Heart Disease
The dos and don’ts to save your heart
Beauty Care
Wellness
Five healthy breakfasts
The Premium Health Magazine
5 butt-shaping KERENG/2012/44529
www.futuremedicineonline.com
October 2013
exercises
Yoga postures
to tone your
tummy Cover Story
Obesity
Challenge
10 ways to celebrate your sexual life UAE - AED 7 US - $5 India - `50
Make yourself an intimacy expert
DIABETES! CAN AFFECT EYES, HEART, KIDNEYS & FEET
CONTROL DIABETES, PREVENT COMPLICATIONS WORLD CLASS DIABETES CARE
GOPALAPURAM MAIN CENTRE 6, Conran Smith Road, Gopalapuram, Chennai - 600 086. India.
CHENNAI BRANCHES/CLINICS ANNANAGAR 91-44-43453800
TAMBARAM 91-44-42288333
OMRKARAPAKKAM 91-44 - 24500235
ADYAR 91-44-42117888
TAMIL NADU BRANCHES VELLORE COIMBATORE 91-416-2248612 91-422-4258888
MADURAI 91-452-4378888
GUDIYATHAM 91-04171-229474
VADAPALANI 91-44 - 43069887
HYDERABAD CENTRES CHUNAMPET 91-44-27596621
DOMALGUDA JUBILEE HILLS 040-43968888 040-20013555
Email: drmohans@diabetes.ind.in Website: www.drmohansdiabetes.com
Volume 2 | Issue 10 | October 2013 Founder & editor Ravi Deecee Executive Editor Ratheema Ravi DC MEDIA - OPERATIONS
dc media - ADVT SALES
dc books
General Manager M Kumar FM - EDITORIAL Associate Editor Dipin Damodharan Chief Copy Editor K S Rajagopal OVERSEAS CORRESPONDENT Prashob K P COORDINATING EDitor - response Sumithra Sathyan Senior Reporters Neethu Mohan Shalet James
HEAD - RESPONSE Kainakari Shibu Sr Key account managers Rajasree Varma Anu P M Biju P Alex Vijimon P B M K Haridas Vinod Joseph Rohil Kumar A B Managers Febin K Francis Siju Thomas special projects Devika Venugopal
Administration General Manager S Arun Kumar Manager-Administration Anil kumar B Manager-Corporate Relations Joseph A G Finance & accounts General Manager Santhosh Kumar M Sr Manager-Costing Christo Antony Sr Manager-Accounts Emy Liju Production General Manager D Sreekumar Editorial - Mango Saraswathy Rajagopal Editorial - DC Books Jayadev K V A V Sreekumar Ramdas R Eswaran Namboothiri H Honey Thomas Anoop G Prakash Marahi Shajikumar K N Sanjeev S Muraleedharan Shaji kumar K N Sreedevi P Sunithananth P T Suresh P S Tency Jacob Aravindakshan N V Purchase Lekha Pradeep Nisha Sunil Online & Portal Jacob Varghese Jeevan K Augustine Rights Sumitha Jyothidas Dileep Kumar T
DC MEDIA - EDITORIAL Sr editorial team Vishnu Rageev R Lakshmi Narayanan Savithri S Iyer Sandeep O P Vinodkumar editorial team Tony William Sujeesh K S Vishnu J J Nair Renku Haridas Photographer Jose Jacob Design & Layout Kailasnath Anil P John Vipinesh Sangeeth K M Arathi R Nair Web Manager S Sreenath
DC Media - MARKETING SENIOR Manager Sabu Varghese Mathew Assistant Managers Priya P A Mobin E Mathew Liju P John Abhilas G Krishnan Sunilkumar P S Maya Murali Sales & accounts Josy John Personnel Dept Reshma Benjamin support team Athul P M Sone Varghese Vishnu dc books Store Sales Dan George Renjithdas H Praveen VJ Jaison P Mathew Tomy Antony Satheeshan Nair Mani V K Rajmohan
SUBSCRIPTION For subscription queries, write to info@dcmediacorp.com or call 0484 3047405 SERVICES If Future Medicine is not available at your news stand, or for other news stand queries, write to info@ dcmediacorp.com, or call us 0484 3047405 PERMISSIONS For permissions to copy or reuse material from Future Medicine, write to editorial@dcmediacorp.com Views and opinions expressed in this magazine are not necessarily those of DC Books, its publisher or editors. We do our best to verify the information published but do not take any responsibility for the absolute accuracy of the information. We do not take responsibility for returning unsolicited material sent without due postal stamps for return postage. No part of this magazine can be reproduced without the prior written permission of the publisher. Future Medicine reserves the right to use the information published herein in any manner whatsoever. Contact Info DC MEDIA , DC Books, 234/C, Adjacent to YMCA, Chittoor Road, Cochin – 35, Kerala, India, Contact, Ph: +91 484 3047 405, Fax: +91 484 4021 145 Business Office - International, DC Books Pvt Ltd, # 1, 601, DSC Tower, Studio City, Dubai, UAE Mail: editorial@dcmediacorp.com, info@dcmediacorp.com Published from DC Books, D C Kizhakemuri Edam, Good Shepherd Street, Kottayam – 686001, Kerala, India and printed at Five Star Offset Printers, Nettoor, Cochin - 40 for DC Press Pvt. Ltd., Industrial Development Area, Poovanthuruth, Kottayam – 686012, Kerala, India. Printed, published & owned by Ravi Deecee
