Future Medicine March 2015

Future March 2015

Medicine Dental Health

Mouth and Teeth Ayurveda Cover Story

Birth defects

Malformed in the womb

Lifestyle regulations Sexual Health

Perils of ageing

Special Story

A guide for first-time parents UAE - AED 7 US - $5 India - `50

Old Age

Life in the twilight zone

Sports medicine, Health Beat: Beauty Fitness yoga

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EDITOR’S NOTE

T

Birth disorders here was a time when parents and other family members used to blame their destiny or fate if a child was born in the family with a genetic disease or some defects like autism, sickle cell anemia or Down syndrome. People in general took it as a curse or a ‘heavenly’ punishment for their misdeeds. The parents of children with birth-defects found themselves alienated in society as everyone else expressed sympathy for their misfortune and the case of those children was far worse since their presence was a taboo at any auspicious ceremony. Only a parent could tell about the agony and dilemma he/she had gone through after having a child with a genetic disorder. There was little knowledge about these diseases a decade or so ago. No one knew about the fact that these were illnesses caused by abnormalities in the genome and it could be or couldn’t be inherited.

Today, the cloud of ignorance about genetic diseases is gone with the scientific knowledge of the causes. People are aware that these diseases can happen to anyone and in any family due to an inherited genetic condition or new mutations/changes to the DNA by environmental causes. The experts in the field are now able to provide every minute detail about how and when it occurs, who is exposed to such conditions and how can this disorder be detected in the early stages? Expecting mothers can undergo advanced medical tests to find out whether there are any abnormalities for the baby in the first few weeks after conceiving. Detection of genetic disorders at the embryonic stage is plausible at least in major hospitals in cities, but what about treatments?

Treatments to prevent genetic diseases at the source are limited however experiments in gene therapy are giving hope to the humankind despite the chances of sideeffects. Many common inherited diseases like cancer and heart problems can be prevented through this treatment, but it should be individualized and there wouldn’t be a generic approach. Besides, since there are many ethical issues as well as commercial interests involved in the complex treatment process, research and experiments often hit roadblocks. In the future, this technique may allow doctors to treat a disorder by replacing a mutated gene that causes disease with a healthy copy of the gene.

We can hope that the day would come when no child will be born with birth-defects, in the world. So the future will be bright for the mankind thanks to the efforts of all those who are involved in research in the area.

The cover story of this issue of Future Medicine makes an in-depth analysis of genetic disorders, which could help our readers understand these diseases better. In addition, a guideline for first-time parents and stories on the latest trends in beauty care make the magazine worth reading.

6 FUTURE MEDICINE I September 2014

cONTENTS

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52

As a teenager, you go through many changes.

Your body is on its way to becoming its adult size. You may notice that you can’t fit into your old shoes or that your jeans are now 3 inches too short. Some of the biggest choices you face are about your health.

COVER STORY

Birth defects

Malformed in the

womb

Birth defects are a widespread health issue. The defects happen while a baby is developing in the mother’s womb.

Congenital anomalies change the shape or function of one or more parts of the body.

They also can affect the overall health of a child. Eminent fertility specialist and gynaecologist Dr N P Vijayalakshmy looks at the reasons behind birth disorders and possible remedies

60

Sexual Health

Perils of ageing Ageing changes in the male reproductive system may include changes in testicular tissue, sperm production, and erectile function.

These changes usually occur gradually

Teen Guide How to stay healthy

10 Eat avocado, keep bad cholesterol at bay Individuals on a moderatefat diet who ate an avocado every day had lower bad cholesterol than those on a similar diet without an avocado a day or on a lower-fat diet, researchers report

Doctors sPeAK Gynaecology Palliative Care Thalassemia Carpei tunnels syndrome

8 FUTURE MEDICINE I March 2015

Dr NP Vijayalakshmy Dr M R Rajagopal Dr Ritu Nair Dr Arun Oomman

42 SPECIAL STORY

Birth pangs A guide for firsttime parents

Whether you just found out that you’re expecting or your due date is fast approaching, find out what you need to know about pregnancy, childbirth and preparing for parenthood

Most dreaded, but highly beneficial

56

A steroid is perhaps the most misunderstood and dreaded drug in the sports world. In reality, it is just an energy booster.

Mouth and teeth Taking good care of your mouth and teeth throughout your life can help prevent problems as you get older. Taking care of your teeth means brushing and flossing every day.

The right bite The benefits of consuming fruits and vegetables of all kinds are infinite. They have been shown to reduce the risk of obesity, cardiovascular illnesses and cancer.

Walking: A step in the right direction

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47

24

Have you been thinking of adding more physical activity to your life? Starting a walking programme may be a great way to be more active.

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12 Wellness-Ayurveda

Lifestyle regulations Seasons, our lifestyle and wellness are interlinked.

Each season requires changes in our lifestyle to suit the climate for sustaining wellness. Here is a look at the seasonal lifestyle regulations

BeAUty CAre

By Ashtavaidyan Vaidyamadham Dr Vasudevan Nambudiri

Look Beautiful with Shahnaz Husain

World renowned beauty and cosmetology expert Shahnaz Husain answers queries on beauty and skincare

Disclaimer: The content of Future Medicine is for information only. Readers are requested to seek advice of a doctor before attempting self medication

March 2015 I FUTURE MEDICINE 9

Health Fruit Avocado

Eat avocado Keep bad cholesterol at bay

Individuals on a moderate-fat diet who ate an avocado every day had lower bad cholesterol than those on a similar diet without an avocado a day or on a lower-fat diet, researchers report

E

ating one avocado a day as part of a heart healthy, cholesterol-lowering moderate-fat diet can help improve bad cholesterol levels in overweight and obese individuals, according to new research published in the Journal of the American Heart Association Researchers evaluated the effect avocados had on traditional and novel

10 FUTURE MEDICINE I March 2015

cardiovascular risk factors by replacing saturated fatty acids from an average American diet with unsaturated fatty acids from avocados.

Forty-five healthy, overweight or obese patients between the ages of 21 and 70 were put on three different cholesterol-lowering diets. Participants consumed an average American diet (consisting of 34 per cent of

calories from fat, 51 per cent carbohydrates, and 16 per cent protein) for two weeks prior to starting one of the following cholesterol lowering diets: lower fat diet without avocado, moderate-fat diet without avocado, and moderate-fat diet with one avocado per day. The two moderate fat diets both provided 34 per cent of calories as fat (17 per cent of calories from monounsaturated

fatty acids/MUFAs), whereas the lower fat diet provided 24 per cent of calories as fat (11 per cent from MUFAs). Each participant consumed each of the three test diet for five weeks. Participants were randomly sequenced through each of the three diets.

Researchers found: •

Compared to the baseline average American diet, lowdensity lipoprotein (LDL) -- the so called ‘bad cholesterol’

•

-- was 13.5 mg/dL lower after consuming the moderate fat diet that included an avocado.

LDL was also lower on the moderate fat diet without the avocado (8.3 mg/dL lower) and the lower fat diet (7.4 mg/dL lower), though the results were not as striking as the avocado diet.

Several additional blood measurements were also more favourable after the avocado diet versus the other two

cholesterol-lowering diets as well: total cholesterol, triglycerides, small dense LDL, non-HDL cholesterol, and others.

These measurements are all considered to be cardio-metabolic risk factors in ways that are independent of the heart-healthy fatty acid effects, said Penny M. Kris-Etherton, Ph.D., R.D., senior study author and Chair of the American Heart Association’s Nutrition Committee and Distinguished Professor of Nutrition at Pennsylvania State University, in University Park, Pennsylvania.

“This was a controlled feeding study, but that is not the real-world -- so it is a proof-of-concept investigation. We need to focus on getting people to eat a hearthealthy diet that includes avocados and other nutrient-rich food sources of better fats,” Kris-Etherton said.

“In the United States avocados are not a mainstream food yet, and they can be expensive, especially at certain times of the year. Also, most people do not really know how to incorporate them in their diet except for making guacamole.

But guacamole is typically eaten with corn chips, which are high in calories and sodium. Avocados, however, can also be eaten with salads, vegetables, sandwiches, lean protein foods (like chicken or fish) or even whole.”

For the study researchers used Hass avocados, the ones with bumpy green skin. In addition to MUFAs, avocados also provided other bioactive components that could have contributed to the findings such as fibere, phytosterols, and other compounds.

According to researchers, many heart-healthy diets recommend replacing saturated fatty acids with MUFAs or polyunsaturated fatty acids to reduce the risk of heart disease. This is because saturated fats can increase bad cholesterol levels and raise the risk of cardiovascular disease.

The Mediterranean diet, includes fruits, vegetables, whole grains, fatty fish, and foods rich in monounsaturated fatty acids--like extra-virgin olive oil and nuts. Like avocados, some research indicates that these not only contain better fats but also certain micronutrients and bioactive components that may play an important role in reducing risk of heart disease.

March 2015 I FUTURE MEDICINE 11

Wellness Ayurveda

Lifestyle regulations Seasons, our lifestyle and wellness are interlinked.

Each season requires changes in our lifestyle to suit the climate for sustaining wellness. Here is a look at the seasonal lifestyle regulations

By Ashtavaidyan Vaidyamadham Dr Vasudevan Nambudiri

12 FUTURE MEDICINE I March 2015

L

ifestyles adopted by man, their health and disease, the climate they live in – all heavily rely on the changing times.

Ancient sages had divided a year into twelve almost equal parts and categorised them as months. Two of them were considered together as a season. Thus a year is comprised of six seasons., viz., sisira, vasanta, greeshma, varsha, sarad and hemanta.

One can differentiate between these seasons in terms of the relative dominance of heat, cold and rain factors.

Exposure to one factor and successive exposure to another factor affect the health and cause effects on the body as diseases.

Modifications and amendments to our lifestyle, taking into consideration these timely varying factors, help us to prevent the ill-effects on the body to some extent. Let us consider such measures explained in Ayurveda that contribute to our health in the winter season.

Character of winter and its effects Apart from the foggy atmosphere that is present throughout the night contributing to cold during

winter, the night hours in comparison to day are extremely dry. Due to this, appetite is more, especially during early morning. Also, the dryness affects the skin, the most exposed organ in the body, and the chances of getting skin lesions are high. Healthy persons having good appetite should pacify their hunger by eating food at the right time in sufficient quantity. Otherwise, they may develop gastritis or ulcerations in the stomach.

Wheat and rice grain powder (soaked in water, dried and powdered), black gram, gingley oil, animal fat, meat, jaggery etc. are preferred during this season as they provide sufficient fuel to the digestive fire. Sweet soft drinks, sugarcane juice and milk are ideal as drinks.

Sweet, sour and salt tastes are preferred more and bitter, astringent and pungent tastes are used only for cleaning teeth and oral cavity.

Modifications in regimen

Exposure to cold has to be prevented and sufficient preventive measures like clothing, footwear, cap etc. have to be adopted while going out. Special care has to be taken for head, arms and

legs while dwelling out in winter. Hot water is preferred for bathing purposes and lukewarm water for drinking.

Thick beddings and room heaters are to be made.

Application of vata-hara oils over the body, massage, exercises are the need of the hour in winter.

Fomentation measures like hot water bath, steam bath, sunbath etc. are ideal in winter.

Above modifications are recommended for healthy persons alone and the persons suffering from any kind of illnesses have to be provided with special care under medical supervision.

The persons suffering from asthma, arthritis, eczema etc. should take medical advice regarding such measures prior to winter.

Tip: A dose of Indukantham Kashayam with a pinch of long pepper daily throughout winter tones up your health to its optimum level.

(The author is Partner, Physician & Factory-incharge, Vaidyamadham Vaidyasala & Nursing home, Mezhathur, Thrithala, Palakkad) March 2015 I FUTURE MEDICINE 13

Beauty Care Shahnaz Husain

Look beautiful with

Shahnaz Husain

World renowned beauty and cosmetology expert Shahnaz Husain answers queries on beauty and skincare.

Apart from being an authority on beauty and skincare and a well respected columnist for many reputed magazines, she is chairperson and managing director of the Shahnaz Husain Group of companies, manufacturers of brand herbal and Ayurvedic beauty products

14 FUTURE MEDICINE I March 2015

I have dark circles near my eyes.

Suggest a home remedy.

Hereditary factors, nutritional deficiencies, stress, inadequate sleep, sun-sensitivity, etc., are some of the aspects that can lead to dark circles under eyes. So, along with external care, you should check these aspects. As a home remedy, daily apply pure almond oil sparingly around eyes and massage it lightly on the skin, using only the ring finger, for one minute under each eye. Massage in one direction only. Leave on for 15 minutes and wipe off gently with moist cotton

wool. You can also mix cucumber juice and potato juice in equal quantities. Apply under eyes daily for 20 minutes. Wash off with water.

I have hair on arms and legs. How can I remove them without using hair removing cream?

Waxing is the best option for the removal of hair on arms and legs. You can have the waxing done at a beauty parlour. Or, you can try using an epilator for arms and legs. It is a small gadget for hair removal. The hair must be at a particular

length before removal.

Please read the directions given with the gadget. There may be some initial pain while removing hair with an epilator. Both waxing and epilation remove hair by the roots. If you wish, you can make a paste with turmeric and milk and rub it on the arms and legs with circular movements. This does not remove hair, but is said to lessen hair growth over a period of time. It may leave a yellowish tinge on the skin. Use whole turmeric to make the paste, in order to get pure turmeric.

I have oily skin.

What is the remedy for that?

For oily skin, after washing the face, apply an astringent lotion. It will be available at a cosmetic store or, you can mix rose water and cucumber juice in equal quantities and apply on the face.

Wash off after 15 minutes. This also helps to reduce oiliness and close the pores. Mix multani mitti with rose water into a paste and apply on the face.

Wash it off when it is dry. Avoid creams.

If the skin feels dry, mix 100 ml rose water with one teaspoon pure glycerin.

Keep in an airtight bottle in the fridge.

Apply a little of this lotion to relieve dryness.

I have small eyes and chubby cheeks. How to make eyes look bigger and cheeks less chubby?

You can make the eyes look bigger and the cheeks look less plump with the help of make-up.

On the lids, use a slightly off-white eye shadow on the inner part of the lid and add a pure white shadow in the inner most part to create a light effect. Pay attention to the lash line to add definition to the eye area. Apply eye pencil close to the lash line on the upper lid. Dot the pencil along the lower lashes and smudge carefully with swab to enlarge the eye area. When applying mascara, pay attention to the lashes at the outer corner. Apply darker colour foundation along the cheeks, at the fullest part. Use your blusher under the cheekbone, starting from under the centre of the eye and going

outwards and slightly upwards. Apply highlighter or translucent powder on the cheekbones, to lift them.

