Category: Articles

Early childhood development, or ECD, for short, encompasses a child’s cognitive, language, social, emotional, and motor development. Research has found that an estimated 250 million children are not meeting their developmental potential in the first five years of life. The risks that threaten children’s development include poverty, malnutrition, infectious illnesses, stress in families, violence, inadequate care and protection, and a lack of early learning opportunities. Without interventions, these early risks have lifelong implications on health, on behaviour, and productivity.

We also know that early childhood is a critical window of opportunity when children are particularly sensitive to experiences that promote development. This is why interventions targeting this age are so important. In the last 30 years, we have learned a great deal about what types of interventions work to support early childhood development. However, we have been less successful in replicating and scaling up these interventions in different contexts around the world to reach the large numbers of children who need these services.

Over the last three decades, we have also amassed evidence that there are multiple risks across a complexity of factors that threaten children’s development. And therefore, single sector interventions alone, while necessary, are not sufficient to promote their ability to thrive. Nurturing care is the provision of stable, emotionally supportive environment that protects children from the threats and provides them with responsive, developmentally stimulating opportunities for healthy development, learning, and interaction. It is provided by the child’s parents, family, caregivers, teachers, and community in the immediate home, childcare settings, pre-primary classrooms, and beyond. So a coordinated response means we must ensure that every child receives all of the services they need, and that their families and caregivers have resources and support to care for them. It also means teachers and carers have the tools and capacities to foster early development and learning, that communities are empowered to advocate for the needs of young children, and families and governments are accountable to their youngest citizens. While there has been increased global, and national funding, and policy commitment to early childhood in the recent years, few effective interventions promoting early childhood development have achieved scale.

A greater emphasis on implementation research and practice is necessary to inform evidence and knowledge for effective, sustainable, and high quality early childhood interventions that can be delivered at scale. ECD is the progressive attainment of sensorimotor, social-emotional, cognitive, and language capacities, as well as a sense of self that are driven by our biology, our genes, and the environment. These capacities are the building blocks for future human capital, enabling us to think, solve problems, communicate, express our emotions, form relationships, create and develop new ideas.

The period of early development begins at conception and continues to about eight years of age. Here we see children transitioning from their family and home environment, to early childhood care and education services, to primary school and their neighbourhood environments. Therefore, young children need a range of interventions to promote ECD.

The World Health Organization, UNICEF, and the World Bank Group put forward the Nurturing Care Framework in 2018. This framework describes all of the inputs young children need in order to thrive. This includes good health, adequate nutrition, responsive caregiving, security and safety, as well as opportunities for early learning. These interventions are not just needed in the first five years of life. But, really, we need to ensure that children continue to receive inputs so that they transition safely and successfully to school and to community environments. The NCF or the Nurturing Care Framework is not meant to be business as usual. It is not enough for us to consider what inputs children need but to ensure that the environment enables children to receive those inputs.

That means building the strengths and the capabilities of caregivers so that they can ensure their children are receiving adequate health, nutrition, that they are safe, and that they’re learning, that caregivers and children are supported by empowered communities, and the empowered communities, the families are supported by services. These services must work together across child protection, social protection, health, and education. And these services, the communities that we live in, our families, our children are supported by policies. At the national level, there are many, many policies that support children and families. But we need to make sure that they are working to serve children and families no matter where they live.

There are multiple interventions that can be delivered throughout the early years and the life course beyond. We need to ensure that all of these interventions come together to allow children to thrive. So what do we mean when we say interventions, platforms, systems, and policies? In addition to the essential interventions of health and nutrition, we need to ensure that ECD is promoted through parenting programs. That is, the skills that parents need to support the healthy development, early learning, responsive care, and care for feeding of their children. It includes the guidance that families might need to prevent violence, to establish safe and healthy routines, for care for their children’s health, hygiene, and nutrition.

It includes interventions in early childhood care and education. It includes interventions that are needed in the first years of primary school. It includes paying attention to the needs of children with disabilities or those who are at risk of developmental delay. It includes supporting mental well-being not only for children but for the caregivers that work with children and for their families. It includes ensuring our neighbourhoods are safe spaces, child-friendly spaces, adding also includes giving opportunities for caregivers to have education, income generation, and training so that they have access to the resources that they can choose to invest for their children in a way that is right for their family.

