New Help for Brittle Bone

Fractures of the vertebral body and lower backbone are common especially among the elderly. Post -menopausal women are particularly susceptible - it affects one out of three woman above 60 years old. Although less common among older men, compression fractures remains a major health concern as Singapore's greying population grows.

Some other causes of vertebral and lower backbone fractures are tumours, long-term steroid treatments and metabolic disorders. Severe fractures can cause significant pain, leading to inability to perform activities of daily living and can even be life threatening.

The good news is that fracture of the vertebra or lower backbone can now be treated with minimally invasive, non-surgical procedures. The procedures involve an image-guided injection of bone cement mixture into the spinal column bone (Vertebroplasty and Kyphoplasty) or lower backbone (Sacroplasty) to stabilise the fracture.

The advantage of these procedures lies in its minimally invasiveness. Most patients are able to return to their normal daily activities almost immediately after the treatment. Even bed bound patients have been known to walk the next day. The procedures are suitable for elderly or frail patients who cannot tolerate open spinal surgery or whose bones are too weak for surgical spinal repair. They are recommended after conservative treatments have been ineffective, or when medications are causing other problems, such as stomach ulcers.

Vertebroplasty is used to strengthen a broken vertebra (spinal bone) that has been weakened by osteoporosis or, less commonly, cancer. The procedure injects a bone cement mixture through a needle into the fractured spinal column bone to stabilise the fracture.

Within four hours, the pain is relieved. Vertebroplasty can increase the patients' functional abilities, allowing them to return to their previous level of activity, and prevent further vertebral collapse.

In cases where the vertebra has collapsed, Kyphoplasty is recommended. It includes an additional step to Vertebroplasty. Prior to injecting the cement-like material, a special balloon is inserted and gently inflated inside the fractured vertebra. The goal of this step is to return it to the correct position to reduce deformity of the spine for improved posture.

Fracture of the lower Backbone - Sacroplasty

Another area people with weak bones often injure is the sacrum or lower backbone. The pain is severe enough to cause immobility.

Usually, there is no history of trauma or a history of low impact trauma. The most common physical signs are low back or groin tenderness, and reduced hip movement. In 25% of the time, there are multiple sites of pain.

In Sacroplasty, bone cement is injected into the lower backbone to stabilise the fractures and provide pain relief.

To find out if you are suitable for any of the procedures, please speak to your family doctor or our Radiologists.

Strategies to Prevent Avian Influenza A (H5N1) in Humans

Isolation Precautions in Health Care Facilities:

Patients should be treated with a combination of standard, contact, droplet, and airborne isolation precautions. Patients should be housed alone in a negative-pressure room, if available, or in a single room with the door closed. If a single room is not available, patients should be housed in designated multibed rooms or wards. The beds should be at least 1 m apart and preferably separated by a physical barrier. High-efficiency masks, long-sleeved cuffed gowns, face shield or eye goggles, and gloves are recommended for health care workers. When feasible, limit the number of health care workers with direct contact with patient and limit access to the environment of patients. If possible, these health care workers should not look after other patients. Restrict visitors to a minimum and give them proper personal protective equipment and instructions in its use.

Health Care Worker Exposures:

Those caring for infected patients should monitor temperature twice daily and report any febrile event. If unwell for any reason, health care workers should not be involved in direct patient care. Health care workers with fever (temperature >38°C) and patient contact should undergo appropriate diagnostic testing. If an alternative cause is not identified, they should be treated immediately with oseltamivir on the assumption of influenza infection. Those who have had a possible exposure to infectious aerosols, secretions, or other body fluids or excretions because of a lapse in aseptic technique should be considered for post-exposure chemoprophylaxis with oseltamivir at a suggested dose of 75 mg once daily for 7 to 10 days. Health care workers involved in high-risk procedures (e.g. aerosol-generating procedures) should consider the need for pre-exposure prophylaxis.

Precautions for Household and Close Contacts:

Household contacts should use appropriate hand hygiene, should not share utensils, should avoid face-to-face contact with patients with suspected or proven cases, and should consider donning hign-efficiency masks and eye protection. Contacts who have shared a defined setting (household, extended family, hospital or other residential institution, or military service) with a patient with proven or suspected avian influenza A (H5N 1) infection should monitor ther own temperature twice daily and check for symptoms for 7 days after their last exposure. In such persons, postexposure prophylaxis with oseltamivir at a suggested dose for adults of 75 mg once daily for 7 to 10 days is advisble. Household or close contacts should receive empirical antiviral treatment and undergo diagnostic testing if fever (temperature> 38°C) and cough, shortness of breath, diarrhea, or other systemic symptoms develop.