What should I do to grow my nails faster and stronger? Suggest home remedies.

Include adequate protein and calcium in your diet. Take skimmed milk, yogurt, cottage cheese, eggs, fish and sprouts. If you suffer from any health problem or disease, consult your doctor before making changes in your diet. Follow a ten-day programme of taking gelatine. Dissolve one teaspoon gelatin in a little boiling water. Cool the water and add it to fruit juice OR cold milk. Have this daily for ten days.

This helps to strengthen nails and encourages growth.

My elbows and knees are dark. Please tell me some home remedies

Take lemon halves and rub them daily on the elbows and knees. Wash it off and then apply sesame seed (til) oil and massage it into the skin. Make a paste of gram flour (besan), curd, lemon juice and a little turmeric (haldi). Apply the paste on these areas at least three times a week. Wash it off after half an hour. You can also apply a cream containing lemon and turmeric daily.

Please tell me how to make and apply a henna pack

Shahnaz Husain To the henna powder add 4 teaspoons each of lemon juice and coffee, 2 raw eggs and enough curd to mix into a thick paste. If you want to avoid eggs, add more curd. It should be of toothpaste-like consistency. Divide the hair in sections and apply the henna on both sides of the section, so that it is totally covered with henna paste.

Wrap the section around the head. Now repeat this with each section, till the hair is totally covered with the henna paste. Keep it on for at least one hour and wash off. Wash it off with water.

You can use shampoo the next day, if you wish. If your hair is dry, also add 2 teaspoons hair oil to the henna..

Beauty Care

Skincare tips for winter season

Winter has always been hailed as one of the most romantic and beautiful seasons. But the season is termed not so beautiful when it comes to skincare

I

t’s not just the usual problems like dry and chapped skin, lack of healthy glowing skin during winters but also the more serious medical problems like Eczema and scaled skin, commonly noticed during the winters. Some of the top skincare tips for winter season are: • Don’t dehydrate yourself: The first and foremost secret tips when it comes to winter skin care is to keep yourself adequately hydrated.

Be it drinking lots of water throughout the day or other supplements like tea, coffee, juice etc, the

16 FUTURE MEDICINE I March 2015

•

•

trick to keeping the skin from getting overtly dry during this season is to keep yourself safe from getting dehydrated.

Keep away from cocktails: Hard drinks tend to make our body warm but our skin way drier and flushed out. You can bid adieu to glowing skin during winter if you can’t restrict yourself from indulging in these cocktails and hard drinks. They also increase the toxin count in our body, thus making our skin feel more chapped.

Cleansing regularly: one of the most

•

•

important things to keep the skin healthy during winter is to keep the skin properly cleaned.

Using more honey or glycerine: when it comes to top skin care tips for the winter season, the use of honey and glycerine is inevitable. They can be incorporated in almost any kind of skin care paste that we can scoop up at home and honey or glycerine in the tiniest of the quantities has the amazing ability to heal the dryness of the skin and return its healthy glow.

Home-made Winter

Paste: One of the most common winter skin care routine that can be easily be prepared at home and used to prevent dry and chapped skin while returning the glowing skin during winter season is the following one. In this mixture, mix equal amounts of glycerine, lemon juice and rose water and use it on your skin every single day after bath. Glycerine would keep the dry skin at bay while the lemon juice would make sure your skin does not get sticky and the rose water would simply rejuvenate you.

Yoga Beat

Yoga

for longevity Yoga for longevity is getting increasingly popular. This is a basic way out to leading quality life. Those who have adopted it are being able to feel a change in their lives. What are you waiting for? Try and experience the change in your health as well

Y

oga for longevity is a way out for getting yourself rid of unhealthy addictions. A proper discipline is required for the wellness of the body in the long run.

Elimination of toxic substances is required for the optimization of your body. Yoga does these all for you.

Yoga for longevity surely improves your lifestyle. It makes you strong, both mentally and physically. You no longer feel helpless and everything in life gets easy for you. In this harsh world, peace can be best attained in this way. Health and wellness are the most valuable wealth, and it is time that you start working at it. Efficient oxygenation, detoxification and digestion are the requisites of a fit body.

One of the most beneficial prescriptions is the yoga for longevity.

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Even the most advanced doctors are prescribing it. A great health does not mean a good weight.

Obesity is what many are suffering from these days, because of junk eating.

Dieting is not the only way out since extremes of it can make you fall sick.

But physical exercise and asana don’t have any such adverse effects.

Wellness of mind is most vital since it regulates your body. In spite of a busy schedule, you have to remain stress-free. How is that possible? It surely is, through doing yoga for longevity. The nerves get to breathe properly in the process.

Daily functioning of all the body muscles is necessary for your health and wellness. Since many of our everyday work are done by machines, our muscles sit back and take rest. This is one such reason for you to practise yoga for longevity.

Nutrition Beat

When you go to a fast food restaurant

Tea, citrus fruits can lower ovarian cancer risk A few cups of black tea and citrus fruits and juices every day could have an impact on reducing the risk of ovarian cancer Tea and citrus fruits and juices are associated with a lower risk of developing ovarian cancer, according to new research. The research reveals that women who consume foods containing flavonols and flavanones (both subclasses of dietary flavonoids) significantly decrease their risk of developing epithelial ovarian cancer, the fifth-leading cause of cancer death among women.

The research team studied the dietary habits of 171,940 women aged between 25 and 55 for more than three decades. The team found that those who consumed food and drinks high in flavonols (found in tea, red wine, apples and grapes) and flavanones (found in citrus fruit and juices) were less likely to develop the disease.

Drumsticks: A warehouse of minerals The drumstick tree, very common in India, is a warehouse of minerals and vitamins. The root, bark, stem, leaves and fruit are all useful n The juice extracted from drumsticks is rich in calcium and is given to children to strengthen bones. n Cooked drumsticks and its leaves are given to pregnant women to avoid complications during deliveries. n Inhaling steam of boiling drumsticks eases congestion and asthma. n The juice of drumstick leaves can arrest hiccups. n Lime juice mixed with drumstick leaves juice can give a glowing complexion.

K

nowing the amount of calories, fat, and salt in fast foods can help you eat healthier. Many restaurants now offer information about their food. This information is much like the nutrition labels on the food that you buy. If it is not posted in the restaurant, ask an employee for a copy.

In general, eat at places that offer salads, soups, and vegetables. In your salads, avoid high-fat items. Dressing, bacon bits, and shredded cheese, all add fat and calories. Choose lettuce and assorted vegetables. Select low-fat or fat-free salad dressings, vinegar, or lemon juice. Ask for salad dressing on the side.

Healthier sandwiches include regular or junior size lean meats.

Adding bacon or cheese will increase the fat and calories.

Ask

for vegetables instead. Select wholegrain breads or bagels. Croissants and biscuits have a lot of fat.

If you want a hamburger, get a single meat patty without cheese and sauce. Ask for extra lettuce, tomatoes, and onions. Limit how many French fries you eat. Ketchup has a lot of calories from sugar.

Look for meats, chicken, and fish that are roasted, grilled, baked, or broiled. Avoid meats that are breaded or fried.

Also pick low-fat toppings, such as vegetables. You can dab the pizza with a paper napkin to get rid of a lot of the fat from the cheese. Eat low-fat desserts. A rich dessert can add fun to a well-balanced diet. But eat them only on special occasions.

Order smaller servings when you can. Split some fast-food items to reduce calories and fat. You can also leave the extra food on your plate.

Your food choices can teach your children how to eat healthy, too.

Choosing a variety of healthy foods and limiting portion size are key to a healthy diet for anyone.

SEX Beat Important aspect Sexual health is an important aspect of men’s and women's health, whether you're trying to prevent pregnancy and sexually transmitted infections or you're worried about low sex drive or other sexual health problems.

Learn how to achieve a fulfilling sexual relationship, and know how to protect yourself from sexually transmitted infections. As you get older, understand common changes in sexual health — and how to maintain a healthy and enjoyable sex life at any age.

Sex and ageing

Feel confident, enjoy life Sexuality is part of being human. Love, affection and intimacy all play a role in healthy relationships from childhood through old age

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ou often hear about the importance of physical health, mental health and spiritual health, but feeling confident about your sexual health also is very important. Achieving sexual health allows for healthy relationships, planned pregnancies and disease prevention.

STD prevention Sexually transmitted diseases (STDs), or sexually transmitted infections (STIs), are infections generally acquired by sexual contact.

You can get an STD by having unprotected sex with a partner who's infected. You can't always tell if someone is infected, however, because many STDs cause no symptoms, at least at first. In fact, a person might have an STD without knowing it.

That's why you have to be vigilant

20 FUTURE MEDICINE I March 2015

about STD prevention. If you're sexually active, your best bet for STD prevention is to have just one sex partner who doesn't have any STDs and who has sex only with you. If you're not in an exclusive relationship, you can still protect yourself by learning about and consistently practicing STD prevention, such as using condoms.

Are sex and ageing like oil and water? No! Many older adults desire and enjoy an active sex life. And an active interest in sex, as well as satisfaction with the frequency and quality of sexual activity, is positively associated with health in later life. So don't let anyone tell you that sex is only for the young.

And remember, whatever your age, take precautions to protect yourself from sexually transmitted infections.

Talking to kids about sex Kids and sexuality — those words strike fear into the hearts of many parents. But talking to kids about sex is an important part of parenting.

Children and adolescents need your guidance to help them make healthy and appropriate decisions about their sexual behaviour.

It's normal to feel uncomfortable when talking to kids about sex. But remember that by providing accurate and open communication, you increase the odds that your child will understand your values and make appropriate choices about sex.

Fitness Beat

Home fitness tips Don’t you have spare time to join a gym for fitness? No need to worry at all, as you can do many exercises at home to gain complete fitness and wellness. By just being consistent, your home fitness tips can give you a perfect, strong and flexible body. Here are a few exercises that can be done at home by anyone Push-ups Push-ups are great for overall fitness as it strengthens knees and legs. It can easily be done while being stood up against a wall.

Jumping

Walking You can walk outside in the park or walk up the stairs. With walking exercise, your leg muscles would be stronger, thus giving you complete fitness.

Jumping is another important exercise which can easily be done at home.

Besides adding to your health, it also proves to be a great cardio exercise and a wonderful warm-up tool.

Squats Squats bring a great deal of benefits to legs and buttocks to keep you fit and fine.

Light weight lifting Even without going to the gym, you can try out light weight lifting by using things used in the house. You can start with light weights and go on for more weighty items for health benefits.

Dancing and step exercises If dancing brings loads of fun besides giving heart benefits, then step exercises can tone the leg muscles. Both these exercises can be repeated many times a day for health and wellness.

Jogging Leg lifts Leg lifts also feature among wonderful home fitness tips to benefit butt, hips and thighs. They are considered great to build up strength and muscles for the legs.

Crunches Crunches are among the best exercises to strengthen and build up abdominal muscles. They are done a lot by the people who want abs in the quickest possible times.

Jogging is considered a wonderful exercise for heart as it brings many benefits to the organ. Put on a good pair of shoes to eliminate stress to the legs so as to enjoy this exercise.

March 2015 I FUTURE MEDICINE 21

Beauty Beat This party season, don’t spend your evenings envying someone else’s glowing skin. Here are five easy homemade tips that will give you an instant glow. So go on and hog the limelight

Make your

skin glow Honey and lemon mask Treat tanned skin with this homemade mask.

Mix one tablespoon of honey with one tablespoon of fresh lemon juice and apply it evenly on your face and neck. Lemon is natural bleach and brightens the skin instantly whereas honey moisturises it. Wash it off after 10 to 15 minutes.

Sandalwood and turmeric mask Go traditional with a good old haldi-chandan remedy! Mix one tablespoon of freshly ground turmeric or turmeric powder, a tablespoon of sandalwood powder and rose water. Apply it on your face and neck, and keep it for 15-20 minutes. Both turmeric and sandalwood improve complexion and give a natural glow.

Ice cube remedy Open pores attract grime and make the skin look dull. Clean your face, apply a light moisturiser and then rub an ice cube all over it.

This will close the pores and give your face a fresh, glowing look. Your makeup will last longer too.

Oats scrub Make a natural scrub, using half cup of oats and warm water and scrub your face, arms and feet with it. It will clear away dead skin cells, impurities and blackheads, leaving you with a dewy glow.

Cucumber and potato juice Dark circles or puffiness under the eyes can ruin your look. Mix a teaspoon each of cucumber juice and potato juice and apply it under your eye. Keep it for 15-20 minutes. You can also apply it to your face. This will make your skin and eyes look brighter.

22 FUTURE MEDICINE I March 2015

Weight Loss Beat r o f s t i b a h y Health

s s o l t weigh Set up your kitchen The family kitchen can trigger unhealthy eating habits if your shelves are lined with sugary snacks. Rearrange the kitchen to make diet-boosting foods the most natural choice.

Keep healthy food in sight. Keep a bowl of fruit on the counter and pre-chopped vegetables in the refrigerator. When you feel hungry, you'll have a healthy snack close at hand.

Reduce temptation. If you know you

can't control yourself around cookies, keep them and other diet-busting foods out of reach, or even better, out of the house.

Always eat off dishes. Eating straight out of a container or a bag promotes overeating.

Use smaller plates. If you start a meal

with less food in front of you, you'll likely eat less by the time it's over.

Practise healthy eating Life gets busy and a lot of people end up eating without thinking about the food they're putting in their mouths. The following habits can help you avoid this mindless eating.

Eat breakfast. An empty stomach is

an invitation to overeat. Start your day with whole-grain bread or cereal, lowfat milk or yogurt, and a piece of fruit.

Plan ahead. Don't wait until you're hungry to decide what to eat. Plan your meals and go shopping when you feel full. Unhealthy options will be easier to pass by.

Power down your screen.

Eating with your eyes on the TV, computer, or any other distracting screen takes your mind

People who succeed at weight loss, turn healthy eating into a habit. These healthy eating habits can help one lose weight and keep it off. off what you're eating. Not only do you miss out on tasting your food, you're more likely to overeat.

Eat healthy food first.

Start with soup or salad and you'll be less hungry when you turn to the main course.

Just steer clear of cream-based soups and salad dressings.

Eat small snacks often.

Rather than 2 or 3 large meals, you can eat smaller meals and healthy snacksto keep yourself going throughout the day.

Weigh yourself.

The information on the scale will help you see how your weight goes up or down depending on how you eat.

Keep your house cool.

Feeling slightly chilly in winter may help you burn more calories than if you keep your home on the warmer side.