All of these interventions are supported by platforms. Investing in early child development– living up to our commitments under the Convention on the Rights of the Child– should be a priority for every society. The reason why is crystal clear. It makes sense on every level. Ensuring the best possible start in life for every member of society is an effective– and cost-effective– way to advance the productivity, creativity, resilience, and overall development of everyone. It helps to expand economic opportunities and can be a factor promoting the resolution of conflicts and grievances.

Rigorous studies have repeatedly demonstrated that the early years of a child’s life lay the foundation for lifelong growth and potential. Investing in policies and programs that target early childhood development will open up multiplier effects throughout the child’s life and across entire generations. It drives greater economic progress, and potentially much more inclusive and sustainable development.

Every child has a right to develop to the maximum extent possible. Every child has the right to a standard of living adequate for their physical, mental, spiritual, moral, and social development. Guaranteeing access to early childhood development programs for those in greatest need is a policy tool that has great promise to break down cycles of exclusion.

Children who live in poverty, who live with disabilities, who are growing up without parental care in the streets, in institutions, or in situations of conflict or displacement, children from indigenous peoples or marginalized minority communities, or migrant families– these are among the most vulnerable, at-risk people in our societies. We are already seeing a huge increase in children being forced to work to feed their families or forced into child marriage. Children are being exposed to heightened threats of experiencing or witnessing physical and psychological violence.

To promote ECD, children need to be nourished and healthy. In addition, they need an environment that supports children’s development and learning. For very young children, this might include a variety of early learning opportunities in the home with their family. Responsive care is a key ingredient. That is the

ability of the caregiver to understand the child’s needs and their wants and to be able to respond to a child in a developmentally appropriate way.

Shabir Ahmad is a UPSC aspirant/emerging writer from Raiyar, Doodhpathri.

Juicing is a quick and simple approach to incorporate nearly all of the necessary fruit and vegetable servings into a single portable container. There are two kinds to juicing. The traditional process of juicing involves extracting juice from fruits and vegetables (cold-pressed juice). The result of this procedure is a concentrated natural juice. There is no way we can eat half a kilo of carrots, an apple, a one-inch piece of raw ginger, and a full lemon right now. Juicing it, concentrates all those nutrients and helps to obtain a lot in a short amount of time. That is a huge advantage of juicing. So let me address the disadvantage: we lose fiber, which makes you feel full and aids in digestion. The alternative way of juicing, known as full juicing, is mixing fruits and vegetables in a high-powered blender. So, the advantage here is that you absolutely get the fiber. But because you’re receiving fiber, you’ll fill up faster, so the nourishment won’t be as concentrated and you still can’t eat half a kilo of carrots at a time.
Concentrated juicing is like taking a multivitamin. It’s like a supercharged vitamin and mineral smack in the face. Juicing is thus more of a snack or a healthy supplement to a meal. Whatever method a juicer employs, we must be cautious and conscious of how much sugar we consume. When we solely use fruits, the concentration might be fairly high. As a dietitian, I would recommend that beginners aim for a 50/50 fruit/vegetable ratio. If you enjoy the taste, consider increasing the vegetables and decreasing the fruit to regulate the sweetness.  Juicing may be done by anybody, but it needs time and planning. It is also important to note that juices are not a substitute for eating fruits and vegetables. There is no such thing as a substitute. Juices provide hydration as well as abundant amounts of vitamins, minerals, and antioxidants. Both juices and smoothies contain extracts from vegetables and fruits. They are a great addition to your meals, especially if you are trying to go on a healthy diet. The difference between juice and smoothie is the presence of fibre. Juicing process filters out the pulp of vegetables or fruits while making smoothies involve blending the whole fruit/vegetable. When you blend your fruits and vegetables into a smoothie, you need to keep in mind that whatever you put in your blender ends up in your body. Smoothies blend these items and deliver the same nutrients that are in juice, but they keep the added fiber content of the produce that was used, as well as any added nutrients you use, such as milk, yogurt, or nut butters. Some of the greatest fresh juices are the most straightforward. Apples, celery, pineapple, cucumber, melon, spinach, kale, ginger, melon, and carrots are some of the greatest foods for juicing, ranging from fruit mixes to green beverages. We should also try to mix them with superfoods such as turmeric, pepper, ginger, lemon etc. A lot of people tend to add too much sugar to their smoothies, offsetting any health benefit of the smoothie. Leave it out from added sugars, preservatives, or colourants, so you can enjoy a natural drink whenever you want. Make it fresh and consume it.

