Q My family member has Hepatitis C virus. Kindly tell me about the best treatment available for this disease in Karachi.
A Your family member would require a proper investigations to determine the stage of his/her disease. The treatment for chronic hepatitis is interferon injections three times a week and tablet Ribavarine daily for six to twelve months, depending on the Hepatitis C genotype. Most patients in Pakistan are infected with Hepatitis C genotype 3, which requires treatment for six months and has the best response rate to treatment. All medications for chronic Hepatitis C are easily available in Pakistan, including pegylated interferon injections, which has the advantage of being given only once a week.
Dr Jamila H. Esmail
Liaquat National Hospital
Q Can you explain to me what frozen shoulder is, and what I can do to get rid of it? Will it ever come back again?
A Frozen shoulder is misnomer and most of time two conditions (rotator cuff tendonitis/bursitis and adhesive capsulitis) are confused together. Actually, frozen shoulder is adhesive capsulitis, in which the genohumeral joint, the main component of shoulder joint becomes stiff due to fibrosis or thickening of joint capsule. The joint capsule is a membrane, which surround the joint to provide stability and allow the free motion at the joint. If this capsule becomes thick and shortened due to various reasons/idiopathic, the free motion of joint will be affected. In this condition the following symptoms can be observed: Pain; Stiffness of shoulder and inability to lift the arm; The arm cannot be lifted beyond 50-60 degree.
This frozen shoulder (adhesive capsulitis) is mostly confused with rotator cuff tendonitis/bursitis. In rotator cuff tendonitis/bursitis, there is inflammation of bursa (a membrane secreting lubricant fluid to facilitate tendon motion) around the rotator cuff tendons. These tendons help in the motion of shoulder. The various motions of shoulder are elevation over the head, rotation like bringing the hand up to mouth, over the head, back of head, touching the opposite shoulder and low back. Due to the rotator cuff tendonitis, the above mentioned movements are affected and patients usually complain of pain around the shoulder and in the arm, which increases during the night and with elevation of hand above and over the head.
The above mentioned two conditions are often confused by the patient and physician as well. So my advice would be to see an orthopaedic surgeon and seek proper advice. Frozen shoulder needs extensive physiotherapy, anti-inflammatory drugs and may require manipulation under anaesthesia. It may take six to nine months to improve
On the other hand, rotator cuff tendonitis requires home-based exercises, hydrotherapy, physiotherapy and anti-inflammatory drugs and it takes three to four months to recover. Both conditions can recur.
Dr Pervaiz Hashmi
Aga Khan University Hospital
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Q My family member has Hepatitis C virus. Kindly tell me about the best treatment available for this disease in Karachi.
