Medgate Today Magazine - Mar-Apr 2015

The Gateway to Health & Medical World

Volume V || Issue VI || March-April 2015

News Update | Doctor Speak | Expert Views | Product Line | Industry Watch | Healthcare Management

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The Union Budget 2015-16 is a breakthrough budget. The healthcare industry has welcomed Budget proposals to increase tax exemption limits for health insurance cover and set up more AIIMS across India, saying such moves enable people’s access to better facilities. The provision to set up 5 new medical colleges along the lines of the AIIMS will go towards bridging the talent gap for qualified healthcare professionals in the entire country. The above step will be useful in dealing with the shortage of qualified manpower in India. This will also boost patient care in India. Increasing the tax exemption on health insurance cover will increase access to healthcare. Increase in visas on arrival facility to 150 countries will give a boost to medical tourism in the country.

Potential Health care industry is the world’s largest industry with total revenues of approx US$ 2.8 Trillion. In India as well, health care has emerged as one of the largest sector with maximum expenditure incurred. An astounding 60% of this is out of pocket expense. India has one of the highest proportions of private health spending, comparable only to a only few countries in the world with a recent history of major internal unrest, such as Cambodia and Myanmar. Such is the lack of trust in the public health system that not only do 80% of the wealthy seek treatment in the private sector, but a similar percentage of the poor also goes to private practitioners, even though the treatment may be of low quality and provided by untrained practitioners Some unfortunate statistics reflect this state of affairs:

To move towards the vision of a healthy India, hygiene and cleanliness programmes have been accorded priority and contributions towards the Swachh Bharat Fund have been made tax exempt.

Have an insightful reading.Your suggestions are most welcome!E-mail: [email protected]: w w w . m e d g a t e t o d a y . c o m

Dr Pradeep BhardwajEditor-in-Chief

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afzal Kamal

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amjad Kamal, SY ahmed Khan, Ranjit Shirsath Deepti Tripathi, Nizamuddin alam

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Volume - V Issue - VI Mar.-April 2015

magazine

Union Health Care Budget 2015-16“Finance Minister Arun Jaitley allocated Rs 33,150

crore for the Healthcare Sector”.

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UpdateNEWSContents

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NEWS

Conference on ‘PHD Manufacturing Signature Series 2015 8Doctors at Fortis Escorts Heart Institute bid affectionate send-off to 16 year old Prince, 12Amitabh Bachchan Inaugurates Latest Technology in Eye Surgery 14Spinal Cord Injuries (SCI) on the Rise 16Ministry of Health & Family Welfare, Government of India Launches 18

EXPERT VIEWS

SMOKING AND CARDIAC SURGERY 44Health Benefits of Walking 45Parenting tips for IVF children 48Sudden Cardiac Arrest: How to prevent it. 50

INTER VIEW Cardiac Arrhythmia, its Sign & Symptom? 52

DOCTOR SPEAK

Liposuction: It a Procedure to Remove Stubborn Fat, Not For Weight Loss 54Swine Flu CanAttack Children too 56Glaucoma the silent killer of Sight 58DENTAL SECTION

Smoking & Oral Health 60

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Swine Flu can prompt Sudden Heart Attack

Medical Devices Industry in India : An overview

Healthcare Budget Reaction from Healthcare Experts Kidney Transplant: Blood groupmatching no more a Barriers

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Swine Flu CanAttack Children too

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UpdateNEWS

PHD Chamber organized a Conference on ‘PHD manufacturing Signature Series 2015- Zed Effect’ on 19th February 2015 at PHD House, New Delhi which

was inaugurated by Shri Narendra Singh Tomar, Hon’ble Union Minister of Steel and Mines, Govt. of India.Mr. Alok B Shriram, Senior Vice President, PHD Chamber while welcoming Shri Narendra Singh Tomar Highlighted that India’s manufacturing sector could reach USD 1 trillion by 2025. This could be achieved on the back of the continually growing demand in the country and the inclination of multinational corporations to establish low-cost plants in India. Up to 90 million domestic jobs could be created by 2025, with the manufacturing sector contributing to about 25–30 per cent of India’s gross domestic product (GDP).

According to World Bank estimates, simply halving the delays due to road blocks, tolls and other stoppages could cut freight times by some 20-30 percent and logistics costs by an even higher 30-40 percent. This alone can go a long way in boosting the competitiveness of India’s key manufacturing sectors by 3 to 4 percent of net sales, thereby helping India return to a high growth trajectory and enabling large scale job creation, he added.

He emphasized that steel is the core sector for development of any economy.Hoping to benefit from the 'Make in India' programme, all steel producers would look to expand their capacity to about 100 - 110 million tonnes per annum. Currently the total output stood at above 83.2 million tonnes in the year 2014, cementing India's position as the fourth-largest steel producer for fifth year now in a row. The sector is also looking to benefit from the fall in iron ore prices to five-year low levels, as also from the declining coking coal prices.Mr. Anil Khaitan, Chairman, Industry Affairs Committee, PHD Chamber while felicitating the Chief Guest and participants said Studies conducted on the manufacturing industry have concluded that India has a working

population of 75%. Out of this, only 600 million have acquired education till middle school. Due to this reason, the manufacturing industry in India , which is labor intensive, can provide the requisite number of employment units in the country. Studies have indicated that the productivity of the manufacturing industry in India is approximately 1/5th of the productivity in the manufacturing industry of United States Of America. It is about ½ as compared to the productivity levels in South Korea as well as Taiwan.Sources estimates that the higher input costs for the Indian manufacturing sector as a result of cascading effect of indirect taxes on selling prices of commodities, higher cost of utilities like power, railway transport, water, higher cost of finance and high transactions costs puts the sector at a severe disadvantage as compared to its Asian counterparts, he added.Mr. Naveen Jindal, Chairman, Jindal Steel and Power Ltd demanded transparent policies from the government for all sectors including Steel, Coal and Mines so that no ambiguity prevails and business is conducted with ease and fairly.Mr. Jindal said that the scarcity of Non Cooking coal and Iron ore is the major concern for the steel sector. India has more than 200 coal blocks but only 30 coal blocks has been started so far. At the time of independence, India and China were producing the same volume of steel whereas now China is producing 822 MT and India could be able to touch at appx.85 MT. Government should take imperative steps to

Conference on ‘PHD Manufacturing Signature Series 2015-Zed Effect’ held on 19th February 2015 at PHD House, New Delhi.

www.steelcospa.com • [email protected] India: [email protected] • Mobile: +91 98111 83839

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UpdateNEWS

Doctors at Fortis Escorts Heart Institute (FEHI), India’s leading cardiac care facility, said that 16 year old Prince is in good health and ready to go back to his hometown toresume a normal life following the successful Heart Transplant Surgery conducted on January 3, 2015, under the guidance and leadership of Dr Ashok Seth, Chairman, Fortis Escorts Heart Institute. The surgery was conducted by Dr Z S Meharwal, Director of Cardiac Surgery along with Dr Yugal Mishra, Director of Cardiac Surgery, Dr Anil Karlekar, Director of Anesthesia,Dr Sameer Shrivastava, Director of Non-Invasive Cardiology and Dr Vishal Rastogi, Head of Heart Failure Program,who took care of the patient during procedure and his recovery.

Prince was suffering from a condition called Idiopathic Dilated Cardio Myopathy, an end stage heart disease with a poor heart function, and an LV ejection fraction of 15%. He had been consulting FEHI for treatment of this disease and was advised heart transplantation when he came two months ago with symptoms of severe breathlessness.

The donor of Prince’s heart was a 30 year old IT professional whose family, based in Hyderabad took a noble decision to donate his organs and save six valuable lives, upon being declared brain dead by a team of doctors at FMRI, on January 3, at 8:48 am.

