Written by Siyanda Rich Shinga (BHSc in Clinical Technology: Neurophysiology)

Sleep is an important and naturally recurring state of mind and body characterized by altered consciousness, relatively inhibited sensory activity, reduced muscle activity and inhibition of nearly all voluntary muscles during rapid eye movement sleep. Sleep-Related Breathing Disorder (SRBD) are disorders in which abnormalities in breathing occur during sleep that may or may not be present while awake. The different types sleep-related breathing disorders include central sleep apnea, Obstructive sleep apnea, mixed sleep apnea, upper air-way resistance syndrome and sleep-related hypoventilation/hypoxaemia.

Types of sleep related breathing disorders

1. Central sleep apnea– defined by episodes of not breathing during which there is no indication of an effort to breathe in the signals that are recorded in a sleep study
   • This is due to increased sensitivity to the respiratory centre to pCO2, producing relative hypocapnia and prolonged circulation time.
2. Obstructive sleep apnea– defined by continued effort to breathe but an obstructed upper air way. Patients with this disorder present with symptoms such as severe snoring, wakes up gasping for air during sleep, persistence fatigue and low sex drive.
3. Mixed sleep apnea– usually starts with central sleep apnea and develops into obstructive sleep apnea later.
4. Upper airway resistance syndrome– is accompanied by subjective and objective evidence of pathologic sleepiness. In some individuals, even a minor reduction of airway patency with sleep onset may lead to a modest increase in upper airway resistance and a slight decrease of tidal volume without hypoxemia.
5. Sleep related Hypoventilation/Hypoxemia– hypoventilation refers to reduction of the amount of air flow and hypoxemia refers to a low oxygen level. Hypoventilation and hypoxemia may occur due to:
   • Impaired gas exchange between the alveoli and blood
   • Failure of inhaled air to reach the lungs
   • Failure of the lungs to properly inflate

Diagnosis of SRBD

• Central sleep apnea- sleep study Polysomnogram (PSG)
• Ostructive Sleep Apnea- sleep study PSG
• Sleep relatated hypoventilation/hypoxeamia

In the evaluation of sleep apnea patients suspected of having sleep apnea syndromes the following is essential:

• Sleep history – both from patient and sleep partner
• Physical examination should include:
  1. Blood pressure
  2. Evidence of right sided heart failure
  3. Abnormal skeletal and muscle configurations of the face and neck
  4. Chest radiographs and electrocardiograms are essential in evaluating pulmonary hypertension, status of right and left ventricle and establishing possible coexistence of cardiopulmonary disease.
  5. A complete blood count- assists in documenting the presence of polycythemia in chronic hypoxeamia or right sided heart failure
  6. Pulmonary function studies with arterial blood gas sampling- may be necessary to determine airway obstruction or investigate primary hypoventilation during waking state and document hypoventilation and hypercapnia.
  7. Polysomnogram- which is necessary for the estimation of the severity of the sleep disordered breathing, sleep fragmentations and oxyhaemoglobin desaturations
     • The severity is determined by the Apnea-Hypopnea Index- that is the number of episodes per hour of sleep

Treatment of SRBD

Treatment of SRBD includes the following:

1. Behavioural interventions

• Weight loss
• Avoidance of alcohol and sedatives
• Avoidance of supine sleep position
• Discontinuation of smoking

2. Continuous positive airway pressure treatments

• Nasal or oral positive airway pressure (NCPAP or OPAP)
• Bilevel positive airway pressure (BPAP)
• Auto-adjusting positive airway pressure (Auto-PAP)

3. Surgical procedures

• Bypass surgery
• Tracheostomy

4. Upper airway reconstructions

• Soft-tissue modifications (Uvulopalatopharyngoplasty [UPPP], laser-assisted UPPP [LAUP], somnoplasty, radiofrequency volumetric reduction of the tongue, laser lingual resection—lingualplasty, tongue base suspension, tonsillectomy)

