As we come on terms with the relentless onslaught of the war waged against humanity by the most primitive of living things, a puny virus, we find that for most of our illnesses, only we are to be blamed. Yes, I am talking about the COVID- 19 pandemic that has brought the entire world to its knees.

We had only begun to understand the working of the virus and remarkably, we were able to figure out ways and means to prevent and treat the disease caused by the virus.  But then there was the malady of self-medication, practicing of unscientific measures, which proved in many ways the inherently unrealistic approach of most humans. I personally know of many people who started their own therapies for COVID management. Alas, we were faced with unheard of conditions like Black Fungus (Mucormycosis) and now Bone Death (Osteonecrosis). The scientific community is not ruling out the incessant usage of life saving steroids for the unexpected rise in both Black Fungus and Bone Death cases.

The single factor that could be blamed for this upsurge in such cases was steroid use. It is an exercise for statisticians to determine whether these drugs were genuinely prescribed by doctors or blatantly self administered by some people. In vulnerable people who have other medical problems like diabetes, injudicious use of some medicines can be catastrophic and lead to disaster as the body’s immunity is severely compromised, allowing unusual conditions to surface.

Bone death is not something novel. It is the necrosis or death of certain areas of bone, especially the upper part of the thigh bone and a few other bones which results in crippling arthritis and disability. While this condition was known by names such as Osteonecrosis and Avascular Necrosis during the normal times, the pandemic has given it a new name, i.e., Bone Death. A significant percentage of Bone Death patients are found to have a history of alcohol abuse and steroid use, which clearly indicates that COVID-19 by itself is highly unlikely to cause the condition. It is more likely to target patients who are on steroids.

As of today, there are just a handful of patients in India who have had post-COVID Bone Death but it is something that needs a high degree of attention and the awareness on part of healthcare workers as well as patients themselves. There is no sure shot way of preventing its occurrence but there are definitely measures that can be taken for its early recognition and identifying the group of patients who are at greater risk.

In medicine, we always say prevention is better than cure and it’s true here as well. Osteonecrosis, once established, usually requires surgery and sometimes joint replacement too. Doctors are a part of the society who are just a bit more informed and aware of the health issues and it takes a very long time to become an efficient doctor. It is in the best interest of patients to trust doctors and try not to indulge in self-harming medication. Adversity is the best teacher and this pandemic has proven the adage quite well.

We will get benefitted as more data is collated regarding all the manifestations of this viral infection and what it does to the various organs. This is no time to be scared but it is also not a time to be unduly belligerent. Bone Death is not trivial and it is paramount that it is recognized and treated. General rule – post COVID, having hip pain that is not getting better with time – go and see your Orthopaedician and follow his advice.

The author is a Senior Orthopaedician at Deep Hospital, Ludhiana.

ACL (anterior cruciate ligament injury) is one of the main stabiliser ligaments of the knee joint. Injury or tear of the ACL is one of the most common injuries of the knee.

When?

It can occur at any age or in any sport, but generally seen in young people during sports that involve pivoting of the knee like soccer, basketball, hockey and skiing, when sudden stops or changes in direction occur during jumping and landing. It is also a common injury in contact sports such as Kabaddi and Wrestling and american football.

Besides sportsmen, the injury can happen to anyone in common activities like jumping actoss a puddle or if you miss the last step of the stairs in a rush or just simply climbing a stool.

Once torn an ACL can never repair itself. 40% of people can manage their sedentary life with occasional sports without a surgery but if someone wants tk run/ jog or play even weekend sports regularly or they experience feeling of giving way (instability) and sense of discomfort then a surgery is recommended to protect the knee from repeated damage and future arthritis.

What happens?

The ‘pop’ sound of ACL rupture may not be heard in every fresh injury case and we have to look for other

common symptoms like:

1- Pain: If you have a minor injury, you may not feel pain. You may feel sore along your knee’s joint line. Some people have trouble standing or putting pressure on the hurt leg.

2- Swelling: This is most likely to happen in the first 24 hours. You can reduce swelling by putting ice on your knee and elevating (raising) your leg on a stool or 2 pillows.

3- Trouble walking: If you’re not able to put pressure on your hurt knee to walk, climb stairs and walk on uneven ground. Some people find that the knee joint feels loose than it should be.

4- Less range of motion. After you damage your ACL, it’s very likely that you won’t be able to bend and flex your knee like you normally would.

Symptoms in a chronic case: Instability is the most common symptom in an ACL deficient knee in which patient feels that his/her knee will buckle in certain movements/positions of knee especially while playing sports.

What is it?