Dr. Ashok Seth, Chairman, Fortis Escorts Heart Institute, said,” It is heartening to see Prince’s progress since his surgery a fortnight ago. He has made an uncomplicated recovery. He wants to go cycling throughout the day and is looking forward to playing with his friends. There are approximately 46 lakh patients who suffer from heart failure in India and 10% of these die every year. Seeing Prince’s recovery gives hope to many people in the country whose future can be changed by a meticulous team work of specialists at Institute’s such as ours,who have made this recovery possible in a total sterile environment to avoid infection and organ rejection.We aim to expand this collaboration to airlift donor hearts from other cities for transplantation at FEHI, to bridge the availability factor.”

Post-surgery, a rehabilitation team assisted the patient to get back to normalcy. The process includes counseling, education and exercise training to help build muscles that keep the recovery ongoing. The rehabilitation starts from sitting up, graduates to taking a few steps and subsequently slowly increases the activity level of the patient.

Dr ZS Meharwal, Director and Coordinator, Cardiovascular Surgery, FEHI and Chief Operating Surgeon for the case,said, “We are delighted to see Prince’s recovery and wish him all the best as he starts a normal lifeincluding going back to his daily routine of resuming school activities and playing. His first endomyocardial biopsy was conducted before discharge and he is absolutely fine with no signs of rejection. He will

continue to be on immuno suppressants and would need to be back for regular check-ups.He needs to take adequate precautions to prevent infection.”

Added Dr Meharwal, “With recent advances in surgical techniques and improved medical management of organ rejection after transplantation, patients can now hope for an increasingly faster recovery after heart transplantation. The new heart is supported with intravenous medications for about 1-2 days until it recovers from the “shock” of the transplant but the patient immediately feels the difference a healthy heart makes. As the immune system gets activated immediately after the heart is transplanted, the patient is given medications to prevent rejection, both before the transplant, and immediately afterwards.”

Dr Yugal Mishra, Director of Cardiovascular Surgery, the second surgeon in the case, “This is a very satisfying and happy moment for the patient and his family and the treating doctors because the Institute has given a successful and uncomplicated recovery to a young patient who got a heart transplant. This is only the first step. Subsequently, the patient has to be maintained with immuno suppressants and monitored for rejection of organs which in itself is a very tedious process. We at the Institute are geared to manage this with extreme care and efficiency. With a growing number of heart failure patients in our country, a heart transplant is an effective and comparatively cheaper mode of treatment as compared to assisted devices. This success has given us tremendous confidence to treat and organize a well structured program in our Institute to take care of these patients. ”Paternal uncle, of the 16 year old boy were also short of words when asked how he felt seeing young Prince all set to take new challenges of life like any other teenager. Tearfully, he thanked the team of doctors saying, “I can never find words to express my gratitude to the team of doctors who gave Prince a new life. More than that, I really have no words to express my intense gratitude to the family who made this possible for him.I salute this God-like gesture of the parents of the donor.”

Doctors at Fortis Escorts Heart Institute bid affectionate send-off to 16 year old Prince, following successful Heart

Transplant Surgery


UpdateNEWS

Â Shri Jagat Prakash Nadda, Union Health Minister, Smt Vasundhara Raje, Rajasthan Chief Minister, and Shri Rajendra Rathore, Rajasthan Health Minister launch first-ever National Deworming Day.

Â National Deworming Day, the single largest deworming drive in the world, is a groundbreaking school-based initiative focused on reducing the threat of parasitic worm infections, a widespread health issue affecting over 241 million children in India alone.

Â Assam, Bihar, Chhattisgarh, Dadra & Nagar Haveli, Haryana, Karnataka, Maharashtra, Madhya Pradesh, Rajasthan, Tamil Nadu and Tripura to observe National Deworming Day in the first phase of its launch; to treat an initial 140 million children at risk for parasitic worms in schools and anganwadi centres.

Â ALBENDAZOLE tablets and syrup will be administered to pre–school and school-age children ages 1-19 years.

The Ministry of Health & Family Welfare today launched the first ‘National Deworming Day’ - a massive school-based deworming effort in twelve states scheduled for February 10, 2015.

Shri Jagat Prakash Nadda, Hon’ble Union Minister for Health & Family Welfare, Government of India inaugurated the national program, in Jaipur, Rajasthan, together with Smt. Vasundhara Raje, Hon’ble Chief Minister, Government of Rajasthan and Mr. Rajendra Rathore, Minister for Health & Family Welfare, Government of Rajasthan, in the presence of senior officials from the Central and State Government.

National Deworming Day is a groundbreaking initiative focused on reducing the threat of parasitic worm infections, a widespread health issue affecting over 241 million children in India alone.

India has the highest burden of soil-transmitted helminths--parasitic worms--in the world. Parasitic worms in children interfere with nutrient uptake, and can contribute to anemia, malnourishment, and impaired mental and physical development. According to the 2012 report ‘Children in India’, published by the Ministry of Statistics and Programme Implementation, Govt. of India, 48% of children under the age of 5 years are stunted and 19.8% are wasted, indicating that half of the country’s children are malnourished.

Shri Jagat Prakash Nadda, Minister for Health & Family Welfare, Government of India said, “The early years of a

child are the most critical and significant. I am confident that if the comprehensive set of actions identified in National Deworming Day Guidelines is fully implemented, children will have improved health outcomes and be able to achieve their potential to the fullest.”

Mass, school-based deworming is safe, cost-effective, and can scale to millions of schools quickly. Deworming has been shown to reduce absenteeism in schools, improve learning outcomes, and increase the likelihood of higher wage jobs later in life. The timely, high quality, mass-based deworming programme for children of pre-school and school age children in India will dramatically reduce the harm caused by parasitic worm infections in millions of children in India. The Government of India is launching a fixed one-day school-based program to ensure intensive deworming coverage and targeted outreach. Community mobilization efforts are also undertaken to engage community-based health workers and other local institutions.

Albendazole was orally administered to pre–school and school-going children ages 1-19 years in government schools and anganwadi centres across the states of Assam, Bihar, Chhattisgarh, Dadra & Nagar Haveli, Haryana, Karnataka, Madhya Pradesh, Maharashtra, Rajasthan, Tamil Nadu and Tripura. The National Deworming Day campaign treated an initial 140 million children at risk for parasitic worms in schools and anganwadi centres with schoolteachers and anganwadi workers administering the drugs. In line with any mass-based public health initiative, stringent adverse event protocols are put in place with teachers, anganwadi workers, health officials trained to respond as needed.

Ministry of Health & Family Welfare, Government of India Launches

‘National Deworming Day’ to Treat 140 Million Children for Parasitic Worms


UpdateNEWS

A boon to Insulin dependent Diabetics!

Dr. Mohan’s Diabetes Specialities Centre launches Insulin Pump Clinic

Insulin Pump therapy has come as yet another innovation in the field of Diabetes treatments, especially for the patients who are Insulin dependents and who need

multiple insulin doses everyday. Dr. Mohan’s Diabetes Specialities Centre (DMDSC) has today added the ‘Insulin Pump Clinic’ facility in it’s Gopalapuram Centre in Chennai. Dedicating the facility, Dr. V. Mohan, Chairman, DMDSC said, “an insulin pump is a small device about the size of a small cell phone that is worn externally and can be discreetly clipped to your belt, slipped into a pocket, or hidden under your clothes. It delivers precise doses of rapid-acting insulin to closely match your body’s needs”.“Small amounts of insulin delivered continuously (24/7) for normal functions of the body (not including food). The programmed rate is determined by our specialists based on the patient’s Diabetes condition. Insulin pumps have bolus calculators that help patients to calculate their bolus amount based on settings that are fixed by our specialists”, he added.During a live interaction with patients on the occasion, Dr. V. Mohan further explained, “since the insulin pump uses only more predictable rapid-acting insulin, patients need not follow a strict schedule for eating, activity, and insulin injections. They have the freedom of eating only when hungry, delaying a meal if required or even broadening the food choices”. “With insulin pump therapy, patients will have to change their infusion set only a few times per month unlike conventional multiple daily injections”, he added. With proper insulin pump use, patients can be four times more likely to achieve their target A1C and potentially reduce their low blood sugar reactions by 84%. Since insulin pump therapy can help achieve better control, it can reduce long-term complications of diabetes such as eye, heart, kidney, and nerve damage.