5. Skeletal modifications

• Mandibular osteotomy with genioglossal advancement and hyoid suspension, maxillomandibular osteotomy and advancement, hyoid myotomy and suspension to mandible, hyoid myotomy and suspension to thyroid cartilage, anterior hyoid advancement, transpalatal advancement pharyngoplasty, nasal surgery

6. Pharmacologic agents

• Medroxyprogesterone, decongestants, nasal steroids, antihistamines, protryptiline, and serotonergic agents: fluoxetine and other selective serotonin reuptake inhibitors, L-tryptophane

Tel: 074 700 0062
E-mail: neurophysiology245@gmail.com
Address: Suite 2, Connor-Med Health Centre, 20 Connor St, Port Shepstone, 4240

References

• Neurology for the Non-Neurologist
• A technologist’s introduction to sleep disorders (AASM)
• Polysomnography in Patients With Obstructive Sleep Apnea (PubMed) Accessed(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3379160/pdf/ohtas-06-38a.pdf)
• PSG in the Diagnosis of Central Sleep Apnea (Medscape) Accessed: (https://www.medscape.com/answers/304967-114297/what-is-the-role-of-polysomnography-in-the-diagnosis-of-central-sleep-apnea-csa)

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The nasal cavities and sinuses are lined by respiratory mucosa. In the healthy state the mucosa is thin and pink. Normal, healthy mucosa produces mucous constantly that is thin and watery. The mucous secretions help to keep the nasal passages moist and trap dirt particles. The mucous is moved by tiny, microscopic hair like structures called cilia. Mucous flows from the sinuses through channels into the nasal cavities, to the back of the nose and then down the throat.

Read more

The post Is SINUSITIS affecting your QUALITY of life? By Dr M Khan (ENT) first appeared on Hibiscus Hospital.

Dr. de Bruin, originally from Pretoria, explains that there are two types of nephrectomies that he performs, simple and radical. “A simple nephrectomy is the removal of only the kidney from the body due to such ailments as recurring infection or poor functioning, while a radical nephrectomy is required when there is a tumor within the kidney and both the kidney and surrounding tissue and often the adrenal gland too must be removed.”

Particularly pleased that it brings this needed service right to the area’s doorstep, Dr. de Bruin says that it makes the surgical experience so much more convenient for patients and their loved ones to be able to check in to a local hospital. “There’s obviously emotional stress that both the patient and their family members go through during surgery and I’ve found this is generally reduced when they’re in a local surroundings and don’t have to deal with travel and accommodation in another area.”

As far as telltale signs that the kidney needs medical attention, Dr. de Bruin says such problems are notoriously asymptomatic. “Often patients experience hematuria (blood in the urine) or general pain but oftentimes it’s discovered by accident. This is why it’s a good idea, especially for the elderly, to have regular checkups.”

Dr. de Bruin has an office in Port Shepstone in the Hibiscus Medical Suites and offers a complete urology practice to the South Coast..

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Eczema is really an allergy, meaning that there are things that do not agree with the body, and the body’s immune system fights them by releasing a substance called histamine.  Histamine is responsible for the earliest and most important sign of eczema – the itch!

1.  WHAT IS A MAINTENANCE PROGRAMME.?
Your self-help programme should include the following

BATHING

• Use a moisturising soap
• Use natural moisturising bath oils (non-scented)
• Use lukewarm water
• Do not use bubble baths
• Avoid perfumed toiletries
• Avoid taking long baths

CLOTHING

• Cotton is preferable
• Avoid wool and synthetic fabrics
• Wear loose-fitting clothing to reduce friction

MOISTURISING
Get moisture regularly, using an unscented moisturiser. Remember, you cannot over moisturise your skin.