DC Media Publication www.futuremedicineonline.com 4 FUTURE MEDICINE I October 2013
AMRITA Amrita Institute of Medical Sciences
i
n the last 15 years we have set new standards and delivered excellence in Quality Affordable Healthcare. We thank the trust and belief of more than 60 lakh patients who have availed our services at
AMRITA. `
135 acre Health Care Campus
`
3,330,000 sq. ft. of built up area
`
1300 Bed Tertiary University Teaching Hospital
`
275 Acute Care Beds
`
Fully digital imaging services, first in south East Asia
`
Fully integrated Health Care delivery system
`
Teleconnectivity with 36 Centres in india, 32 in the African subcontinent, 6 in other Countries
`
more than 50 Clinical departments
`
4500 staff
`
940 Faculty members
—Accredited by—
Offering the fOllOwing ServiceS • • • • • • • • • • • •
Centre For Heart Diseases Cancer Centre Centre For Digestive Diseases Centre For Neurosciences Centre For Plastic/Reconstructive & Microvascular Surgery Centre For Psychiatry & Clinical Psychology Centre For Solid Organ Transplant Centre For Bone, Spine & Muscle Disorders Centre For Endocrinology & Diabetes Centre For Women & Children’s Health Centre For Laboratory Medicine Centre For Medical Informatics, Bioinformatics, Multimedia-Education & Telemedicine
AmritA institute Of medicAl sciences Aims Ponekkara P.O., Kochi, Kerala 682 041 indiA Phone: (91) (484) 2851234/2856151 24 hr. helpline: 9745000553/554 Fax: (91) (484) 2802124 Email: md@aims.amrita.edu Website: www.aimshospital.org
Cost Effective • Compassionate • World Class Health Care
EDITOR’S NOTE Harmful overweight
I
f your child is obese and you are not taking any preventive measures right now, chances are high that he would grow up to become an overweight adult. He would gradually develop diseases like diabetes which could damage the functioning of kidney and heart in the long run. Obesity is detrimental to overall health of an adult and a correction at this stage is only through surgeries although healthy diet and exercise can help in losing weight to an extent that too for a short period. In fact, obesity is a serious health issue that does not occur overnight. Years of harmful lifestyle with no exercise, eating junk foods and long working hours lead you to obesity and super obesity. So the problem of overweight or obesity should be taken care of from the childhood itself. It is important for every child to grow with normal weight and parents need to take necessary steps if their child is found to be overweight. However, the current scenario is gloomy and unfortunate as the number of children with obesity is fast increasing world over. New food habits coupled with poor or no physical activities are giving enough room for obesity. In this context, the only way to bring the situation under control is to create awareness about the harmful effects of obesity in children. It should be the first step to achieve an obesity-free society. For which, private and government agencies should work in tandem. Cardiovascular disease has been the main cause of deaths for many decades. Both men and women fall prey to the fatal disease almost in equal numbers. Despite this, men are more vulnerable to various types of heart disease. Coronary heart disease is the most common among them, killing more than 3,85,000 people annually. Although the disease usually affects older adults, its antecedents begin early in life, making primary prevention efforts necessary from childhood. According to cardiologists, the known causes of heart disease are the increased longevity and lifestyle changes. Another area which needs more attention is paediatric cardiac care. Is anyone else not interested in beauty care? Almost all of us find time to do some exercises if it is for giving the body a better shape. All will be ready to shell out a few more dollars in an attempt to lift their look. Read more articles in this issue to get details of how to attain a perfect body shape. Also, here are a couple of articles that may help you lead a happy sexual life. Hope you would enjoy reading this issue of Future Medicine.
