Future Medicine March 2014

KERENG/2012/44529

March 2014

Grow Old Stay Healthy Accept Age with Grace

Sexual Health

Bedroom Mood

Enhancers Beauty Care

Stop Hair Loss

UAE - AED 7 US - $5 India - `50

healthy fruit

Kiwi: Abundant with Minerals &Vitamins

Wellness

Obesity Control through Ayurveda

celebrity fitness Ranbir Kapoor’s Workout Regimen

Volume 3 | Issue 3 | March 2014 Founder & editor Ravi Deecee Executive Editor Ratheema Ravi DC MEDIA - OPERATIONS

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EDITOR’S NOTE Age with grace

A

geing is not a curse but it is virtually a blessing in disguise. It is a natural process that prepares humans, animals and plants to die eventually.

There is nothing unnatural in the process. But there is one condition that everybody has to adhere to: Accept one’s age gracefully. Then growing old becomes a fantastic experience with joy and excitement. To make this experience pleasant, ailments should be kept under control to an extent through proper care and precautions.

A little bit of healthcare and physical exercise are sure to make lots of difference. So it is nice to be growing old.

Nowadays, there is a growing tendency among us to avoid signs of old age, which are essentially physiological.

Such trend is unfavourable and often proves detrimental to one’s health. According to medical experts, these are the times we need to address, particularly, health problems instead of discarding them totally as our body requires more attention than any other time before. So take care of health and grow old with grace.

The comprehensive cover story has experts’ views on healthy ageing. Diet, exercise, spirituality, adequate hydration and arts are all playing important roles in maintaining healthy ageing. The cover story helps the reader understand better the issues related to ageing.

He/she can also come to know about the early signs of ageing.

Experts say ageing is characterised by changes in appearance such as gradual reduction in height and weight due to loss of muscle and bone mass. Functional decline in audition, vision, kidney, immune, pulmonary and sexual activities occurs with the age. The fact is that day by day the whole system gets deteriorated and the scope for improvement is very limited. We have to live with the gradual physical degeneration.

Beauty lovers and even others can have sufficient information regarding hair loss from the article ‘Methods to control hair loss’. Since hair loss occurs due to stress, pollution, unhealthy diet and inadequate sleep, it can be well controlled through effective Ayurvedic treatments.

According to beauty experts, it is normal to lose about 100 strands of hair a day. Beyond this may be considered as severe hair fall.

‘Bedroom mood enhancers’ is a must read for couples because most of them are not aware of the small, small things that could be bedroom enhancers. Of course, there are things to be maintained in bedroom to make your sex maximum pleasurable. A dull sex life is caused due to lack of attention on matters which you may think are unimportant.

Plus there are columns, special stories and hospital profiles to make this issue most interesting.

COVER STORY

CONTENTS 20 41

Wellness – Obesity Obesity is a disease and it can be effectively controlled through Ayurvedic treatments like nourishing therapy and emaciating therapy which are based on the etiological factors

Columns

48

69 68 62 66 72

Beauty Care – Hair Loss Stronger, lustrous hair locks enhance your beauty and confidence, and you will easily get noticed even in a crowd, but an unhealthy lifestyle can cause hair fall

Pediatric Health Dr Prameela Joji

Women’s Health Dr Meenakshi Sahu

Palliative Care Dr MR Rajagopal

Gynecology Dr Partha Sarathi Das

Sleep Disorders Dr Micheal Bruce

8 FUTURE MEDICINE I March 2014

Grow Old, Stay Young Healthy ageing is a ‘mantra’ today especially when the ageing population across the world is growing steadily, posing challenges to many nations. People need to be aware that growing old is a natural process and it is neither a disease nor an unnatural phenomenon. Here, experts speak about ways to cope with this changing phase of life

34

Sexual Health

Oral Sex Oral sex may cause throat cancer and the risk of developing the cancer is higher when one indulges in oral sex with six or more partners

52

Health Insurance

Why Health Insurance Important Health Insurance provides you with an affordable way to get medical care when you need it. It also protects you and your family from the high cost of healthcare

28

Genetics of Ageing As we age, our organs also start to fail. This can be due to a number of reasons like infections, genetic variants (that make us susceptible), wear and tear, abuse and environmental effects. As longevity has increased in the last century, we are seeing more effects of functional degradation of organs. Alzheimer’s and other neural problems are estimated to be some of the most challenging healthcare issues that we will face in the coming decades with our aging population

14

Healthy Fruit Kiwi With abundance of vitamins and minerals, the kiwi fruit provides a wide range of nutrition benefits

38

Special Story ArmmaN It is a non-profit organisation committed to improve the wellbeing of pregnant women, infants and children in India especially in Mumbai slums

78

Celebrity Fitness Ranbir Kapoor A look at how Bollywood star Ranbir Kapoor maintains a perfect body despite his hectic schedule

March 2014 I FUTURE MEDICINE 9

photospeak

Old Operating Theatre Museum in London

By FM Bureau The Old Operating Theatre Museum in London was built in the end of the 17th century. Thomas Cartwright was the architect. The garret fitted with wooden storage racks was described as the herb garret in 1821 as dried heads of opium plants were found in the rafters. It is likely that the garret was used by the hospital’s resident apothecary to store medicinal herbs. The herb garret was converted into an operating theatre in 1822.

Previously, operations took place in the ward. In 1859, Florence Nightingale became involved in setting up her famous nursing school at the site. It was on her advice that the hospital agreed to move to a new site which the Charing Cross Railway Company bought for the hospital.

In 1862 when the hospital moved to Lambeth, the operation theatre was closed. It was promptly forgotten until researcher Raymond Russell rediscovered it in 1956.

The museum is conveniently located near London Bridge Station and is open every day from 10.30am to 5pm.

10 FUTURE MEDICINE I March 2014

World Down Syndrome Day

Raise awareness of

Down syndrome D World Down Syndrome Day (WDSD) is observed on March 21 every year. The European Down Syndrome Association at its congress held in Palma de Mallorca in February 2005 officially announced the day. In the US, the National Down Syndrome Society observes Down Syndrome Month every October as a forum for dispelling stereotypes, providing accurate information and raising awareness about the potential of individuals with Down syndrome

By FM Bureau

12 FUTURE MEDICINE I March 2014

own syndrome is an abnormality characterised by an extra full or partial copy of the 21st chromosome. Every cell in the body contains genes that are grouped along chromosomes in the cell’s nucleus. There are normally 46 chromosomes in each cell, 23 inherited from mother and 23 from father. When some or all of a person’s cells have an extra full or partial copy of chromosome 21, the result is Down syndrome.

The only factor known to cause Down syndrome in babies is maternal age.

That is, less than one in 1,000 pregnancies for mothers below 30 years old results in a baby with Down syndrome.

For mothers who are 44 years old, about 1 in 35 pregnancies results in a baby with Down syndrome.

Characteristics

Individuals with Down syndrome often have distinct physical characteristics, unique health issues and variability in cognitive development.

Physical •

Eyes that have an upward slant, oblique

• • • • • • •

fissures, epicanthic skin folds on the inner corner and white spots on the iris.

Low muscle tone Small stature and short neck Flat nasal bridge Single, deep creases across the centre of the palm Protruding tongue More than usual space between large and second toe A single flexion furrow of the fifth finger

Key organisations In the early 20th century, many people with Down syndrome were housed in institutions or colonies and excluded from society. However, since the early 1960s, parents and organisations have generally advocated a policy of bringing people with mental and/or physical disabilities into general society as much as possible.

MENCAP founded in the UK in 1946

by Judy Fryd supports all people with mental disabilities.

The National Association for Down Syndrome founded by Kathryn McGee in 1960 was the first known organisation to recognise Down syndrome in the US.

Prominent individuals Dr Karen Gaffney was the first person with Down syndrome to receive Doctor of Humane Letters presented by the University of Portland in 2013.

Stephane Ginnsz became the first film actor with Down syndrome, in 1966.

Sandra Jensen with Down syndrome received a heart-lung transplant for the first time.

Paula Sage was a Scottish film actress and a Special Olympics netball athlete.

Her role in the 2003 film AfterLife brought her the BAFTA Scotland Award for the best first time performance and the best actress award in the Bratislava International Film Festival-2004.

The disease is named after John Langdon Down, a British physician who described the syndrome in 1866.The condition was clinically described by Jean-Étienne Dominique Esquirol in 1838 and Édouard Séguin in 1844.

healthy Fruit Kiwi

Rich in

s n i

m a it

v

The kiwi fruit known as Chinese gooseberry or Macaque peach is the national fruit of China.

The kiwi that tastes like a combination of pineapple, banana and strawberry is the most nutrient dense fruit. Take a look at the different ways that the naturally fat free kiwi helps us to stay healthy

By FM Bureau

14 FUTURE MEDICINE I March 2014

s l ra

e n i

m &

Plenty of vitamins, minerals

The kiwi fruit is rich in vitamin C, vitamin E, potassium, dietary fibre and magnesium. It contains low amount of sodium, cholesterol and saturated fat.

With abundance of vitamins and minerals, the kiwi provides a wide array of nutrition benefits.

A kiwi fruit weighing 177gm contains calories- 108, carbohydrates- 26gm, dietary fiber- 5gm, vitamin C- 133mg, protein- 2gm, sodium- 5mg, sugar- 16gm, calcium- 6%, vitamin E- 3%, and iron- 3%.

• It is one of the best fruit sources of vitamins • With antioxidant properties, the kiwi fruit is effective in protecting against Age-Related Macular Degeneration (ARMD).

• It has more vitamin C than oranges.

• Its consumption could significantly improve sleep quality in adults with sleep problems.

• It provides 16% of the recommended dietary allowance (RDA) for fibre and has a role in the prevention of constipation and some cancers.

• The kiwi has phytonutrients which repair DNA, act against some cancers and

•

•

function as antioxidants.

Children fed 5-7 portions of the kiwi fruit developed 44 % less chances of being affected with wheezing as compared to those who were fed once a week.

The fruit helps to lower blood pressure.

Vitamins •

•

•

The kiwi provides 10% of the RDA for folic acid which is important for expectant mothers and works to produce red blood cells.

A kiwi fruit gives the body 230% of the RDA for vitamin C which helps heal wounds, increase iron absorption, and boost the immune system.

It provides 10% of the RDA for vitamin E which decreases the risk of heart disease.

Minerals •

•

•

Provides 5.5% of the RDA for calcium, 8% of the RDA for copper, 4% of the RDA for iron and 6% of the RDA for magnesium which can enhance energy level.

Provides chromium which aids in regulating heartbeats and potassium that helps in fluid maintenance.

Provides zinc that helps to keep hair, skin, teeth and nails healthy.

Prevention Eczema

How to treat

skin inflammation Eczema also known as atopic dermatitis is a type of chronic skin inflammation. People with eczema have dry, irritable skin, and itching contributes to skin changes. Eczema is treated by avoiding irritants to the skin and using moisturisers, medicated ointments or

By FM Bureau Avoid irritants, allergens

It’s important to try to avoid anything that tends to aggravate your eczema.

Common environmental irritants include soaps, bubble baths, shampoos, solvents, wool, nylon, grass and sand. Pollens, house dust mites, animal dander (small scales from the skin and hair of animals) or even certain foods can also aggravate eczema if you are allergic to them.

Overheating that can also make your eczema worse should be minimised. Always bathe in warm, rather than hot water. In winter, turn down the heater and don’t use an electric blanket. Airconditioning and fans are helpful during summer.

Soap substitutes

Normal soap is alkaline and can further dry out your skin. Soap and detergent-based shampoos should be avoided, and instead soap and shampoo substitutes should be used.

Bath oils (e.g. Alpha Keri bath oil, DermaVeen

shower and bath oil and QV bath oil) can also be helpful, but you should be careful as they make the bath slippery. Bath oils can also be used if you prefer to shower- spray the oil onto wet skin immediately after the shower and then lightly dry the skin with a towel. Shorter or less frequent baths/showers can also help treat dry skin.

Moisturisers or emollients

Moisturising your skin is one of the easiest and most important measures in preventing itching and scratching, as well as reducing eczema flare-ups. As eczema is a chronic condition, it is important to incorporate regular moisturising into your daily skin care routine. Be careful to avoid moisturisers that contain perfumes and preservatives which can irritate the skin.

Moisturisers should be applied frequently for very dry skin at least twice a day all over the skin.

Ointments tend to be more effective than creams or lotions for very dry skin. It’s best to apply the moisturiser or emollient straight after a shower or bath to help seal in the moisture from bathing.

Wet dressings

Wet dressings help to relieve eczema symptoms in some people. Wet dressings are often used in severe flare-up of eczema, generally for a few days. Keep wet dressings for around 15 minutes, 3 to 4 times a day.

Steroids

Creams or ointments containing corticosteroid are commonly used for exacerbations of eczema. It relieves itching by reducing inflammation in the skin and is very effective and safe.

Using high-strength steroid creams over long periods is associated with local side-effects such as thinning skin, stretch marks and dilated blood vessels. So, you should use the lowest strength and smallest amount that works adequately.

Facial skin is particularly susceptible to steroid side-effects.

Immunomodulators

Immunomodulators such as pimecrolimus cream (brand name Elidel) can be used in the treatment of eczema. They control inflammation and can be used to treat eczema symptoms and reduce exacerbations if a steroid cream cannot be used. However, because of concerns over cancers of the lymphatic system and skin, pimecrolimus is not recommended for long-term continuous use.

Antibiotics and antiseptics

It is fairly common for skin that is affected by eczema to be susceptible to infection. If infection occurs, your doctor may prescribe antibiotic cream or tablets to treat the infection. Tablets are usually prescribed because they are more effective than creams. Adding antiseptic solution to your bath water can prevent and treat skin infections, but make sure that the concentration of antiseptic is not too high as it may irritate the skin.

Sedatives

Sedating antihistamines (antihistamines make you drowsy) may be used to relieve itching that is disrupting sleep. Their benefit is mainly due to the sedating effect. They rarely completely suppress itch so they should be taken at night. Oatmeal bath additives and pine tar preparations may also help to relieve itchy skin.

Nutritional supplements

Supplements such as evening primrose oil, fish oil and borage oil have been touted as possible treatments for eczema symptoms.

However, there is a lack of evidence from patient studies to show that nutritional supplements are effective in treating eczema. There is also no scientific proof that vitamin or mineral supplements are effective treatments for eczema.

Treatment for chronic, severe eczema Tablets that suppress your immune system, such as cyclosporin (e.g. Neoral and Sandimmun) can be tried if you have severe eczema. These medicines have some potentially serious side-effects and are only available for adults on prescription from a specialist. They are usually used only when other treatments have failed.