March 2015 I FUTURE MEDICINE 23

Fitness Walking

Walking…

A step in the right direction Have you been thinking of adding more physical activity to your life?

Starting a walking programme may be a great way to be more active.

And walking on a regular basis may lead to many health benefits.

This brochure will give you tips on how to make walking a part of your daily routine 24 FUTURE MEDICINE I March 2015

What are the benefits of walking?

Walking is the most popular physical activity among adults. Taking a walk is low cost and doesn’t require any special clothes or equipment.

Walking may •

• • •

lower your risk of health problems like high blood pressure, heart disease, and diabetes Strengthen your bones and muscles Help you burn more calories Lift your mood

Make walking fun by going to places you enjoy, like a park or shopping center. Bring along a friend

or family member to chat with, or listen to some of your favorite music as you walk. Keep the volume low so that you can hear noises around you.

•

Do I need to see a doctor first?

•

Most people do not need to see a doctor before they start a walking programme.

But if you answer “yes” to any of the questions below, check with your doctor first.

•

•

•

Has your doctor told you that you have heart trouble, diabetes, or asthma?

When you are physically active, do you have pains in your chest, neck, shoulder, or arm?

Do you often feel faint or have dizzy spells?

•

•

Do you feel very breathless after physical activity?

Do you have bone or joint problems, like arthritis, that make it difficult for you to walk?

Are you over 40 years old and have you recently been inactive?

Do you have a health problem that might keep you from starting a walking program?

How do I start?

1. Make a plan

The following questions may help you get started: • Where will you walk?

• How often will you walk?

• Who will walk with you?

• How far or for how long will you walk?

Set goals and reward yourself with a relaxing shower or 30 minutes of quiet time to yourself.

What about safety?

Keep safety in mind as you plan when and where you will walk.

• Walk with others, when possible, and take a phone and ID with you.

• Let your family and friends know your walking time and route.

• If it is dark outside, wear a reflective vest or brightly colored clothing.

• Be aware of your surroundings.

2. Get ready

Make sure you have anything you may need. Here are some examples: • Shoes with proper arch support, a firm heel, and thick flexible soles • Clothes that keep you dry and comfortable • A hat or visor for the sun, sunscreen, and sunglasses • A hat and scarf to cover your head and ears when it’s cold outside

3. Go

Divide your walk into three parts: • Warm up by walking slowly.

• Increase your speed to a brisk walk. This means walking fast enough to raise your heart rate while still being able to speak and breathe easily.

• Cool down by slowing down your pace.

When walking, be sure to use proper form: • Keep your chin up and your shoulders slightly back.

• Let the heel of your foot touch the ground first, and then roll your weight forward.Walk with your toes pointed forward.

• Swing your arms naturally.

4. Add more

As walking becomes easier, walk faster and go farther. Keep track of your progress with a walking journal or log. Record date, time, and distance.

How much do I need to walk?

150 minutes

Amount of time adults need per week of moderate-intensity

aerobic activity (activity that speeds up your heart rate and breathing) to stay healthy.

Break it down

30 minutes per day x 5 days per week = 150 minutes per week Walking briskly for 30 minutes per day, 5 days a week will help you meet this goal. But any 10-minute bout of physical activity helps.

Split it up

10 minutes + 10 minutes + 10 minutes = 30 minutes If you can’t walk for 30 minutes at a time, you can take three 10-minute walks instead.

Step it up

For more health benefits and to control your weight, you may need to walk more. Aim for 300 minutes each week, or about 1 hour a day for 5 days.

The more you walk, the more health benefits you may gain!

ADVICES /

Carpal Tunnel Syndrome

Dr Arun Oommen Consultant Neurosurgeon, Lakeshore Hospital and Research Centre Kochi, India

Dear Doctor, I am a 42-year-old lady living in Chennai. I have been suffering from recurrent numbness and tingling of the middle, index and thumb of my right hand. It gets aggravated especially when I use computers for a long period. I have consulted doctors and have done nerve tests and taken medicines. They gave only temporary relief. Recently my doctor adviced surgery to relieve the problem. I am not comfortable with the idea of a surgery. Is surgery really required?

--Sruthi Karunakaran, Kollam Dear Sruthi, You seem to be having Carpal tunnel syndrome which is a very common problem faced. The carpal tunnel is an anatomical compartment located at the base of the palm. Tendons and a nerve called the median nerve pass through the carpal. The median nerve provides feeling or sensation to the thumb, index finger, long finger, and half of the ring finger. The median nerve can be compressed by a decrease in the size of the canal, an increase in the size of the contents (such as the swelling of lubrication tissue around the flexor tendons), or both.

Patients experience numbness, tingling, or burning sensations in the thumb, the index, middle fingers, and radial half of the ring fingers (median nerve distribution) which is the hallmark neuropathic symptoms (NS) of carpal tunnel entrapment syndrome. Weakness and atrophy of the thenar muscles may occur if the condition remains untreated.

Most cases of CTS are of unknown causes ( idiopathic) . Carpal Tunnel Syndrome can be associated with any condition that causes pressure on the median nerve at the wrist which include obesity, oral contraceptives, hypothyroidism, arthritis, diabetes,), and trauma..

Occupational risk factors of repetitive tasks( continuous use of computer), force, posture, and vibration have been cited.

If history and physical examination suggest CTS, patients can be tested electrodiagnostically with nerve conduction studies and electromyography.

Electrodiagnostic testing is to compare the speed of conduction in the median nerve with conduction in other nerves supplying the hand. When the median nerve is compressed, as in CTS, it will conduct more slowly than normal and more slowly than other nerves.

26 FUTURE MEDICINE I March 2015

Generally accepted treatments include: steroids either orally or injected locally, splinting, and surgical release of the transverse carpal ligament. Predisposing illness like diabetes mellitus, coexistent cervical radiculopathy, hypothyroidism, polyneuropathy, pregnancy, rheumatoid arthritis, has to be tackled.

Surgery is recommended that when there is static (constant, not just intermittent) numbness, muscle weakness, or atrophy, and when night-splinting no longer controls intermittent symptoms. . Release of the transverse carpal ligament is known as “carpal tunnel release� surgery.

Suggested healthy habits such as avoiding repetitive stress, work modification through use of ergonomic equipment (wrist rest, mouse pad), taking proper breaks, using keyboard alternatives (digital pen, voice recognition, and dictation), and drugs like omega-3 fatty acids, and B vitamins have been proposed as methods to help prevent carpal tunnel syndrome.

Radiation

/ ADVICES

Dr M.R.Rajagopal Chairman, Pallium India Director, WHO Collaborating Centre for Training and Policy on Access to Pain Relief

My father has lung cancer. We were told that it had spread to his bones. He has pain in the right shoulder and is getting morphine, but the pain has not reduced and he is unable to move his arm. The palliative care doctor has suggested radiotherapy. Why is it that even after starting palliative care, radiation is advised? Should my father go through this?

--Aravind S, Thiruvananthapuram

Dear Mr Aravind, I am sorry to hear about your father’s problem. Pain on movement can be very difficult to live with, and may also cause him to lose sleep.

Palliative care is aimed at comfort and quality of life, with whatever means necessary to achieve this. In this case, your father’s pain is unlikely to be controlled with medicines alone.

Palliative radiation is a part of palliative care, just as palliative chemotherapy or palliative surgery may have to be considered in specific instances.

Pain relief with medicines may be good for pain at rest; but pain on movement is difficult to control if the disease is involving joints. For more reasons than one, your father should have a consultation with a radiation oncologist, who would be the final authority to advise you on this matter.

Many organisations have given guidelines on this matter. The American Society for Radiation Oncology (ASTRO) has given guidelines according to which, a single fraction of radiation would be ideal and this is what your oncologist is likely to recommend. He may offer you choice of five or ten fractions also, which may mean that his need for a repeat radiation is less. With a single fraction, there is 20% chance that he may need another fraction. However, this is something that can be done later, if necessary.

Generally, single fraction is recommended for palliative radiation because the person with advanced disease should have good quality of life and should not have to waste the remaining precious part of his life in hospital corridors. In short, I would strongly recommend that you consult a radiation oncologist for decision on the recommendation by your palliative care doctor.

March 2015 I FUTURE MEDICINE 27

ADVICES /

Thalassemia

Dr Ritu Nair Department of Medical Genetics, CRAFT Hospital, Kodungallur

Dear doctor, We have been married for 12 years and have a child affected with a blood disorder, Thalassemia. Our child undergoes frequent blood transfusions. We want to have a second child free from this genetic disorder and also want this child to be a savior sibling for the affected one. It’s a pity that none of the genetic diseases have treatment as of date. Is there any centre in INDIA offering savior baby?

--Meera Arjun, Chennai Dear Meera, CRAFT is the only centre in India offering PGD technology for blood related disorders and other chromosomal and single gene disorders. Savior sibling can also be very well offered in conjunction to PGD and HLA matching. First and foremost, parents and the affected child’s DNA will be tested to find out the nature of genetic mutation,

28 FUTURE MEDICINE I March 2015

then HLA linked markers will be studied on them. This would then help us to select normal and HLA matched embryos, created by IVF/ ICSI. This completes the process of savior sibling. The savior sibling’s bone marrow transplantation can help save the affected child. So we test the HLA genes relevant to the proximity of genetics of bone marrow.

Irregular periods

/ ADVICES

Dr N P Vijayalakshmy Chief Medical Officer, Vijaya Institute of Medical Sciences, Kochi

Dear doctor, I am a 25-year-old having very irregular periods. My marriage date is fast approaching. I am concerned about this problem. What are the reasons and the remedies? Will it affect my fertility?

--Neelanjana Das Gupta, New Delhi Dear Neelanjana, I understand your concern. There are many reasons for irregular periods. Some women have hair growth in the face, hands, legs and in the abdomen along with irregular period. There are a few others who suddenly gain weight and start having irregular periods.

Some have discharge from nipple and have irregular period. All these conditions are associated with endocrine problem .The easy method is to undergo blood hormone profile like thyroid function ,serum prolactin level , level of follicular stimulating hormone and luteinizing hormone level in the blood .If any of the hormone is found abnormal , correcting it with medication ,should set your periods normal.

Another condition is PCOD. Do it under the supervision of a gynaecologist.

March 2015 I FUTURE MEDICINE 29

Cover story Birth Defects

30 FUTURE MEDICINE I March 2015

Malformed

in the womb Birth defects are a widespread health issue. The defects happen while a baby is developing in the mother’s womb. Congenital anomalies change the shape or function of one or more parts of the body. They also can affect the overall health of a child. According to “March of Dimes Global Report on Birth Defects, every year an estimated 8 million children-- 6 per cent of total births worldwide--are born with a serious birth defect of genetic or partially genetic origin. At least 3.3 million children below 5 years old die annually because of serious birth defects and the majority of those who survive may be mentally and physically disabled for life. Eminent fertility specialist and gynaecologist Dr. N. P. Vijayalakshmy looks at the reasons behind birth disorders and possible remedies

T

here are three reasons to assess foetal health in utero.

The first is to prevent the loss of a normal child and second, to prevent the birth of a severely malformed baby. The third reason is to correct preventable disorders. Obstetric care takers focus on maternal medical problem like diabetes and hypertensionconnected foetal risk as in intra uterine growth retardation. Birth defects are structural or functional abnormalities present at birth that cause physical or mental disability.

Incidence: Congenital anomalies affect an estimated 8 million children worldwide and at least 3.3 million children less than 5 years of age die annually because of serious birth defects and the majority of those who survive may be mentally and physically disabled for life, says

a report in March of Dimes Global Report on Birth Defects.

Common defects: Birth

defects are of different types. Some examples are orofacial defects, muscular skeletal malformations, central nervous system defects, heart defects, cardiovascular malformations, genitourinary malformations, limb defects etc.

Birth defects of the central nervous system are called neural tube defects. This includes conditions called anencephaly, hydrocephalus, macrocephaly and spina bifida.

Anencephaly happens if a baby is being born without forebrain and cerebrum. Almost all babies born with anencephaly will die shortly after birth. Spina bifida is a fault in the development of the spine and spinal cord which leaves a gap in the spine. Spina bifida might

cause physical and intellectual disabilities that range from mild to severe form. Cerebral palsy results from brain injury during a baby’s development in the womb.

Infections, birth injuries and poor oxygen supply to the brain before, during and immediately after birth, are common factors that can affect a baby’s normal development. Cleft lip and palate is an orofacial defect where baby’s lip or mouth does not form properly during pregnancy.

Surgery to repair this usually occurs in the first few months of life and is recommended within the first 18 months of life. Congenital heart defects are conditions that are present at birth and can affect the structure of a baby’s heart and the way it works.

They are the most common type of birth defect. Pulmonary atresia is a birth defect of the heart where the March 2015 I FUTURE MEDICINE 31

Cover story Birth Defects

valve that controls blood flow from the heart to the lungs doesn’t form at all. An atrial septal defect is a birth defect of the heart in which there is a hole in the septum that divides the upper chambers of the atria. Down syndrome is a genetic disorder caused by extra copy of 21st chromosome ie Trisomy 21. It includes a combination of birth defects, including mental retardation, characteristic facial features, and often a range of health issues, such as impaired hearing, impaired vision, and heart defects.

There are a large number of different musculoskeletal abnormalities affecting one or a

32 FUTURE MEDICINE I March 2015

combination of bone and muscle development in the skull, trunk and limbs.

Causes: Congenital anomalies

are a diverse group of disorders of prenatal origin which can be caused by single gene defects, chromosomal disorders, multifactorial inheritance, environmental teratogens and micronutrient deficiencies.

Socioeconomic factors like maternal nutrional status, genetic factors, infections during pregnancy, and environmental factors like exposure to pesticides, medications, alcohol etc. are the causes and risk factors.

Chromosome anomaly can be structural or numerical. Some of the numerical anomalies are detected after the baby is born since these babies can otherwise survive. For example 45XO Turner’s syndrome, baby is born as a girl, her ovaries are streak and will not be able to function as normal female. Some of the anomalies are recurrent, will not progress beyond 12th week of intrauterine life and results in recurrent abortion. These are conditions where aneuploidy is responsible in which chromosome number is abnormal. Aneuploidy originates during cell division when the chromosomes do not

separate properly between the two cells.

Prevention: Preconception counseling to the would-be mother especially if she is coming from a family history of diabetes will help her to plan her pregnancy and maintain normal glycemic level which may prevent abnormalities due to diabetes. Antenatal screening includes screening for maternal age, RH blood group incompatibility, carrier screening for genetic disorders, and advise not to use alcohol or tobacco.