Case study suggests thalassemia most prevalent in the South Asia and South East Asia regionsThalassemia one of the hot topics covered at the haematology conference at MEDLAB Asia Pacific 2015Singapore:Thalassemia is a blood disorder inherited through families in which the body makes an abnormal form of haemoglobin. Haemoglobin is the protein in red blood cells that carries oxygen. The disorder results in large numbers of red blood cells being destroyed, which causes anaemia. According to a recent case study,the highest prevalence of beta thalassemia, which results from one or more genetic defects, is in India, Bangladeshand South East Asia (where the carrier frequency is approximately1–5%). Worldwide, it has 80 to 90million carriers (1.5% of the global population).1

There are two main types of thalassemia; alpha thalassemia occurs when one or more genes related to the alpha globin protein are missing or mutated. Beta thalassemia occurs when similar gene defects affect production of the beta globin protein.Dr VipViprakasit, Department of Paediatrics and ThalassemiaCentre, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, is the co-author of the study. He says, “There are two main types of thalassemia patients; TDT (Transfusion Dependent Thalassemia) and NTDT (Non-Transfusion Dependent Thalassemia). These two conditions will need an extensive clinical and laboratory evaluation including DNA technology for properly diagnosis both. Due to the heterogeneity of mutations underlying thalassemia, DNA testing is the best way to provide the most accurate diagnosis of thalassemia.”Dr Viprakasit will discuss thekey techniques for the management of thalassemia atthehaematology conference atMEDLAB Asia Pacific, organised by Informa Life Sciences Exhibitions, will take placeat the Sands Expo and Convention Centre, Singapore from 18-20 March 2015.In the past, α- and β-thalassaemias were restricted to malaria-endemic tropical and subtropical regions. However, in recent years, human global migration from these regions has caused an increase in these conditions in countries previously relatively unaffected by thalassaemias, such as those in North Europe and North America. Therefore, thalassaemia syndromes are no longer ‘rare’ conditions in such regions and warrant awareness from all health care providers involved.2

Patients suffering from thalassemia should be constantly monitored by a specialist in order to manage their condition long-term. They should therefore bereferred to a haematologistas soon as they are diagnosed.

UPdAtEPRODUCT


LINE

We are entering into an era where the world will soon start traveling using their Password instead of Passport. Technology has transformed the way we cater to our day to day needs. We use social networking sites to connect with friends, e-commerce sites to buy stuff, and rely heavily on sites like Wikipedia and YouTube for knowledge enrichment and entertainment. Evidently, there’s no surprise that people in India are thronging over the web to take care of their health. As a testimony to this fact, a study has estimated that India ranks 3rd amongst the countries where people frequently go to the internet to read about their health issues.Given this massive shift towards the World Wide Web for virtually everything, the moot question for doctors is: “Are you already there where your patients are?” Well, the perceptible answer to this is that doctors are definitely reaching there, but there’s a lot of ambiguity about how to make the most out of this surge.Just like any other basic amenity, healthcare delivery in India is also evolving towards making healthcare easily accessible for patients. Use of the internet for booking appointments with doctors is very much in vogue these days. Doctors have also started connecting with patients on social media platforms. But all these activities still leave a wide gap for doctors where it becomes difficult for them to understand the impact of time they’re spending on the web.In order to bridge this yawning gap, Lybrate has taken a considerable leap to enable doctors make the most out of the time they spend on online platforms. The company has launched India’s first “Mobile-based” platform where doctors and patients can seamlessly connect with each other. While patients get the required consultation right on their smartphone, doctors have the flexibility to decide when they want their consultation fee to be paid. Consultation on smartphone enables doctors to spend more time with patients and save more lives.Let us take a comprehensive view of Lybrate’s intuitive WhatsApp-like platform where proactive doctors like you can enhance your online reputation

Lybrate: An Easy Way to Connect with More Patients

as well as income with incredible ease and effectiveness:Lybrate has come up with this easy-to-use platform where you can give “Free Opinion” or even “Paid Consultation” to millions of patients. Under the ambit of Free Opinion, also known as “Open Questions”, thousands of patients put forth their health-related doubts on Lybrate every day and you can clear those doubts. You can also agree to other doctor’s response to reinforce the opinion offered to any particular patient. Open questions strengthen your credibility further on the web and let you connect with other good doctors from various cities.Now comes the other significant part of the platform – “Paid Consultation” aka “Private Questions”. We conducted a survey with 1000 doctors to get their views on how technology is changing their practice. Out of 1000, 887 doctors said that patients have been buzzing them every now and then on WhatsApp to show medical reports, or to understand dosages, or just to get the follow-up treatment. Such frequent intervention were disturbing them when they’re busy seeing other patients.Now with Lybrate on your smartphone, you can serve your patients better without compromising on your consultation fee. It works just like WhatsApp where you can ask your patients to share their medical reports, X-ray and MRI scans, pictures, medication history, etc for a better understanding of their issues. You can even have a voice-chat to add more personal touch to your consultation. At

any point of the private conversation you have the privilege to decide what amount you want your patient to pay.In addition, you can also give a try to Lybrate’s Practice Management software to increase your efficiency and cut down your operational cost. You can effectively manage things like patients records, bills, appointments, etc right from your smartphone.We, at Lybrate, are seeing the upcoming future of the healthcare delivery in India. It’s all about empowering patients to get access to better healthcare services irrespective of their geographic location or social standing. And proactive doctors like you will play an instrumental role in helping patients get access to better health.

UPdAtEUPdAtE


UpdateDOCTOR

Update


SPEAK

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SPEAKDOCTOR

In Manipal Hospital Goa, The Division of Gastrointestinal & Hepatobiliary Surgery is dedicated to providing comprehensive surgical care for patients with basic

and complex gastrointestinal, liver, pancreas and biliary diseases. The facility is dedicated to management of a variety of benign and malignant GI disorders via open and laparoscopic approaches with the state-of-the-art technology.Gastrointestinal Diseases include:• Repair of primary, recurrent, and complex abdominal

wall hernias• Gastroesophageal reflux disease, hiatal hernias, and

achalasia• Cancer of esophagus and stomach• Weight-loss surgeries (gastric bypass, vertical sleeve

gastrectomy, adjustable gastric banding, and revisions)• Colon and rectal cancer• Crohn’s disease and ulcerative colitis• Enterocutaneous fistula and short bowel syndrome• Anorectal disease including rectal prolapse, incontinenceWe also have a multidisciplinary Hepatobiliary clinic functioning as a part of the Gastrointestinal division.

Manipal Hospitals, Goa: Department of Gastrointestinal & Hepatobiliary Surgery

Manipal Multidisciplinary Liver, Gall Bladder and Pancreas ClinicA complete team of health care professionals to provide expert, specialised, holistic and all-round care for people with liver, pancreatic, biliary and gall bladder disorders.This includes, as appropriate, diagnostic and interventional radiology, endoscopy, surgery, nuclear medicine, oncology and palliative care.Disciplines involved1. Hepatobiliary and pancreatic surgery 2. Diagnostic and Interventional Radiology3. Medical gastroenterologyClinical services• Use of less invasive diagnostic techniques, including

high resolution ultrasonography, magnetic resonance imaging (MRI), endoscopy and endoscopic ultrasound for diagnosis and surveillance.

• New and advanced surgical techniques like CUSA assisted liver resection, laparascopy and intraoperative ultrasound.

• Innovative palliative and curative procedures for primary and secondary liver tumors, including radiofrequency ablation, chemoembolization, bland embolisation and percutaneous biliary drainage.

• Specialist endoscopic procedures.• Management of acute and chronic pancreatitis (including

step up management of acute pancreatitis, Puestow’s and Frey’s procedure for chronic pancreatitis.