Phototherapy using ultraviolet light is another form of treatment for chronic, severe eczema. Phototherapy involves controlled exposure to ultraviolet light for a few minutes, 2-3 times a week. This treatment is expensive as well as timeconsuming, and can have possible longterm side-effects, including premature skin ageing and skin cancer.

March 2014 I FUTURE MEDICINE 17

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Infertility Medical Case History

Genetic issues result in

repeated abortions

Dr C Mohamed Ashraf Medical Director, Craft Hospital and Research Centre

Dear Doctor, I was married to my cousin three years ago. I got pregnant twice during this period but the first pregnancy resulted in abortion. When I conceived again, the child had a genetic disease called spinal muscular atrophy and I lost the child when it was just four months old.

Now we are trying again for a baby. Is it possible for me to conceive a child free from any genetic/ chromosomal disease?

Do we carry the genetic mutations for SMA? I also want to know why the child did not get proper treatment in spite of early detection of the genetic disease.

Aparna Ghosh, Navi Mumbai

Here readers are welcome to ask their questions regarding infertility and gynecology problems which affect many a couple. Our doctor answers the genuine questions on priority basis.

Dear Aparna, The answer is definitely ‘Yes’. With an increase in the number of blood relation marriages in our country, studies show a high incidence of chromosomal and single gene disorders.

SMA is an autosomal recessive genetic disease affecting the control of muscle movement. In this case, there is always a 100% chance to conceive a normal child with the help of a technique known as pre-implantation genetic diagnosis (PGD). But before that, it is very essential to

get the DNA test done as either of the parent could be a carrier of SMA gene. With the help of the DNA test and effective genetic counseling, reproductive options like IVF or ICSI can be advised.

With the embryos created through IVF/ ICSI, PGD can be done on embryos to check the genetic disease and a chosen genetically viable and good embryo can be implanted in the uterus resulting in normal and successful pregnancy.

The answer for the improper treatment in spite of disease detection lies in the fact that genetic diseases detected after the birth have no treatment as these are inherent diseases. The answer lies in prevention of the birth of children with genetic/chromosomal abnormalities like SMA and many more serious blood disorders by adopting and utilizing safe and advanced options like PGD in order to achieve a healthy pregnancy.

This not only ensures the birth of a healthy child but also improves the mother’s health as genetic issues result in repeated abortions.

Genetic testing in general is applied in a way to improve healthcare. PGD can be opted as an alternative to prevent the birth of an anomalous child.

SMA, The term spinal muscular atrophy is used for the genetic disorder caused by deficient SMN, and for a larger number of rare genetic disorders.

March 2014 I FUTURE MEDICINE 19

COVER STORY Healthy Ageing

Graceful& Healthy 20 FUTURE MEDICINE I March 2014

Ageing

When we grow old, our body cells begin to fail. During the ageing process, damage accumulates itself in the body by external influences such as UV-radiation, which causes damage to DNA and proteins in our cells. But the harmful influences don’t just occur on the outside. They cause damage during the metabolic process, converting substances into other substances. Therefore life itself creates damage thus we age, and eventually die.

Ageing is continuum of degenerating process after the peak at the age of 35 or so , and some people tend to have “biological ageing” faster than others. Several studies show how we can know the ageing process, such as artery ageing by means of carotid ultrasound and Ankle Brachial index, bone ageing by means of a bone scan and a screening form for cognitive function.

Ageing is characterised by changes in appearance, a lower metabolic rate, longer reaction time, decline in certain memory functions and decline in sexual activity.

So, ageing is something that can be judged by appearance. Everyone recognises the signs: balding, grey hair and especially wrinkles. But, when does the ageing process actually begin?

Here, Future Medicine makes an effort to know the mystery of ageing from experts like Dr Suresh Rattan, who heads the Laboratory of Cellullar Ageing at the Department of Molecular Biology and Genetics, Aarhus University, Denmark. Excerpts from an interview

By Sumithra Sathyan

March 2014 I FUTURE MEDICINE 21

COVER STORY Healthy Ageing

Ageing and anti-ageing Can you tell us about your involvement in ageing research?

I have been involved in ageing research since my university days at Guru Nanak Dev University, Amritsar, where I did research projects on the ageing of insects for my BSc and MSc studies (until 1977); then I worked on the regeneration of Hydra at Jawaharlal Nehru University, New Delhi, for my MPhil research project (1979); then I studied ageing of human cells at the National Institute for Medical Research (NIMR), Mill Hill, London, for my PhD (1982); and finally I earned a post-PhD degree of DSc on the biology of ageing from Aarhus University, Denmark (1995). So, my whole academic career of more than 35 years has been around the question of biological basis of ageing.

My basic research on ageing also led to some new ideas and products on ageing modulation. For example, my discovery of kinetin and zeatin as ageing modulatory compounds are used in numerous skin care products worldwide. More recently, my ideas on mild stress-induced health beneficial effects, known as HORMESIS, are being developed into practical ageing modulatory methods called hormetins, including new skin care products, and general health promoting products at the nutritional and psychological levels.

So in your opinion, what is exactly ageing and anti-ageing?

Well, it is not my personal opinion, but a general scientific understanding emerging from more than 50 years of modern biological research on ageing, that ageing is the process and period beyond the age of about 45 years in which there is a progressive loss of our ability to maintain health, which leads to increased chances of occurrence of one or more agerelated diseases and eventual death.

As regards anti-ageing, scientists avoid using this term because ageing is not a disease in itself (it happens to all if they live long enough; and something that happens to everyone is not a disease!!), and so cannot be treated or reversed. Ageing can be manipulated, and the rate of ageing can be slowed down to some extent, and health can be maintained. But ageing cannot be reverted; and anyone who claims

22 FUTURE MEDICINE I March 2014

Dr Suresh Rattan

Scientific research has shown that there are no special genes which make us become old and die. Genes determine our ability to live and maintain health for about 40 years after which our cells and organs start becoming weaker and less functional. Several lifestyle factors, such as food, physical activity and psychosocial interactions affect ageing and lifespan

that he or she can reverse ageing or do a complete antiageing therapy, or achieve full rejuvenation is telling lies, and selling false promises.

If we have perfect genes and a perfect environment in which no damage occurs, is it possible to remain healthy, young and immortal?

What does “immortal” mean- infinity or a couple of hundred of years or what?

If we have perfect genes and a perfect environment in which no damage occurs and nothing goes wrong in complex biological processes, then yes, we can remain healthy, young and immortal.

But that is purely a wishful thinking. Evolution has not made us immortal, and laws of quantum physics do not allow anything to remain error-free all the time. Sooner or later all systems collapse. But there is no biological programme which makes us old or forces us to die. It is purely a chance event. And that is why we can

surely do a lot of things to maintain health and to extend health-span.

Suggestions for healthy living Please share some important thoughts or notes which may make us live healthy.

Taking steps for a healthy life may point out as below.

Some of these steps may look like common sense, but there is also a lot of science behind these steps now. Four main steps, in my view, are: • Understand the importance of proper food in terms of proteins, carbohydrates, fats, minerals and other micronutrients. Our body needs every kind of food for proper physical and mental functioning. Even water can be a killer if over-used. Moderation, variety and pleasure are the secrets of a healthy nutritional lifestyle.

• Recognise the importance

COVER STORY Healthy Ageing

One of the more damaging myths of ageing is that after a certain age, you just won’t be able to try anything new or contribute anymore. The opposite is the truth. Middle aged and older adults are just as capable of learning new things and thriving in new environments as youngsters, plus they have the wisdom that comes with life experience. If you believe in and have confidence in yourself, you are setting up a positive environment for change, no matter what your age is

•

•

of physical and mental activity for a healthy life. Challenging yourself with physical and mental challenge-a kind of mild stress of choice, such as exercise- is the basis of hormesis, which gives numerous health benefits.

Stress is bad only when it is not of your own choice. So choose your stress physical, mental, emotional face the challenge, and it will give you a sense of fulfillment, achievement, and better health.

Accept yourself ; you cannot become young or healthy or whatever by denying your age or your other physical and mental conditions.

Use medicine to regulate blood sugar levels, blood pressure etc to help you stay physically and mentally functional. Measure your health by your physical and mental independence, and not by the labels of diseases Be responsible to yourself and your surroundings- (plants, animals and atmosphere) . It is important for your health, survival and longevity that the health, survival and longevity of others are also maintained.

Current disease-perspective of health Does the current diseaseperspective of health need a change?

Disease-oriented approach to health is just like a religion’s hell-oriented approach to ethics, that if you are not behaving good then you will burn forever in hell. It does not work. We need to make health as something attractive in itself, just as being ethical is important in itself, not because otherwise we will go to hell. But the main problem so far is we do not know what exactly health is- it can be highly variable and very personalised. We have to find our own limits of health, which make us physically and mentally independent in activities of daily living- this is how we define health. We need new methods and drugs For health, not AGAINST this disease or that fear or that hell

24 FUTURE MEDICINE I March 2014

COVER STORY Healthy Ageing

Healthy

t e i D

By FM Bureau

A

healthy diet may even slow down the impact of aging process and also keep us young and active too. Eating foods such as fruits, vegetables, fish, nuts, and whole grains protects against many chronic conditions that could limit our life, including diabetes and heart disease. These foods help keep your blood vessels in good shape, which is important for the heart and other organs of the body. Certain foods can protect eyesight and hearing. Healthy foods may even help preserve memory and protect against Alzheimer’s disease.

Colourful fruits and vegetables

The antioxidants in colourful vegetables and fruits, such as leafy greens, deep red tomatoes, blueberries and carrots help stop unstable molecules from damaging healthy cells. You cannot feel it when some cells are damaged or dying but you can see it as the signs of ageing such as wrinkles.

Three antioxidants

You can slow down the process of ageing with a healthy diet that mainly includes fruits and vegetables. Fish, whole grains and dairy foods can also help protect against early ageing

26 FUTURE MEDICINE I March 2014

Vitamin C, zinc and betacarotene help protect eyesight from macular degeneration, a leading cause of blindness in the aged. If you already have macular degeneration, eating foods with these nutrients may slow its progress. Dark green leafy vegetables such as spinach, kale, collard, and mustard greens help the most. A powerful antioxidant in grapes and red wine called

resveratrol helps reduce the risk of cancer, heart disease and premature ageing.

Whole grains

Eating whole grains rich in fiber, oats, quinoa, barley, wheat, and brown rice lowers your chance of developing Type 2 diabetes. A healthy diet that contains whole grains also keeps blood vessels in peak condition. Your goal is three servings of whole grains a day.

Fish

Omega-3 fatty acids in fish oil offer many anti-ageing benefits. They protect the heart, reduce the risk of stroke and may even lower the risk of Alzheimer’s disease. Help yourself to two servings a week of fatty fish such as salmon, lake trout or tuna.

Dairy foods

The calcium and fortified vitamin D in dairy foods are crucial to strong bones. They help prevent osteoporosis and keep you active in your golden years. Include three cups of low-fat milk, yoghurt, or other dairy products a day to ensure strong bones. By choosing low-fat instead of regular dairy, you’ll help keep your cholesterol levels in check, making you less likely to get heart disease.

Nuts

The fatty acids in nuts are among the healthiest you can find. If you avoid nuts because you think they’re high in fat, think again. In fact, one study showed that snacking on nuts reduced the risk of high blood pressure and high cholesterol by about 20%. You only need to eat 1/4 of an ounce a day to get the benefits- that’s about four almonds.

Beans and lentils

These foods give you loads of plant-based protein, so they’re an age-protecting alternative to red meat with saturated fat, which is linked to heart disease and diabetes. Beans and lentils are inexpensive and easy to add to soups, casseroles and side dishes.

Anti-ageing diet

For the best anti-ageing diet, it’s important to limit foods that can harm your body. It’s easy if you follow these three guidelines. Go easy on high-fat meat, high-fat dairy and bakery treats.

The saturated fat found in these foods can clog your arteries, which can lead to heart problems.

Limit sugar as much as possible. Eating too much sugar can send your blood sugar levels on a roller-coaster ride of ups and downs.

Eating too much salt, a form of sodium, can raise your blood pressure. Over time, high blood pressure can damage many parts of your body, including your kidneys, your eyes, and your brain. Limit sodium to 2,400 mg- about one teaspoon of table salt- a day.

(By arrangement with www.webmd.com) March 2014 I FUTURE MEDICINE 27

COVER STORY Healthy Ageing

Genetics of ageing How do we age?

Our genes play a significant role in deciding not only how long we live but also how healthy we are. Longevity seems to run well in families and hence the hereditary factor has been never in doubt. However, we are not able to pin point the specific genes or variants that drive this. The deciphering of the human genome in 2003 and subsequent exponential fall of DNA sequencing costs led most to believe that the answers would soon be found.

A number of genomic studies focusing on centenarians were also begun in the last few years. Though they have started giving tantalising clues to longevity, science is yet to get definite answers

By Sam Santhosh

28 FUTURE MEDICINE I March 2014

Our ageing happens both at the cellular level and the organ level. Life from conception is all about cell division- a single cell formed as a fusion of the sperm and egg divides to form trillions of cells and in that process generates our various body organs. The DNA in the cell has the instructions to produce the proteins for doing so. However, cells stop dividing after some time. They seem to have an inbuilt mechanism that tells them to stop dividing after a specific number of times. This is called cellular senescence.

One possible cause of cellular senescence has been ascribed to the ‘telomeres’, which are pieces of DNA that cap the end of chromosomes.

The telomeres become shorter and shorter as the cell divides

Sam Santhosh, CEO, SciGenom Labs,Kochi

and finally they become so short that the cell cannot divide any further.

As we age, our organs also start to fail.

This can be due to a number of reasons like infections, genetic variants (that make us susceptible), wear and tear, abuse and environmental effects. As longevity has increased in the last century, we are seeing more effects of functional degradation of organs. Alzheimer’s and other neural problems are estimated to be some of the most challenging healthcare issues that we will face in the coming decades with our ageing population.

Can we delay ageing?

Studies have shown that lifestyle plays a significant role in how a person ages. The most critical of these is what we eat and how much. Lower calorie intake has shown clear co-relation to longer life. Do you want to starve and live longer? But one does not need to starve. Eating more fruits and vegetables and avoiding sugars and oils can help very well.

Regular exercise (physical and mental), avoiding smoking and drug abuse, reducing stress etc. have shown without doubt to delay the ageing process. Scientists like Ray Kurzweil also advise taking nutritional supplements based on your age and physical characteristics that they claim will delay ageing.