Precautions for Travelers:

Travelers to areas with avian influenza activity should be immunized with the available trivalent human vaccine, preferably at least 2 weeks before traveling. Travelers should avoid all direct contact with poultry, including chickens, ducks, or geese that appear to be well, and farms or live-animal markets with poultry, and should avoid touching surfaces contaminated with poultry feces or secretions. Travelers should reduce possible exposure by practicing good hand hygiene with frequent hand washing or use of alcohol gels and by not ingesting undercooked eggs or foods from poultry. Hand washing is important when handling raw poultry for cooking (e.g. during cooking classes). Travelers should be advised to consult a health care provider if they become ill with f respiratory symptoms within 10 days of returning affected area.

World Blood Donor Day 2006

Most countries fall short of ensuring a safe blood supply but some progress made

The world is making slow progress towards the goal of 100% unpaid, voluntary blood donation, falling short of ensuring the safety and the sustainability of blood supplies. Most developing countries still depend on paid donors or family member donors. However, some countries such as China, Malaysia and India have shown progress in the last two years by applying stricter principles within their AIDS prevention programmes.

On World Blood Donor Day, 14 June, the World Health Organization (WHO) publishes findings from its most recent global survey on blood collection and blood testing practices.

Regular, unpaid voluntary donors are the mainstay of a safe and sustainable blood supply because they are less likely to lie about their health status.

Evidence indicates that they are also more likely to keep themselves healthy. South Africa, for instance, has an HIV prevalence of 23.3 % in the adult population but only 0.03% among its regular blood donors.

The WHO survey shows that out of the 124 countries that provided data to WHO, 56 saw an increase in unpaid voluntary donation. The remaining 68 have either made no progress or have seen a decline in the number of unpaid voluntary donors. Of the 124 countries, 49 have reached 100% unpaid voluntary blood donation. Out of those 49, only 17 are developing countries.

The number of donations per 1000 population is about 15 times greater in high-income than in low-income countries. This is concerning because developing countries have an even greater need for sustained supplies of safe blood since many conditions requiring blood transfusions - such as severe malaria-related anaemia in children or serious pregnancy complications - are still claiming over one million lives every year. About 25% of deaths caused by severe bleeding during delivery could be prevented through access to safe blood.

In the area of blood testing, 56 out of 124 countries did not screen all of their donated blood for HIV, hepatitis Band C and syphilis. Reasons given for this include scarcity or unaffordability of test kits, lack of infrastructure and shortage of trained staff.

On the other hand, several countries have risen to the challenge. Of the countries surveyed, St. Lucia made the biggest jump forward, going from 24.39% of collected blood coming from unpaid volunteers in 2002 to 83.05% in 2004. Malaysia went from 50% in 2002 to 99% in 2004 and India from 45% to 52.42%.

According to government responses to the WHO questionnaire, the reason for progress is tied to stronger AIDS prevention programmes. In China, government figures show that all donated blood in 2005 was tested for the four infections. In the area of blood donation, China has seen a rise of unpaid voluntary donors from 22% in 1998 to 94.5% in 2005. China's progress is due particularly to its reduction of commercial blood and plasma, thus minimizing the practice of unregulated blood collection and provision throughout the country while also strengthening HIV prevention.

The World Health Organization introduced the 100% unpaid, voluntary blood donation policy in 1997. World Blood Donor Day, an annual event on June 14, is a day to help governments reach that target by creating awareness ofthe need for sustainable supplies of safe blood. It is also a day to thank existing blood donors for the remarkable gift they make to those whose lives they have improved or saved, and to encourage new donors to commit. Commitment is the theme of this year's World Blood Donor Day; from regular and potential donors, but also from governments and the global community to maintain blood safety high on the agenda as a vital factor in treatment and disease prevention.

The global celebration of World Blood Donor Day 2006 on June 14 will take place in Bangkok, Thailand. It will be hosted by the WHO Collaborating Centre for Training in Blood Transfusion Medicine and the Thai Red Cross Society National Blood Centre. Over 100 other countries will join in the celebrations.

World Blood Donor Day was established at the 58th World Health Assembly in May 2005 by WHO's 192 Member States, to urge all countries in the world to thank blood donors, promote voluntary, unpaid blood donations and ensure safe supplies of blood for all.

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