By Beenish Zohra, Dietitian and clinical nutritionist, Research Scholar (Dietitics and Nutrition), Certified Diabetes Educator. She can be reached out at [email protected]

By: Dr Farooq Ahmad Ganie
Assistant Professor Department of Cardiovascular and Thoracic Surgery SKIMS SOURA.

Cold  weather is one of  the most common risk factor you encounter in the winter which can impact your health  specifically your heart in many ways. Heart attacks are more common in winter There are several theories why heart attacks increase in winter.The main risk factor is biological: The cold causes blood vessels to contract, which can raise blood pressure, increasing the risk of heart attack and stroke. Angina, or chest pain due to coronary heart disease, can also worsen in winter when coronary arteries constrict in the cold. Furthermore, your heart has to work extra hard to maintain a healthy body temperature, and winter wind can make this even more difficult because it causes the body to lose heat more quickly. If your body temperature drops  below 95 F (35 C ) hypothermia can damage the heart muscle,Lifestyle changes, particularly physical activity, can impact your risk as well., temperature, physical activity and emotional stress can contribute to an increased risk for heart attack during the winter. However, you can take extra precautions by following a few strategic tips Dress for the weather,Wear layers and especially wear hats, gloves and heavy socks. Give yourself breaks to warm up if you’re spending time outside in the cold.Wash your hands frequently. Respiratory infections can increase the risk of heart attack. Get help. If you have new symptoms of a heart condition, don’t delay getting help,

By: Dr Farooq Ahmad Ganie  Assistant Professor Department of Cardiovascular and Thoracic Surgery SKIMS SOURA.

Where is the aorta?

The aorta runs throughout your torso. It begins at the main pumping chamber of your heart (the left ventricle), extends up through the front middle of your chest, arches from front to back under the base of your neck, then travels downward along the front of your spine — through your chest (thoracic aorta) and abdomen (abdominal aorta) — before branching just below your navel to two other arteries called the right and left common iliac arteries. Your aorta is the main artery that delivers oxygen- and nutrient-rich blood from your heart to the rest of your body. The wall of your aorta is made up of three tissue layers — an inner layer (intima), middle layer (media) and outer layer (adventitia).

What is aortic dissection? 

Aorta dissection is a tear in the inner layer of a weakened area of your aorta. An aortic dissection begins abruptly when a tear occurs in the inner layer of a weakened area of your aorta. Blood surges through the tear, causing the inner and middle layers to separate (“dissect”). As diverted blood flows between the tissue layers, the normal blood flow to parts of your body may be slowed or stopped, or the aorta may rupture completely. Aortic dissection is a life-threatening condition that can cause sudden death if it is not recognized and quickly treated. Treatment includes several types of surgeries  and medication

Different types of aortic dissection?

There are two main types:

Stanford Type A Aortic Dissection: This type of dissection occurs in the first part of the aorta, closer to the heart, and can be immediately life-threatening. It usually requires emergency  surgery to repair or replace the first segment of the aorta where the tear started (ascending aorta +/- the arch and/or aortic valve).

Stanford Type B Aortic Dissection: This type of tear begins farther down the aorta (descending aorta beyond the arch), and farther from the heart. Like the type A dissection, this usually extends from the descending aorta into the abdominal segment (abdominal aorta), but doesn’t involve the first part of the aorta in the front of the chest. Surgery may or may not be needed immediately, depending on exactly where the dissection is located and if it is or isn’t cutting off blood flow to your organs. These operations usually can be performed with a stent-graft device inserted into the aorta.
Another classification system (DeBakey Classification) defines dissection by three types. Type 1 originates in the ascending aorta and extends through the downstream aorta. Type 2 originates and is limited to the ascending aorta (both would be considered Stanford Type A). Type 3 originates in the descending aorta and extends downward (similar to Type B).
What are the signs and symptoms of aortic dissection?
The most common characteristic  signs and symptoms  of aortic dissection is its abrupt start. It can happen at any time, while doing anything, or at rest or when you’re sleeping.
Common signs and symptoms include:
Sudden severe, sharp pain in your chest or upper back, also described as a tearing, stabbing or ripping feeling,Shortness of breath,Fainting or dizziness,Low blood pressure,Rapid weak pulse,Heavy sweating,Confusion,Loss of vision,Stroke symptoms, including weakness or paralysis on one side of your body, trouble talking. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. If you have any of the above symptoms  of aortic dissection seek emergency care.
What causes aortic dissection? Aortic dissection happens because there is an underlying, slow breakdown of the cells that make up the walls of your aorta. The breakdown has likely been going on silently for many years before the weakened area of the aortic wall finally gives way, resulting in a tear, which leads to the aortic dissection.
Why does the aortic wall weaken in some people and not others? It’s believed that most aortic dissections are caused by an underlying vulnerability that may be inherited. In others, the stress to the aortic wall from constant high blood pressure can weaken the aorta wall in susceptible people, resulting in a tear and dissection.
Aortic dissection in the ascending aorta (the section closest to the heart where the pressure is the highest) is nearly two times more common than those that occur in the descending aorta. Tears in the aorta typically occur in areas where the stress on the wall of the aorta is highest.