But can there be a wonder drug or gene therapy that can delay ageing? In the 90s, a number of companies had sprung up claiming to delay ageing through lengthening the telomeres in the cells. But none of the companies were successful and most closed down. Genetic therapy is too far in the future and is also turning out to be a more complex process than we thought initially.

The future

Extending our life span to over 100 to 120 years seems very much likely with the current science and medical knowledge.

Taking life beyond that will depend on how new technologies like nanotechnology, organ re-generation, 3D printing etc. will grow.

We need to keep in mind that genetically we are not programmed to live too long. After reproduction and taking care of our young till they grow up, our role in the circle of life seems over. As explained in the book Selfish Gene by Richard Dawkins, our body seems to be just a vehicle for our genes. But now that we are able to decode our genes and manipulate them, it will not be too long that we re-engineer them to serve us instead of we serve them.

Those who are interested in learning more about ageing can read Transcend by Ray Kurzweil. Listening to Aubrey De Grey at TED. com will also be very enlightening.

COVER STORY Healthy Ageing

Unhealthy ageing:

Prevention and cure Ageing is a natural process that you cannot stop but you can slow down physical degeneration by remaining mentally and physically healthy

By Dr Salitpong Kanjanawongdeengam

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nhealthy ageing means that you age with problems as fatigue, lack of wellbeing, osteoporosis, Alzheimer’s disease, heart disease, obesity, diabetes, hypertension, etc. The best way to deal with this is to prevent or lower such risks.

You can live a healthy life, maintaining wellbeing and low risk of chronic diseases throughout your life with proper planning. You can keep yourself healthy with: • Good nutrition • Lowering your stress level • Lessening some belly fat • Doing more exercise Optimising the cellular function is the key to make this a reality. You can supply many things that our cells and body need in order to maximise their function and slow down degeneration.

Healthy lifestyle

First, ensure a healthy lifestyle by maintaining a low-stress life and environment, stopping smoking and alcohol, having enough sleep and exercise, losing excess weight, taking more fruits and vegetables, eating less sugar and salt and

30 FUTURE MEDICINE I March 2014

keeping good mental health.

Second, find what deficiency we have, such as a lack of micronutrients and hormones, then fill up and balance them to optimise body functions.

Third, prevent chronic diseases by early detection.

Use many comprehensive laboratory investigations to find hidden problems before they turn to be serious diseases, so you can better plan to cope with this, or you can even reverse and be back to healthy condition.

Fourth, genetic testing can tell you about risk of some chronic diseases or cancer. And you can plan to have surveillance over specific diseases.

Research to broaden horizons

Stem cell is a new hope of humanity. In a few years, it can be used in humans effectively. You can maximise your own stem cell by doing things mentioned above.

Healthy living depends on yourself, change to a healthy lifestyle and have a good planning for optimising your body and prevent chronic diseases with the help of anti-ageing physicians.

In an ageing society, issues will come up again and again in planning for the management of osteoporosis, hypertension, depression, incontinence, dementia, Parkinson’s disease and dozens of other conditions that are common in the elderly. Many of the methodological tools that are available are still evolving. We are embarking on a difficult and demanding agenda but it is one that we must pursue in order to understand the nature and scope of the illness burden faced by our ageing populations, and the implications of that burden for preventive therapies.

Dr Salitpong Kanjanawongdeengam American Board of AntiAgeing and Regenerative Medicine (ABAARM) Clinical Focus: Acupuncture, Anti-Ageing Medicine and Chelation Therapy

Brain functions Art benefits elderly

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t any age, art in all forms can provide benefits; this is particularly true for the elderly. Neurological research clearly shows that making art can improve cognitive functions by producing both new neural pathways and thicker, stronger dendrites (involved in passing on signals in the brain). In this way, art helps the brain by using more efficient networks. It even helps the brain to re-map how some connections made as cells in one area become incapacitated. The process is called elasticity as some cells replace the function of others. In short, making art causes

the brain continue to reshape, adapt and restructure.

In a groundbreaking new book published in 2000, Dr Gene Cohen expounded on the idea of what was possible with ageing, moving research towards a goal beyond “what is ageing?�

His research recognised that older adults had a capacity for creativity that was not being recognised due to negative attitudes towards the elderly.

His study, the first of its kind, found a link between creativity and healthier ageing. Compared to those in the study’s control groups, people who participated in art programmes enjoyed better health, both physical and mental.

Spirituality lessens anxiety, depression

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here is abundant evidence that spirituality and religious participation are associated with positive mental health outcomes. Intrinsically religious people internalise their faith, and have higher self-esteem, better personality functioning, less paranoia and lower rates of depression or anxiety while extrinsically religious people use religion to obtain status, security, sociability or health.

Most studies find that higher religiousness and spirituality are associated with lower levels of death, anxiety or alcoholism, with better marriages, reduced loneliness, lesser distress among dementia caregivers, and better mental health.

A number of studies examine the association of religion with depression.

The studies have shown religious activity to be associated with remission of depression in Protestants, Catholic Netherlanders and in older adults. It has been found that religiously involved people had less depression and less anxiety. Religious commitment also has been found to moderate the relationship between functional disability and depression.

Religious and spiritual themes can be present in the context of mental illness, such as schizophrenia or bipolar disorder.

On another note, highly stressful life events can transform normative religious beliefs into excessive preoccupations that involve delusional guilt.

Need for

adequate hydration Ensuring that older people are well hydrated is essential.

Dehydration by as little as 2% loss of body weight results in impaired physiological and performance responses.

In extreme cases, mental confusion that has been interpreted as the onset of senility has been reversed by adequate hydration.

COVER STORY Healthy Ageing

Smooth skin

for best look Age catches up unfailingly with everyone, but still everyone wants to look young. Skin care is one way to look young and there are several ways to keep the skin wrinkle-free

By Dr Pumori Telang Saokar

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oday everyone wants to look and feel his or her best. Like the eyes are the mirrors of the heart, the skin reflects your health. No one can gain good health overnight and it applies to skin too, no matter what your age.

Skin care should become a part of one’s daily routine. This involves simple things like using a sunscreen and an appropriate cleanser for your skin type during the day. At night all make-up should be removed completely. Then use some skin moisturising lotion or anti-ageing cream as necessary. While doing this we should not forget other healthy habits like balanced diet, good sleep, regular exercise and adequate water intake, which are equally important for a healthy skin.

The age catches up with everyone, but still everyone wants to look that wee bit nicer and younger. A short visit to a dermatologist for Botox or fillers can do wonders to those sagging folds. A new, good, safe, painless, effective and long lasting anti-ageing option is Radio frequency skin tightening. It tightens skin and smoothens the folds around the eyes, mouth, jaw line and neck in a natural way without going under a surgeon’s knife. It is done in a dermatologist’s clinic without the need for hospital admission and it is scarless too. The same machine can dissolve fat and can be used for localised fat removal and body reshaping in areas like the double chin, flabby arms, loose belly and fat thighs. Laser resurfacing can magically remove fine wrinkling of the face. The latest entrant to the anti-ageing arsenal is ‘threads’ which can give a facelift without surgery.

32 FUTURE MEDICINE I March February 2014 2014

A new, good, safe, painless, effective and long lasting anti-ageing option is radio frequency skin tightening. It tightens skin and smoothens the folds around the eyes, mouth, jaw line and neck in a natural way without going under a surgeon’s knife

When undertaking anti-ageing procedures, it is extremely important to have realistic expectations. A person should not and cannot expect to look 20 at the age of 50. That is unreasonable.

The aim is to look younger, attractive and as natural as possible for your age.

Approximately 5 to 10 years younger is desirable.

We Asians have a problem of hyper pigmentation, which is having dark spots or patches on the skin. Lasers, skin polishing, peels, electroporation, a variety of masks and cosmetics are an endless list of procedures and products available in the market today to reduce or remove unwanted pigmentation. Some of these will do the trick for you but some won’t work. All fairness creams contain skin-bleaching chemicals, which may have side effects on some. Don’t lose heart because there is a newer kind of treatment is available, which is called stem cell extract. It is made from plants and is totally harmless. Autologous platlet rich plasma is an even better option.

Combined with a newer laser called fractional CO2 laser it can get rid of many kinds of scars, blemishes or even stretch marks. This can be used of face as well as other parts of the body like the back, shoulders, arms and legs. The same treatment, with little modification, is used to shrink open pores and to give an instant glow to the face. A clean blemishless face is always appreciated and gives a younger look too.

Long lustrous hair is a sign of youth and vitality. There are a wide variety of therapies available for hair

growth, aside from a range of vitamin combinations and home care lotions such as platlet rich plasma, plant stem cell extract and electroporation, hair transplant.

Any healthy skin may have few natural handicaps, which may make a person uncomfortable. For example excess hair in visible parts of the body such as face, which although natural may not be socially acceptable.

Common methods for hair removal include threading, plucking, bleaching and waxing. These methods are painful and never a permanent solution for the problem. Newer technologies have made a huge impact on this problem. Newer lasers are very effective and can stop unwanted hair growth with no side effects. And guess what, it is painless too.

It can be used on the face and also on other areas of the body, which were not treatable with older varieties of lasers. Yes, the initial cost may be more but the advantage of lasting results makes it worthwhile.

Advances in skin care today are many. They allow a person to get a nearly perfect blemish-free skin at any age. However, the mantra remains the same, be healthy, and maintain a healthy skin.

(The author is a consultant dermatologist in Jehangir Hospital,Pune)

Sexual Health Knowledge of sex is most essential for having a happy married life. Family life, more than anything else, is based on the healthy sexual relationship between the partners who need to explore all possible routes to maximise their enjoyment and understanding each other

34 FUTURE MEDICINE I February 2014

SEXUAL HEALTH

Condoms effective, reliable It is found that condoms are highly effective in preventing unwanted pregnancies and transmission of HIV and other sexually transmitted diseases (STDs) Facts you should know about condoms • • • •

With consistent and correct use, condoms can reduce the risk of STDs, including HIV, chlamydia, gonorrhea, syphilis, HPV and herpes 2,3 Latex condoms are durable, with a long shelf life.

Condoms are made in a variety of sizes and styles to accommodate every user’s preferences.

User error, which contributes to most condom failures, is correctable with simple, appropriate educational measures.

STD statistics • • • • •

Prevalence is higher than ever before in the US. In 2008, over 1 million people in the US were living with HIV (an increase of more than 10% from 2003).

Incidence of new cases has stabilised over the past decade at 56,000 new cases annually.

Sexual contact is responsible for the majority of infections.

Prevalence is highest among young and minority women.

Gonorrhea • • • •

Second most commonly reported infectious disease in the US. Prevalence is highest among adolescent girls and young women.

In 2008, 70% of cases were seen in black patients.

Rates of infection are higher among minority groups.

Syphilis • • •

It has re-emerged as a public health problem.

In 2008, 13,500 cases were reported: the highest number since 1995.

Majority of cases were among men who have sex with men.

SEXUAL HEALTH Throat Cancer

Oral sex with multiple partners increases risk People who have six or more oral sex partners during their lifetime are 3.4 times more likely to have throat cancer

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hroat cancers that arise from Human Papilloma Virus (HPV) do not appear to raise the risk of the same cancer in partners, said Gypsyamber D’Souza, PhD, of the Johns Hopkins School of Public Health, at the American Society of Clinical Oncology annual meeting in Chicago, Illinois.

Dr D’Souza explained that in their pilot study, they found that the prevalence of HPV among partners/ spouses of an affected person was approximately 7 percent, no different from that of the general population.

It was found that the HPV 16 subtype was present in just 2% of female partners and 0% of male partners. HPV 16 is responsible for the majority of throat cancers. Of the partners/spouses who underwent a visual oral exam, none had cancer or

pre-cancer.

D’Souza said that the risk of developing head and neck cancers for people whose partners have HPV-related cancer is very low.

Oral sex with six or more partners raises risk of throat cancer, said a study published in New England Journal of Medicine. Dr Maura Gillison of Johns Hopkins Bloomberg School of Public Health, Maryland, US, and his team suggested that people who have oral sex with six or more partners have a significantly higher risk of developing throat cancer.

They found that people who had six or more oral-sex partners during their lifetime were 3.4 times more likely to have throat cancer.

Those with 26 or more vaginal-sex partners had a 3.1 times higher risk of developing throat cancer.

(By arrangement with Medical News Today)

SEXUAL HEALTH

Bedroom mood

enhancers There are certain things to be maintained in bedroom to make your sex maximum pleasurable.

A dull sex life is caused due to lack of attention on matters which you may think are unimportant Dirty talks

Talking dirty can spruce up sex life, but it all depends on the right moments. If the time, mood and ambience are right, then it is only better to talk naughty.

Confidence

Good sex and confidence go hand in hand and lack of confidence and a feeling of insecurity may kill mood in bedroom. So be energetic and enthusiastic while in bedroom, which can create security feeling.

A little alcohol

Being a little tipsy is good and it helps you loosen up. But, getting too drunk can be a mood killer. Too much of alcohol can adversely affect your sex drive.

Foreplay

It is a fact that for happy, healthy sex life, foreplay is very important and essential. While a quickie is fun once in a while, don’t miss out on foreplay when you have the time.

Personal hygiene

Seriously forget sex, nobody even wants to be around someone who smells bad or has unclean nails or ears. For some rocking sex, good hygiene is a must.

Don’t be shy

If you’re willing to have sex, you should act like a grownup and not like a shy schoolgirl.

What matters is how well you perform between the sheets.

Different positions

Using the same position over and over again can be plain boring and will kill your partner’s mood. Use your imagination and overcome the shyness to try different positions to spice up things.

Relax before the act

It is hard to feel sexy when your mind is on a million other things. Clear your head and learn to relax before going to bed.