ITCHING

• Keep your nails short
• Keep your skin cool
• Avoid becoming overtired and stressed

2.  MEDICAL HELP
Corticosteroids – oral or applied may help reduce inflammation and itching

Antibiotics – oral or applied
Secondary infections are common and should be treated quickly

Antihistamines – oral or applied

• Reduce itching
• May assist with broken sleep patterns
• Wet Bandaging
• Sterile bandages must be used
• Soothes and reduces itchiness
• Helps to heal lesions

Allergy Testing
A skin prick or blood test performed by a medical practitioner can confirm allergies (e.g. House dust mite, certain grasses, tree pollens, etc.)

Diet
Consult a dietitian for assistance and guidance regarding a suitable diet.

3. COMPLICATIONS
Eczema itself is not infectious. No one can catch it from you. But, as eczema skin often dries, cracks and breaks, it puts the sufferer at a greater risk of contracting skin infections. Medical advice should be sought at the first sign of any infection.

This article was provided in the public interest by Dr. Ayoob Bux, Chairman of Hibiscus Private Hospital and Chairman of the IPA Independent Practitioners Association.  It is presented for your general information and is not a substitute for seeing your own doctor.

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The word “vaccination” was first used by Edward Jenner in 1796. Louis Pasteur furthered the concept through his ground-breaking work in microbiology. In common speech, ‘vaccination’ and ‘immunisation’  have the same meaning.

Historically, infectious diseases have been a major cause of illness, and in many cases leading to disability or death. To this effect, immunisation programs are one of the great public health successes of the 20th century. It has prevented disease, disability and death from infants to senior citizens. Vaccination protects us against diseases like measles, mumps, rubella, hepatitis B, polio, diphtheria, tetanus and pertussis (whooping cough).

How does it work?
Your immune system helps your body fight germs by producing antibodies to combat them. Once the antibodies are formed, the immune system “remembers” the germ and can fight it again. Vaccines contain germs that have been killed or weakened and when given to a healthy person, the vaccine triggers the immune system to respond and thus build immunity.

Immunisation is of the most successful and cost-effective methods of preventing infectious diseases.  Through immunisation, smallpox and polio have been almost eradicated from the western hemisphere, and cases of measles have been reduced by over 95%.

Immunisation prevents between 2 and 3 million deaths per year but ironically the fact that immunisation has made many infectious diseases rare can lead to the opinion among parents and health professionals that immunisation is no longer necessary. Due to gaps in vaccination coverage, diseases like diphtheria, measles and polio are making a comeback. Remember disease outbreaks affect everyone.

Vaccines are available at local state clinics and hospitals.

For more information please contact your family practitioner.

DON’T WAIT. VACCINATE

This article was supplied by Dr.  A.M. Bux  (General Practitioner)

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Pregnancy is a very exciting time in the lives of many. Initially, one experiences extreme joy and happiness on learning of one’s pregnancy. As the pregnancy progresses, one experiences a number of changes physically and emotionally during its course. These sometimes result in questions, concerns and anxieties especially for the first time mums to be. Reading and learning about these changes is very helpful to allay one’s anxieties as to what to expect in pregnancy and will therefore make your pregnancy less stressful. Each pregnancy is unique and no amount of research can make one be fully prepared for the experience. Pregnancy is ten full months completed, and not nine months as popularly believed to be.

Some of the common ailments in pregnancy could lead to excessive discomfort. These include: Morning sickness, which can sometimes persist for the whole day and usually disappear by the third or fourth month of pregnancy. Avoiding the precipitating odors and foods may help reduce queasiness, nausea and vomiting. If the vomiting is unrelenting, medical help should be sought. Backache, pelvic discomfort, leg cramps, heartburn, frequency of urination, dizziness, constipation, aggravated piles and extreme tiredness are all but some of the symptoms that may be experienced.