Beneficiaries:• Chronic alcoholics.• Liver cirrhosis patients.• Patients with gall bladder stones.• Short and long duration abdominal pain.• Viral hepatitis patients.• Patients with jaundice.• Diabetics.• Patients with fatty liver.• Patients with liver and pancreatic tumours.

UPdAtEUPdAtE


UpdateHEALTH

Update


BUDGET

www.medegatetoday.com NoveMber-DeceMber 201442

It is a very good, balanced and forward looking budget that gives you a great sense in terms of directional clarity of what the honorable FM wants to do. He has laid down the intent and the road map for the economy

in the years to come and has clearly spelt out the vision of the government.

The budget covers a whole spectrum of areas that are directed at giving a boost to the economy, stressing on social inclusivity and channeling funds for public good.

The FM has clearly focused on the key elements of infrastructure, including the development of Roads, Housing, Electrification of villages, Skill development and Employment generation. The budget is broad based and provides a thrust to society including the marginalized, the young and the elderly.

To move towards the vision of a healthy India, hygiene and cleanliness programs have been accorded priority and contributions towards the Swachh Bharat Fund have been made tax exempt. In tandem, there is a focus on increasing access to healthcare in the cities and villages by widening the health insurance net. There is also a provision to set up 5 new medical colleges along the lines of the AIIMS in J&K, Assam, Punjab, Tamil Nadu and Himachal Pradesh which will go towards bridging the talent gap for qualified medical

professionals in the country.

I see the budget as a strong booster for industry. The further opening up of foreign investment, tax-free bonds for infrastructure, simplification and progressive reduction in corporate taxes are welcome steps and will all go towards catalyzing economic growth. I think private investment will certainly increase and there is a dire need for it.

Overall a very good budget! I look forward to this getting executed and India crossing an 8 % GDP.

Malvinder Mohan SinghExecutive Chairman Fortis Healthcare Ltd.

Healthcare Budget Reaction from Healthcare ExpertsReaction from Malvinder Mohan Singh, Executive Chairman Fortis Group

UPdAtEUPdAtE

www.medegatetoday.com March-april 2015 45

UpdateHEALTH

Update


BUDGET

Quotes from Sanjay Murdeshwar : AstraZeneca Pharma India Ltd.

“Overall, it’s a positive and balanced Budget. Increase in infrastructure investments, roll out of GST next year, single window in regulatory processes and phased reduction in corporate tax are steps in the right direction.

Even though there is no direct impetus to the pharmaceutical industry, plans announced for the healthcare sector are welcome. Setting up of five new AIIMS across the country will help patients and medical education. Three more National Institute of Pharmaceuticals Education and Research will play an important role in bridging the skill gap, the National Skills Mission is an excellent endeavor in this area. Improving accessibility to healthcare has been stimulated through raise in health insurance premium from Rs 15,000 to Rs 25,000. Rs 150 crore announced for scientific research is a positive move, though incentivizing medical/Pharma research would have helped trigger more R&D investments into the sector.

This is a positive start with more hits and not many misses, it remains to be seen how effectively it will be implemented.”

Sanjay Murdeshwar

Managing DirectorAstraZeneca Pharma India Ltd. (AZPIL)

Today as the world stresses on economic growth, globalisation and privatisation; a silent section of the society seems to slip through all safety nets. In India,

one is talking about at least 26% of the population who fit into this category. The percentage varies from state to state. In most of the northern states poverty seems to be increasing and if you further disaggregate from urban to rural, you will find that 40% of the rural population in 10 states in India are below the poverty line. If one further disaggregates the figures into schedule caste, schedule tribes, the marginalised etc., the percentages just keep on rising. So we have to accept the fact that there is a segment in our society, and we are talking about 260 million Indians, who are surviving with the burden of disease, estimated of around $ 30 billion constituting 5% of GDP.Potential Health care industry is the world's largest industry with total revenues of approx US$ 2.8 Trillion. In India as well, health care has emerged as one of the largest sector with maximum expenditure incurred. An astounding 60% of this is out of pocket expense. India has one of the highest

proportions of private health spending, comparable only to a only few countries in the world with a recent history of major internal unrest, such as Cambodia and Myanmar. Such is the lack of trust in the public health system that not only do 80% of the wealthy seek treatment in the private sector, but a similar percentage of the poor also goes to private practitioners, even though the treatment may be of low quality and provided by untrained practitionersSome unfortunate statistics reflect this state of affairs:One quarter of hospitalised Indians slip below the poverty line because of hospital expenses alone. Hospitalised Indians spend more than half of their annual expenditures on healthcare. ? More than 40% of those hospitalised borrow money or sell assets to cover expenses. The poorest 20% Indians have more than twice the rate of mortality, malnutrition and fertility of the richest 20%.To address these disturbing facts, we have to approach the healthcare system with a fresh new look and fight on all fronts on a war footing. While I appreciate that the government is facing a severe financial crunch and that the hon’ble finance minister may not have had enough cash to spend, it is a matter of concern to me that the healthcare issues of the country are not being given the importance that they deserve.

While I am very happy with the Hon’bleFinanceMinister’sproposaltoincrease

the Income Tax Exemption Limit on Health Insurance premiums to Rs 25000 a year, it is slightly disappointing to see that there is

no provision for increasing the public health spending and to decrease the out of pocket

expenses of those seeking healthcare access.

”

Dr. Naveen Nishchal, Dr. Shuchin Bajaj, Dr. Dinesh BatraDirectors, CYGNUS Group of Hospital

Budget Reaction from CYGNUS Group of Hospitals

“

DR.SHUCHIN BAJAJ


VIEWSEXPERT

failure. Deregulation of enzymes may gradually normalize after smoking cessation, a noticeable vein recovery needs at least 6 months, vein enzymes do not completely return to normal levels even after one year.

There has been much controversy about whether smokers should receive the same opportunities for CABG as nonsmokers. Discussion on this subject was mainly based on the consistent finding that continued smoking after CABG increased clinical complications, such as myocardial infarction and repeat coronary revascularization. At one year after surgery, smokers had more than twice the risk for myocardial infarction and reoperation as compared with patients who had stopped smoking since surgery.

The persistent smokers have a greater risk of death from all causes as compared with patients who stopped smoking after surgery over a long period of follow up. Over a period of time the risk of death from any cause is greater in patients who continued smoking after CABG than it was in those who quit.

The benefit of smoking cessation on mortality may be explained largely by the reduction in cardiac death which is higher for the persistent smokers than it is for those who quit. It would be advisable to stop smoking at the 6 weeks prior to surgery but it has been observed that many patients can have adverse cardiac events during this period so smoking status alone should not preclude these patients from receiving these operations. However we emphasize that this should not translate into ignorance of continued smoking in patients undergoing cardiac surgery. Given this adverse effects of smoking on overall cardio vascular morbidity and mortality, patient should be encouraged and even assisted in endeavors to quit smoking.

SMOKING AND CARDIAC SURGERY

Dr. Yugal K. Mishra Director, Department of Cardiovascular SurgeryFortis Escorts Heart Institute

Cigarette smoking is a powerful risk factor for coronary artery disease, myocardial infarction and cardiac causes of death. Coronary artery bypass is a relatively safe and commonly

performed cardiac operation with the mortality of 0.6% to 2.0%. Given the ever increasing cardiac surgical patient population and intractable problem of continued smoking within these patients is a priority to clearly delineate the impact of smoking status.

Persistent smoking after cardiac surgery has been consistently identified as a predictor of increased mortality in the follow-up studies after cardiac surgery, late mortality is significantly worse. Smokers also have a greater incidence of recent myocardial infarction, left main stenosis, urgent operation and chronic obstructive pulmonary disease(COPD). The rationale behind this is poor CABG outcome due to failure of the vein graft patency, greater risk of post operative complications, mortality and earlier need for reoperation. Length of ICU stay is also high in smoker likely due to the fact that smoker most often present with the respiratory disease and have grater ventilator requirement in the post operative period.