March 2014 I FUTURE MEDICINE 37

Special story

The ‘lord’ of the

slum-dwellers ARMMAN is a non-profit organisation committed to improve the wellbeing of pregnant women, infants and children in the first five years of their life. Its vision is to design and implement sustainable programmes to reduce maternal, neonatal and child mortality and morbidity in the underprivileged urban and rural communities in India. By identifying and addressing systemic gaps in health services, delivery and community healthcare practices and by adopting a multi sect oral evidence-based ‘community needs assessment’ approach, the organisation improves healthcare service in the most neglected section of our urban society

By Sumithra Sathyan

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RMMAN’s core and mobile app; Arogya programmes make Sakhi, a home-based care innovative use project which trains village of technology to women to become health develop viable assistants to provide homeinterventions and maximise based antenatal, postnatal outreach. Its projects include and infancy care and mother mMitra, a free mobile voice and child healthcare tracking Dr Aparna Hegde system using antenatal, infancy call and animation film service providing timed and targeted preventive and childhood forms coded into mobile care information weekly/twice a week phones of the auxiliary nurse/midwives directly to pregnant women and women which enables early detection of high with children in the local dialect; HERO, risk factors in the mother and child and which provides real time information prompt referral. regarding the availability of ICU beds, Mumbai slums blood and also about blood banks in Armman’s major initiative directed the city 24 x 7 through a website, towards pregnant women and mothers phone number, SMS autoreply system with children in the slums of Mumbai 38 FUTURE MEDICINE I March 2014

is mMitra voice call service. mMitra will provide timed and targeted culturally appropriate comprehensive information on preventive care and simple interventions in case of emergencies directly to pregnant women and women with children under age one. The voice calls will be in the local dialect, specific to the woman’s gestational age or the age of the child and will be sent weekly/ twice a week free of cost directly to the beneficiaries. mMitra will use two key channels for enrolling women in the programme: through government municipal hospitals and approaching the community directly. In the first approach, health workers will be stationed in all antenatal clinics of all municipal hospitals and will enroll all the women attending the clinic.

In the community approach, Sakhis of the community partners working in the slums of Mumbai will enroll women directly from the slums.

“The voice calls can be accessed either through a mobile phone or a fixed land line. The women will be given a choice of one hour time slot every day when they can choose to receive the voice message. She will ensure that her phone or her husband’s phone is accessible during that time slot every day,” says Dr Aparna Hegde, founder, chairperson and managing trustee of ARMMAN.

A section of Mumbai slums Throughout pregnancy and the first three months of the child’s life, the service will attempt to reach the enrolled woman through a phone call for the first message of the week thrice daily in her chosen one-hour time slot from Monday to Wednesday.

If the woman misses the voice messages on all three days, she can give a missed call to the system until Wednesday evening and the service will call her back immediately with the voice message. Similarly, an attempt will be made to send the second voice message of the week in the same time slot on Thursday, Friday and Saturday with the

provision that if the woman misses the phone call again on all three days, then the enrolled woman can give a missed call to the system until Saturday evening and the service will call her back immediately.

“We are also setting up a call centre that will enable the enrolled woman to inform the service regarding a change in her phone number, change in the preferred time slot, when she has delivered or if she has had an abortion/ stillbirth,” says Dr Aparna.

Experiences in slums of Mumbai

Due to heavy rush of patients at the antenatal clinic, Dr Aparna has no time

mMitra was the winner of the people’s choice at the Saving Lives at Birth event in Washington DC in 2010.

Dr Aparna Hegde with the organisers of the event.

I can never forget this patient who visited a peripheral hospital in her third month but never came back and developed gestational diabetes in the fifth month that went undiagnosed. She only came back in labour.

The labour resulted in shoulder dystocia and she was transferred to Sion Hospital (an hour and half journey) with the baby’s head sticking out of her vulva. She had to be operated upon to remove the baby and it was difficult to take the baby out from the abdomen during the cesarean section as it was jammed.

We had to actually behead the baby on the operating table and because we could not give a beheaded baby to the relatives, we had to stitch the baby’s head to the body with a twine.

-Dr Aparna Hegde

Special story

The health problems of the urban poor are complex and inextricably linked to the unique socioeconomic conditions (poor sanitation, environmental pollution and overcrowding) prevalent in the underserved slums. Hence, provision of primary healthcare for the urban slum population cannot be compartmentalised and has to be improved as part of comprehensive urban slum development to counsel the patients regarding the need for the remaining antenatal visits, the danger signs and potential complications.

Often the patients don’t come back to access care during the antenatal period.

Many amongst them come to the hospital only during labour with some major high risk factor that had not been picked up due to lack of appropriate antenatal care.

“I can never forget this patient who visited a peripheral hospital in her third month but never came back and developed gestational diabetes in the fifth month that went undiagnosed. She only came back in labour. The labour resulted in shoulder dystocia and she was transferred to Sion Hospital (an hour and half journey) with the baby’s head sticking out of her vulva. She had to be operated upon to remove the baby and it was difficult to take the baby out from the abdomen during the cesarean section as it was jammed. We had to actually behead the baby on the operating table and because we could not give a beheaded dead baby to the relatives, we had to stitch the baby’s head to the body with a twine. The mother died three days later. This incident that occurred during my first post of residency 40 FUTURE MEDICINE I March 2014

will always stay with me,’’ says Dr Aparna.

“It is tragic because she had visited the antenatal clinic in the third month.

She had come to access care but because of lack of counseling and lack of access to information, she never came back for her remaining antenatal care. We can’t afford to lose such patients.

It is important to ensure they come back, that we counsel them, guide them gently through their pregnancy and infancy,’’ Dr Aparna adds.

Complex health issues among urban poor

There is growing recognition of the urban health conundrum on the part of policy makers and the government is evident in the expansion of the mandate of the national rural health mission to include the urban poor. The health problems of the urban poor are complex and inextricably linked to the unique socioeconomic conditions prevalent in the underserved slums. Hence, provision of primary healthcare for urban slum population cannot be compartmentalised and has to be improved as part of comprehensive urban slum development.There has always been an emphasis on curative services rather than preventive and promotive services .

Subhuman living conditions

Majority of India’s population is currently living in slums. Every year, thousands of men, women, and children die around the world and India alone is responsible for 25% of the deaths. By 1980, slum-dwellers constituted half of India’s entire population. Slum-dwellers constantly deal with issues such as lack of clean water, constant migration at slums, no sewage or waste disposal facilities, pollution, and unsanitary living conditions. High levels of pollution, lack of basic amenities and room-crowding are some of the basic characteristics of slum housing. The Government of India has not been able to solve the problems so far, that are strangling the entire population of Indian slums.

There are two kinds of slums: notified and non-notified.

Areas notified as slums by the respective municipalities, corporations, local bodies or development authorities are treated as notified slums. A slum where only about 20 households live is considered as a non-notified slum.

Of the 19,749 non-notified slums estimated to exist in urban India, Maharashtra accounted for about 29% (5,769), West Bengal about 14% (2,684) and Gujarat about 10% (2,058). Of an estimated 13,761 notified slums in urban India, Andhra Pradesh has about 23%, Maharashtra about 14% and Madhya Pradesh, West Bengal and Tamil Nadu about 9% each.

Wellness Ayurveda is a traditional medical practice which has been designed for the wellbeing of people through proper care and cure. This medical system emphasises prevention of diseases with healthy diet and lifestyle, ensuring an active, long life for everyone

Wellness Ayurveda

OBESITY CONTROL There are many effective medications and therapies in Ayurveda to control obesity, which is considered a widely affected lifestyle disease across the world

By Dr Vasudevan Namboothiri

42 FUTURE MEDICINE I March 2014

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besity is a common health problem. Though it is more common among the rich, its reach is now beyond the developed countries and people from developing nations are equally affected, thanks to globalisation.

Development has been equated with growth of technology and to a certain extent, mechanisation has replaced the human element in most of the occupations. This has led to a decline in the energy expenditure of humans. As the balance between nourishment and energy expenditure gets tilted, obesity and related health issues are the resultants.

Lack of physical exercise and diet regulation are major factors identified for causing obesity. These factors have a cumulative effect on the fat tissue in the human

body and in due course obesity is compounded with other chronic illnesses also.

Need for physical exercise

“Aayaama of different anga of the human body is termed as Vyaayama in Ayurveda.�

That means, all activities combining different movements of the body parts is considered as Vyaayama. Irrespective of a person indulging in diet regulations or treatment for obesity, Vyaayama has to be practised on a daily basis.

Yogaabhyaasa, gymnastics, kalari, other martial arts and simple act of walking, all are different forms of Vyaayama. Walking is a natural act, devoid of any ill effects and is an ideal one for all ages and conditions. Mahatma Gandhi, was a famous exponent of this exercise.

Diet regulation

Regulations have to be implied not

only over the quantity of food one chooses, but also over the quality and the frequency of the intake.

Effort has to be taken on developing a daily regimen which comprises timely consumption of restricted quantity of low fat food twice or thrice a day. Care should be taken to avoid food that is difficult to digest (eg: curd, maida), cold items, frozen and re-heated food.

Also avoid food before digestion of previous meal and don’t sleep immediately after food intake.

Treatment of obesity

Treatment of diseases in Ayurveda is two-fold based on the etiological factors, viz., santarpana (nourishing therapy) and apatarpana (emaciating therapy). Apatarpana is again sub-classified into sodhana (bio-purification) and samana (pacification).

Sodhana-chikitsa

Bio-purification of fat accumlated body tissues is the focus of this therapy. Vamana (Emesis), virechana (purgation), vasti (enema), nasya (errhine) and raktamoksha (blood-letting) are the five-fold measures (Panchakarma) of trans-membraneous biopurification. Vasti-chikitsa (administration of medicated enema having scrapping effect over adipose tissue) has an important role in sodhana. Abhyanga and udvartana are two therapies which transdermally purify the body to some extent and provide stability to

Obesity, when associated with diabetes is managed with a gruel prepared with laaja (popped rice) and mudga (green gram) cooked along with asana (Pterocarpus marsupium) Daily consumption of plain gingely oil is also found beneficial for obesity tissues.

Samana-chikitsa

Long term internal medications and adoption of regimen aimed at pacification of disease is termed as samana-chikitsa. Reducing intake of rice and replacing it with chaama (Panicum sumatrense – little millet) and yava (Hordeum vulgare – barley), intake of warm rice gruel and honey diluted with water (in empty stomach) are recommendable.

Vyoshaadi gulika, a combination of herbs and minerals has been reported with good results in obesity. Myrobalans (Triphala) along with khadira (Acacia catechu) and asana (Pterocarpus marsupium) has also found effective.

A paste made of naalpaamara (Ficus racemosa, Ficus microcarpa,

Ficus relegiosa and Ficus benghalensis), elaadi gana (a herbal formulation) and haridra (Curcuma longa – turmeric) grounded in milk and mixed with gingely oil applied over the body mobilises fat deposits. Sireesha (Albizzia lebbeck), lodhra (Sympiocos racemosa), usheera (Vetiveria Zizanioidis) and nagakesara (Mesua ferrea) powdered and applied over body reduces bad odour. Kulatha (horse gram) powdered and applied over the body cleanses the blood and is more recommended in cold season.

Kulatha (horse gram), chaama (Panicum sumatrense – little millet), yava ((Hordeum vulgare – barley), mudga (Green gram), whey water (of curd) and butter milk all are advisable in diet.

Many such highly effective medications and therapies are practised by highly expertised Ayurveda physicians and these remedies are to be adopted and applied by any one only on their advise. An old Ayurveda text says and underlines the role of Vyaayama, “Lightness of body, endurance & stamina, improved digestive fire, reduction of fat, and well built and strong physique are virtues of proper Vyaayama”.

(The author is an Ashtavaidyan and Factory-in-charge, Ashtavaidya Vaidyamadham, Mezhathur)

WELLNESS Yoga

Prevent

Obesity

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to many health problems such as cardiovascular disease, diabetes,sleep apnea, certain types of cancer and osteoarthritis. Obesity and overweight now considered as a “killer lifestyle� disease, becomes the fifth leading cause of preventable death worldwide

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besity has increased globally, more than double since 1980. According to the World Health Organization (WHO), 1.2 billion people worldwide are officially classified as overweight and probably the most sedentary generation of people in the history of the world.

People are considered obese when their body mass index (BMI) goes above the normal BMI which is an estimate of the amount of body fat a person has based on his or her height and weight.

Obesity is due to intake of excessive food energy and lack of physical activity.

It can also be hereditary.

44 FUTURE MEDICINE I March February 2014 2014

However, in some cases it is caused by genes, endocrine disorders, some medication or psychiatric illness. The main treatments for obesity are dieting and physical activity. One has to avoid energy dense food intake such as fat and direct sugar.

One can use more dietary fibre which inhibits the absorption of sugar. Antiobesity drugs may be taken to reduce appetite or inhibit fat absorption together with a suitable diet.

Recent medical findings on overweight indicate that the accumulation of body fat is a symptom rather than a disease. In majority of cases, obesity is due to psychological rather than physical causes. However, in a small group of people,

through

a g Yo

By Vedamurthachar A

obesity may result from faulty or subnormal functioning of the endocrine glands. But, the main cause for obese is over nutrition or under oxidation of the food consumed, or a combination of both. Unused ingested food are deposited in the body tissues as fat, and accumulate in those parts of the body which are least affected by muscular action.

Fatty deposits in the area of the hips and abdomen are both unsightly and difficult to remove by western exercises.

One of the basic objectives of the yogasanas is to exercise the trunk and mid-trunk to reduce excessive fat. It is also found that constipation is one major reason for obesity. The postures such as Hastapadangustasana, Hastapadasana, Thrikonasana, Ardha mathsendrasana and its movements usually enhance tonicity of internal muscles and massages walls of the abdomen, which found to be successful treatment for functional and chronic constipation.

Yoga indicatemainly lifestyle. Yogic lifestyle includes physical, mental and emotional health. Ashtanga yoga can play an important role in treating Obesity.

Asanas, pranayamas and right diet can affect the body-mind complex which in turn affects the internal organs, endocrine glands, brain and mind.

You can effectively practise various yoga techniques to reduce weight and achieve normal health. Asanas such as forward bending, twisting and backward bending help to reduce the fats near abdomen, hips and other areas. One can practise various postures in different positions (standing, seated, reclining, prone and inverted) to reduce

weight. Few Yogasanas such as Paschimottanasana, Bhujangasana, Sarvangasana, Halasana, Dhanurasana, Veerasana, Trikonasana and Ardha Matsyendrasana are very effective. Before asanas one should start with sun salutations which mainly addresses the abdominal region Kapalbhati, Bhastrika, fast breathing and sudarshana kriya can be practised by people suffering from obesity.

Regular practice of these Pranayamas help burn fat.

Cleansing kriyas such as Shanka Prakshalana and Agnisar kriyas are specially intended to rid the body of excess toxins and fat.

However, these kriyas should be practised under guidance.

Rapid movement of abdominal muscles in and out during kriyas is very good exercise to get rid of the accumulated fats around the abdominal region and also it helps in streamlining digestive system.

Food plays major role in reducing obesity. Yoga recommends satvik diet regularly. The ideal yoga diet is a vegetarian one, composed of pure, simple, natural and easily digestible foods that promote health and overall well-being. Raw vegetable, fruits and sprouts should be main meals.