During late pregnancy, teaching the mother about foetal movement count and to watch out for any

abnormal vaginal discharge will help in early detection of premature rupture of membrane and any other complications.

In early pregnancy, there is double marker test, PAPPA test (pregnancy-associated plasma protein A) ultrasound evaluation of intrauterine gestational sac and yolk sac ratio. As the woman crosses the first trimester there are various blood tests like triple marker test and ultrasonography to rule out some of the congenital anomalies. Newborn screening tests look for developmental, genetic, and metabolic disorders in the newborn baby. Screening

for deafness and heart defects as well as early detection of birth defects can facilitate lifesaving treatments and prevent the progression towards some physical, intellectual, visual or auditory disabilities.

To build up a healthy, intelligent next generation, preconceptional counseling, good antenatal care and good intra and post-partum care of the baby will help the baby, parents and society.

(Dr. N. P. Vijayalakshmy M.D.., D.G.O. is chief medical officer of Vijaya Institute of Medical Sciences, Cochin, Kerala)

Cover story Birth Defects

Why birth defects happen

In most cases, doctors don’t know what caused a baby’s birth defect.

When the cause is known, it might be environmental (such as a baby’s exposure to chemicals or viruses while in the womb), a problem with the foetus’ genes, or a combination of these things.

Environmental causes

If a mother has certain infections (such as toxoplasmosis) during pregnancy, her baby can have a birth defect. Other conditions that cause defects include rubella and chickenpox (varicella). Fortunately, many people get vaccinated against these diseases so these infections are rare.

Also, alcohol abuse by the mother may cause foetal alcohol syndrome, and certain medicines taken by the mother can cause birth defects. (Doctors try to avoid harmful medicines during pregnancy, so a pregnant woman should tell any doctor she consults that she’s expecting.)

Genetic causes

Every cell in the body has chromosomes containing genes that determine a person’s unique characteristics. During conception, a child inherits one of each pair of chromosomes (and one of each pair of the genes they contain) from each parent. An error during this process can cause a baby to be born with too few or too many chromosomes, or with a damaged chromosome.

One well-known birth defect caused by a chromosome problem isDown syndrome. A baby develops Down syndrome after getting one extra chromosome. Other genetic defects happen when both parents pass along a faulty gene for the same disease; this is calledrecessive inheritance and includes conditions such as Tay-Sachs disease and cystic fibrosis.

A disease or defect also can happen when only one parent passes along the gene for that disease.

This is called dominantinheritance.

This includes birth defects such as

34 FUTURE MEDICINE I March 2015

achondroplasia (a form of dwarfism) and Marfan syndrome (a disorder characterized by abnormally long fingers, arms, and legs).

Finally, some boys inherit disorders from genes passed onto them only by their mothers. These defects, which include conditions like hemophilia and color blindness, are called X-linked because the genes are carried on the X chromosome. Males have only one X chromosome, which is received from the mother, whereas females have two X chromosomes — one from each parent. A faulty gene on the X chromosome will be more likely to cause a problem in boys because they don’t have a normal copy of the gene. Females who have an altered gene on one X chromosome and a normal gene on the other sometimes have mild features of the given defect-KidsHealth

Who is at high risk

Birth defects can occur during pregnancy, but some pregnancies are at higher risk than others. The following situations place pregnant women at higher risk of having a child with a birth defect

Lack of folic acid: Women who are pregnant or who could become pregnant should take 400 micrograms of folic acid every day to prevent neutral tube defects (NTDS). According to a report, only 2 out of every 5 women of childbearing age, however, take folic acid every day.3 Drinking alcohol: Drinking alcohol

during pregnancy can lead to a variety of problems, including birth defects.

For example, using alcohol can lead to foetal alcohol syndrome, which is characterised by physical challenges, and behavioural problems. There is no safe level of alcohol consumption during pregnancy.

Smoking cigarettes: Smoking cigarettes during pregnancy can lead to a variety of problems, including lung issues such as asthma. Evidence strongly suggests that certain birth defects, such as problems with the heart and intestines, are caused by smoking during pregnancy.5 In addition, infants of mothers who smoke during pregnancy are at higher

Cover story Birth Defects

risk for sudden infant death syndrome (SIDS).

Using drugs: Using drugs during pregnancy can increase the risk of various birth defects, including IDDs and behavioral problems. For example, using cocaine during pregnancy increases the risk that the infant will be born with structural birth defects of the arms and legs, urinary system, and heart.

Medication use: Certain medications are known to cause birth defects if taken during pregnancy. Thalidomide, which is currently used to treat certain cancers and other serious conditions, was once sold as a treatment for morning sickness until it was discovered that it caused severe birth defects. Infants whose mothers took thalidomide had a range of structural and functional problems, including misshapen ears and shortened limbs. Although the thalidomide situation led to much stricter controls on drugs used during pregnancy, the majority of medications currently used by pregnant women have not been tested for safety or efficacy in pregnant women. Women who are pregnant or who might become pregnant should discuss all medications and supplements they take with their health care providers.

Infections: Women who get certain infections during pregnancy are at higher risk for having a child with birth defects. Some of the more common infections that are linked to birth defects are cytomegalovirus, a common virus that spreads through body fluids and usually causes no symptoms in healthy people, and toxoplasmosis, a parasitic infection that spreads through contact with cat feces, raw meat, and contaminated food and water..

Obesity or uncontrolled diabetes:

Obesity is also associated with other health problems and long-term health issues. Poorly controlled blood sugar places women at higher risk of having a baby that is too large, that has breathing problems, and other poor health outcomes. These outcomes are likely regardless of whether the woman had diabetes before she got pregnant (type 1 or 2 diabetes) or whether she developed diabetes during pregnancy (gestational diabetes).

36 FUTURE MEDICINE I March 2015

Common birth defects Cleft lip and/or palate happens when the

tissues of the mouth or lip don’t form properly during foetal development, leaving an opening, division, or split in that area. This is called “clefting.” A cleft lip is a long opening between the upper lip and the nose. A cleft palate is an opening between the roof of the mouth and the nasal cavity.

Cerebral palsy usually isn’t found until weeks to months after birth. Kids with cerebral palsy have difficulty controlling the motions their muscles make — which muscles and how severely they are impaired varies from person to person. There’s no cure for cerebral palsy, but therapies and other treatments can help kids improve their quality of life.

Clubfoot is a term used to describe a group of

structural defects of the foot and ankle in which the bones, joints, muscles, and blood vessels are formed incorrectly. These defects range from mild to severe and may affect one or both feet. Feet affected by this defect most often point down, turn in, and have a limited range of motion.

Developmental dysplasia of the hip is

when the round upper end of the thighbone doesn’t sit inside the socket of the pelvis properly. This can happen in one or both hips and occurs in 1 in 1,000 births.

While the exact cause is unknown, it tends to happen more in girls and runs in families. It’s usually discovered at birth and treated soon after by placing the baby in a soft sling for 6 to 9 months. If it’s not recognized and treated early, surgery may be necessary.

Congenital hypothyroidism, which occurs in about 1 in 3,000 to 4,000 births, happens when the baby’s thyroid gland (located in the front of the neck) is absent or underdeveloped at birth or if a metabolic defect blocks production of thyroid hormone. This causes a lack of thyroid hormone, which is important for supporting normal growth and brain development. If this condition isn’t recognized and treated with thyroid hormone medicines within the first few weeks of life, a baby will develop a developmental delay and permanent intellectual disability (mental retardation).

Foetal alcohol syndrome (FAS) causes slowed growth, intellectual disability, abnormalities in facial features, and problems with the central nervous system FAS cannot be cured or treated, but can be prevented by avoiding alcohol intake during pregnancy.

Neural tube defects (NTD) happen in the first month of pregnancy when the structure that develops into the brain and spinal cord is forming.

Normally, this structure folds into a tube by the 29th day after conception. When the tube doesn’t close completely, the baby has a neural tube defect.

March 2015 I FUTURE MEDICINE 37

Cover story Birth Defects

The genetic

revolution

The identification of disease-related genes has led to an increase in the number of available genetic tests that detect disease or an individual’s risk of disease. Dr Ritu Nair writes about the possibilities of genetic testing and the facilities available at CRAFT Hospital, Kodungallur, Kerala

G

enetics is the study of how biological traits and characteristics are transmitted through generations and families.

Molecular medicine examines how illness and disease occur or can be prevented at the cellular or molecular level. The identification of diseaserelated genes has led to an increase in the number of available genetic tests that detect disease or an individual’s risk of disease.

As the number and types of such diseases they detect increase, there is concern over the reliability and limitations of such tests, as well as the implications of testing and disclosure.

Putting this mission into practice, CRAFT has now installed path-breaking medical techniques to detect genetic disorders at the earliest.

Here at CRAFT we aim to give services at all stages of pregnancy– pre implantation, pre-natal and post-natal stages. This will help early detection of even severe genetic disorders and help prevent the birth of a genetically-affected child.

Medical genetic services at CRAFT Hospital 38 FUTURE MEDICINE I March 2015

have shown tremendous advancements since its establishment in terms of genetic disease prevention in time and have been able to report positive pregnancies after preimplantation genetic tests.

There is a range of genetic testing performed in our lab with the most sophisticated and highly advanced state-of-the-art equipment.

Genetic testing in male infertility

Abnormal sperm parameters are a cause of chromosomal abnormalities in men. Prior testing of chromosomes helps diagnose a male infertility problem and helps in clinical management.

In our experience, we have come across cases where males with less sperm count or even with zero sperm count had some chromosomal balanced translocations/ Y chromosomal abnormalities which explain the reasons for low sperm count and with proper counseling, the management was given to such patients.

Y chromosome microdeletions

This is to look for small micro level gene changes

in Y chromosome which would help a clinician explain the chances of sperm retrieval during micro TESE. Sperm FISH testing: It is also performed on males to know the chromosomal aneuploidies. This will help to know whether at what percentage the embryos generated during IVF will be chromosomally abnormal and how it can be prevented.

Genetic tests in female factor infertility:

Chromosomal abnormalities in females lead to reduce the number of oocytes at times and they are also major causes of secondary infertility where there are first trimester abortions.

Fragile X syndrome detection Peimplantation genetic diagnosis:

Selecting chromosomally normal embryos prior to embryo transfer. This is done with IVF/ICSI. Indications for PGD/ PGS Advanced maternal age Previous IVF/ICSI Failures Recurrent implantation failures Family history of any abnormal \ity Parents carriers of balanced translocations

Parents carriers of single gene disorders

Endometrial Recptor Gene assay (ERGA)

It is a genetic test of the endometrium where around 300 genes are checked to see the upregulation / downregulation of genes required for implantation.

In case the gene expression is not correct, it is corrected with the help of medications. This lets the clinician decide the timely transfer of embryos.

We have got success with nearly 13 cases of recurrent implantation failures, where after ERGA test, patients could achieve pregnancy.

Prenatal diagnosis: Our foetal medicine department is well supported and has full-fledged prenatal diagnostic services available.

Prenatal Genetic services • • • • • •

Genetic counseling Prenatal diagnostic services NIPT testing Karyotyping on amniotic fluid and fetal blood sampling Rapid FISH for prenatal samples Mutation testing via NGS

Since 1962

departments

An ISO 9001 650 bedded Multi Speciality Hospital

Caritas CanCer institute  Medical Oncology  Surgical Oncology  Radiation Oncology  Palliative Care | Caritas Heart institute  Interventional Cardiology  Cardiac Surgery | neuro sCienCes  Neurology  Neuro Surgery | Gastroenterology & Hepatology | Nephrology & Renal Transplantation | Plastic & Reconstructive Surgery | Neonatology | Paediatric Surgery | Urology | General Medicine | Orthopaedics & Traumatology Department | Dermatology, Venereology and Leprosy | Caritas psyCHologiCal and psyCHiatriC serviCe  Psychiatry  Counselling & Child Guidance | Department of General, Minimal Access and Bariatric Surgery | Pulmonology | Oto-Rhino-Laryngology (ENT) | Obstetrics and Gynaecology | Anaesthesiology | Dentistry | Ophthalmology | Paediatric Department | Department of Pastoral Care and Counselling | Department of Radiology and imaging | Laboratory Science & Transfusion Medicine | Emergency Medicine | Department of Physical Medicine and Rehabilitation

Special Story Old Age

Life in the twilight zone

Dr. Alex Jacob Ernakulam Medical Centre Hospital

By Dr Alex Jacob

Old age brings in lots of problems and some of them, especially diseases, are really challenging.

One of the common illnesses which requires immediate hospitalisation is geriatric fractures. A look at what Ernakulam Medical Centre Hospital offers to geriatric patients

40 FUTURE MEDICINE I March 2015

T

hough India is proud of having a demographically young population at present, the numbers are going to change dramatically over the next few years.

According to the United Nations Population Division (UN 2011), India’s older population will increase over the next four decades. The share of India’s population ages 60 and older is projected to climb from 8 per cent in 2010 to 19 per cent in 2050, by mid-century, India’s 60 and older population is expected to encompass 323 million people, a number greater than the total US population in 2012. This profound shift in the share of older Indians—taking place in the context of changing family relationships and severely limited old-age income support—brings with it a variety of social, economic, and healthcare policy challenges.

Adding to this, almost one-half (47 per cent) of older Indians has at least one chronic disease such as asthma, angina, arthritis, depression, or diabetes.

Data from the Western world shows that hip fracture as a major cause of hospital admission and 90 per cent of them are over the age of 60. Studies have shown that hip fractures have high mortality rates and unfortunately one in four of these patients die within a year.

The demographics in India is a bit alarming with fall in fertility rate, change from joint family to nuclear family concept and increase in life expectancy. The average age of

population is going to go up within a few years and we will have to face the reality of taking care of this population with hip fractures, with most of them with associated problems like diabetes, cardiac, dementia etc.

The old standard of treatment of hip fracture is surgical management by reconstruction or replacement, in order to improve the quality of life and bring them to pre fracture status. Traditionally, these patients with fractures were admitted through the emergency department and took almost 3 to 4 days before they were optimised for surgery, because of the associated illnesses and the lower priority given to the elder patient with fracture compared to other emergency situations.

This however led to an increase in mortality and readmission rates.

In order to improve this situation, the policy makers and stakeholders thought of prioritising this group of patients, started treating them as a semi-emergency and got these patients ready for surgery within 24 to 32 hours, with written protocols from admission to discharge and rehabilitation. These changes brought about substantial reduction in the length of stay, mortality, complication rates, and readmission rates.