Patient who continue to smoke or who start smoking again after coronary bypass surgery have an elevated rise not only for myocardial infarction but also for the return of angina pectoris and the need for coronary bypass surgery.

Despite the similar rates of early outcome, the continued adverse health effects from smoking on multiple organ systems is well established and should not be ignored. This is reflected in long term follow-up of these patients.

The researchers found that heavy smoking noticeably increased matrix metalloproteinase enzyme level in the saphenous vein. These enzymes have been linked to vein graft


VIEWSEXPERT

Walking is one of the best and most practical forms of physical exercise. Regular exercise prevents coronary heart disease (CHD) and premature sudden death. Physically fit men and

women live longer than unfit people. To prevent CHD, it is not necessary to become an athlete. Brisk walking or any other exercise of equal intensity like swimming, and cycling, or light games like badminton and table tennis for 30 minutes a day, 5-7 times a week is enough. The correct intensity of exercise is one that is somewhat difficult for an individual and is neither too light nor too hard. There is no need to test the limit of endurance, to sweat or to become markedly breathlessness. Excessive effort may be injurious for the muscles and the joints without additional benefits. The level of physical effort can always be increased gradually as one becomes more and more fit. The pace of walking on treadmill may be monitored more objectively by setting a target heart rate. The heart rate tends to increase as the pace of exercise is increased. But there is a limit to which the heart rate can increase in response to exercise. The maximum predicted heart rate (MPHR) is dependent on age and may be calculated as 220 minus age in years. A healthy person may start with a target heart rate to 60% of MPHR and gradually progress to 85% of MPHR.

Warm-up - a brief session of slow, gentle, rhythmic and repetitive movements of the major joints of the body before any exercise - is important to improve the flexibility of joints and prevention of injury. It also ensures a smooth and gradual rise in heart rate and blood pressure before exercise. Some cool-down stretching should always be performed after exercise. Cool-downs are vigorous stretches performed after exercise to prevent muscle and joint stiffness, and abrupt fall in blood pressure after cessation of exercise. A few minutes of physical and mental relaxation after cool-down are also rewarding.

Exercise either before, or 2 hours after major meals. Avoid exercise when unwell. Avoid a steaming hot shower after

exercise. Don’t discontinue exercise for more than 2 weeks at a stretch. Any fresh symptoms should be medically evaluated. Execute all movements gently and rhythmically. Avoid difficult exercises. Avoid breath holding.

Avoid early morning walks in winter. Don’t walk against cold wind. Avoid heavy woolens, and wear a face scarf in extreme cold. Wear loose and light coloured cotton clothes in summer and exercise under shade. Drink water before, during, and after exercise. Slow down the pace during extremely hot weather. Be alert for signs of heat injury (headache, dizziness, faintness, nausea, cramps and palpitations). Elderly should avoid high impact activities. They should step up the pace of exercise very gradually over a period of time. Obese people should perform low intensity, low impact exercises like brisk walking. They should exercise at least 5 days in a week. Hypertensive patients should avoid vigorous exercise if blood pressure is not well controlled. They should not hold their breath during exercise, and avoid weight training.

Benefits of Physical Exercise

Lack of regular physical activity has profound effect on physical and psychological well-being. For example, merely 2-3 weeks of bed rest may lead to as much as 20% drop in peak exercise capacity, whether measured in previously active or in sedentary people (Figure 1). The decrease is observed both in the young or middle aged and the elderly. While in the apparently healthy, this is purely due to physical deconditioning, other factors may also play an important

Dr. Peeyush Jain

Principal Consultant Cardiologist and Head, Dept. of Preventive Cardiology, Fortis Escorts Heart Institute, New Delhi

role when bed rest is forced by illness. For example, after a heart attack, exercise capacity may

Health Benefits of Walking


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decrease as a result of decrease in pumping efficiency of the heart (heart failure).

The sense of well-being reported by people who exercise regularly is partially due to psychological boosting. However, exercise also increases the capability to perform the same physical tasks with less fatigue or breathlessness. This is due to an increase in maximal oxygen uptake (VÖ2 max. in scientific literature) after exercise training. As oxygen uptake required for a given task remains the same, irrespective of whether a person is sedentary or physically active, physically-conditioned people need a smaller percentage of the VÖ2 max to perform a task (Figure 2). This also explains why most patients with angina pectoris who exercise regularly report reduction in effort-related angina threshold.

The increase in physical capacity with regular exercise is largely explained by an improvement in functioning of the musculoskeletal system of the body though improvements in circulatory dynamics also contribute. One of the major factors that limit a person’s exercise capacity is muscle fatigue that may progress on to pain if exercise is not interrupted. Muscle fatigue and pain during exercise is due to accumulation of lactic acid (lactate) in exercising muscles. Lactate begins to accumulate at about 55 percent of the peak exercise capacity in the apparently healthy, untrained people. The threshold for lactate accumulation occurs much later in

people accustomed to exercise (Figure 3). This is brought upon by specific adaptations in the muscles that favour less production and a more rapid removal of lactate at any particular exercise level.

Exercise training may retard the progression of coronary atherosclerosis by its salutary effects on some classical coronary risk factors like lipids (cholesterol) and blood pressure. For example, physical training for 3 months has been shown to increase HDL (good) cholesterol by 15-23%. The reduction in total cholesterol and LDL (bad) cholesterol is a more modest 12% (Figures 4, 5). It is generally agreed that these changes are usually observed when exercise is prolonged and high intensity, for example walking approximately 20 miles per week at 60-85% of the peak capacity.

Regular physical activity also leads to weight loss and restores normal body composition. In obese people, there is an increase in deposition of fat in muscles that contributes to insulin resistance. Insulin is a hormone with multiple actions. It is released by the pancreas into circulation in response to increase in blood glucose (sugar) levels. Resistance to the actions of insulin sets a chain of chemical reactions in the body including increased release of fat and cholesterol rich particles from the liver, decrease in HDL (good) cholesterol levels, and preponderance of small, sense LDL


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(bad) cholesterol, all of which increase the risk of arterial blockages in the heart, brain, and lower limbs. Insulin resistance also contributes to increase in accumulation of fat in abdomen (central obesity), blood pressure (hypertension), and blood glucose (diabetes mellitus). Exercise is a key method of restoring insulin sensitivity.

Majority of the scientific studies report a reduction in both systolic blood pressure (SBP) and diastolic blood pressure (DBP) with regular exercise. With regular exercise, the average decrease in BP in hypertensive patients is estimated to be -11/-6 mmHg. In non-hypertensive people, the average decrease in BP is -4/-4 mm Hg. Besides decrease in resting BP, exercise training also blunts the hypertensive response to physical exercise. High intensity exercise may also reverse exercise-induced drop in systolic BP that is often observed in people with significant heart disease.

Exercise training also reduces spontaneous clotting of blood. Many factors contribute to this effect including decrease in platelet aggregation, efficient clot-lysis, decrease in blood viscosity, and improved red blood cell (RBC) deformability.

In humans, lack of habitual leisure time physical activity predicts progression of coronary heart disease (CHD). Exercise training, on the other hand, appears to retard or even reverse coronary artery blockages. While the best way to achieve retardation of progression or regression of CAD is a judicious combination of diet, exercise, and drug therapy, yet exercise alone may contribute by enlarging the size of coronary arteries that increases the size of arterial lumen. In one study, regression was observed only in those who expended at least 2,200 kcal (kilocalories) per week during exercise training.

The most dramatic benefit of regular physical activity is reduction in the risk of sudden death (Figure 6) due to malignant heart rhythm disorders (arrhythmias). Animal experiments have demonstrated that habitual physical activity increases arrhythmia threshold (Figure 7).