What factors can increase the risk of developing aortic dissection?
Factors that can increase your risk for developing aortic dissection include,Ongoing High blood pressure  (hypertension). This is the most important risk factor. High blood pressure causes direct damage to the layers of aortic tissue, causing loss of elastic fibers, breakdown of the wall structure and increased wall stiffness.Atherosclerosis (or buildup of plaque in the arteries)/high cholesterol and smoking, Aortic aneurysm. This is an abnormal enlargement or bulge in the aortic wall,Aortic valve disease.Congenital (“born with”) heart conditions like a bicuspid aortic valve  (has two leaflets instead of the normal three) Connective tissue disorders, such as Marfan syndrome and Ehlers –Danlos syndrome . These are genetically linked problems that can be passed down to family members.Other hereditary thoracic aortic conditions that primarily affect the aorta that are also genetically caused,Family history of aortic dissection, Vasculitis specifically aortitis. This inflammatory disease affects the body’s blood vessels,Traumatic injury to the chest (e.g., after a high-speed car crash or serious fall from a height of > 20 feet),Age between 50 and 65 years. The aortic wall loses its elasticity with age, Being pregnant and having high blood pressure during delivery,Activities that extend periods of high blood pressure, such as cocaine or amphetamine use, Strenuous powerlifting may increase the speed of development of aneurysms or dissection in susceptible people.
Cold weather and aortic rupture or dissection:
Several studies have reported a seasonal variation in the incidence of in aortic rupture or dissection, the incidence of aortic dissection and rapture were found to be higher in winter time than in summer, The underlying cause is unknown, but hypertension and tobacco smoking are predisposing factors to aortic aneurysm rupture. Exposure to tobacco smoke is known to be greater indoors in cold weather and there is a winter peak of blood pressure in hypertensive patients. A relatively high positive correlation was found between the incidence of acute aortic dissection and the mean atmospheric pressure in some of the studies. Winter is also characterized by pro-thrombotic state. Fibrinogen levels demonstrate wide seasonal variation, increasing up to 23% during the colder months. Moreover, activation of the sympathetic nervous system and secretion of catecholamine are increased in response to cold temperatures. This could result in an increase in blood pressure through increased heart rate and peripheral vascular resistance. This enhances the forces that act to produce wall deformation, and increase friction and shear stress on the internal surface. The consequent vascular damage may progress, culminating in arterial dissection and rupture of the aorta
Can aortic dissection be prevented?
Many of the factors that increase the risk of developing aortic dissection can’t be changed, such as being born with certain heart conditions, connective tissue disorders, or genetic triggers associated with having a family history of aortic dissection. However, like many other medical diseases and conditions, you can decrease some of your risks by changing the risk factors that can be modified. These risks include:
Lowering high blood pressure to the goal of 120/80 mm/Hg with medication, dietary changes and other measures recommended by your healthcare provider,Quitting smoking/using tobacco products and maintaining a healthy weight, Wearing your seat belt to prevent injury to your chest in case of an accident.Seeing your provider for regularly scheduled check-ups and any other times you experience a change in your health.It’s important for first-degree relatives of a person who has had an aortic dissection to be screened for their risk of aortic disease. They can be closely followed and treated before an aortic event occurs.

Being physically active is one of the best things you can do for your heart.
Regular exercise helps reduce your risk for heart disease and adds years to your life. You do not need to spend hours in the gym every day to see benefits. Moving your body just 30 minutes a day is enough to improve your heart health.Exercise helps your heart in several ways. This can help you lose extra pounds (kilograms) or stay at a healthy weight. Being overweight is a major risk factor for heart disease.
Doing some type of moderate aerobic exercise, for 30 to 60 minutes on most days of the week, can help lower blood pressure. Regular exercise is a proven stress buster. Experts are not sure if stress plays a direct role in heart disease. But it may contribute to other risk factors.Exercise can lower your LDL (“bad” cholesterol level). A high LDL level is a major risk factor for heart disease.