Reducing/avoiding refined and processed food, fast food and non-vegetarian diet helps in weight control. Have a low fat meal, with fiber rich vegetables and fruits. Fasting is also a very important component of yoga since it purifies and eliminates excessive fat from the body.

A special fasting programe once in 15 days has proven exceedingly helpful and rewarding.

The author is the Director, Living Well Programs, Art of Living International Campus, Bengaluru.

Paschimottanasana

Bhujangasana

Dhanurasana

Sarvangasana

WELLNESS Healthy Food

By FM Bureau

Blueberry jam

Ingredients: 300 gm frozen or fresh blueberries, 1 tablespoon honey or a little stevia to sweeten juice from ½ lemon, 1 teaspoon vanilla extract or paste, 1 ½ tablespoons ground or whole chia seed Preparation: Combine blueberries, honey, lemon juice and vanilla. Simmer over a low heat for five minutes until the mixture looks syrupy.

Add the chia seeds and mix through. Remove from the heat and allow it to sit for five minutes before placing into the fridge. Keep it for an hour until the jam forms a lovely jelly-like consistency.

Protein: 0.4 gm, fat: 0.4 gm, carbohydrates: 4.7gm, calories: 25, kilojoules: 104, fiber: 0.9 gm

Mixed fruit jam

Strawberry jam

Ingredients: 6 cups fresh strawberries, 1 cup granulated sugar, juice of 1/2 lemon, 2 teaspoons fresh thyme leaves Preparation: Combine ingredients in a nonreactive pot and toss well. Bring to a boil over medium heat, reduce to a simmer and cook until thickened (about 30 minutes). Cool to room temperature. Transfer to re-sealable containers and store in the refrigerator for up to three weeks.

Calories: 35, fat: 0 gm, saturated fat: 0 gm, carbohydrates: 9 gm, protein: 0gm, sodium: 0mg, cholesterol: 0mg, fiber: 0.5gm 46 FUTURE MEDICINE I March 2014

Ingredients: 12 cups fresh fruit, 1-2 cups granulated sugar or brown sugar, 1/2 cup water, 1 1.75-ounce packet “no sugar needed” pectin Preparation: Combine fruit, sugar to taste and water in a Dutch oven.

Bring to a vigorous boil and crush fruit with a potato masher until desired consistency. Add pectin in a steady stream, stirring constantly. Stir until the pectin is dissolved. Bring to a full rolling boil (a boil that cannot be stirred down), stirring constantly. Boil, stirring, for 1 minute. Remove from the heat.

If freezing or refrigerating, ladle the jam into clean canning jars to within 1/2 inch of the rim. Wipe rims clean.

Cover with lids. Let the jars stand at room temperature for about 24 hours, before refrigerating or freezing. Or process in a water bath to store at room temperature.

Calories: 12, fat: 0gm, cholesterol: 0mg, carbohydrates: 3gm, protein: 0gm, fiber: 0gm, sodium: 1mg, potassium: 32mg

Peach freezer jam

Ingredients: 2 pounds ripe peaches, pitted and quartered (5-6 peaches), 1 3/4 cups unsweetened white grape or apple juice, 1/2 teaspoon freshly grated lemon zest, 1 tablespoon lemon juice, 1 1.75-ounce package “no sugar needed� fruit pectin, 1-3 cups sugar Preparation: Coarsely chop peaches in a food processor. Measure out 3 cups. (reserve the rest for another use such as a smoothie). Place white grape (or apple) juice, lemon zest and juice in a large saucepan. Gradually stir in pectin; continue stirring until completely dissolved. Place over medium-high heat and bring to a full rolling boil, stirring frequently. Boil hard for 1 minute. Remove from the heat. Divide the jam among six 8-ounce canning jars, leaving at least 1/2 inch of space between the top of the jam and the top of the jar (this space allows the jam to expand as it freezes).

Cover with lids and let the jam stand at room temperature until set, about 24 hours. Store it in refrigerator or freezer until ready to use.

Calories: 13, fat: 0 gm, cholesterol: 0 mg, carbohydrates: 3gm, protein: 0gm, fiber: 0gm, sodium: 1mg, potassium: 20 mg

Spicey onion jam

Ingredients: 2-4 dried ancho chilies, stemmed, seeded and broken into pieces, 1 cup pomegranate juice, 2 tablespoons extra-virgin olive oil, 2 pounds onions, thinly sliced, 1 tablespoon brown sugar, 1 tablespoon distilled white vinegar, 1/2 teaspoon salt Preparation: Place chilies in a small dry saucepan over medium heat. Cook, stirring occasionally, until fragrant, about two minutes.

Add pomegranate juice and bring to a boil; cover and remove from the heat. Let stand for 20 minutes. Transfer to a food processor or blender and puree until smooth. Heat oil in a large skillet over medium-high. Reduce heat to medium-low, add onions and cook until very soft and lightly browned, about 30 minutes. Add sugar and vinegar and cook until the sugar dissolves, about 1 minute. Increase heat to medium; add the chilie puree and cook, stirring occasionally, until thickened, about 4 minutes. Stir in salt.

Calories: 20 (per tablespoon), fat 1gm, cholesterol: 0mg, carbohydrates: 3gm, protein: 0gm, fiber: 0gm, sodium: 38mg, potassium: 40mg

Beauty Care Hair loss Hair loss is a common problem and it occurs due to stress, pollution, unhealthy diet and inadequate sleep. In modern medicine, there are effective preventive measures and cures for hair loss, which are less expensive and easy to practise

Hair BEAUTY CARE

Stop

hair loss Hair loss affects millions around the world. According to beauty experts, it is normal to lose about 100 strands of hair a day. Beyond this may be considered as severe hair fall

By FM Bureau Lack of essential nutrients in the body, excessive use of chemicals through hair colouring and hair styling treatments, improper and unhealthy dietary habits, hormonal imbalance, certain medications, dandruff, alopecia and other scalp disorders are the main causes of hair fall.

Even stress, tension and also thyroid are some of the common problems causing rapid hair fall.

How to reduce hair fall • • • • •

• • • •

A wide-toothed comb should ideally be used for the hair.

It is best not to comb the hair while it is wet.

Let it be dry or semi-dry before combing.

Do not rub your hair vigorously with your towel.

Clean your combs every week. This is a necessary precaution to take for hair fall control.

Hot oil treatments: Natural oils such as coconut, olive, canola, jojoba, sesame etc. can be used to massage the scalp. Warm the oil by heating it; ensure that it’s not too hot but bearable, gently massage the scalp.

Try to switch to shampoos that are sulfate, silicone and paraben-free to avoid loading the scalp and hair with harsh chemicals.

Wash your hair at least every three days with a gentle hair cleanser or shampoo to remove all accumulated dust, dirt and oil.

Do not subject your hair to frequent chemical treatments, excessive blow drying, ironing and colouring.

Avoid hair styles such as wearing tight ponytails, pigtails or braids on a daily basis, using elastics and rubber bands to pull back hair tightly.

March 2014 I FUTURE MEDICINE 49

BEAUTY CARE Food

Lustrous tresses Stronger, lustrous hair locks enhance your beauty and confidence, and you will be noticed even in a crowd. So keep your hair clean and healthy by taking nutrient rich foods Salmon

Besides being rich in protein and vitamin D, the omega-3 fatty acids found in this tasty cold-water fish is the best for falling hair.

Other options: fish like herring, sardines, trout, and mackerel, as well as avocado, pumpkin seeds, and walnuts

Walnuts

This is the only type of nut that has a significant amount of omega-3 fatty acids. It is also rich in biotin and vitamin E which helps protect your cells from DNA damage. Walnut has copper, a mineral that helps keep your hair colour rich and lustrous.

Oysters

Oysters are rich in zinc, a lack

50 FUTURE MEDICINE I March 2014

Hair loss at a glance •

Hair loss is a very common condition that affects most people at some points in their lives.

•

Androgenetic hair loss is seen in both men and women but it is worse in men.

•

Health issues like thyroid disease, anemia and low vitamin levels may cause hair loss.

•

Alopecia areata is a very common, coin-shaped temporary hair loss patch that usually resolves on its own.

•

Medications for hair re-growth include minoxidil (rogaine), finasteride(propecia), and dutasteride(avodart).

•

Prevention includes good hair hygiene, regular shampooing and good nutrition.

•

Medical health screening for hair loss may include tests like complete blood count (CBC), iron level, vitamin B, and thyroid function tests (TFT).

of which can lead to hair loss (even in your eyelashes), as well as a dry, flaky scalp.

Other options: leafy vegetables such as broccoli, kale and Swiss chard

Sweet potatoes

Lentils

Sweet potatoes are a great source of the antioxidant beta carotene which is essential for hair growth.

Other options: Carrots, cantaloupe, mangoes, pumpkin and apricots are all good sources of beta carotene.

Eggs

A great source of protein, eggs are loaded with four key minerals: zinc, selenium, sulphur, and iron. Iron is especially important because it helps cells carry oxygen to the hair follicles, and too little iron (anemia) is a major cause of hair loss.

Other options: animal sources, including chicken, fish, pork, and beef

Spinach

Iron, beta carotene, folate, and vitamin C in spinach help keep hair follicles healthy.

Tiny but mighty, these legumes are teeming with protein, iron, zinc, and biotin.

Greek yoghurt

Cruise the dairy aisle for low-fat options such as Greek yoghurt which is high in hair-friendly protein, vitamin B5 (pantothenic acid) and vitamin D. Other options: cottage cheese, low-fat cheese and skim milk also fit the bill.

Vitamins prevent hair loss

Adding vitamins to the diet helps hair grow by improving circulation, reducing stress and adjusting hormones.

Vitamin A

Vitamin A is involved in the growth and maintenance of hair, as well as the skin.

Vitamin A regulates the synthesis of retinoic acid in

the hair follicle.

B vitamins

B vitamins help hair grow by aiding the body to handle stress which is also a cause of hair loss.

Vitamin C

Vitamin C also helps the body absorb iron which is needed for hair growth.

The human body does not make its own vitamin C, so food or supplement sources are required, such as fruits and vegetables.

The recommended dose of vitamin C is 1000 to 2000 mg a day.

Vitamin D

Vitamin D can stop hair loss.

Vitamin E

Vitamin E builds capillaries in the body and improved blood flow on the scalp encourages hair growth. Adding 400 IU a day of vitamin E to the diet stimulates the hair follicles that grow hair.

Health Insurance

Why Health Insurance important One day you are all fine, working hard, raring to go and having huge future plans for your children and family. A small symptom, regular visits to the family doctor and a few medical tests can completely turn your life and your family upside down. Health Insurance provides you with an affordable way to get medical care when you need it. It also protects you and your family from the high cost of healthcare

W

By M Mohan

ith an unhealthy lifestyle, the younger generation is at an alarming risk of a critical chronic ailment before reaching the age of 50.

At the same time, with the way medical science and emergency care have advanced, the chances of surviving a critical illness are reasonably high.

However, the costs of survival and maintenance could be unaffordable and daunting.

These things may sound scary, but the good news is that with the right plan, you can protect yourself from the burden of any types of medical expenses. But the fact is that many people don’t get/ seek the medical care they need because they are worried about the cost. One of the key benefits of Health Insurance is access to a large network of doctors and hospitals. Other benefits of health insurance include: (a) Being able to quickly and easily find the help you need (b) Peace of mind and less stress during tough time because you know you’re covered (c) Access to affordable care and health information that keep you happy and healthy.

Is an accident / a critical illness riskier than death?

Yes! Surviving a critical illness can have a larger impact in the long term on the financial aspects of the entire family, sometimes even more than the death.

52 FUTURE MEDICINE I March 2014

A member of the ailing family may have to withdraw from a highpaying challenging role (say a stressful leadership role), and take up a more relaxed job which would result in reduced income. Family members need to spend more time attending to the patient. An earning member has to curtail work hours and hence reduced income.

In certain cases, modifications may be required in the house. For instance, if the patient is bed-ridden, there would be a need to make the house wheel-chair friendly.

So, an accident or a critical illness can turn out to be a huge financial risk for the entire family. It is therefore extremely important that you consider protecting your family against this financial risk.

How to protect your family against the risk of serious illness?

Apart from maintaining a healthy lifestyle, family members need to take some measures to ensure that they are all physically and mentally fit to carry out their duties.

Get preventive medical tests every year after you have crossed the age of 30, don’t ignore small sustained signals your body gives you (aches and sensations), take second opinion always in case of serious health issues, be adequately covered for the long term under a Health Insurance policy and protect your family with a Critical Illness Insurance Policy which is a must to avoid a medical emergency in any family.

What does it cover?

Health Insurance is a contract between you and your insurance company. You buy a plan and the company agrees to pay part of your medical costs when you get sick or hurt.

• In-patient treatments • Pre-hospitalisation • Post-hospitalisation • Day care procedures The medical expenses are paid by the insurance company irrespective of what costs you have actually incurred.

(Benefits differ from company to company) (The author is a Health Insurance expert)

Pet Care Dog

The foods dogs should not eat If you’re the owner of a dog, you should know about the foods that turn fatal to the pet.

Some foods which are not harmful to humans make dogs ill overnight

By FM Bureau Avocado

No matter how good the guacamole is, you shouldn’t give it to your dog. Avocados contain a substance called persin that is harmless for people who aren’t allergic but it may be toxic to dogs.

include restlessness, rapid breathing, heart palpitations, muscle tremors, fits and bleeding. In addition to tea and coffee, including beans and grounds, caffeine can be found in cocoa, chocolate, colas, and stimulant drinks such as Red Bull.

Alcohol

Grapes and raisins

Beer, liquor, wine and foods containing alcohol- none of them are good for dogs.

Alcohol has the same effect on a dog’s liver and brain as it has on humans. But it takes far less to do its damage. Just a little can cause vomiting, diarrhea, central nervous system depression, problems with coordination, difficulty breathing, coma and even death. The smaller dogs have greater effects.

Onions and garlic

Powdered, raw, cooked, or dehydrated onions and garlic can destroy a dog’s red blood cells, leading to anemia. It can happen even with the onion powder found in some baby food. An occasional small dose is probably okay. But just eating a large quantity once or eating smaller amounts regularly can cause poisoning. Symptoms of anemia include weakness, vomiting, little interest in food, dullness and breathlessness.

Coffee, tea and other caffeine

Caffeine in large quantities can be fatal for dogs. Symptoms of caffeine poisoning

52 FUTURE MEDICINE I February 2014

Grapes and raisins have often been used as treats for dogs. But it’s not a good idea.