Summary of Benefits

Improves exercise capacity Increases muscular strength Reduces subjective feeling of fatigue and breathlessness Improves lipid profile, especially HDL (good)

cholesterol Improves glucose tolerance Attenuates SBP and SBP rise with physical activity Reduces platelet aggregation Increases intrinsic fibrinolytic activity Decreases blood viscosity and increases RBC

deformability

Reduces cardiovascular response to stress Retards or reverses atherosclerosis Improves overall quality of life Reduces the risk of sudden deathGlossary

Angina pectoris Chest pain or sensation of progressive oppression or tightness in mid-chest or both sides of the chest on physical exertion in presence of critical blockage(s) of one or more major coronary arteries that supply blood to the heart muscle.

Atherosclerosis At birth, major arteries of the body are smooth, open and elastic conduits, expanding and contracting as blood flows through them. With ageing, arteries lose their flexibility and fatty substance(s) circulating in the blood may clog them up at places. This gradually compromises blood flow through the arteries over a number of decades. These changes constitute, what is known as, atherosclerosis.

Hypertensive response to exercise Excessive rise in blood pressure during exercise.

Insulin A hormone secreted by pancreas that plays a central role in regulation of blood glucose (sugar) level. Either lack of insulin secretion or resistance to insulin action (insulin resistance) is thought to cause diabetes mellitus. Insulin resistance may also contribute to occurrence of high blood pressure, lipid (cholesterol) abnormalities, and coronary heart disease.

Platelet A blood cell that is crucial in blood clotting. Overactive platelets contribute to excessive tendency for clotting that may interrupt blood supply to crucial organs like brain, heart, kidneys, and limbs.


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They say ‘However motherhood comes to you; it’s a Miracle.’ Oh! The ‘Happy beginning’ of finally holding life in their arms after, sometimes, years of

struggling to become adoring mothers and fathers to a little one. To become a parent, to watch a life curl up near you, to see your baby grow into a young child, to be willing to take that fall along and stand right back up, is a dream that one begins to cultivate through the IVF journey. IVF brings hope to the shattered hope to become and experience parenthood. It makes all of the physical, emotional and financial troubles worth it. In vitro fertilization (IVF) is the most common and most effective type of assisted reproductive technology (ART) to help women become pregnant. The procedure involves fertilizing an egg outside the body, in a laboratory dish, and then implanting it in a woman’s uterus. More than 4.3 million children around the world have been conceived using the technology. Studies have shown that Parenting and the children’s psychosocial development do not differ significantly between IVF families and control families. Most children born through IVF, have grown into healthy young adults, with a quality of life and educational achievements similar to their normally conceived peer. IVF offers another ray on impact of ‘nature and nurture’, on the bringing up of the little one. The Parenting styles adopted to raise IVF children shape on how they turn out. Here are some tips to bring up beautifully, Young Confident Individuals:

• Give Unconditional Love The childhood of your child is the time when you can

spend maximum amount of time with your child and grow close to her. Once, they grow into teenagers and adults, they get so busy with their own lives. You should try to have as many as happy memories as possible of each age of your child from toddler to teenager. Let them know how much you love .

• Do not Be Overprotective This makes the child timid and introvert. Let the child

explore things on his own so that he can learn and understand it on their own. Just supervise their actions.• Have Family-Time!

You should try and make it a point to do something together as a family. This will help all of you bond

Parenting tips for IVF children

together as a family and will also help siblings become closer.

• Use Genuine Encounter Moments (GEMS) Your child’s self-esteem is greatly influenced by the

quality of time you spend with him or home ; not the amount of time that you spend. With our busy lives, we are often thinking about the next thing that we have to do, instead of prioritizing our children. Focus on their feelings and emotions. Communicate with them for there is nothing more promising and fulfilling than a good conversation. If we don’t give our child GEMS throughout the day, he might start to misbehave or feel isolated..• Parent with the End in Mind

Most parents act to bring a certain behavior or situation under control as soon as possible. Don’t look for a expedient solution. This often results in children feeling overpowered. But good parenting requires one to keep in mind how we want our child to be as an adult, thus being more thoughtful in our approach. For example, if we spank our child, he will learn to use acts of aggression to get what he wants when he grows up.• Be Consistent, Follow Through

If you have made an agreement that your child cannot buy candy when she gets to the store, do not give in to her pleads, tears, demands or pouting. Your child will learn to respect you more if you mean what you say.

Lastly, ‘Adopt the pace of nature: her secret is patience. So, Be patient and nurture your child with love, affection, knowledge because Parenting is one job that never gets a vacation.

MMC Accredited


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Sudden Cardiac Arrest: How to prevent it.

Dr Aparna Jaswal,MBBS (Gold Medalist), MD Medicine,

DNB Cardiology (Gold Medalist), Certified Cardiac Device Specialist USA,

Fellow Heart Rhythm Society USA, Principal Consultant Cardiologist,

Fortis Escorts Heart Institute,New Delhi

A study in the popular medical journal Lancet recently revealed that 60% of world’s heart patients will be in India. Today most of the cardiac death is due to Coronary Artery Disease which

in turn is usually due to a SCA (Sudden Cardiac Arrest) or Ventricular Fibrillation, a problem of the electrical system of the heart.

As a complex and very important organ the heart muscles have the capacity of generating pulses on their own if the sinus node fails to do so. However, the rate of pulse generation is random. Any disturbance in the sinus node or the flow of electrical impulses through the heart results in an abnormal rhythm- ‘arrhythmia’. The rate at which the heart is beating can become abnormally faster or slower than normal. The resultant irregular fast or slow rhythm interferes with efficient pumping action of the heart, compromising blood supply to all parts of the body and at times causing the heart to suddenly stop beating rhythmically. Generally the arrhythmias are momentary and harmless; however some types (Ventricular tachycardia or fibrillation) can be serious or fatal.

Sudden cardiac arrest (SCA) is a sudden, unexpected failure of heart function occurring due to fast fluttering action of the ventricles, which does not allow enough blood to be pumped out to the organs which include the brain and the heart itself. SCA is a medical emergency, which can be fatal if not treated immediately. Cardiac arrest is reversible if the victim is administered prompt and appropriate emergency care. This generally involves administration of cardiopulmonary resuscitation (CPR), shock treatment to the chest to reset the heart’s rhythm (defibrillation) and advanced life support.

SCA being the result of a disturbed rhythm pattern the only effective treatment is the delivery of an electrical shock.

As per WHO census statistics mortality due to cardiac causes

has overtaken mortality due to all cancers put together. In

India alone we have about 4280 sudden cardiac deaths per

lakh annually.India among highest risk

countries by 2030Source: World Health Statistics Report – 2008 (by WHO)


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The risk factors for developing heart disease also put one at risk of suffering sudden cardiac arrest.• Family history of heart disease, smoking, high blood

pressure, high blood cholesterol, obesity, diabetes, a sedentary lifestyle, pre existing cardiac diseases like heart rhythm disorders, congenital heart defects, congestive heart failure and cardiomyopathy.

• Poor heart function, previous episode of cardiac arrest or heart attack, electrolyte imbalances, hyperthyroidism, pulmonary hypertension, certain medications that affect the heart function and use of illicit drugs, such as cocaine or amphetamines.

While some drugs are used to try and suppress fast heart rates, none have been able to ward off all episodes of SCD. Automated External Defibrillators (AEDs) are devices that are used to deliver the shocks. An AED is extremely easy to use by trained laypersons, with voice-activated instructions and is critical for rapid response to a cardiac arrest. This device can save lives if made available within 4 to 7 minutes of the onset of Ventricular fibrillation. With the healthcare infrastructure and system in India being a lot behind that in the USA, such devices are not freely available in public or even most ambulances. It is also not always convenient to carry one around and connect whenever required. Thus more than 99% of Indians who experience Sustained Ventricular fibrillation face certain death.