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CAUSES:
• Worrying about events beyond our control
• Hurried approach to life
• Relationship problems caused by your behaviour

BEHAVIOURAL EFFECTS:
• Fatigue

• Headaches
• Tearfulness
• Aches and pains (due to muscle tension)
• Sweating
• Lack of energy
• Insomnia
• Loss of appetite or over eating
• Low concentration
• A reduced ability to apply new information
• Lower levels of creativity
• Low self-esteem

EMOTIONAL EFFECTS:
• Depression
• Anxiety
• Irritability
• An inability to relax

STRESS REDUCERS:
• Get organised – evaluate your time management
• Take one day at a time.
• Separate worries from concerns
• Simplify life
• Adopt a forgiving attitude
• Live within your budget
• Make time to be alone
• Be grateful for at least one thing every day
• Positive re-enforcement and affirmation; remember your good qualities and focus on these.
• Avoid “should have”
• Do not compare yourself with others
• Teach yourself to say NO
• Laugh more
• Avoid criticising yourself with put-downs and negative comments
• Eat healthy, sleep well, exercise and relax
• Remember, the shortest distance between despair and hope is often a good night’s sleep!

The post Understanding stress first appeared on Hibiscus Hospital.

The Cancer Association of South Africa (CANSA) says that there is no such thing as a safe tan. Daily damage done by the sun’s ultra violet rays builds up over time. CANSA says that as much as 80% of ultra violet-related skin damage occurs by age 18. Just one blistering sunburn as a child significantly increases the risk of developing skin cancer later in life. Against the backdrop of these and other eye-opening realities, Hibiscus Private Hospital in Port Shepstone recently organised a Free Skin Cancer Detection Day.

The event, which was held at the hospital’s Hibiscus Medical Centre, proved to be very popular. Specialist Dermatologist Dr Marc Roscher and General Practitioners Dr Ayoob Bux and Dr Yasmin Khan all donated their time for the event which was free to the public. The general practitioners referred individuals with risky looking spots to Dr Roscher for further examination and diagnosis.

Executive Managing Director of Hibiscus Private Hospital, Richard Mills says, “We were happy to see how well our skin cancer detection event was received. We urge everyone who lives in our beautiful sunny climate to follow CANSA’s sunsmart guidelines and to see your doctor regularly for early diagnosis of abnormalities on your skin.”

The event was also supported by Johnsons® Suncare, which provided sunblock samples and Fedics, which provides the food service at Hibiscus Private Hospital. Fedics supplied beverages for the participants as they waited for their appointments. Vitaderm was also present with samples of their dermatologist-formulated cream.

Those wanting additional information on skin care and skin cancer can learn more at
www.cansa.org.za.

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Bronchiolitis
For young children, bronchiolitis is a less severe form of pneumonia, but pneumonia can develop if it is left unchecked. Caused mainly by virus but secondary bacterial infection can occur.

Bronchiolitis is basically an infection of the bronchiolar tubes so it’s a respiratory infection. Babies and small children are susceptible to bronchiolitis because the airways are smaller and their immune systems are not mature enough to handle all the winter infections that come their way. Bronchiolitis is contagious and  it can be caught from others when they sneeze or cough or touching places where an infected person has touched with infected secretions in hands.

What are the most common symptoms of bronchiolitis?

A dry cough, runny and blocked nose initially like a common cold.

Headache, chills, fever and wheezing with tightness of chest follow later.

How will it be diagnosed?
If you suspect your child has bronchiolitis, take them to your Doctor,  who will examine the chest with a stethoscope to determine whether there is infection.
A further X-ray may be needed.

Bronchiolitis treatment

Treatment depends on the type of infection your child has. If it has been caused by a virus, antibiotics will not work and the doctor will probably advise you to take your child home, make sure they get plenty of rest, drink lots of fluids and give him lots of love. Nose has to be kept clear with saline spray. If your child’s bronchiolitis was caused by bacteria, antibiotics may be prescribed depending on the age of your child. Bronchiolitis is the leading cause of hospital admission in infants. Peak age of infection is 2 to 6 months of age. 1 in 10 children with bronchiolitis will need admission to hospital.