Just a small amount can make a dog ill. It isn’t clear how grapes and raisins can cause kidney failure in dogs. Repeated vomiting is an early sign. Within a day, the dog will become lethargic and depressed.

Milk and other dairy products

On a hot day, it may be tempting to share your ice cream cone with your dog.

But it would thank you for not doing so.

Milk and milk-based products can cause diarrhea, other digestive problems and food allergies.

Macadamia nuts

Dogs should not eat macadamia nuts or foods containing macadamia nuts because they can be fatal. As few as six raw or roasted macadamia nuts can make a dog ill. Symptoms of poisoning include muscle tremors, weakness, paralysis, vomiting, elevated body temperature and rapid heart rate.

Needed, best food for dogs High quality food can make your dog more healthy and active. But what constitutes high quality dog food and how can you ensure that your dog receives high nutritious food .There are six nutrient groups that are important for all dogs: proteins, carbohydrates, fats, vitamins, minerals and water Proteins

It performs many functions and is important for growth, maintenance, reproduction and repair of damaged tissues. Amino acids are the building blocks on which proteins are formed.

Essential amino acids are required in the diet.

Fats

Dogs require adequate levels of nutrients in their diet to maintain health. If the nutrient balance is not correct, dogs may become ill.Nutrients are supplied by the ingredients that make up the diet. One specific ingredient cannot provide a complete and balanced nutrition.

Fats are an important energy source and are required for various body functions. Fatty acids, a specific type of fat, play an important role in regulating the body’s inflammatory response.

amounts as catalysts for necessary chemical reactions that occur within dog’s body tissues and cells.

Minerals

Minerals are inorganic compounds that are important as components of bones and teeth as well as many other metabolic functions.

Water

Many diets provide some water content for dog, but access to a clean, fresh water supply is important.

Water should not be overlooked as an important nutrient.

Carbohydrates

Carbohydrates are another important source of energy for your dog. Carbohydrates include simple sugars such as glucose and more complex sugars such as fiber which helps keep the intestinal tract healthy.

Carbohydrates present in food can provide a valuable source of fiber and energy.

Vitamins

Vitamins are necessary in small January March 2014 2014I IFUTURE FUTUREMEDICINE MEDICINE55 53

FOCUS Hinduja Medical Research Centre

s of 63 year , y b d e k Bac xpertise e d n a nce & experie duja Hospital in ntre PD H arch Ce n e s e R l oder Medica ultra-m iary n a is tert today pecialty itted s ilt u m omm spital c are for o h e r a c lthc lity Hea s a u Q “ o t pleted it m o c g , vin All”. Ha ubilee in 2011 J d e no ston Diamon s e v a up pital le eeping the hos k in d e gy unturn technolo l t s e t la a with the niques, clinic h c s e t and d variou n a e c n tion excelle al opera e it p s o h of to th aspects ervices s s it e mall nc to enha ough it had a s ic n Th OPD cli n people. a s a g nd beginnin trong vision a s s e of , it in 1951 tion make it on ia d ina als in In determ it p s o h t the bes

By S. Sathyan

56 FUTURE MEDICINE I March 2014

T

he PD Hinduja Hospital & Medical Research Centre in Mumbai had a small beginning as an OPD clinic on December 10, 1951. It added in-patient facilities and more services later and became a 402-bed, ultra-modern tertiary care hospital in a short span of time. With the help of a strategic advisory contribution by Massachusetts General Hospital (MGM), Boston, a world class infrastructure was created at the hospital

to provide the highest quality of care to the patients.

Appalled by the poor health facilities existed in India in the early years of Independence, PD Hinduja, industrialist and a philanthropist, founded the hospital with a noble vision to provide “Quality Healthcare for All”.He believed that healthcare is the birthright of every citizen and no Indian would suffer because of lack of adequate medical facilities.

It was a time when people sought better treatment abroad.

Reforming tertiary care in India Nursing College that offers BSc, MSc and PhD programmes.

Achievements

Dr Sanjay Agarwala (Director Professional

Pramod Lele

Services)

(CEO)

Ever since, the hospital has pursued quality through people, processes and technology. The hospital has now more than 100 full time consultants and many of them are renowned and respected across the globe for their medical care and research.

Academics, Research and Clinical Work Right from the beginning, the institution recognised the need to develop the three pillars

Joy Chakraborty (COO)

It became the first hospital in 2006 to have a College of American Pathologist (CAP) accredited laboratory (the first lab in South Asia to be CAP accredited), in 2009 it became the first hospital to win IMC Ramakrishna Bajaj Award for Quality; the same year it became the second hospital to have NABH accreditation in Mumbai; in 2010 and 2013 it got the Best Prax recognition in the strategic planning category and in 2011, was awarded the ISO 27001 Certification for Information Security Management Systems.

It has HACCP accreditation by DNV Netherlands, which is the apex certification for food and the NABL accreditation for its

lab. The lab also is the Centre of Excellence (COE) for Clinical Flow Cytometry. The recent feather that the hospital has added to its research cap is ‘TB Champions’ by Global Health Strategies for the significant contribution in the field of tuberculosis.

The hospital has been in the forefront of adopting new technologies. It was the first hospital in India to acquire Gamma Knife and Twin Speed MRI. Similarly, it is one of the few institutions to have a PET CT, Linear Accelerator with Multileaf Collimeter (MLC) and Micro MLC. The Radial Lounge, the first of its kind in India, is to carry out Coronary Angiography from hand in a sitting position. NAT Blood Testing, the state-of-the-art Guided Air Flow OTs and many more are thereby pioneering the new look of healthcare itself, in India.

of healthcare: Academics, Research and Clinical Work. The result of which is evident as some of the renowned doctors working at the hospital today, have emerged from the academics herein. Also displaying the research ability through the in-house research studies which have earned credibility worldwide, the hospital runs DNB courses in 23 specialties; MSc and PhD programmes in research; Lalita Girdhar Hinduja with former Prime Minister Rajiv Gandhi. Lalitha Girdhar who believed in providing world class healthcare to all, established the School of technical courses for Nursing at PD Hinduja Hospital and Medical Research Centre in Mumbai. technicians and a March 2014 I FUTURE MEDICINE 57

FOCUS

The Winner’s Trophy -International Diamond Prize for Customer Satisfaction in Italy

Hinduja Hospital in 1956 “Quality of Care” rather than ROI has always guided the hospital. The returns have followed both tangibly and nationally through recognition. To integrate care it is developing its own Hospital Information Systems (HIS) and recently implemented the PACS system for radiology. The MRI Suites at the Radiology department are the most unique and the only facility of its kind in western India, that provides diagnostic and treatment opportunities for various conditions with options to choose ambience that suits the patient’s mood.

The hospital recently opened up a world class and most advanced Bone Marrow Transplant Unit.

Medical specialties

the patients. Recently, the team of doctors, nurses and other specialties who were sent to the US for advanced training in transplant, created a history by successfully doing a lung transplant on a lady. Another landmark effort, being made by the hospital is in the area of Emergency Services and medical assistance at the consumer’s doorstep through “Care @ Home” and “Poison Centre” (Tele Assistance) services.

“Short Stay Services”: a unique concept service provided by the centre can be defined as a dedicated hospital within a hospital with an exclusive service experience and quick turnaround for people with less serious surgery needs and requiring a short stay at the hospital. The hospital offers almost 122 surgeries under this system and has been overwhelmed with the response.

ICUs form the core of tertiary care multi-specialty healthcare hospital.

PD Hinduja Hospital & Medical Research Centre has developed a reputed ICU team, trained in quick response and advanced equipment for better patient care.

The ICUs and OTs are monitored by a cross functional team consisting of ICU, Engineering and Infection Control Group for minimising instances of hospital acquired infections. The hospital has over 45 medical specialties with the exception of Obstetrics.

The doctors serving the institution have earned respect not only in their field of specialisation but also across healthcare nationally and internationally. The hospital takes extra efforts in sending its cross departmental teams to the The Dalai Lama lighting a lamp at the inaugural West for advanced training in function of Hinduja Hospital in Mumbai. Lt. Gen. their category and the outcome H.S. Banga, A.P. Hinduja and Usha. S. Raheja has always been in favour of were present 58 FUTURE MEDICINE I March 2014

Awards & recognitions In 2013, the hospital was given Special Jury Recognition Award for Operational Excellence at the 2013 FICCI HEAL Awards. This award was given for hospitals’ innovative services, Short Stay Services & Care @ Home. The hospital has been conferred with “Excellence in Hospital” at MedscapeIndia, 2013.The hospital has received “International Diamond Prize for Customer Satisfaction” by the European Society of Quality Research and “Excellence Award” for CSR project at the Asia Healthcare Management Awards, 2012. In 2011 & 2013, the hospital was adjudged the ‘Best Multi Specialty Hospital’ at the ICICI Lombard & CNBC-TV18 Healthcare Awards.

Vijaya Institute of Medical Sciences FOCUS

The best choice ever Vijaya Institute of Medical Sciences’ success journey continues in the area of infertility treatment helping several childless families to have healthy children

T

By Shalet James

Dr N P Vijayalakshmy, MD, DGO, FASRM, is the chief ART specialist at Vijaya Institute of Medical Sciences, Kochi. She pioneered the IVF treatment in Kerala by starting the first IVF centre- The Vijaya Fertility IVF and Endoscopy Centre.

Dr Vijayalakshmy started her career as a lecturer in 1975.

he sedentary lifestyle and eating-out culture have made people prone to many lifestyle diseases. When we look at the health issues that people face today, infertility seems to be the major problem, creating apprehension in society. Bringing hopes to several childless families, Vijaya Institute of Medical Sciences in Kochi continues to serve childless couples through its fertility treatments.

Founded by Dr NP Vijayalakshmy in 1996 and based in Kadavanthra, Kochi, Vijaya Institute of Medical Sciences has the distinction of achieving the first Test tube baby in Kerala. It was in 1997 that triplet Test tube babies

were born through Assisted Reproductive Technology (ART) at the centre.

The chief ART specialist of the centre, Dr Vijayalakshmy started this hospital in a small way and later expanded the facility to offer world class service to infertile couples.

“I have worked in different medical colleges in Kerala and met many couples who had infertility problems. In the 1980s, childless couples were seeking treatments for infertility in other states as fertility hospitals were very few in Kerala.

Then I decided to start a fertility centre somewhere in the state and provide the best available treatment to the patients,” says Dr NP Vijayalakshmy, Managing Director, Founder, March 2014 I FUTURE MEDICINE 59

FOCUS Vijaya Institute of Medical Sciences Vijaya Institute of Medical Sciences, adding that “the triplets who were born in 1997 have grown up and have celebrated their 16th birthday. I am extremely happy on seeing them”.

Vijaya Institute is the first fertility centre in the state to successfully conduct IVF (test tube baby) and other ARTs that include IVF, ICSI, PESA and TESA/ICSI/ET. With thousands of babies born in this centre through infertility treatments, Vijaya is among the first few centres in India to successfully achieve pregnancies using the ICSI technique. With a success rate of 45%, this centre has carried out thousands of treatment cycles of IVF and ICSI. More than 20,000 intrauterine insemination cycles have been carried out with a success rate of 22 to 25%. It has also carried out thousands of laparoscopies for severe endometriosis, PCOD, myomas and hysteroscopy for uterine septolysis, sub mucus myomas removal, intrauterine adhesion, adhesolyis, polypectomy etc.

“We conduct orientation programmes here. The couples are educated on the ovulation and also on the whole process. With this,

Dr N P Vijayalakshmy at the hospital 60 FUTURE MEDICINE I March 2014

they get a clear idea and then in the counselling section, we come to understand their problems, and treatments are suggested accordingly.

Only after complete evaluation and counselling, a procedure suitable for the couple is decided. ART is the last line of treatment. We make couples understand how the cost of treatment is calculated. We always encourage outpatient procedure and if it is absolutely necessary, they are made to stay in the hospital,” says Dr Vijayalakshmy.

The centre also has a relaxation programme headed by psychologist Dr Sindu. The programme gives couples an opportunity to speak to the doctor about their problems.

Couples who cannot conceive naturally or can’t have a baby with all available fertility treatments can opt for surrogacy programme. “Erectile and ejaculatory dysfunctions are seen in men because of stress. Today, women are also boozing and smoking.

It can create lots of problems” adds Dr Vijayalakshmy. Plans are there to start research and establish the centre as a full-fledged unit for infertility treatments with a promise to deliver healthy babies to numerous childless couples.

Only after complete evaluation and counselling, a procedure suitable for the couple is decided. ART is the last line of treatment. We make couples understand how the cost of treatment is calculated Infertility treatment options • • • • •

Male evaluation Female evaluation Ovulation induction Artificial insemination Intrauterine insemination

Assisted Reproductive Technology •

IVF, ICSI, PESA and TESA

Donor programme • • •

Egg donation Sperm donation Embryo donation

Emergency Medicine

First aid after snakebite If the snake is venomous, the person who was bitten by a snake should be given first aid. If the snake is not venomous, treat it as a puncture wound

By FM Bureau

Immediate steps • • • • •

Move the person beyond the striking distance of the snake Have the person lie down with the wound below the heart Keep the person still to prevent venom from spreading Cover the wound with loose, sterile bandage Note the snake’s nature and describe it to the emergency staff

Don’t do • • • •

Cut a bite wound Attempt to suck out venom Apply tourniquet, ice or water Give the person alcohol or caffeinated drinks

Follow-up in case you treat the bite at home • • •

Contact a healthcare expert The person may need a tetanus shot Tetanus boosters should be given every 10 years

March 2014 I FUTURE MEDICINE 61

Palliative Care

Dr M.R.Rajagopal MD Chairman, Pallium India

What exactly is

palliative care?

The World Health Organization has defined palliative care as: “An approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through prevention and relief of suffering by means of early identification, impeccable assessment, treatment of pain and other problems, physical, psychosocial and spiritual.”

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Imagine yourself waking up one morning with a really bad cold.

Your body is aching, you are sneezing away, your nose is blocked, throat is sore and you are feeling miserable. It is audit day at the office; you cannot possibly take rest. You also fear that it may be one of the nasty new kinds of fevers. Could this be dengue?

You get to the doctor on the phone. He seems to take it very lightly. “Take a Paracetamol and get some rest” is what he says.

Before you proceed, he has hung up.

The difference in

perspective between you and the doctor is striking.

To you, the problem is your cold, your pain, the interference with the routine work and your fear all put together. To the doctor, it is just a common cold. Amartya Sen calls it the difference between the internal view (the patient’s view, focussed on the suffering) and the external view (the doctor’s perception focussed on the disease).