An Emergency Room inside Your Chest:As a treatment option following a sudden cardiac arrest, once the patient’s condition stabilizes, Implantable Cardioverter-Defibrillator (ICD) maybe recommended. Studies have proved that people who are at high risk of SCA can be identified using certain routine diagnostic tests. An ICD (Implantable Cardioverter Defibrillator) is a device that can be implanted into these patients is the only fool proof solution available today. It is a battery-powered unit that is implanted near the collarbone. One or more electrode-tipped wires run from the ICD through veins to the heart. It constantly monitors the heart rhythm. If a rhythm that is too slow is detected it paces the heart as a pacemaker would. If it detects ventricular tachycardia or ventricular fibrillation, low- or high-energy shocks are sent to reset the heart to a normal rhythm. ICDs now also collect information for the physician to use by remotely diagnosing and programming the device to the exact needs of the patient, without the need for repeat surgery or hospitalization. For patients with ICDs, the first-year recurrence rate of sudden cardiac arrest has been reduced to 1 to 2 percent. While ICDs are a recent invention (10 to 15 years globally) it is necessary to identify patients at high risk for SCA and get them ICDs to help then jump back to life whenever they encounter one. Prevention is better than Loss.

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What is cardiac arrhythmia, its sign & symptom?An irregular heartbeat is called cardiac arrhythmia.A healthy heart beats 60-100 times per minute, which is necessary to supply oxygen-rich blood to the body.

A heartbeat that is too fast, usually more than 100 beats per minute is called tachycardia. A heartbeat that is too slow, usually less than 60 beats per minute is called bradycardia.

Arrhythmia can be silent, sometimes harmless and may not cause any symptoms but some can be serious or even life threatening wherein they can cause the heart to stop pumping oxygen rich blood to the body—these arrhythmias cause sudden cardiac arrest (SCA).

People who have heart disease are at higher risk for SCA. However, SCA can also happen in people who appear healthy and have no known heart disease or other risk factors for SCA. Some of the common symptoms one is likely to experience are lightheadedness, rapid heartbeat, palpitations, extreme fatigue, shortness of breath, chest pain, inability to exercise or fainting spells. These symptoms could adversely affect the quality of life and prevent one from leading a normal life.

Required certain test for this particular disease?A doctor can detect an irregular heartbeat during a physical exam by taking your pulse or through any of the following:

• Electrocardiogram (ECG)- An ECG uses sensors (electrodes) that are attached to your chest and limbs and measures the timing and duration of each electrical phase in your heartbeat and can reveal disturbances in heart rhythm.

• Exercise ECG or stress test-It usually involves walking on a treadmill or pedaling a stationary bike at increasing levels of difficulty, while your ECG, heart rate, and blood pressure are monitored.

• Holter monitor- Electrode patches are placed under the clothing on the chest to measure and records heart’s electrical activity. The patches have wires attached to them and are connected to a portable monitor and is worn for one to two days.

• Insertable Loop Recorder–It is a small insertable device that continuously monitors heart rhythms and records them either automatically or when you use a hand-held patient assistant. It is inserted just beneath the skin in the upper chest area and can record for a longer duration.

• External Loop Recorder- Abnormal heart rhythms and cardiac symptoms may come and go. So to record your heart rate and rhythm during a symptom, there is a device called as the External Loop Recorder (ELR). An ELR has the capability to monitor a patient for a long duration (7 to 30 days), and hence has a higher chance of providing a diagnosis to patients with infrequent short-duration transient symptoms, recurring over weeks. The device is placed on the skin in the chest region. This completely wireless system is auto-triggered and also has patient activation capability via a patient trigger magnet (for the patient to activate whenever he/she feels any symptoms of arrhythmia like breathlessness, fainting or palpitations)

How can we prevent cardiac arrhythmia?When an arrhythmia is serious, an urgent treatment is required to restore a normal rhythm. This may include electrical “shock” therapy,intravenous medications (given through a vein) or by mouth.Dr. Ameya Udyavar

Consultant Cardiologist and EctrophysiologistHinduja Hospital, (Mumbai)

Cardiac Arrhythmia, its Sign & Symptom?

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1. Treatment Options for Bradycardia

The standard treatment for a slow heartbeat is to implant a pacemaker. For people with bradycardia, this small device can help restore a normal heartbeat.

Pacemakers

If you have bradycardia, you may be eligible for an implantable heart device called a pacemaker. Pacemakers are small devices that are implanted under the skin, most often below your collarbone on the left or right side of your chest.

The pacemaker continuously monitors your heart, and if it detects a slow rhythm problem, it sends out small undetectable electrical signals to correct it.

Treatment Options for Tachycardia

Treatments for tachycardia range from medication to surgery. Some of the patients of tachycardia can be cured by a procedure called electrophysiology studywhich assesses the electrical activity and conduction pathways of the heart.The most effective way to treat sudden cardiac arrest is defibrillation. A defibrillator gets your heart back into its normal rhythm. Defibrillators can be external or implanted in your body for long term protection:

Automated External Defibrillator (AED)

An external defibrillator is a portable device which measures the electrical activity of the heart and delivers a therapy shock if a dangerously fast heart rhythm is detected. Most emergency response teams carry and use external defibrillators, and many public places now have external defibrillators. The goal is to provide access to defibrillation when needed as quickly as possible.

Implantable Cardioverter Defibrillator (ICD)

An implantable cardioverter defibrillator (ICD) is a small device implanted under your skin. It serves the same purpose as an external defibrillator, but ICDs automatically monitor your heart rhythm and deliver therapy as needed to prevent sudden cardiac arrest. It is always there, monitoring your heart rate and administering treatment if needed.

Give your expert advice to doctors as well as to patients?My advice to patients is not to ignore

symptoms like palpitations, fainting and breathlessness as they may be due to heart beat problems and most of them can be diagnosed by simple tests.

My advice to doctors is, if a patient’s ejection fraction (blood pumped out of heart during each beat) is less than 30%-35% (even after bypass surgery or angioplasty), then a defibrillator should be implanted to prevent sudden cardiac arrest and every effort should be made to improve functioning of the heart.

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UpdateDOCTOR

Update


SPEAK

www.medegatetoday.com NoveMber-DeceMber 201456

Liposuction or removal of excess fat from the body is a much tal ked about procedure in cosmetic industry today. With greater exposure to the both national and

international media, and with the mushrooming of several clinics who offer the procedure, general awareness about the same has grown in India. However, a lack of clear understanding about the procedure and misconceptions about the same are rampant. Since liposuction is a cosmetic procedure aimed at improving appearance, not a surgery required for health reasons, it is pertinent that people should know in detail about it. Proper awareness ensures that they make informed decisions about going for the procedure.Is Liposuction a Weight Loss Procedure? The simple answer is no. Liposuction should not be confused to be a weight loss procedure per se though the patient undergoing it may automatically lose some weight on account of fat loss. Liposuction is aimed at removing excessive fat from any area of the body. For example, the front of the abdomen or the sides of the abdomen, the thighs, the neck, buttocks and even face.Bulges of fat are extremely common in human body. Indians are especially prone to accumulate fat on the tummy. Often, this is a result of our lazy lifestyle, lack of workout as well as fat-rich diet. However, sometimes, despite our best efforts with exercise and diet control, some areas refuse to lose fat. So, while our overall weight would be under control, the stubborn fat on the side of the tummy or on the buttocks would refuse to burn. Liposuction is an ideal procedure to target such stubborn fat.Liposuction as stated above is a procedure to remove small bulges of fat on various parts of the body that diet and exercise could not address. This helps bring the body in better shape which all areas having the right proportion of fat. It should be understood that liposuction does not remove cellulite.How is it done?As the name suggests lipo-suction involve suctioning or pumping out excess fat from a particular area of the body that has pockets of stubborn fat.During the procedure, small and thin tube-like devices are inserted into small incisions made into the skin; and fat is suctioned out through the tubes in a targeted way. The procedure is usually an out-patient procedure but the duration of your stay in the hospital may be determined by the location of the surgery or the amount of fat being removed. This will also determine whether you are administered local