In co-management as the name suggest, the patient is taken care by the orthopaedic surgeon and the physician together and not independently. They are well assisted by a team comprising anaesthetist, Emergency Medicine, Nursing and Rehabilitation Services. The team would follow written protocols in each and every step, from the time of admission to discharge. This has led to better communication within the team and with the patient’s relatives.

Each and every member has an important role to play and would come in at the appropriate time during the stay. At times multiple people need to coordinate for the smooth running of the protocol. The team sits together once in a month for an audit to see the efficiency

and take corrective measures if any needed be.

In view of the emerging challenge, we at Ernakulam Medical Centre Hospital has implemented geriatric fracture care programme to

ensure a comprehensive healthcare for the geriatric population. Our early results are encouraging with better outcome in the form of less hospital stay and readmission rate, with better patient satisfaction.

March 2015 I FUTURE MEDICINE 41

Special Story Pregnancy

Birth pangs A guide for first-time parents

Y

ou’ve survived 9 months of pregnancy. You’ve made it through the excitement of labor and delivery, and now you’re ready to head home and begin life with your baby. Once home, though, you frantically realize you have no idea what you’re doing!

These tips can help even the most nervous first-time parents feel confident about caring for a newborn in no time.

Getting help after the birth

Consider getting help during this time, which can be very hectic and overwhelming. While in the hospital, talk to the experts around you. Many hospitals have feeding specialists or lactation consultants who can help you get started nursing or bottle-feeding.

In addition, nurses are a great resource to show you how to hold, burp, change, and care for your baby.

For in-home help, you might want to hire a baby nurse or a responsible neighbourhood teenager to help you for a short time after the birth. Your doctor or the hospital can be good resources for finding information about inhome help, and might even be able to make a referral to home health agencies.

In addition, relatives and friends often want to help. Even if you disagree on certain things, don’t dismiss their experience.

But if you don’t feel up to having guests or you have other concerns, don’t feel guilty about placing restrictions on visitors

Handling a newborn Whether you just found out that you’re expecting or your due date is fast approaching, find out what you need to know about pregnancy, childbirth, and preparing for parenthood

If you haven’t spent a lot of time around newborns, their fragility may be intimidating. Here are a few basics to remember: • Wash your hands (or use a hand sanitizer) before handling your baby.

Newborns don’t have a strong

•

•

•

•

immune system yet, so they are susceptible to infection. Make sure that everyone who handles your baby has clean hands.

Be careful to support your baby’s head and neck. Cradle the head when carrying your baby and support the head when carrying the baby upright or when you lay your baby down.

Be careful not to shake your newborn, whether in play or in frustration. Shaking that is vigorous can cause bleeding in the brain and even death. If you need to wake your infant, don’t do it by shaking — instead, tickle your baby’s feet or blow gently on a cheek.

Make sure your baby is securely fastened into the carrier, stroller, or car seat. Limit any activity that could be too rough or bouncy.

Remember that your newborn is not ready for rough play, such as being jiggled on the knee or thrown in the air.

Bonding and Soothing Techniques

Bonding, probably one of the most pleasurable aspects of infant care, occurs during the sensitive time in the first hours and days after birth when parents make a deep connection with their infant. Physical closeness can promote an emotional connection.

For infants, the attachment contributes to their emotional growth, which also affects their development in other areas, such as physical growth. Another way to think of bonding is

“falling in love” with your baby.

Children thrive from having a parent or other adult in their life who loves them unconditionally.

Begin bonding by cradling your baby and gently stroking him or her in different patterns. Both you and your partner can also take the opportunity to be “skinto-skin,” holding your newborn against your own skin while feeding or cradling.

Babies, especially premature babies and those with medical problems, may respond to infant massage. Certain types of massage may enhance bonding and help with infant growth and development. Many books and videos cover infant massage — ask your doctor for recommendations.

Be careful, however — babies are not as strong as adults, so massage your baby gently.

Babies usually love vocal sounds, such as talking, babbling, singing, and cooing. Your baby will probably also love listening to music. Baby rattles and musical mobiles are other good ways to stimulate your infant’s hearing.

If your little one is being fussy, try singing, reciting poetry and nursery rhymes, or reading aloud as you sway or rock your baby gently in a chair.

Some babies can be unusually sensitive to touch, light, or sound, and might startle and cry easily, sleep less than expected, or turn their faces away when someone speaks or sings to them. If that’s the case with your baby, keep noise and light levels low to moderate.

Diapering Dos and Don’ts

You’ll probably decide before you bring your baby home whether you’ll use cloth or disposable diapers. Whichever you use, your little one will dirty diapers about 10 times a day, or about 70 times a week.

Before diapering your baby,

make sure you have all supplies within reach so you won’t have to leave your infant unattended on the changing table. You’ll need: • a clean diaper • fasteners (if cloth prefold diapers are used) • diaper ointment if the baby has a rash • a container of warm water • clean washcloth, diaper wipes, or cotton balls After each bowel movement or if the diaper is wet, lay your baby on his or her back and remove the dirty diaper. Use the water, cotton balls, and washcloth or the wipes to gently wipe your baby’s genital area clean. When removing a boy’s diaper, do so carefully because exposure to the air may make him urinate. When wiping a girl, wipe her bottom from front to back to avoid a urinary tract infection.

To prevent or heal a rash, apply ointment. Always remember to wash your hands thoroughly after changing a diaper.

Diaper rash is a common concern. Typically the rash is red and bumpy and will go away in a few days with warm baths, some diaper cream, and a little time out of the diaper. Most rashes occur because the baby’s skin is sensitive and becomes irritated by the wet or poopy diaper.

To prevent or heal diaper rash, try these tips: • Change your baby’s diaper frequently, and as soon as possible after bowel movements.

• After cleaning the area with mild soap and water or a wipe, apply a diaper rash or “barrier” cream. Creams with zinc oxide are preferred because they form a barrier against moisture.

• If you use cloth diapers, wash them in dye- and fragrancefree detergents.

• Let the baby go undiapered for part of the day. This gives the skin a chance to air out.

March 2015 I FUTURE MEDICINE 43

Special Story Pregnancy

If the diaper rash continues for more than 3 days or seems to be getting worse, call your doctor — it may be caused by a fungal infection that requires a prescription.

Bathing Basics

You should give your baby a sponge bath until: • the umbilical cord falls off and the navel heals completely (1-4 weeks) • the circumcision heals (1-2 weeks) A bath two or three times a week in the first year is fine. More frequent bathing may be drying to the skin.

Have these items ready before bathing your baby: • a soft, clean washcloth • mild, unscented baby soap and shampoo • a soft brush to stimulate the baby’s scalp • towels or blankets • a clean diaper • clean clothes Sponge baths. For a sponge bath, select a safe, flat surface (such as a changing table, floor, or counter) in a warm room.

Fill a sink, if nearby, or bowl with warm (not hot!) water. Undress your baby and wrap him or her in a towel. Wipe your infant’s eyes with a washcloth (or a clean cotton ball) dampened with water only, starting with one eye and wiping from the inner corner to the outer corner. Use a clean corner of the washcloth or another cotton ball to wash the other eye. Clean your baby’s nose and ears with the damp washcloth.

Then wet the cloth again and, using a little soap, wash his or her face gently and pat it dry.

44 FUTURE MEDICINE I March 2015

Next, using baby shampoo, create a lather and gently wash your baby’s head and rinse.

Using a wet cloth and soap, gently wash the rest of the baby, paying special attention to creases under the arms, behind the ears, around the neck, and in the genital area. Once you have washed those areas, make sure they are dry and then diaper and dress your baby.

Tub baths. When your baby is ready for tub baths, the first baths should be gentle and brief. If he or she becomes upset, go back to sponge baths for a week or two, then try

the bath again.

In addition to the supplies listed above, add: • an infant tub with 2 to 3 inches of warm — not hot! — water (to test the water temperature, feel the water with the inside of your elbow or wrist).

An infant tub is a plastic tub that can fit in the bathtub; it’s a better size for babies and makes bathing easier to manage.

Undress your baby and then place him or her in the water immediately, in a warm room, to prevent chills. Make sure the water in the tub is no more than 2 to 3 inches deep, and that the water is no longer running in the tub. Use one of your hands to support the head and the

other hand to guide the baby in feet-first. Speaking gently, slowly lower your baby up to the chest into the tub.

Use a washcloth to wash his or her face and hair. Gently massage your baby’s scalp with the pads of your fingers or a soft baby hairbrush, including the area over the fontanelles (soft spots) on the top of the head.

When you rinse the soap or shampoo from your baby’s head, cup your hand across the forehead so the suds run toward the sides and soap doesn’t get into the eyes. Gently wash the rest of your baby’s body with water and a small amount of soap.

Throughout the bath, regularly pour water gently over your baby’s body so he or she doesn’t get cold. After the bath, wrap your baby in a towel immediately, making sure to cover his or her head.

Baby towels with hoods are great for keeping a freshly washed baby warm.

While bathing your infant, never leave the baby alone. If you need to leave the bathroom, wrap the baby in a towel and take him or her with you.

Umbilical Cord Care Umbilical cord care in

newborns is also important.

Some doctors suggest swabbing the area with rubbing alcohol until the cord stump dries up and falls off, usually in 10 days to 3 weeks, but others recommend leaving the area alone. Talk to your child’s doctor to see what he or she prefers.

An infant’s navel area shouldn’t be submerged in water until the cord stump falls off and the area is healed. Until it falls off, the cord stump will change color from yellow to brown or black — this is normal.

Consult your doctor if the navel area becomes reddened or if a foul odor or discharge develops.

if you’re breastfeeding, it can be a little trickier. If your baby seems satisfied, produces about six wet diapers and several stools a day, sleeps well, and is gaining weight regularly, then he or she is probably eating enough.

Another good way to tell if your baby is getting milk is to notice if your breasts feel full before feeding your baby and less full after feeding. Talk to your doctor if you have concerns about your child’sgrowth or feeding schedule.

Babies often swallow air during feedings, which can make them fussy. You can prevent this by burping your baby frequently.

Try burping your baby every 2-3 ounces (60-90 milliliters) if you bottle-feed, and each time you switch breasts if you breastfeed.

If your baby tends to be gassy, has gastroesophageal reflux, or seems fussy during feeding, try burping your little one every ounce during bottle-feeding or every 5 minutes during breastfeeding.

Try these burping strategies: • Hold your baby upright with his or her head on your shoulder. Support your baby’s head and back while gently patting the back with your other hand.

Feeding and Burping Your Baby

Whether feeding your newborn by breast or a bottle, you may be stumped as to how often to do so.

Generally, it’s recommended that babies be fed on demand — whenever they seem hungry. Your baby may cue you by crying, putting fingers in his or her mouth, or making sucking noises.

A newborn baby needs to be fed every 2 to 3 hours.

If you’re breastfeeding, give your baby the chance to nurse about 10-15 minutes at each breast. If you’re formula-feeding, your baby will most likely take about 2-3 ounces (60-90 milliliters) at each feeding.

Some newborns may need to be awakened every few hours to make sure they get enough to eat. Call your baby’s doctor if you need to awaken your newborn frequently or if your baby doesn’t seem interested in eating or sucking.

If you’re formulafeeding, you can easily monitor if your baby is getting enough to eat, but March 2015 I FUTURE MEDICINE 45

Special Story Pregnancy •

Sit your baby on your lap. Support your baby’s chest and head with one hand by cradling your baby’s chin in the palm of your hand and resting the heel of your hand on your baby’s chest (be careful to grip your baby’s chin — not throat). Use the other hand to gently pat your baby’s back.

• Lay your baby face-down on your lap. Support your baby’s head, making sure it’s higher than his or her chest, and gently pat or rub his or her back.

If your baby doesn’t burp after a few minutes, change the baby’s position and try burping for another few minutes before feeding again. Always burp your baby when feeding time is over, then keep him or her in an upright position for at least 10-15 minutes to avoid spitting up.

Sleeping Basics

As a new parent, you may be surprised to learn that your newborn, who seems to need you every minute of the day, actually sleeps about 16 hours or more! Newborns typically sleep for periods of 2-4 hours. Don’t expect yours to sleep through the night — the digestive system of babies is so small that they need nourishment every few hours and should be awakened if they haven’t been fed for 4 hours (or more frequently if your doctor is concerned about weight gain).

When can you expect your baby to sleep through the night? Many babies sleep through the night (between 6-8 hours) at 3 months of age, but if yours doesn’t, it’s not a cause for concern.

Like adults, babies must develop their own sleep patterns and cycles, so if your newborn is gaining weight and appears healthy, don’t despair if he or she hasn’t slept through the night at 3 months.

It’s important to place babies on their backs to sleep to reduce the risk of SIDS. In addition, remove all fluffy bedding, quilts, sheepskins, stuffed animals, and pillows from the crib to ensure that your baby doesn’t get tangled in them or suffocate.

Also be sure to alternate the position of your baby’s head from night to night (first right, then left, and so on) to prevent the development of a flat spoton one side of the head.

Many newborns have their days and nights “mixed up.” They tend to be more awake and alert at night, and more sleepy during the day. One way to help them is to keep the stimulation at night to a minimum. Keep the lights low, such as by using a nightlight. Reserve talking and playing with your baby for the daytime. When your baby wakes up during the day try to keep him or her awake a little longer by talking and playing.

Even though you may feel anxious about handling a newborn, in a few short weeks you’ll develop a routine and be parenting like a pro! If you have questions or concerns, ask your doctor to recommend resources that can help you and your baby grow together.

50 FUTURE MEDICINE I March 46 January2015 2015

FOODPATH

The benefits of consuming fruits and vegetables of all kinds are infinite.

They have been shown to reduce the risk of obesity, cardiovascular illnesses and even certain types of cancer. However, deciding which foods to eat for specific benefits can sometimes be difficult. here is a list of food products along with information regarding their potential health benefits

The right bite Almonds

Almonds are a rich source of vitamin E, copper, magnesium, good quality protein, and healthy unsaturated fatty acids. Studies have revealed that almonds can potentially help prevent cardiovascular heart diseases, cut the risk of cancer and help prolong life..

Apples Apples are sometimes called “nutritional powerhouses� because of their impressive nutritional

profile. Apples are rich in Vitamin C (a powerful natural antioxidant), B-complex vitamins, dietary fibere, phytonutrients (which help protect the body from the detrimental effects of free radicals), and minerals such as calcium and potassium. Studies have revealed that eating apples can potentially help prevent dementia, reduce risk of stroke and reduce risk of diabetes .

Asparagus

Asparagus is considered to be one of the delicacies of the vegetable world.

The spring vegetable is well known for its unique and strong savory taste.

