Loss of appetite
  • Changes in bowel habits

  • Medical history: Your medical history may be reviewed by your gastroenterologist. The gastroenterologist may palpitate your abdomen to identify areas of tenderness.
  • Imaging tests: Ultrasonography, X-rays, CT scan, or MRI may be recommended to check for any specific issues suspected by the gastroenterologist.
  • Laboratory tests: Various blood tests or stool tests can be performed to identify specific problems.

  • General measures:
    • Rest: this allows the body to recover.
    • Hydration: drink plenty of fluids, especially if dehydrated from vomiting or diarrhoea.
  • Medications:
    • Antacids: to relieve indigestion and heartburn.
    • Pain relievers: temporary over-the-counter medications like anti-spasmodic or anti-inflammatory drugs such as paracetamol can be taken. However, consultation with your doctor is preferable to self-medication.
    • Prescription medications: for specific conditions certain prescription drugs will be required (e.g., antibiotics for infections).
  • Lifestyle and dietary adjustments:
    • Avoid trigger foods (spicy, fatty, or highly acidic).
    • Eat smaller, more frequent meals.
    • Keep a food journal to identify patterns.

Seek immediate medical attention if you experience severe or persistent pain; pain accompanied by fever, vomiting, or jaundice; presence of blood in stool or vomit; or sudden onset of severe abdominal pain. If the stomach pain persists or worsens, it is crucial to consult a healthcare professional for a proper diagnosis and treatment.

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Shoulder Dislocation

Management Team

Shoulder Dislocation

Overview

The shoulder joint is covered by ligaments, a capsule, and a glenoid labrum (bumper of the cup part of the bone), which maintain joint stability. A shoulder joint is said to be dislocated when there is a complete separation of the articulating surface between two bones.

  • While most dislocations can be traumatic (due to injury), some people have generalised laxity, which makes them prone to dislocation.
  • Anterior (ball part coming out in the front) dislocation is more common than posterior dislocation (ball part coming out from the back).
  • Younger age (less than 20 years): The chances of shoulder dislocation decrease with aging. The rate of recurrence after the first episode of dislocation can be more than 90% before 20 years, 50%–60% between 20 and 40 years, and 10%–20% above 40 years of age.

The clinical diagnosis of shoulder dislocation is done with the patient giving a history of arm abduction and performing external rotation and extension (ball throwing position). The orthopaedic surgeon can perform the following examinations to confirm diagnosis:

  • Physical examination:
    • The surgeon can appreciate the loss of normal shoulder contour and complete restriction of movements of the affected shoulder with excruciating pain in an acute (recent) shoulder dislocation.
    • The chronic (old) or recurrent shoulder dislocation patient would demonstrate an apprehension when the arm is moved in abduction, external rotation, and extension (position in which the dislocation occurred).
      • Fracture can be observed along with the dislocation. However, the possibility of neurological association is rare.
  • Imaging studies:
    • X-rays to assess the anterior or posterior dislocation pattern or the presence of a fracture around the shoulder girdle.
    • Magnetic resonance imaging (MRI) to assess soft tissue injuries like a Bankart lesion (tear of the glenoid labrum) or Hill Sach’s lesion (depression in the head part of the ball bone).
    • Computed tomography (CT) for patients with recurrent shoulder dislocation to assess the condition of the glenoid (cup) bone, which can show loss of width, increasing the risk of shoulder dislocation.

Non-surgical treatment

  • Acute shoulder dislocation is usually treated under an emergency procedure, and reduction is performed using various manoeuvres with or without sedation.
  • After the reduction, the arm is immobilised using a sling or immobiliser for at least 3–4 weeks following which the patient undergoes a rehabilitation programme.
  • Physical therapies (like icing) and anti-inflammatories are prescribed for pain management following the reduction manoeuvre.
  • Patients may be referred to the pain management clinic for further management of chronic pain.

Surgical treatment

  • This is advised for patients with associated fractures or in whom closed reduction is not possible.
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