Dr Farooq Ahmad ganie (Assistant professor department Of cardiovascular and thoracic surgery SKIMS SOURA)

MUBAIRAH JAN

The Prophet Muhammad(صلى الله عليه وسلم) said, ”The best wedding is that upon which the least trouble and expense Is bestowed” (Mishkat). How many of us have seen people or themselves following the narrated Hadith? Every now and then we come across a majority of weddings where people spend their whole life’s earnings only to impress the society and just to compete with each other. As has been almost everyone’s experience, we in Kashmir want to get everything done royally without keeping in mind that there are different types of people living in the society. We forget the fact that if we can easily afford the things, the other people living around may not. By giving a go-bye to the lesser privileged families, we just are creating a social stigma for such families once they fail to exhibit lavishness in their wedding ceremonies.
In every wedding lakhs are being spent on unnecessary things. Such fashions and trends have been included in weddings that can’t be afforded by a normal person and were unheard of some years ago. We frequently get to read about the suicidal cases that are being attempted by girls and guardians of the girls. Is this fair? Do we need to think and rethink about the same? These expenses may be as easy as pie for a rich person but at the same time it can be a cause of death for a poor person. We as society need to change this system as a whole and we as educated fellows need to change the mindset of those people who think that by making all these expenses they are doing no good to the society. This month I attended a wedding of a close relative and I saw so many unnecessary things that I outrightly felt should have not been done. I saw costly dry fruit boxes, which made me think whether such a thing was needed and at the same time made me think whether a normal fellow in the society can afford it at all. Similarly I saw the bride taking gifts with her inlaw’s house which were too expensive and nonetheless given the ongoing trend, the marriage thing will be more difficult for the people with lesser means and resources. Wazwan is known to everyone and happens to be a part of our tradition. Preparing cuisine for relatives and friends is not bad but the evil starts at the time when more and more things are added in it like expensive crockery, new dishes and like things, just to show-off one’s wealth. Same is the case with Wardan (clothing for bride and groom). I want everyone to think and rethink about such things. For me, if this huge amount of money that’s being spent on weddings for unnecessary things would be rather spent for many other noble causes, a better nation can be built. If we donate this money or a part of it, no one would be poor in Kashmir. How can we then expect an incredible Kashmir in return Kashmir when lakhs of rupees are spent on decorations only. Before summarising, I am here giving you a brief summary about Islamic wedding. The actual Islamic wedding is known as NIKKAH. It is supposed to be a simple ceremony, at which the bride does not have to be present as long as she sends two witnesses to the drawn up agreement . Normally ,the ceremony consists of reading from the Quran ,and the exchange of vows in front of witnesses for both partners. And has been enshrined in Ahadith, this ceremony should be normally conducted in a masjid. If everyone will follow this kind of methodology for weddings, a better society can be witnessed. We all need to realize that the Sunnah made by Allah and followed by our Prophet Muhammad (SAW) should be performed in the manner as we have been told to. We need to share this message with the whole of Ummah .Let us maintain the beauty of a simple Nikkah and set an example for everyone .Let us marry our children with as much humbleness as our Prophet (PBUH) did. If somebody has to take an initiative ,then why not
I, we and you?

MUBAIRAH JAN

It’s always said that a woman is
the main pillar of a family. She is
always considered as the main in
gredient in the dish called home.

An African proverb reads; “If we educate a man we only educate a person, but if we educate a woman, we educate a whole nation.” We see so many of us working in NGO’S for Women Empowerment.

There are hundreds of institutions running for women empowerment with the number only increasing with the
passage of time. We also know that by all these efforts women have achieved a good position in society by such initiatives. And nowadays women are no less
than men in any field and are playing
their roles in a better way, however in contemporary times recognized for hightech and digitization, do we bother about the women in remote and far-flung areas, where there is scarcity of every ease that
is enjoyed by the people of forward areas.