Ligaments are strong bands of tissue that connect one bone to another. The ACL, one of two ligaments inside the knee that cross in the centre and stop undue movement of your thighbone (femur) on your shinbone (tibia).

When injured, it puts stress on the knee.

Who is at risk?

1- Being female — possibly due to differences in anatomy, muscle strength and hormonal

influences

2- Participating in certain sports, such as soccer, kabbaddi, basketball, gymnastics,

skiing and Wrestling.

3- Poor conditioning of muscles that can actually protect against violent movements.

4- Wearing footwear that doesnt fit properly

5- Using poorly maintained sports equipment or wrong techniques.

6- Playing on artificial turf surfaces

How Is It Diagnosed?

-Detailed History: Your doctor will want to hear exactly how you injured your knee. He’ll look

at both the knees to see if the sore one looks different.

-Clinical Examination: Your doctor may ask you to lie on your back and bend your hips and/or

your knees at certain angles. He’ll then place his hands on different parts of your leg and gently shift the leg around. If any of your bones move in a way that isn’t normal, that could be a sign that your ACL is damaged.

-X-ray: Soft tissues like the ACL don’t appear on X-rays, but your doctor may want to rule out

broken bones.

-MRI: This exam can show both soft tissue and bone. If you have a damaged ACL, it shows up on the scan.

Treatment?

-Arthroscopy: This literally means to “look within the joint.” During this exam, an orthopedic

surgeon makes a small 4mm keyhole into your skin. He inserts a camera attached on a pencil-sized tool that contains a lighting system and lens (arthroscope) into the joint. The camera projects a magnified image of the joint onto a large screen. Your doctor can see what type of injury you have and repair as needed.

Treatment:

Treatment depends on how badly you’ve been hurt.

First is first aid: If your injury is minor, you just put ice on your knee, elevate your leg,

and stay off your foot for a while. You can reduce swelling by wrapping a crepe bandage around

your knee. Crutches/walker can help you to keep weight off your knee.

Medication: Analgesics and anti-inflammatory drugs help to reduce swelling and pain.

Rarely for intense pain and swelling, you may have to get the blood aspirated and get an injection into your knee with a steroid.

Knee brace: Some people with a damaged ACL can get by with wearing a brace on their knee when they run or play sports. It provides extra support.

Physical therapy: You may need this a few days a week to get your knee back in working order. During your sessions, you’ll do exercises to strengthen the muscles around your knee and help

you regain a full range of motion. You may asked to exercise on your own.

Surgery is done when all else fails and is called Arthroscopic ACL reconstruction in which Surgeon will remove the damaged ACL stump through a keyhole and replace it with a graft sometimes made from the core of your hamstring muscle or a fibretape.

This is usually a daycare surgery and after surgery with proper rehabilitation ie Proprioceptive and strengthening exercises patients can resume brisk walk in 6 weeks and jogging in three months. Active contact sports again within six months.

With modern surgical techniques and fixation methods available, ACL surgery for sportsmen  especially, has proven to be highly successful procedure.

About the author:

ACL (anterior cruciate ligament injury) is one of the main stabiliser ligaments of the knee joint. Injury or tear of the ACL is one of the most common injuries of the knee.

When?

It can occur at any age or in any sport, but generally seen in young people during sports that involve pivoting of the knee like soccer, basketball, hockey and skiing, when sudden stops or changes in direction occur during jumping and landing. It is also a common injury in contact sports such as Kabaddi and Wrestling and american football.

Besides sportsmen, the injury can happen to anyone in common activities like jumping actoss a puddle or if you miss the last step of the stairs in a rush or just simply climbing a stool.

Once torn an ACL can never repair itself. 40% of people can manage their sedentary life with occasional sports without a surgery but if someone wants tk run/ jog or play even weekend sports regularly or they experience feeling of giving way (instability) and sense of discomfort then a surgery is recommended to protect the knee from repeated damage and future arthritis.

What happens?

The ‘pop’ sound of ACL rupture may not be heard in every fresh injury case and we have to look for other

common symptoms like:

1- Pain: If you have a minor injury, you may not feel pain. You may feel sore along your knee’s joint line. Some people have trouble standing or putting pressure on the hurt leg.

2- Swelling: This is most likely to happen in the first 24 hours. You can reduce swelling by putting ice on your knee and elevating (raising) your leg on a stool or 2 pillows.

3- Trouble walking: If you’re not able to put pressure on your hurt knee to walk, climb stairs and walk on uneven ground. Some people find that the knee joint feels loose than it should be.

4- Less range of motion. After you damage your ACL, it’s very likely that you won’t be able to bend and flex your knee like you normally would.