Liposuction: It a Procedure to Remove Stubborn Fat,

Not For Weight Loss

anesthesia or general anesthesia during the procedure.Small cuts are made in the target area and fat is pumped out using a suction device or a large syringe. There is a limit to the amount of fat that can be removed at on go, therefore it is suggested that people with average or a little more than average weight are ideal candidates for it. People with excessive weight are not ideal candidates and are not recommended a liposuction. Moreover, liposuction should not be considered a weight loss procedure. It is a targeted fat removal procedure.Its VariantsTraditionally the liposuction surgery was done under general anesthesia, using small tubes to pump out fat from the desired area. However, recent advances in the field have put forward better and easier options which are actively being used today. They do away with the need of general anesthesia, hence eliminating the risks associated with it and making the procedure safer. In what is called as tumescent liposuction, a local anesthesia is given to numb the target area and then an anesthetic solution is injected into the fatty tissue that is to be sucked out. The patient can remain awake throughout the solution. Similarly, in Laser Assisted Liposuction, low energy lasers are used to liquefy the fat in a targeted way. The liquefied fat is then easily removed using a small tube. In Ultrasound Assisted liposuction, on the other hand, ultrasound is used to liquefy the fat which makes it easier to remove then.The later day advances have undoubtedly made liposuction a much safer and easier procedure. However, a lot of care should be taken during recovery. While it is an outpatient procedure usually, complete recovery takes time as bandages have to be wrapped around firmly at the target areas. Antibiotics have to be given to prevent infections, and care should be taken to support healing. Strictly a Cosmetic Procedure:It should be remembered, however, that liposuction should not be considered a weight loss procedure. It is aimed to help you get rid of fat bulges that give your body a poor shape. Liposuction is ideal for you if you have achieved a healthy body weight but are disappointed by stubborn fat that continues to cling on to your tummy or thighs.For people with excessive weight or those with morbid obesity, there are other surgical options like bariatric surgery.

Dr Mandeep Singh, Consultant Cosmetic &

Plastic Surgery, Paras Hospitals

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As a new mum, we welcome you to the nine month long roller coaster ride known as pregnancy! Wandering just what you want to

expect from the whole thing?The moment a child is born, the mother is also born.

She never existed before. The woman existed but the mother never. A mother is something absolutely new.

I was recently talking to my client who is also a new mum said, “You know all those things people tell you about being a new mum are actually true; those things that you heard and quickly dismissed as being not applicable to yourself and your unborn child”.

While of course individual experiences vary, the common denominator cannot be escaped. Sharing experiences of our clients:

In the first month of pregnancy for the first time, you might not even know that you are four weeks pregnant. Since, now you know that you are creating a new life, it is time to clean up dirty and fun habits (smoking, drinking etc). It is good to start making other mommy friends who can guide you and also convince you your pregnancy is normal. At two months of pregnancy, you must have realized that the term “morning sickness” is just bullshit but the sickness is round the clock. In the third month, your partner should know what you expect of him over the next six months. Fourth month is the best part of your pregnancy as you will start to look as if you are expecting: your hair is shining, skin will radiate the pregnancy glow and you have the courage to share this news with your friends and relatives. Fifth month is the halfway point of your pregnancy as it is all downhill from here. During your sixth month, you can feel the baby’s the first kick and also need to change your pre-pregnancy wardrobe with beautiful maternity clothes of great shape. Seventh month brings to you stretch marks, and turning movement of your baby. You can also get crazy dreams. In your eighth month, movements will reduce and you are in the final stretch. Breathing becomes difficult and you don’t have the stamina to take long strides anymore. At full term, you cannot sleep comfortably: so take help of pillows or try different positions.

Being a mother doesn’t mean that your life is over: in fact, it is the beginning of a new journey. As a new mum after delivery, you still look totally pregnant and will for some time. The uterus starts to contract in the postnatal period which leads to discomfort for few weeks. You are going

to be making up for that bliss for the next month or so with something nasty called lochia pouring out of you faster than an extra super maxipad can keep up with. Try to remember that your baby is just a baby, not an alien. You are made to take care of this creature and you can do it really. If breastfeeding comes to you easily, consider yourself lucky and if you are struggling, take help of your lactation consultant or a support group from your hospital.

Bonding with your baby is never immediate: it might take time but don’t worry if you don’t feel that maternal ooze of love. You can feel weepy due to change in hormonal levels, anxiety and exhaustion. If this feeling is more than baby blues, talk to your doctor: it can be a form of postpartum depression. The sooner you get the help, better it is.

Things are not easy yet but, hopefully, you are finding some semblance of a groove by now.

Babies love to be touched, and no matter what your mother-in-law might say, you are not going to spoil your month old infant by holding him/her too much. Better yet, wear your baby in a sling or carrier of some sort, so you can have a round around the house and your baby can feel close to you. Win/win all the way around. Your baby will make love stronger, your nights longer, days shorter, home happier, clothes dirtier, the past forgotten and the future worth living for.

For you, as a new mum is the start of a new adventure: new challenges to face, new memories to make and new obstacles to overcome. Being a mother is learning about the strengths you didn’t know you had, and dealing with fears you didn’t know existed. Just giving birth to a child doesn’t make you a mother! Being a mother means taking care of your kids, cuddling, watching them grow, watching them play and argue, being there for the good and the bad, and most importantly showing them your unconditional love every second of EVERYDAY.

I conclude by saying that “Being a new mum is one of the most rewarding blessings in the world”.

Pregnancy aspects and being a New Mum

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SPEAK

Swine Flu CanAttack Children too

Dr. Rajiva KumarChild Specialist Muzaffarpur, Bihar, India

Are there signs parents should watch for?“Parents should monitor closely for any signs that children are getting worse, if they have any difficulty breathing, if they are not able to drink, or are not urinating well, if they are very irritable even after their fever goes down, if they have any sort of rash, or if the fever goes down and flu symptoms get better, then get worse again,” Dr. Rajiva says.Call a doctor or seek immediate medical attention if your child:• Has bluish or gray skin color• Is not drinking enough fluids or taking feeding well• Has trouble breathing• Has severe or persistent vomiting• Is not waking up or not interacting• Is so irritable that the child does not want to be held• Has flu-like symptoms improve but then return with

fever and worse cough

Has other conditions such as heart or lung disease, diabetes, or asthma and develops flu symptoms including fever and cough

Causes of Swine FluSwine flu is contagious, and it spreads in the same way as the seasonal flu. When people who have it cough or sneeze, they spray tiny drops of the virus into the air. If you come in contact with these drops or touch a surface (such as a doorknob or sink) that an infected person has recently touched, you can catch H1N1 swine flu.Despite the name, you can’t catch swine flu from eating bacon, ham, or any other pork product.

Swine Flu SymptomsPeople who have swine flu can be contagious one day before they have any symptoms, and as many as 7 days after they get sick. Kids can be contagious for as long as 10 days.Most symptoms are the same as seasonal flu. They can include:• cough • fever• sore throat • stuffy or runny nose• body aches • headache• chills • fatigueLike seasonal flu, swine flu can lead to more serious complications, including pneumonia and respiratory failure. And it can make conditions like diabetes or asthma worse. If you have symptoms like shortness of breath, severe vomiting, abdominal pain, dizziness, or confusion.

Tests for Swine FluIt’s hard to tell whether you have swine flu or seasonal flu, because most symptoms are the same. People with swine flu may be more likely to feel nauseous and throw up than people who have seasonal flu. But a lab test is the only way to know for sure. Vaccine for Swine Flu

The same flu vaccine that protects against seasonal flu also protects against the H1N1 swine flu strain. You can get it as a shot or as a nasal spray. Either way, it “teaches” your immune system to attack the real virus.

If your child is younger than 5, or if your child of any age has a medical condition

such as asthma, diabetes, or a neurologic problem, call your doctor or get medical

attention. Younger kids and kids with longstanding medical conditions are at risk of serious disease if they get either seasonal or pandemic H1N1 swine flu.


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