For me a far-flung woman should enjoy the same comforts as are enjoyed by any
other woman in the modern world. While visiting a remote village of Rajwar in frontier Kupwara district, I witnessed a lot of problems the women
face. Everyone on a humanitarian basis should take steps to change their lives,
be in education, health, lifestyle and such other things.
While I was trekking, I met a beautiful soul namely Rehana, a girl about
22-years-old. On talking to her I came to
know about many miseries that they are going through, of which I am going to share some.They don’t have basic facilities like schooling in their early age, they lack hygienic environment, health facilities. Trust me she, at the age of 22, didn’t knew of sanitary pads. On listening to
her I was like, ‘in this modern era how someone can be so unaware about the basic things.’ I felt so bad as how people are
oblivious of the plight faced by the people living in such far-flung and remote areas! No doubt the Government has taken many steps to benefit the female gender including the ‘Beti Bachao, Beti Pad
hao’ scheme, even as Rajouri district administration, having organised ‘Mahila Shakti Kendra’ awareness programme
for tribal women and SHGs and such other steps to reach out to the women, however it takes something more and big
to redress the needs of these vulnerable souls. In such areas girls are deprived of education rather to say this thing is not
even remotely discussed. For the majority like me, girl education is of utmost
importance to set the wheels of a nation into motion.
People from far flung areas believe in early marriages even as patriarchy is something seen too common. There are
many more things that are socially misconstrued in such places. We as the people from fairly advanced areas need to
rise upto the occasion to generate awareness as to see an end to the problems
faced by these people especially women.
Awareness camps about girl education, no early marriages, more power to women folk must be prioritized in order to change the minds of these for a better
tomorrow.
I must reiterate, women empowerment is a must! The need to accept women’s viewpoints or make an effort to seek them, raise the status of women through education, amplify women’s voices and
ideas, mentor girls and women, give women opportunities, remove gender bias, help bridge the wage gap are issues that need immediate attention.
One would say women empowerment in not only required in far flung areas but it has to be inclusive for the
development and advancement of family system, for community and the nation in general. Hence it must be a leading concern of the Government to bring women into the force of the development strategy by empowering them via numerous development oriented schemes.

Dr Farooq Ahmad Ganie (Assistant Professor Department of Cardiovascular and Thoracic Surgery Skims Soura)