Symptoms in a chronic case: Instability is the most common symptom in an ACL deficient knee in which patient feels that his/her knee will buckle in certain movements/positions of knee especially while playing sports.

What is it?

Ligaments are strong bands of tissue that connect one bone to another. The ACL, one of two ligaments inside the knee that cross in the centre and stop undue movement of your thighbone (femur) on your shinbone (tibia).

When injured, it puts stress on the knee.

Who is at risk?

1- Being female — possibly due to differences in anatomy, muscle strength and hormonal

influences

2- Participating in certain sports, such as soccer, kabbaddi, basketball, gymnastics,

skiing and Wrestling.

3- Poor conditioning of muscles that can actually protect against violent movements.

4- Wearing footwear that doesnt fit properly

5- Using poorly maintained sports equipment or wrong techniques.

6- Playing on artificial turf surfaces

How Is It Diagnosed?

-Detailed History: Your doctor will want to hear exactly how you injured your knee. He’ll look

at both the knees to see if the sore one looks different.

-Clinical Examination: Your doctor may ask you to lie on your back and bend your hips and/or

your knees at certain angles. He’ll then place his hands on different parts of your leg and gently shift the leg around. If any of your bones move in a way that isn’t normal, that could be a sign that your ACL is damaged.

-X-ray: Soft tissues like the ACL don’t appear on X-rays, but your doctor may want to rule out

broken bones.

-MRI: This exam can show both soft tissue and bone. If you have a damaged ACL, it shows up on the scan.

Treatment?

-Arthroscopy: This literally means to “look within the joint.” During this exam, an orthopedic

surgeon makes a small 4mm keyhole into your skin. He inserts a camera attached on a pencil-sized tool that contains a lighting system and lens (arthroscope) into the joint. The camera projects a magnified image of the joint onto a large screen. Your doctor can see what type of injury you have and repair as needed.

Treatment:

Treatment depends on how badly you’ve been hurt.

First is first aid: If your injury is minor, you just put ice on your knee, elevate your leg,

and stay off your foot for a while. You can reduce swelling by wrapping a crepe bandage around

your knee. Crutches/walker can help you to keep weight off your knee.

Medication: Analgesics and anti-inflammatory drugs help to reduce swelling and pain.

Rarely for intense pain and swelling, you may have to get the blood aspirated and get an injection into your knee with a steroid.

Knee brace: Some people with a damaged ACL can get by with wearing a brace on their knee when they run or play sports. It provides extra support.

Physical therapy: You may need this a few days a week to get your knee back in working order. During your sessions, you’ll do exercises to strengthen the muscles around your knee and help

you regain a full range of motion. You may asked to exercise on your own.

Surgery is done when all else fails and is called Arthroscopic ACL reconstruction in which Surgeon will remove the damaged ACL stump through a keyhole and replace it with a graft sometimes made from the core of your hamstring muscle or a fibretape.

This is usually a daycare surgery and after surgery with proper rehabilitation ie Proprioceptive and strengthening exercises patients can resume brisk walk in 6 weeks and jogging in three months. Active contact sports again within six months.

With modern surgical techniques and fixation methods available, ACL surgery for sportsmen  especially, has proven to be highly successful procedure.

The author is an Orthopedic and  Joint Replacement Surgeon at NHS Hospital, Jalandhar.

A new study has found that adults with chronic kidney disease are at higher risk of metabolic syndrome. It also found that metabolic syndrome increases the risk of premature death and cardiovascular problems.

The findings of the study were published in the Journal of Internal Medicine. Among 5,110 adults in Germany who had chronic kidney disease, 64.3 per cent also had metabolic syndrome.

During 6.5 years of follow-up, 605 patients died and 650 experienced major cardiovascular events (such as heart attacks and strokes). Patients with metabolic syndrome had a 26 per cent higher risk of dying and a 48 per cent higher risk of experiencing cardiovascular events.

The risk increased steadily with a growing number of metabolic syndrome components, such as increased waist circumference, blood sugar levels, triglycerides, and blood pressure, and decreased HDL cholesterol. “Although our study uncovered a shockingly high frequency of metabolic syndrome in this high-risk patient group, there’s a motivating message for our patients: each metabolic syndrome component avoided might considerably decrease the risk for a cardiovascular endpoint or premature death,” said senior author Florian Kronenberg, MD, of the Medical University of Innsbruck, in Austria.

Exercise can boost kids’ vocabulary growth. A new research has come out with this finding.