Warning signs for admissions

• Children below 3 months
• Rapid breathing
• Difficulty in breathing
• Poor feeding
• High Fever
• Blue lips and tongue

Pneumonia
Because the symptoms are very similar to a cold (runny nose etc.), pneumonia in infants is often overlooked by parents. There are different types of pneumonia, bacterial and viral. Severe bacterial pneumonia can happen particularly when the immune system is lower than normal.

What are the most common symptoms of pneumonia?
Bacterial

• High fever, chills
• A bad cough
• Rapid breathing

Viral

• Cough
• Wheeze
• Mild fever

The difference with pneumonia is that these symptoms will not improve in time but steadily worsen. They can also follow other illnesses. If you notice your child has had these symptoms but is not getting any better even after a few days of rest, fluids and fever medicine, consult your doctor immediately.

If pneumonia is suspected your child may have to go to for a chest X-ray to check how serious the infection is. If the condition is severe the medical staff may take a sample of phlegm to grow under laboratory conditions in order to discover which type of pneumonia your child has got.

In addition to infants, children and elderly people with low immune systems also include vulnerable groups affected by pneumonia.

Recognize characteristics by rhythm breath counting
The easiest way to recognize if your child is stricken with possible pneumonia is to count his breath in a minute.

1. Characteristics of children whose age is less than 2 months, when stricken with pneumonia is the breathing faster than 60 times per minute.
2. If age 2-12 months, then his breathing faster than 50 times per minute.
3. If age 1-5 years, breathing faster than 40 beats per minute.

Parents can do breath counting at home to determine whether the children has early rapid breathing or not, but it is advisable to seek medical advice as early as possible if you suspect pneumonia, as it can be fatal.

How can I help my child?
Make sure your child gets plenty of rest, fluids and keep their rooms cosy, warm and well ventilated. If he/she is old enough a pillow propped up behind him might help breathing a little easier.

Remember to keep your child’s vaccinations up to date as this helps to stop many of the illnesses that can lead to pneumonia, for instance measles and bacterial pneumonias caused by Hemophillus and Pneumococcus.

This article was supplied by Dr. P. Raghunathan (Paediatrician)

The post Bronchiolitis and Pneumonia in babies and children first appeared on Hibiscus Hospital.

Tuberculosis (TB) is a common and often deadly infectious disease caused by mycobacterium, in humans.TB is a contagious disease. Like the common cold, it spreads through the air; when infectious people cough, sneeze, or spit they propel TB germs into the air! A person needs only to inhale a small number of these to be infected.
Tuberculosis usually attacks the lungs as capital TB but can also affect many other parts of the body.

What are the signs and symptoms?

• A cough for longer than 2 weeks
• Loss of appetite and weight
• Night sweats, even when the weathers cold
• Chest pains
• Tiredness and weakness
• Coughing up blood

How is TB diagnosed?
Any of the above may be an indication of the disease. Saliva is tested for the TB germ. A chest X-Ray may show TB in the lungs. A skin test done on children can also be an indication. When a person has been diagnosed as suffering from TB, all those who have been in close contact with that person should be examined. TB testing and treatment is free in South Africa.

Treatment
Medication must be started as soon as possible and it must be taken regularly. It takes 6 months for TB to be cured. Within 2 weeks of starting treatment, the person will no longer spread the disease.
If treatment is missed, the risk of a drug resistant strain of TB is possible. This TB is very difficult to treat and needs more than 18 months of treatment with long hospitalisation. If medicines are stopped too soon the disease may start all over again.

How can TB be prevented?

• Cover your mouth when coughing.
• Immunisation of all babies at a clinic within 1 year of birth.
• Eating balanced meals consisting of food like meat, fish, eggs, beans, brown bread, maize meal, vegetables, and fruits.
• Alcohol should be avoided because it lowers body resistance, and affects the treatment.
• Smoking causes further damage to the lungs and can also cause heart disease and lung cancer.
• Getting some sunshine, fresh air, exercise and living in a clean environment.

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