Varicose veins are swollen and enlarged veins. They are often blue or dark purple and lumpy, bulging, and twisted in appearance. They occur on the legs and feet. Not all varicose veins bulge to the surface; sometimes they can be invisible and buried deep in the tissueTherefore, some people experience pain and discomfort for a long time before discovering the cause it happens when the valves in the veins do not work properly, so the blood does not flow effectively The exact pathophysiology is debated, but it involves a genetic predisposition, incompetent valves, weakened vascular walls, and increased intravenous pressure. Risk factors include family history of venous disease; female sex; older age; chronically increased intra-abdominal pressure due to obesity, pregnancy, chronic constipation, or a tumor; and prolonged standing. Symptoms of varicose veins include a heavy, achy feeling and an itching or burning sensation; these symptoms worsen with prolonged standing. Potential complications include infection, leg ulcers, stasis changes, and thrombosis.( blood clot in veins). In severe cases, a varicose vein may rupture, or develop into varicose ulcers
Diagnosis: To diagnose varicose veins, your doctor will do a physical exam, including looking at your legs while you’re standing to check for swelling. Your doctor may also ask you to describe any pain and aching in your legs.You also may need an ultrasound test to see if the valves in your veins are functioning normally or if there’s any evidence of a blood clot. In this noninvasive test, a doctor runs a small hand-held device (transducer), about the size of a bar of soap, against your skin over the area of your body being examined. The transducer transmits images of the veins in your legs to a monitor, so a doctor can see them.
The veins need treatment if there is swelling, aching, painful legs , venous ulcer and if there is considerable discomfort,or varicose ulcers
Treatment: Conservative treatment options include external compression; lifestyle modifications, such as avoidance of prolonged standing and straining, exercise, wearing nonrestrictive clothing, modification of cardiovascular risk factors, and interventions to reduce peripheral edema; elevation of the affected leg; weight loss;
Self-care — such as exercising, losing weight, not wearing tight clothes, elevating your legs, and avoiding long periods of standing or sitting — can ease pain and prevent varicose veins from getting worse
Compression stockings: Wearing compression stockings all day is often the first approach to try before moving on to other treatments. They steadily squeeze your legs, helping veins and leg muscles move blood more efficiently. The amount of compression varies by type and brand. You can buy compression stockings at most pharmacies and medical supply stores Or online.
treatments for more-severe varicose veins remains surgical: Although open surgery was once the standard of care, it largely has been replaced by endovenous thermal ablation, which can be performed under local anesthesia and may have better outcomes and fewer complications than other treatments
Fortunately, now the surgical treatment usually doesn’t mean a hospital stay or a long, uncomfortable recovery. Thanks to less invasive procedures, varicose veins are generally being treated on an outpatient basis which is quite routine in our department at SKIMS
If you don’t respond to self-care or compression stockings, or if your condition is more severe, your doctor may suggest one of these varicose vein treatments:
Sclerotherapy. In this procedure, your doctor injects small- and medium-sized varicose veins with a solution or foam that scars and closes those veins. In a few weeks, treated varicose veins should fade.Although the same vein may need to be injected more than once, sclerotherapy is effective if done correctly. Sclerotherapy doesn’t require anesthesia and can be done in your doctor’s office.
Laser treatment. in laser treatments to close off smaller varicose veins and spider veins. Laser treatment works by sending strong bursts of light onto the vein, which makes the vein slowly fade and disappear. No incisions or needles are used.
Catheter-assisted procedures using radiofrequency energy. Endovenous Radio-Frequency Ablation (RFA) is a useful treatment modality for varicose vein disease primarily due to great saphenous insufficiency with marked symptomatic improvement and least recurrence.The post operative recovery is quick with a high patient acceptance. In RFA The doctor inserts a thin tube (catheter) into an enlarged vein and heats the tip of the catheter using either radiofrequency or laser energy. As the catheter is pulled out, the heat destroys the vein by causing it to collapse and seal shut. This procedure is the preferred treatment for larger varicose veins.
High ligation and vein stripping. This procedure involves tying off a vein before it joins a deep vein and removing the vein through small incisions. This is an in patient procedure for most people. Removing the vein won’t keep blood from circulating in your leg because veins deeper in the leg take care of the larger volumes of blood.
Ambulatory phlebectomy:Your doctor removes smaller varicose veins through a series of tiny skin punctures. Only the parts of your leg that are being pricked are numbed in this outpatient procedure. Scarring is generally minimal.
Endoscopic vein surgery. You might need this operation only in an advanced case involving leg ulcers if other techniques fail. Your surgeon uses a thin video camera inserted in your leg to visualize and close varicose veins and then removes the veins through small incisions.
Varicose veins are very common part of pregnancy for some women usually harmless ,They happen when the uterus applies pressure to the large vein (the inferior vena cava) that carries blood back to the heart from your feet and legs. The heavy weight of the growing baby, which presses on the large blood vessels in the pelvis, altering blood flow and impairs venous return Varicose veins that develop during pregnancy generally improve without medical treatment within three to 12 months after delivery however if these veins continue after delivery for more then a year patient may need surgical treatment.

Covid -19 A severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak has been declared a Public Health Emergency by WHO since January 2020. The rapid, exponential, increase in cases makes prevention and control of coronavirus disease (COVID-19) extremely critical. Although clinical manifestations of COVID-19 are mainly respiratory, however patients may develop severe cardiovascular damage which may lead to fatal outcome,the impact of COVID-19 on cardiac surgery have been immense . Cardiac surgery practice might not be on the frontline of COVID-19 patient care. However, the pandemic affects cardiac surgery units in important ways like limited intensive care unit (ICU) beds and ventilation sites, necessity to postpone elective and/or complex cardiac surgeries, shortage of health care workers, sick health care staff, restrictions in clinical cardio-surgical meetings ( limiting the number of attendees in cardio-surgical meetings), patients developing COVID-19 after cardiac surgery, patients with COVID-19 needing urgent cardiac operations, and cancelation of training and education, professional conferences, exams, courses. Due to all thes factors the cardiac surgery has been badly touched, As cardiac surgeons, we have a responsibility to ensure that evidence-based, essential cardiac operations are provided to the general public at prsent health care crisis time but at the same time the wider burden of those procedures on the healthcare system and health care workers must be minimized of COVID-19 to do away with the crisis.