The study, published in the Journal of Speech Language and Hearing Research, detailed one of the first studies on the effect of exercise on vocabulary learning in children. Children ages 6 to 12 were taught new words before doing one of three things—swimming, taking part in CrossFit exercises or completing a colouring sheet. The children who swam were 13 per cent more accurate in follow up tests of the vocabulary words.

It makes sense to the lead researcher, Maddy Pruitt, herself a former college swimmer who now regularly takes CrossFit classes. “Motor movement helps in encoding new words,” she said, explaining that exercise is known to increase levels of brain-derived neurotrophic factor, a protein Pruitt describes as the “Miracle-Gro of the brain.”

Why then, did swimming make a difference while CrossFit did not? Pruitt attributed it to the amount of energy each exercise demands of the brain. Swimming is an activity the kids could complete without much thought or instruction. It was more automatic, while the CrossFit exercises were new to them. The children needed to learn the moves, which required mental energy.

Pruitt conducted the research as part of her Master’s Capstone Project and graduated in 2020. She now works as a speech language pathologist at an elementary school in South Carolina, where she puts her findings into practice. “My sessions are very rarely at a table,” she said. “I’ll take my kids out to the playground or we’ll take a walk around the schchild

Cancer survivors, especially older people, are more likely to experience accelerated functional decline as they age, compared with those without a history of cancer, according to a new study.

The research was published in the Journal of the American Geriatrics Society. As per the research, between 2006 and 2019, 1728 men and women (aged 22 to 100 years) were evaluated, with 359 of these adults reporting a history of cancer.

Among all participants, a history of cancer was associated with a 1.42 greater odds of weak grip strength. Among participants older than 65 years of age, those with a history of cancer had a 1.61 greater odds of slow gait speed than those with no cancer history, and they had lower physical performance scores.

Also, older individuals with a history of cancer experienced steeper declines in grip strength and gait speed compared with older adults with no history of cancer. “Findings from our study add to the evidence that cancer and its treatment may have adverse effects on ageing-related processes, putting cancer survivors at risk for accelerated functional decline,” said senior author Lisa Gallicchio, PhD, of the National Cancer Institute.

“Understanding which cancer survivors are at highest risk, and when the accelerated decline in physical functioning is most likely to begin, is important in developing interventions to prevent, mitigate, or reverse the adverse ageing-related effects of cancer and its treatment,” concluded Gallicchio.

A global review of studies has found high levels of depression, PTSD, anxiety and burn-out amongst frontline medical staff during Covid-19. This suggests that more support needs to be put in place for hospital workers dealing with the pandemic.

The review, conducted by the University of York and the Mental Health Foundation, also revealed that Covid patients with other physical health problems and children and adolescents are struggling with a host of mental health issues during the pandemic. The study was published in the journal PLOS ONE.

The study looked at 25 systematic reviews conducted during the early months of the pandemic. Many of these studies were of hospital workers in China. Estimates varied from 12 per cent for anxiety in one review of healthcare workers in the hospital, to 51 per cent for depression and PTSD in another review.

For children, changes in household interactions and social changes such as school closures may increase the risk of adverse mental health outcomes. The review was a collaboration between the University of York’s Centre for Reviews and Dissemination and the Mental Health Foundation. In addition, a panel of six UK healthcare workers helped the researchers to interpret the findings of the review.

Based on feedback from the panel, the study authors highlight a lack of responsibility from the UK government to support healthcare workers, pointing out a need for tangible support more so than orchestrated initiatives such as ‘Clap for Carers.’

The panel confirmed review findings on the importance of support from colleagues, clear communication in the workplace, and the need for resources and support for a shift to working from home for community workers. Lead author, Noortje Uphoff, a Research Fellow at the University of York’s Centre for Reviews and Dissemination, said additional support during outbreaks such as Covid-19 could prevent an increased burden of mental health problems in the population.

“Many people worldwide have felt the impact of the Covid pandemic on their mental health, but some groups of people may be more at risk of experiencing poor mental health than others.”

“Healthcare workers may already have a higher risk of adverse mental health outcomes due to the stressful nature of their work. However, there were some indications that mental health may be further affected as a result of working on the frontline during an infectious disease outbreak.

“This review indicates which types of support should be explored to protect the mental health of healthcare workers and other vulnerable groups during this pandemic and any future coronavirus outbreaks.”

Dr Antonis Kousoulis, Director at the Mental Health Foundation said “Much has been said about the impact of the pandemic on healthcare workers. However, our novel partnership approach to complete this review brought a range of unique perspectives to the project. Our team consisted of researchers and workers with academic, third sector, clinical and lived experience, thus supporting the idea that research can be more meaningful if inclusive.

WITH ANI INPUTS