If the distinction is so striking even in the matter of a common cold, how dreadful it can be when it is something really serious, like a heart

attack, a stroke or cancer?

The doctor takes refuge in Latin words signifying the names of diseases and often does not seem to understand the suffering that is induced in the patient by the medical problem.

In the second half of the last century, came the technology revolution.

New imaging techniques enabled the medical professional to precisely diagnose and localise disease processes. Rather imperceptibly, healthcare service got converted to healthcare industry.

In this whole process, the medical professional

became more of a technologist, concentrating on diseases more than ever and often ignoring the suffering that went with patients.

Palliative care formation

It was in this medicotechnological nightmare that palliative care came in like a breath of fresh air in the 1960s and gradually spread across the world. It seemed to give new meaning to the World Health Organization’s definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

The World Health Organization defined Palliative Care as: “Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with lifethreatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”

The emphasis is on quality of life. The definition says that it is applicable in all lifethreatening diseases; perhaps it is important to point out that life is not something to be defined only in the matter of time; it is also one defined by quality. A young man, who falls from a tree and is paralysed from the waist down, may still live for a long time, but his life in the broader sense of the word is threatened, nevertheless.

Again, by definition, palliative care addresses suffering not only of the patient, but also of the family.

The suffering of family

members is something that the medical system has, by and large, ignored. The concept of palliative care forced healthcare professionals and others to look at suffering as a whole, and to perceive that when one person suffers agonising pain or is facing a fatal disease, the whole family suffers, leaving indelible scars on the family, including the next generation.

Beyond diagnosis and curative treatment

Palliative care also recognises that suffering from a disease is important beyond a diagnosis and curative treatment. From the physician’s external view, the pain and suffering may be just a matter of time. Eventually, when the course of antibiotics or the course of chemotherapy is over, the disease would get better. But the patient and family are totally unable to take this dispassionate external view. For them, the suffering is real and now, and the medical system fails them, if they do not take that into account.

Palliative care tries to look at disease from the internal the patient’s and family’s point of view and to seek solutions for all domains of suffering.

This recognition has happened all over the western world but in the developing countries where the burden of suffering is much more, paradoxically, care is too oriented to cure alone. This fact led the World Health Organization to pass the landmark resolution on January 23, 2014, recommending to the World Health Assembly in favour of integration of palliative care into routine healthcare.

The suffering of family members is something that the medical system has, by and large, ignored. The concept of palliative care forced healthcare professionals and others to look at suffering as a whole, and to perceive that when one person suffers agonising pain or is facing a fatal disease, the whole family suffers, leaving indelible scars on the family, including the next generation March 2014 I FUTURE MEDICINE 63

Stress management

Stress is when you’re in distress ‘Stress’ is the response of the body to distressing or unpleasant situations where the body takes precaustions urgently mobilising energy

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s per the Oxford Dictionary of English definition, stress is likely to be a short form of distress. Some scholars believe it to be derived from the Latin word ‘Stringere’ meaning ‘to draw tight’. Even 14th century Christian poems have mentioned ‘stress’ to give the meaning of hardships. It is worth remembering that the common usage for stress among most people is ‘tension’ and ‘blood pressure’. Popular relative of stress is technically called ‘hypertension’. Edmund Jacobson, one of the pioneers of Stress Medicine in the last century, suggested that it is accompanied with excessive muscular contraction and opined that progressive muscular relaxation

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of the face (as well as other muscle groups) would lead to a significant reduction in stress. It was after the work of Robert Hooke that stress took on more of an engineering parallel like the ability of bridges to withstand without collapsing when the load is placed on it.

So the broad meaning of ‘stress’ is ‘the response of the body to distressing or unpleasant situations’.

Hans Selye, considered by many to be the father of stress research, called it the General Adaptation Syndrome. People have come to associate stress with the cumulative effect on the body and mind of the various challenges or wear and tear of everyday living. Despite the quasi

Dr Mathew R John

Consultant Psychiatrist at Matha Hospital, Thellakom, Kottayam and is a NIMHANS, Bengaluru alumnus

Whether you fight, flee or freeze in response to an emergency, what happens is an urgent mobilisation of energy

An important piece of this jigsaw puzzle is that there is a definite psychological component to the stress response that occurs in human beings

scientific explanation, it is important to see stress from a more biological angle.

Walter Cannon in 1914 proposed the fight or flight mechanism for the body, human as well as other organisms, as the fundamental response to unpleasant situations. ‘Freeze’ is also included nowadays, and it sometimes seems so obvious after all the freezing responses that occur when somebody from the unsuspecting audience is suddenly handed over the microphone for an opinion. Cannon believed that “the body responds to all threats- physical or social- in a similar manner whether or not that manner is immediately relevant.”

Whether you fight, flee or freeze in response to an emergency, what happens is an urgent mobilisation of energy. Though the social situation has changed dramatically reducing the frequency and severity of emergency situations like predators on the hunt, the human body has not changed and still responds to perceived emergencies using the full range of the fight or flight response.

So what makes our adrenaline shoot up the same way when we encounter our teachers suddenly on the road the same way as when we would encounter a lion?

The answer is complex but there is definitely a genetic bias or proneness to a hypersensitive stress response, the simplest reflection of which is said to be an exaggerated startle response.

Coupled with increased frequency of environmental triggers, this sets an

individual on the road of stress and stress induced disease.

Very simply put. If you are quick to anger or quick to fear or you have been experiencing more and more frequent bouts of anger or fear, you are in the club. This one liner will help those who become more confused by people’s remark “You are looking as if you are stressed out.” Once you know this, you need to find ways to cool the body off in a more than literal sense.

Stressed out?

What happens when the stress response goes exaggerated and persistent? It leads to excess of adrenaline effects and excess of corticosteroid responses which are the emergency hormones.

Over time, this leads to increased risk of heart disease, vascular disease, atrophy of selective brain areas and other complications. Bruce McEwen of Rockefeller University calls this Allostatic Load. So, taking preventive and curative steps do matter for a long and satisfying life.

An important piece of this jigsaw puzzle is that there is a definite psychological component to the stress response that occurs in human beings.

This can be as an accompaniment of physical stress as in a bodily disease or purely psychological. Being endowed with a complex brain, human beings have opportunities to modulate the stress response in some situations at least, so that the stress becomes bearable.

March 2014 I FUTURE MEDICINE 65

gynecology

Dr Partha Sarathi Das Specialist Gynecologist Zulekha Hospital,Sharjah

Smoking

Women fertility bearing the brunt Smoking is an addiction for both men and women but the latter suffers the most as it directly affects women’s natural capacity for conceiving and childbearing

W

hy do we smoke? Well, none of us in this world can be able to give an accurate answer to the question.

Probably habit, that’s what differentiates between healthy and unhealthy.

What starts with peer pressure in early years becomes an obsessive compulsion to have cigarette

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later. The addiction to nicotine is so poisonous that situations can be created to have a smoke. There is an urge to smoke in order to gain satisfaction, erade loneliness, celebrate success, cope with failures etc.

There are innumerable articles about the ill-effects of smoking and the bottom tag line on a cigarette packet “Smoking is injurious to

health”, hardly ever bothers a smoker. In fact, a smoker might doubt about the originality of the cigarette pack if it doesn’t come with the tag line. Such is the illeffect of smoking which mars one’s power of reasoning.

Women, who smoke compromise not only their health but also their fertility status and pregnancy complications increase.

Some facts • • • • •

• • • •

Smoking decreases female hormone estradiol necessary for egg development.

Smoking may lead to premature ovarian failure.

Menopause sets in at a very early age.

The quality of eggs diminishes resulting in failed or poor fertilization.

Nicotine alters the tubal propulsive movements leading to defective sperm and embryo transport and ectopic pregnancy.

Nicotine narrows down the caliber of blood vessels of pelvis supplying blood to ovaries, uterus.

Chances of low birth weight baby and premature birth are high.

Higher chances of undergoing assisted reproductive technology procedures.

Higher doses of injectable hormones required to generate more eggs and subsequently to raise estradiol levels.

•

In men, smoking lowers sperm count, motility and abnormalities in sperm morphology.

There are plenty of studies done all over the world which have demonstrated the relation of smoking with bad oral hygiene, heart disease, stroke and cancer. The first step to attain good health is cessation of smoking and there is no auspicious time to stop smoking and that stop it right now.

Maternal smoking has also been linked to asthma among infants and young children. The odds of developing asthma are twice as high among children whose mothers smoke more than 10 cigarettes a day. The most effective way to protect the fetus is to quit smoking

March 2014 I FUTURE MEDICINE 67

Qa &

Dr Meenakshi T Sahu Sr. Consultant Dept of Obstetrics and Gynecology Fortis la Femme Hospital, New Delhi

Women’s Health

Expectant mothers Stop smoking •

Smoking increases the risk of miscarriage and slow growth of the baby

No alcohol

•

I’m a 26-year-old woman in the first month of pregnancy. Please provide me details of a balanced diet and some healthy tips which I can follow now.

Shalini Somraj, Mumbai Pregnancy can be a very exciting time for most women. Expectant mothers also get anxious about what they need to do and what need not. Try to keep a balanced diet which includes foods with plenty of iron, calcium and folic acid as a growing baby needs these nutrients right from the start of pregnancy.

• Eat red meat, pulses, dried fruits, green vegetables and fortified cereals which all contain iron.

• Dairy products such as milk, cheese and yoghurt have calcium.

• Green vegetables, brown rice and fortified cereals contain folic acid. You should take folic acid tablets (supplements).

• Ideally, the diet should start at least one month before you get pregnant and continue

68 FUTURE MEDICINE I March 2014

•

•

•

•

•

with it until at least the end of the 12th week of pregnancy even if you are healthy.

Folic acid is a naturally occurring vitamin found in spinach, sprouts, broccoli, green beans and potatoes.

Iodine which is essential for the brain development of a baby in the womb mainly comes from milk, yoghurt, eggs and fish.

It is important to do some regular physical activities during pregnancy. In most cases, moderate physical activity during pregnancy is safe and can benefit both the mother and baby.However, you should consult a doctor before starting any exercise.

During pregnancy, immunity of the body is low and you are prone to catch infection and so avoid going to infectious places.

Undergo necessary examination and tests. Two doses of tetanus injections are given during pregnancy.

It causes damage to the growing baby in the womb

Try to remain stressyfree, do some hobbies to cheer up your mood like listening to music or reading books.

Remember pregnancy is not a disease, it just needs some precautions and extra care.

What are the foods that need to be limited during pregnancy?

Tharanath Balan, Maduraie Limit the amount of caffeine to no more than 200 mg per day. Caffeine is a substance that occurs naturally in foods such as tea, coffee and chocolate, and is added to some drinks such as cola and energy drinks. It is also an ingredient in some cough and cold remedies, and some painkillers.

Which vitamin should I take at the time of pregnancy?

Bhagyalakshmi Prasad, New Delhi Vitamin D supplements are most useful at the time of pregnancy. It is needed for the baby’s growth. The dose is 400 units (10 micrograms) a day.

Send queries: editorial @ futuremedicineonline.com.

Qa &

Dr Prameela Joji Sr. Consultant Department of Pediatrics KIMS Hospital, Thiruvananthapuram

Child Health

Help children face exams

My son is studying in the eighth standard and has exams in March.

How can I support him mentally and physically?

Jayanthi Ramachandran, Mahi Examinations are important milestones in your children’s school life. Here are some guidelines that you can follow.

• Never let your children postpone studying until a day before the exams. This will only increase their anxiety and stress levels. Preparation is the key to success.

Don’t listen to any excuses and don’t be swayed by assurances. The best way is to make them study for some time every day. Even if this is not possible, ensure that they begin preparing for the exams at least two to three weeks in advance.

• Do not impose yourself on your children. Some children require more support while others are happier studying on their own.However, let them know that you’re always there to help them. Hold question and answer sessions where you ask them random questions on the subject once they have finished studying.

• Prepare a timetable for

•

•

•

•

each child. You can cover subjects in the order of the examination schedule or you can tackle difficult subjects first.

Don’t allow your children to stay up late or wake up too early. Make sure that they get at least eight hours of sleep.

Inadequate sleep affects the brain’s functioning and will reduce your children’s retention. Discourage use of caffeine or other stimulants to remain awake. Make sure they take adequate food and water.

Create a study-ritual for your children. Encourage them to use the same place to study every day, preferably somewhere quiet and pleasant. The outdoors is a great option as well. If they are studying for long durations, schedule breaks every one or two hours.

Just before the examination: It’s important to get a good night’s sleep before any examination, so discourage your child from staying up late to study.

The exam day: Wake up your children in time and serve

them a light breakfast. Teach them relaxation exercises.

Wish them luck and hope for the best!

Dos and don’ts for parents Don’ts • • •

Dos • • • • • •

Getting angry will not help Do not compare your child with other children Don’t pressurise your child Reach out to your child with complete love Protect your child from getting into any kind of depression Help your child develop a positive attitude Understand where he is lacking and help him work upon that Keep tracking your child’s progress The secret to doing well in examinations lies in planning.

Send queries: editorial @ futuremedicineonline.com.

March 2014 I FUTURE MEDICINE 69

EYE CARE

Right s e s n e l t c a t con There are different types of contact lenses, including the disposable ones, in the market. A user should know which is good and which is not...

By FM Bureau • Don’t opt for brands without consulting your eye care professional. The water content and the shape of brands may differ.

It is not advisable to change the brand you are comfortable with.

Frequent change of brands should be avoided.

• While choosing a contact lens, factors such as quality, suitability and guarantee are important. Insist on a receipt and guarantee.

• In the case of disposable contact lenses, don’t use them beyond the recommended period. Replace the contact lenses in time to avoid any harm. Also don’t use an old prescription while buying new ones meant for long-term use. As per regulations, prescriptions expire after a limited period.

• Use contact lenses even if you

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use glasses regularly. For sports and other hectic activities, daily disposable contact lenses may be more convenient. Such contact lenses are not expensive.

• Don’t try to modify the contact lenses in any manner. For example, don’t try to tint them with colours.

It may lead to infections. Contact lenses are best as they come.

• Don’t neglect any discomfort caused by contact lenses. Consult eye care professional immediately as there might be ulceration which may lead to infection if left unattended.

Serious infections if not treated in time may lead to permanent impairment of vision.

• Consult your eye care professional in case you are not satisfied with your contact lenses. These days, due to rapid technological

advancements, many types of contact lenses, including bifocals, are available. With a wide range of contact lenses available, you can easily find one that suits you.