It is very rich in dietary fibre and contains high levels of vitamin B6, calcium, zinc and magnesium. The potential health benefits of asparagus include: reducing the risk of diabetes, preventing kidney stones and reducing the risk of neural tube defects in babies.

Bananas

Bananas are naturally free of fat, cholesterol and sodium and is very rich in potassium.The potential health benefits of bananas include: lowering blood pressure, reduce the risk of developing childhood leukemia, and supporting heart health.

Basil ( Thulasi) Basil is rich in vitamin A, vitamin K, vitamin C, magnesium, iron, potassium, and calcium. Studies have revealed that basil can potentially reduce inflammatio and swelling, prevent the harmful effects of ageing and may be useful in treating arthritis and inflammatory bowel diseases.

Beetroot Beetroot has been gaining in popularity as a new super food due to

March 2015 I FUTURE MEDICINE 47

FOODPATH

recent studies claiming that beets and beetroot juice can improve athletic performance, lower blood pressure and increase blood flow. Beetroot is a rich source of folate and manganese and also contains thiamine, riboflavin, vitamin B-6, pantothenic acid, choline, betaine, magnesium, phosphorus, potassium, zinc, copper and selenium.

Carrots

of eating chocolate are said to include: lowering cholesterol levels, preventing cognitive decline, and reducing the risk of cardiovascular problems.

Coriander

Coriander comes from the plant Coriandrum sativum. In the United States, the leaves of the plant are referred to as cilantro (the Spanish translation) and the seeds are referred to as coriander.

Many studies have suggested that increasing consumption of plant foods like coriander decreases the risk of obesity, overall mortality, diabetes and heart diseasesw while promoting a healthy skin and hair, increased energy and overall lower weight.

Cinnamon Carrots are a great source of vitamin A. They provide 210% of tan average adult’s needs for the day. The potential health benefits of carrots include: preventing lung cancer , destroying leukemia cells and inhibiting their progression, and helping to restore vision..

Cauliflower

Cauliflower contains antioxidants and phytonutrients that can protect against cancer, fibre that helps with satiety, weight loss and a healthy digestive tract, choline that is essential for learning and memory as well as many other important nutrients. The potential health benefits of cauliflower include preventing mutations and reducing stress from free radicals, preventing constipation and helping memory.

Chocolate

Chocolate is rich in antioxidants.

Despite its bad reputation for causing weight gain, there are a number of health benefits being associated with its consumption. The potential benefits 48 FUTURE MEDICINE I March 2015

Grapefruit

Studies have found that cinnamon can potentially be effective against HIV, improve glucose and lipids levels in patients with type 2 diabetes, help prevent Alzheimer’s diseses and stop the destructive process of multiple scelerosis (MS). In addition, researchers found that consuming cinnamon can help reduce the body’s negative responses to eating high-fat meals.

Eggplant

The eggplant, also known as aubergine, garden egg, guinea squash, melongene and brinjal, is usually distinguishable by its signature egg-like shape and vibrant purple colour. The potential health benefits of eggplant, include supporting heart health, maintaining weight and blood cholesterol levels and exhibiting anticancer effects.

Grapes The portability, texture, flavour and variety of grapes have made them a popular finger food in countries all over the world. Studies have associated grapes with the prevention of cancer, heart disease, high blood pressure and constipation as well as decreasing the risk of obesity and overall mortality.

Grapefruits are low in calories but full of nutrients. They support clear, healthy skin, help to lower our risk for many diseases and conditions and may even help with weight loss as part of an overall healthy and varied diet. The potential health benefits of grapefruit include boosting weight loss, maintaining healthy blood pressure and heart health and combating free radicals.

Green Tea Green tea may well be one of the world’s healthiest drinks and contains the highest amount of antioxidants of any tea. Studies have found that drinking green tea is associated with a reduced risk of stroke, and may help fight prostate cancer.

Mango Eating mango decreases the risk of obesity and overall mortality, diabetes, heart disease and promotes a healthy complexion and hair, increased energy, overall lower weight.

Mint Mint, also known as mentha, is actually a genus or group of around 15-20 types of plants including peppermint and spearmint. Mint oil is often used in toothpaste, gum, candy and beauty products while the leaves are used either fresh or dried for teas and food. Mint has one of the highest antioxidant capacities of any food.

Mint has possible positive effects on allergies, common cold, indigestion, irritable bowel syndrome and skin.

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FOODPATH

Mushrooms

Mushrooms provide several important nutrients. The potential health benefits of mushrooms including assisting in inhibiting the growth of cancer cells, regulating blood pressure and improving immune response to infection.

Orange

An orange has over 170 different phytochemicals and more than 60 flavonoids, many of which have been shown to have anti-inflammatory properties and strong antioxidant

Oily fish

Oily fish, such as salmon or mackerel, are an excellent source of Omega-3 oils and lean protein.

Potential health benefits of eating oily fish include: preventing cardiovascular disease, reducing your risk of rheumatoid arthritis, boosting infant sensory, cognitive, and motor development, , improving memory, protecting vision, and preventing oral and skin cancers.

Oilve Oil

People who regularly consume olive oil are at a lower risk of developing cardiovascular diseases, including hypertension (high blood pressure), stroke, and hyperlipidemia (high blood cholesterol and triglyceride levels).

In addition, olive oil intake may help treat inflammation, endothelial dysfunction (problems with the inner linings of blood vessels), thrombosis and carbohydrate metabolism

Onions Onions can vary in size, shape, colour and flavour. The most common types are red, yellow and white onion.

Flavours can vary from sweet and juicy with a mild flavour to sharp, spicy, and pungent, often depending on the season in which they are grown and consumed. The possible health benefits of consuming onions include lowering the risk of several types of cancer, improving mood and maintaining the health of skin and hair.

Potato Potatoes are one of the cheapest universal crops to produce and are available year-round. The health benefits of consuming potatoes include maintaining bone structure, supporting heart health, reducing chronic inflammation and preventing constipation.

50 FUTURE MEDICINE I March 2015

effects. Oranges also contain thiamin, riboflavin, niacin, vitamin B-6, folate, pantothenic acid, phosphorus, magnesium, manganese, selenium and copper. Because of their high vitamin C content (over twice the daily need) oranges are associated with boosting the immune system.

Papaya

Papayas grow in tropical climates and are also known as papaws or pawpaws. The possible health benefits of consuming papaya include a reduced risk of heart disease, diabetes, cancer, aiding in digestion, improving blood glucose control in diabetics, lowering blood pressure, and improving wound healing.

Pineapple

Pineapple is a source of important vitamins and minerals such as thiamin, riboflavin, vitamin B-6, folate, pantothenic acid, magnesium, manganese and potassium and antioxidants and polyphenols, such as beta-carotene. Fresh pineapple is the only known source of an enzyme called bromelain, which has been used in studies to determine it’s effectiveness in

alleviating joint pain, arthritis, reduce inflammation, inhibit tumor growth and shorten recovery time following plastic surgery.

Strawberry

Strawberries are one of the most popular, refreshing and healthy treats on the planet and contain many vitamins and antioxidants that can be beneficial for your health. The potential health benefits of strawberries include: reducing the risk of heart disease, stroke, cancer, blood pressure, constipation, allergies, diabetes and depression.

Tomato

The tomato has been referred to as a “functional food,� a food that goes beyond providing just basic nutrition, additionally preventing chronic disease and delivering other health benefits, due to beneficial phytochemicals such as lycopene.

Tomatoes are a rich source of vitamins A and C and folic acid. Tomatoes contain a wide array of beneficial nutrients and antioxidants, including alpha-lipoic acid, lycopene, choline, folic acid, beta-carotene and lutein.

Watermelon

Watermelon contains thiamin, riboflavin, niacin, vitamin B-6, folate, pantothenic acid, magnesium, phosphorus, potassium, zinc, copper, manganese, selenium, choline, lycopene and betaine. According to the National Watermelon Promotion Board, watermelon contains more lycopene than any other fruit or vegetable. The possible health benefits of watermelon include asthma prevention, reduction of high blood pressure, regulation of digestion, inflammation reduction, promoting healthy hair and skin.

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Teen Guide

As a teenager, you go through many changes. Your body is on its way to becoming its adult size. You may notice that you can’t fit into your old shoes or that your jeans are now 3 inches short. Along with these changes, you are probably becoming more independent and making more of your own choices. Some of the biggest choices you face are about your health

H

ealthy habits, including eating a healthy diet and being physically active, can help you feel good, look good, and do your best in school, work, or sports. They might also prevent diseases such as diabetes, high blood pressure, heart disease, osteoporosis, stroke, and some cancers when you are olde. Some frequently asked questions and their answers: Will the habits I have now really make a difference when I’m older?

Yes, 65% of all deaths in adults are caused by heart disease, cancer and stroke. In many cases, these diseases were preventable. Many of the behaviors that cause these diseases begin at a young age. For example, if you use tobacco as a teenager, you’re more likely to get heart disease, cancer or stroke when you’re an adult.

What can I do now to keep myself healthy?

Avoid using any type of tobacco product. Try not to breathe second hand cigarette smoke. n Get regular exercise. n Eat a healthy diet. n Always use your seat belt. n Don’t drink and drive. Don’t get into a car with a driver who has been drinking alcohol or using drugs. n Wear protective headgear, such as n

52 FUTURE MEDICINE I February 2015

How to stay

healthy

motorcycle or bike helmets, when participating in sports. n Never swim alone. n Talk to your parents or your doctor if you’re feeling really sad or if you’re thinking about harming yourself. n Avoid situations where violence or fighting may cause you to be physically injured. n If you have sex, use condoms to avoid pregnancy and sexually transmitted diseases.

(Remember, however, the “safest” sex is no sex.) n See your doctor regularly.

What might my doctor do?

The doctor might do any of the following to help you stay healthy: n Determine your risk for certain health problems. n Measure your height, weight, cholesterol levels and blood pressure. n Order tests to check your general health or to find certain diseases. n Provide immunizations (“shots” or “vaccines”) to reduce your risk of getting diseases such as mumps, tetanus and hepatitis.

At my age, what should I especially be concerned about?

Car accidents, unintentional physical injury, homicide and suicide are the top killers of teenagers and young adults. Cancer and heart disease can also affect you at this age. Unplanned pregnancy and sexually transmitted diseases (including HIV and AIDS) can cause you social and personal problems, in addition to harming your health.

Do young men have different health risks than young women?

Yes. Young men don’t wear seat belts as often as young women do. They’re also more likely to carry weapons, to get into physical fights, to use smokeless tobacco or marijuana, to drink alcohol heavily, and to have more sexual partners. On the other hand, young women have some special risks. They try to commit suicide more often and they try to lose weight in harmful ways more often than young men.

Should I talk to my doctor if I am worried about my health or my body?

Yes. It’s important to talk to your doctor if you have any concerns about your health or your body. Your doctor is there to help you.

- MedlinePlus

March 2015 I FUTURE MEDICINE 53

Social Health Wealth

The mind-wallet

connection Wealth, power or lack of it is at the heart of many mental disorders. People with little sense of power or lack of selfesteem and those who are overconfident and aggressive are vulnerable to poor immune system and mental disorders

A

rich man’s ego may be the size of his financial empire, but that doesn’t mean he’s the picture of mental health. The same can be said about the self-esteem of people who are living from pay cheque to pay cheque or unemployed. New research underscores this mindwallet connection, linking feelings of self-worth to such afflictions as bipolar disorder, narcissistic personality disorder, anxiety and depression.

The researchers at UC Berkeley have linked inflated or deflated feelings of self-worth to such afflictions as bipolar disorder, narcissistic personality disorder, anxiety and depression, providing yet more evidence that the widening gulf between rich and poor can be bad for your health.

“We found that it is important to consider the motivation to

54 FUTURE MEDICINE I March 2015

pursue power, beliefs about how much power one has attained, pro-social and aggressive strategies for attaining power, and emotions related to attaining power,” said Sheri Johnson, UC Berkeley psychologist and senior author of the study published in the journal Psychology and Psychotherapy: Theory, Research and Practice.

In a study of more than 600 young men and women conducted at UC Berkeley, researchers concluded that one’s perceived social status or lack thereof is at the heart of a wide range of mental illnesses. The findings make a strong case for assessing such traits as “ruthless ambition,” “discomfort with leadership” and “hubristic pride”.

“People prone to depression or anxiety reported feeling little sense of pride in their accomplishments and little sense of power,” Johnson

said. “In contrast, people at risk for mania tended to report high levels of pride and an emphasis on the pursuit of power despite interpersonal costs.”

Specifically, Johnson and fellow researchers Eliot Tang-Smith of the University of Miami and Stephen Chen of Wellesley College looked at how study participants fit into the “dominance behavioural system,” a construct in which humans and other mammals assess their place in the social hierarchy and respond accordingly to promote cooperation and avoid conflict and aggression. The concept is rooted in the evolutionary principle that dominant mammals gain easier access to resources for the sake of reproductive success and the survival of the species.

Studies have long established that feelings of powerlessness and helplessness weaken the

immune system, making one vulnerable to physical and mental ailments. Conversely, an inflated sense of power is among the behaviours associated with bipolar disorder and narcissistic personality disorder, which can be both personally and socially corrosive.

Recent studies have found that people living in developed countries with the highest levels of income inequality were three times more likely to develop depression or anxiety disorders than their more egalitarian counterparts.

Similar results were found in a state-by-state comparison of income and mental illness in the United States.

For this latest study, 612 young men and women rated their social status, propensity toward manic, depressive or anxious symptoms, drive to achieve power, comfort with leadership and degree of pride, among other measures.

In one study, they were gauged for two distinct kinds of pride: “authentic pride,” which is based on specific

achievements and is related to positive social behaviours and healthy self-esteem; and “hubristic pride,” which is defined as being overconfident, and is correlated with aggression, hostility and poor interpersonal skills.

And in a test for tendencies toward hypomania, a manic mood disorder, participants ranked how strongly they agreed or disagreed with such statements as “I often have moods where I feel so energetic and optimistic that I feel I could outperform almost anyone at anything,” or “I would rather be an ordinary success in life than a spectacular failure.” Overall, the results showed a strong correlation between the highs and lows of perceived power and mood disorders.

“This is the first study to assess the dominance behavioural system across psychopathologies,” Johnson said. “The findings present more evidence that it is important to consider dominance in understanding vulnerability to psychological symptoms.”