As COVID-19 puts health services and health care providers under immense mental and pysical pressure. While decisions on whether or not to perform cardiac surgery is not always easy with continued escalation of dissease burden the decisions on cardiac surgeries became more difficult with many dilemmas Should we operate in this escalating phase only on younger, low risk patients or only extrem emergencie it is very important when these decisions are made, both the decision process and the decision made has to be documented and should with stand with medicolegal aspect too. At the same time the surgeon while taking the descision must consider the risk of exposing these patients to a possible COVID-19 infection during hospitalization and/or exposing himself and other health care workers to infection. We must bear in mind that Most patients with COVID-19 have mild or no symptoms and therefore, it may be difficult to identify such patients. One must realize that cardiac surgery units have a responsibility to the patient, in a particular state. Therefore, in this hard times , patients with elective cardiac procedures may be best managed by delaying their care until a few months or year . This may be in the patient`s best interest,and in the intrest of health care provider . as It has been proved that patients with acute cardiac pathologies who are infected with SARS-CoV-2 often have a poor prognosis . Therefore, developing COVID-19 after cardiac surgery might be associated with a high mortality
But there is a certain group of patients like patients with acute coronary syndrome in case of severe coronary artery disease (e.g. severe left main trunk stenosis, severe triple vessel disease with high SYNTAX score) who are not eligible for conservative or interventional treatment may be operated on. This may be true also for younger patients with symptomatic severe aortic valve stenosis, left-sided endocarditis with a severe valve defect and/or large mobile vegetation, large ascending aortic aneurysm, acute type A aortic dissection and acute heart failure due to severe coronary artery or valvular heart disease, Under such circumstances decisions should be made depending on available resources and supported by an ethical and legal framework. what should be done and what should be avoided remains still un answered. how can we protect the patient and health care workers.It is crucial to provide a thoughtful decision making process on whether or not a cardiac surgery should be performed. Decisions made today may be different from those made only a few days later under these rapidly changing circumstances. One must weigh the risk of delaying surgical care with the risk of exposing the patient to COVID-19.
The COVID‐19 pandemic has affected health care system with uncertainty of decisions Massive and large scale research is need of hour to understand to develop preventive treatments, and establish management protocols in cardiac surgery patients through such period.

Dr Farooq Ahmad Ganie
Assistant Professor Department of Cardiovascular and Thoracic Surgery Skims Soura.

It is requisite that all patients who have under gone open heart surgery should receive the COVID-19 vaccine. The vaccine does not necessarily prevent you from catching the COVID-19 infection, but it will reduce the likelihood of serious illness which may require hospital admission, and could result in poor outcome .

People who have undergone open heart surgery may be at increased risk of dying from COVID-19 infection , because the infection places stress on the heart through diverse mechanisms, including direct inflammation of the heart and dysfunction of valves . Therefore, it is essential that all these patients to go for vaccination as soon as possiable. The COVID-19 vaccine trials included patients with post open heart surgeries did not demonstrate any serious effects from the vaccine in such patients.

The most common complaints with this vaccine is pain at the injection site, tiredness, headache, muscle pain or chills. The arm may be stiff and painful for a couple of days. Fatigue and chills are secondary to the effects of the immune ssystem recognising the viral proteins as foreign.

It does not mean that the vaccine has resulted in COVID-19 infection. It is possible that, during the second shot of vaccine when the immune response to the vaccine is likely to be more exaggerated, patients who take anticoagulant medications such as warfarin or Some patients who take combined anti-platelet drugs such as aspirin, clopidogrel, ticagrelor or prasugrel.

Such patients are at an increased risk of bleeding after trauma, including a needle inserted into the arm muscle during COVID-19 vaccination. It is anticipated that the risk of bruising or swelling around the injection site will be slightly increased in these patients.

A fine needle (23 or 25 gauge) should be used for the vaccination, followed by firm pressure applied to the site without rubbing for at least two minutes. And is important that The patient should be informed about the risk of haematoma from the injection.

Patients who are on anticoagulants like warfarin, are up to date with scheduled INR testing and with their INR (not more then 2.5 ) below the upper level of the therapeutic range can receive intramuscular vaccination, usually patients do not need to interrupt their anticoagulant before getting the vaccine,it has been shown that intramuscular flu shots in patients who are on full dose of anticoagulants do not increased the risk for bleeding at the site of the injection ,similarly it is predictable that the risk of significant bleeding at the site of injection is also not increased in open heart patients who are on anticoagulants.There is currently no evidence to suggest that patients who have undergone open heart surgery have any contraindication for the vaccine.

Farooq Ahmad Ganie Assistant Professor Department of Cardiovascular and Thoracic Surgery Skims Soura.