• Don’t share your contact lenses with anyone. Contact lenses are meant to be used by a single person and are not meant sharing in any case even for a short while. It is unhygienic and there is danger of contracting infections. Moreover, all contact lenses do not suit everyone.

• Allow teenagers to use contact lenses if they want to. There is no harm in using them if proper care is taken.

• Do read the manufacturer’s instructions thoroughly and take proper care of your contact lenses.

Use only recommended cleaning solutions and never reuse them.

pharma news

Lupin acquires Nanomi BV

Suven Life gets three patents

he Mumbai-based drug firm, Lupin Ltd, has recently announced that it is acquiring Netherland-based injectable company Nanomi BV. The acquisition is expected to help the company to expand its business in patented products.

The Indian drug firm said that the expertise of Nanomi in the nano and micro particles will help it to look at new disease portfolios in the injectable segment.

The company also said that it wants to operate in an area of healthcare that has high technology barrier and limited competition. The acquisition is expected to help the company to focus on the specific therapeutic areas. Lupin has already shown phenomenal growth in its US operations with a 42% rise in the third quarter net profit ending December to `476 crore. The growth in the US market was largely driven by new products launches such as Trilipix, used for treating high cholesterol and Cymbalta.

uven Life has received three product patents in Canada, China and India for its new chemical entities for treatment of disorders associated with neurodegenerative diseases.

The patents include the class of selective 5-HT compounds discovered by Suven and these patents are valid through 2025. It may be noted that the new chemical entities are being developed as therapeutic agents and are useful in treatment of cognitive impairment associated with neurodegenerative diseases such as Alzheimer’s disease, attention deficient hyperactivity disorder (ADHD), Huntington’s disease, Parkinson’s and Schizophrenia.

The company believes that these areas have huge market potential globally. With these new patents, the company now has a total of 14 granted patents from Canada, 12 from China and 17 from India.

Eli Lilly to introduce more products

Aurobindo to acquire Actavis’ operations

li Lilly and Co India is planning to become part of the top 20 pharma firms in India by 2020.

The company is looking to introduce more innovation-based products across the five therapeutic segments, including diabetes, in the next six years.

The company has recently launched an insulin delivery pen, HumapenSavvio, and it currently stands at the 47th position in terms of revenues in the Indian pharmaceutical industry. The company is putting maximum focus on the diabetes portfolio and plans to launch more new products to cater to over 60 million patients in India. The company also has presence in the osteoporosis, cardiovascular, oncology and growth hormones segments apart from the diabetes segment.

he generic drug maker in India, Aurobindo Pharma, has signed a binding offer agreement with Actavis plc to acquire its commercial operations in seven western European nations.

The Indian company expects to acquire personnel, commercial infrastructure products, marketing authorisations and dossier licence rights in the seven countries.

It may be noted that the acquisition expands Aurobindo’s front-end operations into five segments (generics, prescription products, over-the-counter products, hospital products and generics tenders) with approximately 1,200 products and an additional pipeline of over 200 products. The Indian drug firm expects the acquisition to help expand its operations to achieve critical mass in Western Europe.

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(By arrangement with www.brandindiapharma.in) March 2014 I FUTURE MEDICINE 71

Sleep disorders

? p e e l your s

Does your job pose hazards to Long work hours as well as shift job are sure to affect one’s health, particularly sleep, as is evident from various researches in the area. So it’s time to have a closer look at sleep routine and work hours in your life

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or many of us, our work gives shape to our daily lives. Most of us must work to support ourselves, our households, and our families. It’s not uncommon to spend more waking time on the job or otherwise engaged with work than any other aspect of our lives. Given the scope of the role that work plays in our lives, we don’t pay nearly enough attention to the impact of our jobs on our health—and in particular, our sleep.

It’s true that some jobs and industries pose greater challenges to sleep. Rotating schedules, overnight or early morning hours, extensive

travel, high-stress and highpressure responsibilities—these and other on-the-job realities can undermine healthy sleep routines, and bring about chronic health problems, especially as we age.

Air traffic controllers and pilots, medical residents and truck drivers—these are some of the jobs that garner at least some attention (if not enough) for the hazards they pose to sleep.

But what about the financial analyst who is up before dawn communicating with a colleague on the other side of the world?

Or the restaurant worker whose work isn’t finished until well beyond the 1 am last call? These

and many other jobs come with sleep risks that fly under the radar, often going unnoticed and unaddressed.

Depending on its schedules and demands, different jobs will pose different challenges to regular, restful, sufficient sleep.

Here are a few of the most common work-related sleep problems:

Shift work: Shift work can pose serious problems for sleep.

Working changing or rotating schedules makes it difficult to establish a consistent sleep routine. Getting up and going to bed at different times of the day isn’t just inconvenient but this lack of routine can cause disruption to the body’s circadian rhythm, the 24-hour biological ‘clock’ that regulates sleep-wake cycles. Shift workers are at higher risk of sleep disorders, including insomnia and obstructive sleep apnea.

Research shows that shift workers are at greater risk of accidents and injury, as well as chronic diseases associated with poor sleep, including heart disease and stroke.

Who works shifts? In today’s world, more and more people work something other than the traditional, routine Mondayto-Friday daytime schedule.

Doctors, nurses and other medical professionals, as well as airline and airport personnel, and manufacturing workers are some of the professions that traditionally involve shift work. But in our globally connected, 24/7 society, people in fields like technical support, customer service are often working irregular and evening shifts. People who have to travel frequently for work can also experience similar sleep problems to shift workers.

Many of our public health and safety professionals work shifts, including police and firefighters.

This means sleep problems associated with shift work is a public health issue.

Long hours: Sometimes, it’s

Dr Michael J. Breus, Clinical Psychologist,the American Board of Sleep Medicine not a changing schedule that interferes with sleep, but the duration of work that poses hazards to sleep and health.

Studies show that working long hours is associated with several sleep problems, including shortened sleep times, difficulty falling asleep and daytime impairment. A recent study of nurses found that those working overtime and long hours were more likely to report poor sleep than those with less grueling schedules.

These same nurses were also more likely to be overweight or obese and to exercise less, and were more likely to engage in unhealthy behaviours like smoking. A great many jobs fall into the “long hours” category, including many supervisory and management positions. The connection between long hours and sleep problems may not be as recognized as that of shift work, but the impact is very real, and deserves more study and attention.

science and engineering, and information technology often come with non-stop pressure and responsibility that can undermine health and sleep.

Positions like these demand long work hours. Many of these demanding, high-pressure jobs are ones that people never really leave, where the separation between work life and non-work life is tenuous at best. Research begins to explore the toll that high-intensity work has on health and sleep. Recent studies have shown significantly elevated rates of insomnia among software engineers, compared to the general population, and Wall Street investment bankers contending with insomnia and depression.

Often we’re so busy managing our daily lives that we stop paying attention to what’s right in front of us. If you’re having trouble building and maintaining a healthy sleep routine, taking a closer look at how your job affects your sleep may help lead you to more effective strategies for getting the rest you need.

High stress: Stress and worry are enemies to sleep. And a high-stress, high-pressure job can make it difficult to leave work concerns at the office.

Research shows that worry has its greatest effect on sleep during the ages 35-55- right smack in the middle of most career trajectories. (of course, it’s also the time when people are also often raising families.)

Jobs that from the outside may seem downright cushy, high-paying, high-prestige positions in industries such as business and finance,

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MEDICAL DIGEST

Pregnant women with low vitamin D levels prone to preeclampsia

New approach to treat Parkinson’s disease

Pittsburgh (US): Women who are deficient in vitamin D in the first 26 weeks of their pregnancy may be at risk of developing severe preeclampsia, a potentially life-threatening disorder with an increase in blood pressure and protein in the urine, says a research by the University of Pittsburgh Graduate School of Public Health.

In one of the largest studies to date, researchers studied blood samples collected from 700 pregnant women who later developed preeclampsia in an effort to examine a woman’s vitamin D status during pregnancy and her risk of developing preeclampsia.

Washington: Astrocytes, a population of support cells, can provide a new and promising approach to treat Parkinson’s disease, shows a new study. These findings, which were made using an animal model of the disease, demonstrate that a single therapy could simultaneously repair the multiple types of neurological damage caused by Parkinson’s, providing an overall benefit that has not been achieved in other approaches.

US scientists find genetic basis for an organism’s dietary needs

California (US): University of Southern California scientists Sean Curran and Shanshan Pang have identified a collection of genes that allow an organism to adapt to different diets and showed that without it, even minor tweaks to diet can cause premature ageing and death.

Finding a genetic basis for an organism’s dietary needs suggests that different individuals may be genetically predisposed to thrive on different diets and that now, in the age of commercial gene sequencing, people might be able to identify which diet would work best for them through a simple blood test.

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Childhood depression may fuel heart disease later

Washington: An early prevention and treatment of childhood depression can reduce adult cardiovascular disease, shows a study. Depressed children are likely to be obese, smoke and be inactive that can lead to heart disease as early as their teen years. “We were quite surprised to find that the parents of the affected adolescents were reporting a history of heart attacks and other serious events,” said associate professor of psychology Jonathan Rottenberg at University of South Florida in the US. The investigators surveyed over 200 children with a history of clinical depression, as well as about 200 of their siblings who have never suffered from depression.

New laser can detect disease in your breath Sydney: Researchers at the University of Adelaide Physics have developed a new type of laser that will enable exciting new advances in areas as diverse as breath analysis for disease diagnosis and remote sensing of critical greenhouse gases. The researchers from the University’s Institute for Photonics and Advanced Sensing and the School of Chemistry and Physics published in the journal Optics Letters describe how they have been able to produce 25 times more light emission than other lasers operating at a similar wavelength, opening the way for detection of very low concentrations of gases..

Foods that kill bad breath

Will ancient ‘Black Death’ plague strain re-emerge?

Washington: Dave Wagner, an associate professor at the Centre for Microbial Genetics and Genomics at Northern Arizona University, said the Justinian strain, one of the world’s most devastating pandemicsthe plague of Justinian and the Black Death, which earlier research traced to having its origins in Asia, lies “smack between” two groups that are still found in China. These plagues are responsible for killing as many as half the people in Europe.

The strain that helped bring an end to the Roman Empire about 1,500 years ago on its own.

But the other, which flourished 800 years later, led to worldwide re-emergence in the late 1800s and is still with us today, killing thousands each year. The findings suggest a new strain of bubonic plague could emerge again in humans in the future.

The plague of Justinian struck in the sixth century and is estimated to have killed between 30 and 50 million people- virtually half the world’s population as it spread across Asia, North Africa, Arabia and Europe.

The Black Death struck about 800 years later with similar force, killing 50 million Europeans between 1347 and 1351.

New Delhi: Consuming vitamin C rich foods and drinking tea help in keeping your breath fresh, says nutritionist and weight management expert. Here are few tips.

Water: Just swish and swirl some water in the mouth like gargling (but softly, not loudly) and drink it up or rinse it out. When you get dehydrated, the saliva generated in the mouth automatically decreases. Saliva tends to clean the mouth by diluting the bacteria. Bacteria and their by-products are responsible for that offensive bad breath.

Vitamin C rich foods: Oranges, sweet lime, lemons, kiwis and all citrus fruits rich in the vitamin help in keeping the breath fresh. Vitamin C is known to fight bacteria.

Apple: When we crunch on to an apple, salivary secretion gets stimulated. This literally bathes the mouth and rinses out the odour generating bacteria in the mouth thereby making the breath fresh.

Cinnamon tea: It is helpful in keeping the mouth and breath fresh.

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medical Conference

Emergencies in Medicine Conference Park City (US): The 32nd Annual Emergencies in Medicine Conference will be held in North Escala Court Park City, United States, from March 2 to 6. This five-day conference will provide a perfect setting for interactive medical education and communication. It will focus on virtually every aspect of emergency medicine through case-based lectures and audience interaction. From disaster planning to wound care and pain management, quality mandates, practice management and economics, each of these educational areas is timely and central to the emergency physicians’ effort to maintain medical excellence

Miami Breast Cancer Conference

Florida (US): The 31st Annual Miami Breast Cancer Conference will be held from March 6 to 9 in Miami, Florida. The conference will bring together surgical, medical and radiation oncologists to create awareness of the state-of-the-art treatments in each therapeutic area and encourage cross-team cooperation in the clinic. The pioneers of innovative approaches in each of these sub-specialties will provide insights into the optimal multidisciplinary management of patients with breast cancer and its application

19th Annual Conference: 2014 Radiology Review

Chicago (US): The 19th Annual Conference: 2014 Radiology Review will be held in Chicago, the US, from March 10 to 14. Experts will share their clinical experiences at the meet.There will also be an exciting, comprehensive review and update of the practical aspects of all major subspecialties of diagnostic radiology.

Current and future trends in radiology informatics will also be explored.

Unknown case reviews will be held

after each morning and afternoon lecture sessions allowing participants to test themselves in a relaxed atmosphere. These sessions will stress practical clinical problems and differential diagnoses.

World Congress on ophthalmology Lisbon (Portugal): The 5th World Congress on Controversies in Ophthalmology (COPHy) will take place in Lisbon, Portugal, from March 20 to 23. The COPHy will be devoted to evidence-based debates and discussions by chairpersons, speakers and the audience, all of whom will examine and analyse the most relevant issues raised in the field of ophthalmology last year. This educational 76 FUTURE MEDICINE I March 2014

congress will focus on anterior segment, glaucoma and retina sections, and will discuss controversies in other areas of ophthalmology such as neuro-ophthalmology. The scientific programme will include overviews, the state-of-the-art lectures and controversial debates.

Celebrity Fitness

Ranbir Kapoor Born on September 28, 1982, Ranbir Kapoor is one of the successful and highest paid actors in Bollywood. The son of actors Rishi Kapoor and Neetu Singh, and the grandson of actordirector Raj Kapoor, Ranbir made his entry into Bollywood with Bhansali’s 2007 tragic romance Saawariya

Workout Regular with gym, four times a week and does a lot of weights and cardio every time. Working out on chest and back Mostly listens to music while working out Loves to play football regularly

Takes protein shake before and after workouts

Diet Breakfast: Milk with

cornflakes and a banana/egg white omelette and brown bread toast with a glass of fresh juice. Black/espresso coffee

Lunch: Tandoori chicken with daal and two chapatis

Dinner: Grilled salmon, fish, and chicken

On the sets Fruits and juices, green tea and Darjeeling tea

Supplements Multi-vitamins and whey protein shakes twice a day- after workouts and after dinner. Drinks a lot of water

78 FUTURE MEDICINE I March 2014