SPORTS HEALTH Steroids

Most dreaded, but highly beneficial A steroid is perhaps the most misunderstood and dreaded drug in the sports world. In reality, it is just an energy booster, which functions as an essential for almost all body functions. Sports people who take steroids are accused of depriving the real talents of their victories. Dr Ranjith Nair, specialist in sports medicine, looks at the benefits and the sideeffects of anabolic steroids

S

teroid is a drug which is most dreaded, misunderstood and hated by the common man: Each and every complication of a drug, a disease, a treatment or even the food is attributed to the abuse or adulteration by steroids. In our daily life, we come across so many 56 FUTURE MEDICINE I March January2015 2015

allegations against steroidssteroid injected chicken and meat products, steroid injected fruits and baby foods adulterated with steroids. Even Ayurveda and Homoeopathy medicines are alleged for injudicious use of steroids.

Are steroids such bad drugs and to be avoided? The answer

is a big NO. Let us go through some of the properties and good qualities of steroids.

What is steroid?

Steroids are substances which are produced in the body by adrenal gland.

These are otherwise called Glucocorticoids. These are essential for almost all body

functions. After produced by the adrenal glands, it is secreted into the blood to reach different tissues for various functions like energy production, body building defence mechanisms etc. What we are getting in the market is called synthetic steroids which has got high absorption power and acts as steroids inside the body.

Role of liver: Liver is the major organ for steroid inactivation by making it water soluble.

What do steroids do in our body? It regulates the metabolism of protein, carbohydrates and fat. It reduces the insulin production and increases glucose concentration in the body which is very much essential for the production of energy inside the cells.

Steroids are anti-inflammatory agents which are the protectors of accelerated self defence mechanism of the body. Human body has its own self defence system called immune system which identifies the harmful organisms and foreign bodies entering into the body and develop inflammatory response against them to destroy them. But this reaction itself becomes harmful when it is against body’s own components.

Steroids prevent these reactions as in Asthma or organ transplantations.

Uses of steroids:

1. Steroids are widely used for its immunosuppressive actions and anti-allergic actions in all types of allergies.

2. To prevent rejection of transplanted organs 3. To increase the availability of energy during high metabolic demands as on sports medicine.

4. To increase the protein lysis to make more glucose 5. Improves the cell metabolisms for high energy cellular reactions used in sports medicines

Steroid in sports as performance enhancing agents:

To fulfill the dream of medal winning for the country or securing a place in the professional team, the athletes or sports personnel are forced to take these drugs for a short term gain.

Anabolic steroids:

Actually, the steroids of our body defence, as already mentioned, are catabolic. But the hormones synthesized from the same place – adrenal cortex, called testosterone, a male hormone which is a vieilising hormone having anabolic properties ie body building properties. Anabolic steroids are synthetically prepared with the same effect of testosterone.

Benefits:

1. Promotes muscle building 2. Short term energy production trigger These can make them feel energetic during the event and perform wonderfully in the event.

But the use of it in the athlete is like killing of the Golden Duck.

Side-effects:

1. Male features in female 2. Acne, baldness 3. Infertility 4. Shrunken testis in male, impotence, sterility

Increased risk of

1. Liver anomalies 2. Tendon rupture 3. Increased LDL and decreased HDL 4. Heart problems 5. Psychiatric problems 6. Infections etc

Judicious use of anabolic steroids:

These can be used short term during early months of training and for only structural body building phase. After usage, regular follow-up should be made such as investigations of serum levels, clinical evaluations etc.

Sports personnel should undergo all kinds of consultations before taking the steroid therapy and after its use, regular health check-ups should be done.

Steroids should be taken at the correct time in correct dosage under the supervision of medical personnel.

March 2015 I FUTURE MEDICINE 57

Mental Health

How sound is your

mind?

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel and act in life. It also helps determine how we handle stress, relate to others, and make choices

M

ental health is important at every stage of life, from childhood through to adulthood.

Mental illnesses are serious disorders which can affect one’s thinking, mood, and behaviour.

There are many causes of mental disorders. One’s genes and family history may play a role. One’s life experiences, such as stress or a history of abuse, may also matter.

Biological factors can also be part of the cause. Mental disorders are common, but treatments are available.

Keeping emotional health What is good emotional health?

People who are emotionally healthy are in control of their thoughts, feelings and behaviours.

They feel good about themselves and have good relationships. They can keep problems in perspective.

Even people who have good emotional health can sometimes have emotional problems or mental illness. Mental illness often has a physical cause, such as a chemical imbalance in the brain.

Stress and problems with family, work or school can sometimes trigger mental illness or make it worse.

However, people who are emotionally healthy have learned ways to cope with stress and problems. They know when to seek help from their doctor or a counselor.

much or abusing drugs, you may have a problem dealing with anger.

It’s very important to talk to your doctor or a counselor about getting help.

What about anger?

Tips on dealing with emotions

People are sometimes not aware of what causes their anger, how much anger they are holding inside or how to express anger appropriately. You may be angry about certain events, your own actions or other people’s actions.

Many little things can build up to make you feel that life is unfair.

If you find yourself becoming increasingly irritable or taking unhealthy risks such as drinking too

Mental health and wellness

Positive mental health allows people to:

Realize their full potential Cope with the stresses of life n Work productively n Make meaningful contributions to their communities n n

Learn to express your feelings in appropriate ways. It’s important to let people close to you know when something is bothering you. Keeping feelings of sadness or anger inside takes extra energy. It can also cause problems in your relationships and at work or school.

Think before you act. Emotions can be powerful. But before you get carried away by your emotions and say or do something you might regret, give yourself time to think.

Strive for balance in your life.

Make time for things you enjoy.

Focus on positive things in your life.

Take care of your physical health.

Your physical health can affect your emotional health. Take care of your body by exercising regularly, eating healthy meals and getting enough sleep. Don’t abuse drugs or alcohol.

What can you do to avoid problems?

Early warning signs Not sure if you or someone you know is living with mental health problems? Experiencing one or more of the following feelings or behaviours can be an early warning sign of a problem: n Eating or sleeping too much or too little n Pulling away from people and usual activities n Having low or no energy n Feeling numb or like nothing matters n Having unexplained aches and pains n Feeling helpless or hopeless n Smoking, drinking, or using drugs more than usual n Feeling unusually confused, forgetful, on edge, angry, upset, worried, or scared n Yelling or fighting with family and friends n Experiencing severe mood swings that cause problems in relationships n Having persistent thoughts and memories you can’t get out of your head n Hearing voices or believing things that are not true n Thinking of harming yourself or others n Inability to perform daily tasks like taking care of your kids or getting to work or school

First, try to be more aware of your emotions and reactions. To help you do a better job of managing your emotional health, learn to identify and address the reasons for sadness, frustration and anger in your life.

The box to the right gives some other helpful tips.

How does stress affect emotions?

Ways to maintain positive mental health include:

Getting professional help if you need it n Connecting with others n Staying positive n Getting physically active n Helping others n Getting enough sleep n Developing coping skills n

Your body responds to stress by making stress hormones. These hormones help your body respond to situations of extreme need, such as when you are in danger. But when your body makes too many of these hormones for a long period of time, the hormones wear down your body -- and your emotions. People who are under stress a lot are often emotional, anxious, irritable and even depressed.

If possible, try to change the situation that is causing your stress.

Relaxation methods, such as deep breathing and meditation, and

exercise are also useful ways to cope with stress.

Can emotional problems be treated?

Yes. Counseling, support groups and medicines can help people who have emotional problems or mental illness. If you have an ongoing emotional problem, talk to your family doctor. He or she can help you find the right type of treatment.

March 2015 I FUTURE MEDICINE 59

Sexual Health

Perils of ageing Ageing changes in the male reproductive system may include changes in testicular tissue, sperm production, and erectile function.

These changes usually occur gradually

U

nlike women, men do not experience a major, rapid (over several months) change in fertility as they age (like menopause). Instead, changes occur gradually during a process that some people call andropause.

Ageing changes in the male reproductive system occur primarily in the testes. Testicular tissue mass decreases and the level of the male sex hormone testosterone stays the same or decreases very slightly.

There may be problems with erectile function. However, this is a general slowing, rather than a complete lack of function.

Fertility

The tubes that carry sperm may become less elastic (a process called sclerosis). The testes continue to produce sperm, but the rate of sperm cell production slows. The epididymis, seminal vesicles, and prostate gland lose some of their surface cells but continue to produce the fluid that helps carry sperm.

Urinary function

The prostate gland enlarges with age as some of the prostate tissue is replaced with a scarlike tissue. This condition, called benign prostatic hypertrophy (BPH), affects about 50% of men. This may cause problems with slowed urination, as well as with

60 FUTURE MEDICINE I March 2015

ejaculation.

In both men and women, reproductive system changes are closely related to changes in the urinary system.

Effect of changes

Fertility varies from man to man, and age is not a good predictor of male fertility.

Prostate function is not closely related to fertility, and a man can father children even if his prostate gland has been removed. Some fairly old men can (and do) father children.

The volume of fluid ejaculated usually remains the same, but there are fewer living sperm in the fluid.

Decreases in the sex drive (libido) may occur in some men. Sexual responses may become slower and less intense. This may be related to decreased testosterone level, but it may also result from psychological or social changes related to aging (such as the lack of a willing partner), illness, chronic conditions, or medications.

Ageing by itself does not prevent a man from being able to enjoy sexual relationships.

Common problems Erectile dysfunction (ED) may be a concern for ageing men. It is normal for erections to occur less frequently than when a man was younger, and ageing men often have less ability to experience repeated ejaculation. However, ED is most often the result of a medical or psychological problem rather than simple aging, and 90% of ED is believed to be of medical rather than psychological origin.

Medications (especially those used to treat hypertension and certain other conditions) can cause some men to be unable to

develop or maintain enough of an erection for intercourse.

Disorders such as diabetes can also cause ED. Erectile dysfunction that is caused by medications or illness is often successfully treated. Talk to your primary health care provider or a urologist if you are concerned about this condition.

BPH may eventually interfere with urination. The enlarged prostate partially blocks the tube that drains the urinary bladder (urethra).

Changes in the prostate gland make elderly men more likely to have urinary tract infections.

Backup of urine into the kidneys (vesicoureteral reflux) may develop if the bladder is not fully drained. If this is not treated, it can eventually lead to kidney failure.

Prostate gland infections or inflammation ( prostatitis) may also occur.

Prostate cancer becomes more common as men age. It is one of the most frequent causes of cancer death in men. Bladder cancer also becomes more common with age. Testicular cancers are possible, but these occur more often in younger men.

Prevention

Many physical age-related changes, such as prostate enlargement or testicular atrophy, are not preventable.

Getting treatment for health disorders (such as high blood pressure and diabetes) that lead to changes in urinary and sexual health may prevent later problems with urinary and sexual function.

Changes in sexual response are most often related to factors other than simple aging. Older men are more likely to have good sex if they have continued to have sexual activity during middle age.

March 2015 I FUTURE MEDICINE 61

Palliative care

Give love and compassion Living and dying with dignity is everybody’s right. It’s also the duty of a dear one, the doctor and other well-wishers to give a patient in his/ her last leg of journey a painless and peaceful exit

By Dr M R Rajagopal

D

on’t we have some of the best hospitals in the world? Don’t people travel to India for even complicated heart surgery? Is health tourism not a growing industry in India?

True, we do have some of the best hospitals.

Another side of the story: In the year 2010, the “economic intelligence unit” did a survey in 40 countries. Using 24 different indicators, they assessed the kind of treatment meted out to people in their end of life time. As far as the quality of such care was concerned, do you want to guess what India’s position was? India came 40th, right below Uganda.

You may find this hard to believe. To understand this phenomenon, look at the email that Pallium India got from Esther Munyoro from Kenya. She had brought her aunt for operation to an excellent hospital in Hyderabad. Esther has good things to say about the hospital and about the surgery.

She writes: “I am a Palliative Care Doctor in Kenya who is involved in caring for patients who have had treatment in India and I have also escorted patients to hospitals in India. My concern is that even in a country with such an advanced medical care, patients do not have their physical pain adequately addressed.

When opioids are prescribed it is usually too little, too late. In a country that has a robust medical healthcare system with evidence-based practice, why is pain not adequately dealt with?”

Esther is talking about post62 FUTURE MEDICINE I February 2015

operative pain. But in our country, this is equally or more relevant in all pains, especially for people with incurable diseases and in an advanced stage.

In them, the problem acquires the status of the cruellest form of torture.

The poor, in that situation, groan and scream in the darkest alleys of society. Their situation is bad, but the rich have an even more cruel kind of suffering awaiting them.

Somehow, a tradition has been established in India in the last few decades that the rich must die in an Intensive Care Unit. This is not modern; this is actually primitive. In India, particularly, in the name of cleanliness and sterility, relatives are not allowed in Intensive Care Units.

What does the dying person need, if it is reasonably certain that the disease is incurable? Is it humane to push a tube into the throat and into every other orifice, give artificial respiration when breathing stops and make them suffer intolerable pain till they die? Is it humane to tie their hands and feet up when they resist? Do they not need and deserve a little bit of love, a gentle touch and the presence of loved ones? Does not humanity demand that when one says the final Goodbye, it would be after a affectionate farewell, a loving kiss on the forehead, and a gentle stroke on the aching muscles?

Many would not have seen the inside of an Intensive Care Unit. In the artificial lighting, there is no day

What does the dying person need, if it is reasonably certain that the disease is incurable? Is it humane to push a tube into the throat and into every other orifice, give artificial respiration when breathing stops and make them suffer intolerable pain till they die? Do they not need and deserve a little bit of love, a gentle touch and the presence of loved ones? and night. Every bed is surrounded by machines, emitting several bleeps and this becomes an alien, intolerable noise. At least one-third of the patients there (or two-thirds, in the case of the elderly) would have lost their sense, some crying out aloud. As the situation progresses, many of them would begin to have hallucinations and reached the stage of intense panic or agitation.

There is no scientific basis for allowing people to go through such inhumanity.

The main reason for such practices being allowed to continue is that we do not have a law covering this situation and unfortunately, medical ethics have not been taken seriously either by medical educators or by the statutory bodies that are supposed to look after them. Healthcare

professionals who do not know what is right sometimes feel it as their duty to prolong life at all cost, even at the expense of such intense suffering. Many families get destroyed because of the economic implications; but when asked, “He will die now, unless he is put on a ventilator, do you agree?�, they are emotionally blackmailed into accepting.

There is only one way in which we can protect ourselves today. We must write a Living Will, expressing what we desire. It must clearly say that in the event of futility of treatment, we have no desire to prolong life by a few more days with artificial life-support measures. It must mention that, in that sort of situation, we desire palliative care and not intensive care.

It is not enough writing it down, it is necessary to make our close relatives understand this , because if there is a clash of interest between our living will and our family’s desires in the hospital, only the latter will win.

Medical Science is a great blessing, when one is suffering from serious disease. But even the greatest boon can become a weapon inflicting suffering, if used inappropriately. We have the right to receive, and the duty to provide, love and compassion to the dying.

Post Script. A copy of a model living will is available here: http:// palliumindia.org/cms/wp-content/ uploads/2014/10/My-Living-Willmodified-by-Pallium-India.pdf March 2015 I FUTURE MEDICINE 63

Meditation/longevity

Meditate and live longer A new study by researchers at UCLA Brain Mapping Center finds that meditation can help preserve the brain’s gray matter and help people live longer

S

ince 1970, life expectancy around the world has risen dramatically, with people living more than 10 years longer.

That’s the good news.

The bad news is that starting when people are in their mid-to-late-20s, the brain begins to wither -- its volume and weight begin to decrease. As this occurs, the brain can begin to lose some of its functional abilities.

So although people might be living longer, the years they gain often come with increased risks for mental illness and neurodegenerative disease. Fortunately, a new study shows meditation could be one way to minimise those risks.

The scientists looked specifically at the association between age and gray matter. They compared 50 people who had mediated for years and 50 who didn’t. People in both groups showed a loss of gray matter as they aged. But the researchers found among those who meditated, the volume of gray matter did not decline as much as it did among those who didn’t.

The article appears in the February online edition of the journal Frontiers in Psychology.

64 FUTURE MEDICINE I March 2015

Dr. Florian Kurth, a co-author of the study and postdoctoral fellow at the UCLA Brain Mapping Center, said the researchers were surprised by the magnitude of the difference.

“We expected rather small and distinct effects located in some of the regions that had previously been associated with meditating,” he said.

“Instead, what we actually observed was a widespread effect of meditation that encompassed regions throughout the entire brain.”

As baby boomers have aged and the elderly population has grown, the incidence of cognitive decline and dementia has increased substantially as the brain ages.

“In that light, it seems essential that longer life expectancies do not come at the cost of a reduced quality of life,” said Dr. Eileen Luders, first author and assistant professor of neurology at the David Geffen School of Medicine at UCLA. “While much research has focused on identifying factors that increase the risk of mental illness and neurodegenerative decline, relatively less attention has been turned to approaches aimed at enhancing cerebral health.”

The participants’ brains were scanned using high-resolution magnetic resonance imaging. Although the researchers found a negative correlation between gray matter and age in both groups of people -suggesting a loss of brain tissue with increasing age -- they also found that large parts of the gray matter in the brains of those who meditated seemed to be better preserved, Kurth said.

The researchers cautioned that they cannot draw a direct, causal connection between meditation and preserving gray matter in the brain.

Too many other factors may come into play, including lifestyle choices, personality traits, and genetic brain differences.

“Still, our results are promising,” Luders said. “Hopefully they will stimulate other studies exploring the potential of meditation to better preserve our aging brains and minds.

Accumulating scientific evidence that meditation has brain-altering capabilities might ultimately allow for an effective translation from research to practice, not only in the framework of healthy ageing but also pathological ageing.”

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MOTHER & CHILD

With love and affection

B

onding is the intense attachment that develops between parents and their baby. It makes parents want to shower their baby with love and affection and to protect and nourish their little one. Bonding gets parents up in the middle of the night to feed their hungry baby and makes them attentive to the baby’s wide range of cries.

Scientists are still learning a lot about bonding. They know that the strong ties between parents and their child provide the baby’s first model for intimate relationships and foster a sense of security and positive selfesteem. And parents’ responsiveness to an infant’s signals can affect

66 FUTURE MEDICINE I March 2015

the child’s social and cognitive development.

Why is bonding important?

Bonding is essential for a baby.

Studies of newborn monkeys who were given mannequin mothers at birth showed that, even when the mannequins were made of soft material and provided formula to the baby monkeys, the babies were better socialized when they had live mothers to interact with. The baby monkeys with mannequin mothers also were more likely to suffer from despair. Scientists suspect that lack of bonding in human babies can cause similar problems.

Most infants are ready to bond

immediately. Parents, on the other hand, may have a mixture of feelings about it. Some parents feel an intense attachment within the first minutes or days after their baby’s birth. For others — especially if the baby is adopted or has been placed in intensive care — it may take a bit longer.

But bonding is a process, not something that takes place within minutes and not something that has to be limited to happening within a certain time period after birth. For many parents, bonding is a byproduct of everyday caregiving. You may not even know it’s happening until you observe your baby’s first smile and suddenly realize that you’re filled with love and joy.

Dental Health

Taking good care of your mouth and teeth throughout your whole life can help prevent problems as you get older. Taking care of your teeth means brushing and flossing every day and seeing the dentist regularly.

Mouth and Teeth How to keep them healthy Don’t smoke or chew tobacco, which can stain your teeth, give you bad breath and cause cancer. n Wear the right protective headgear while playing contact sports. n See your dentist every 6 months for regular check-ups and cleanings.

Infants and children

n

The first set of teeth is already almost completely formed at birth.

At first these teeth are “hiding” under the gums. These teeth are important, because after they come in, they let your baby chew food and talk well.

You baby’s first set of teeth also holds the space where permanent teeth will eventually be. They help permanent teeth grow in straight.

You can care for your baby’s teeth by following these suggestions: n Clean the new teeth every day. When the teeth first come in, clean them by rubbing them gently with a clean wet washcloth. When the teeth are bigger, use a child’s toothbrush. n Children under 2 years of age shouldn’t use toothpaste. Instead, use water to brush your child’s teeth. n Don’t let your baby go to sleep with a bottle. This can leave milk or juice sitting on the teeth and cause cavities that are known as “baby-bottle tooth decay.” n Encourage older children to eat lowsugar snacks, such as fruits, cheese and vegetables. Avoid giving your child sticky, chewy candy.

Adults

Teach your children how to brush their teeth and the importance of keeping their teeth clean. n Take your children to the dentist regularly. The American Dental Association recommends that children see their dentist starting at 1 year of age. n

Teens

Taking good care of your mouth and teeth will help you have pleasant breath, a nice smile and fewer cavities. Here are some simple things you can do: n Brush your teeth at least twice a day with a fluoride toothpaste. n Floss your teeth at least once a day.

Continuing good mouth and tooth care as an adult can help you avoid tooth loss, painful gums or other problems. Here are some helpful things you can do: n Brush your teeth at least twice a day with a fluoride toothpaste. n Floss your teeth at least once a day. n Don’t smoke or chew tobacco. n Ask your doctor if your medicines have side effects that might damage your teeth. (For example, some medicines may cause you to have a dry mouth.) n Look inside your mouth regularly for sores that don’t heal, irritated gums or other changes. n See your dentist every 6 months for regular check-ups and cleanings.

If you have any problems with your teeth or concerns about your mouth, see your doctor or dentist right away.

March 2015 I FUTURE MEDICINE 67

In focus

Kerala at

the helm of healthcare Kerala is one of the few regions in the developing world, which has achieved substantial progress in the realm of education and health. The demographic. morbidity, mortality, epidemiological and health transitions have been substantial and follow a pattern similar to many advanced countries.

By Dr Arun Oommen

68 FUTURE MEDICINE I February 2015

K

erala has become a model Indian state viewed in terms of low birth and death rates, infant and maternal mortality rates. high life expectancy at birth, favourable sex ratio and achievements in public health surveillance.

The health sector development and the illness pattern in Kerala are mostly different from the other Indian states.

It is difficult to identify a single factor responsible for the demographic, epidemiological and health transitions in Kerala . Kerala has nurtured progressive policies, social reform movements that had succeeded in awakening a collective consciousness to principles of equity, equality, public policies that involves land reform, welfare schemes, public distribution system and investments in social sectors such as health and education.

Apart from the socio-economic factors, the universally available public health system

in Kerala has also contributed to this much acclaimed health system of the people.

The state has a three-tier-system of health care - the primary health centres (PHC), community healthcare centre (CHC), taluk and district hospital and medical colleges evenly distributed in the rural and urban areas. Specific steps have been taken by the government of Kerala to improve the general socio-economic status of the people and preventive and curative health care through primary, secondary and tertiary level health care institutions.

Apart from this, there is an extensive network of medical care institutions practicing Homoeopathy Unani, and Ayurveda in government, voluntary and private sectors. The indigenous medical systems particularly ayurveda has been dominant and contributed significantly to public health and overall health transition in Kerala.

Kerala’s achievement of total fertility rate in spite of low per capita income disproves the theory that economic development is an essential prerequisite for reduction in fertility.

High status of women, female literacy, higher age of marriage and low infant mortality were thought to be the factors behind the rapid fall in the fertility rate in Kerala Human development index of Kerala is the highest among the states of india. Its because it has the highest literacy rate, highest life expectancy and the lowest sex ratio (male:female).

The female literacy rate is remarkably high. Kerala HDI is 0.79 compared to India’s 0.586 and US 0.914.

Healthcare indicators include birth rate, couple protection rate (%),death rate (per 1,000 population), infant mortality rate (per 1,000 population), life at birth (average), life at birth (female), life at birth (male), maternal mortality ratio (per lakh live births) , total fertility rate (per woman) The basis for the state’s impressive health standards is the statewide infrastructure of primary health centres. There are 330 beds per 100,000 population, the highest in the country.

With virtually all mothers taught to breast-feed, and a state-supported nutrition programme for pregnant and new mothers, infant mortality in 2011 was 12 per thousand, compared with 91 for low-income countries, 47 for india as a whole and 6 for the US .

In Kerala the birth rate is 40 per cent below that of the national average and almost 60 per cent below the rate for poor countries in general. India’s rate is 25 per 1,000 females and that

of the U.S. is 16.. Life expectancy at birth in Kerala is 75 years compared to 64 years in India and 77 years in the US. Female life expectancy in Kerala exceeds that of the male, just as it does in the developed world., Kerala’s maternal mortality rate is0 .81 /1,000 live births ,lowest in India compared to 0.21 in US. Its adult literacy rate is 94.59 per cent compared to India’s 65 per cent and the US 99 per cent.

The Economist has lauded the ‘Kerala Community Model’ in healthcare. With only 3% of India’s population, the tiny state provides

two-thirds of India’s palliative care services., The Economist has patted the Kerala Government for providing palliative care policy (It is the only Indian state with such a policy) and funding for community-based care programmes. Kerala is one of the first of India’s states to relax narcotics regulations to permit use of morphine by palliative care providers. Kerala has also extended the definition of palliative care to include the longterm chronically ill and even the mentally incapacitated. Kerala’s formal palliative care policy, the only state with such a policy, the communitybased Neighbourhood Network in Palliative Care (NNPC) project that employs an army of volunteers and the government funding for these local community-based care units, has earned it many an accolade.

Political awareness among the common people including children is quite high, The history in Kerala shows a trend of an alternating elected Right wing and Left government, which results in an increase in public welfare activities, much to the benefit of the common man.

Though Kerala spends fairly substantial amount on medical and public health compared to other Indian states public health system is getting alienated from the common man due lack of medicines and sophisticated infrastructure facilities in the government hospitals. Thus, public health centers are being utilised mostly for maternal and child health care programmes especially for immunization schemes. This has led to the impetus growth of the private medical care set up in the state and the dependence on private health care is quite high even among the lower expenditure classes and rural areas. In the changing scenario, the private sector reigns supremacy in the infrastructure and health manpower in the state.

Kerala reports the highest morbidity prevalence rates in the country. The number of hospitalisation in the below poverty line category in both India and Kerala is less than the above poverty line category. The poor are compelled to substitute outpatient care for inpatient care on cost affordability grounds.

March 2015 I FUTURE MEDICINE 69

MBBS � MD (Anatomy) � MD (Pathology) � MD (Microbiology) � MD (Physiology) � MD (Pharmacology) � MD (General Medicine) � MD (Paediatrics) � MD (Dermatology) � MD (OBG) � MD (Anesthesiology) � MD (Psychiatry) � MD (Radiogiagnosis) � MS (General Surgery) � MS (ENT) � MS (Orthopeadics) � DA (Dip. Anesthesiology) � DMRD (Dip. Radiodiagnosis) � DCH (Dip. Child Health) � DPM (Dip. Psychiatric Medicine) � DVD (Dip. Venerology & Dermatology) � DO (Dip. Ophthalmology) � DM (Cardiology) � DM (Neurology)* � DM (Nephrology)* � M.Ch (Neuro Surgery) � M.Ch (Urology)*

PUSHPAGIRI COLLEGE OF DENTAL SCIENCES

PUSHPAGIRI COLLEGE OF ALLLIED HEALTH SCIENCES

BDS � MDS (Oral & MaxilloFacial Surgery) � MDS (Peridontology) � MDS (Prosthodontics & Crown and Bridge) � MDS (Orthodontics) � MDS (Endodontics)

Two Year Diploma Courses run by CMAI (Christian Medical Association of India) � Diploma in ACCT (Anesthesia & Critical Care Technology) � Diploma in MIT (Medical Imaging Technology) � Diploma in MRHIT (Medical Records & Health Information Technology) � Diploma in MLT * (Medical Laboratory Technology)

PUSHPAGIRI COLLEGE OF PHARMACY B.Pharm � Pham D M.Pharm (Pharmacy Practice) � M.Pharm (Pharmacology) � M.Pharm (Pharmaceutical Chemistry) � Pharm D (Post Baccaularate) � M.Pharm (Pharmaceutics) � �

PUSHPAGIRI COLLEGE OF NURSING � �

B.Sc (Nursing) � M.Sc (Medical & Surgical) M.Sc (Paediatrics) � M.Sc. (Psychiatry)

�

PUSHPAGIRI RESEARCH CENTRE

(Approved Ph.D centre by Kerala University of Health Science) � Ph.D in Medicine & Life Sciences Project /Dissertation work for MD/MS/M.Tech) � M.Pharm/M.Phil/M.Sc/B.Tech/B.SC Courses

PUSHPAGIRI SCHOOL OF NURSING �

GNM (Non-Science students are also eligible)

Pushpagiri Medical College Hospital Tiruvalla - 689 101. Kerala, India.

Email: academicdirector@pushpagiri.in Tel : 0469 - 2700755 www.pushpagiri.in Pushpagiri Institute of Medical Sciences & Research Centre

Pushpagiri Medical College Hospital

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PUSHPAGIRI INSTITUTE OF MEDICAL SCIENCES & RESEARCH CENTRE

Future Medicine Monthly, Published on 8th January 2015 `50 ‘registered’ Regn No:KL/KTM/136/2014-16 RNI No: KERENG/2012/44529