6 FUTURE MEDICINE I October 2013
October 2013 I FUTURE MEDICINE 7
COVER STORY
CONTENTS 20 45
Columns
52
68 70 71 69 58 66
Wellness Ayurveda is the only medical system in the world that emphasizes the ‘living with Nature’ principle. It also nourishes a treatment combining medication and lifestyles in harmony with Nature
Beauty Care - Butt Do exercise and take healthy diet before you want others to give a good look at your beautiful round buttock
Pediatric Health Dr Prameela Joji
Intelligence Quotient Dr Mahesh Kandasamy
Cirrhosis Dr Harikumar R Nair
Menopause Dr Meenakshi T Sahu
Brain death Dr M Pradeep
Sex & Life Lesley Stedmon
8 FUTURE MEDICINE I October 2013
Obesity challenge Considered as a ‘killer lifestyle disease’, obesity has now become a global health issue. Lack of exercise, eating junk foods, long working hours and stress are the main causes of obesity. Worldwide, 1.2 billion people worldwide are officially classified as overweight. In India, more than three per cent (3 crore) of the population is obese
62
‘Dubai will become the medical hub of Middle East’
CSH, Dubai Dr Hayder Al Zubaidy, CEO, Canadian Specialist Hospital, talks about the potential of the healthcare sector of the country and the future plans of CSH
60
Organic farming: Benefits are many and long-term
Occupying the second position in the world, India has about 44,926 certified organic farms producing around 5,85,970 mt of organic products worth $6.8 million a year
28
36
CONJUGAL BLISS An enjoyable sexual life is what every couple really needs to make their relationship stronger and lasting. Minute things which may not be noticed by partners in their married life can make a huge difference in their sexual life. It could be the smell in the bedroom, the type of bedspread or your hygiene-all these and many others can create an ambience for perfect love making
Disease Special Heart Cardiovascular disease has been the leading cause of deaths worldwide, especially after the 1970s
60
Celebrity Fitness John Abraham Discipline and diet go a long way in helping to get a great body
56
Subhasini Mistry The woman who dared to dream big A young widow with four small children, Subhasini Mistry in the midst of poverty took a path that no one dared to tread October 2013 I FUTURE MEDICINE 9
photospeak A CHALLENGING MISSION: A total computer navigated knee replacement surgery is performed at Al Shifa
Hospital, Perinthalmanna, Kerala
10 FUTURE MEDICINE I October 2013
A
s you know, a picture is worth a thousand words. Equipped with the advanced technology, operation theatres today have become the backbone of hospitals. Here is a hospital theatre with hectic activities.
What
Total computer navigated knee replacement surgery.
Where
Al Shifa Hospital, Perinthalmanna. It is one of the hospitals in Kerala where maximum number of computer navigated knee replacement surgeries take place.
Why
Precise, accurate and reproducible implant positioning. It promises an accuracy rate of 90 per cent whereas traditional surgeries have got only 70-80 per cent accuracy.
October 2013 I FUTURE MEDICINE 11
WORLD STROKE DAY - OCT 29
Be aware of
stroke S
troke is a medical condition in which the brain cells die suddenly due to the lack of oxygen. It can occur due to the disturbance in the blood supply or due to the damage to blood vessel. Studies prove that one in six people worldwide will have a stroke in their life time. World Stroke Day is observed on October 29 to emphasise the grim nature and high rates of stroke and also to raise responsiveness of the prevention and treatment of the illness, and ensure better care and support for survivors. Is any one aware of the fact that 80% of the stroke cases can be prevented? Here are some tips that can help protect you and your dear ones against stroke. • • • • • • • • •
Did You Know?
*Stroke is the most common cause of death, after cancer and ischemic heart disease. *Two third of stroke victims are above 60 years old. *A study by The Journal of the American Heart Association found that drinking three cups of tea per day reduces the risk of stroke.
12 FUTURE MEDICINE I October 2013
Know and control blood pressure Manage cholesterol Control diabetes Stop smoking Manage exercise Follow a healthy diet Treat your blood circulation problems Identify abnormal heart beats Avoid drugs
FRUIT THERAPY Papaya
One fruit, numerous benefits
Eat papaya every day if possible as its health benefits are numerous. Your skin, digestive system, cardiovascular and gastrointestinal systems will be healthy with regular intake of this fruit By FM Bureau
W
hat can a papaya contribute to your health? Papaya, the neighborhood fruit or the angel’s fruit, can help you prevent many lifestyle diseases, especially the skin diseases. If you want a glowing skin, start having a piece of papaya every day from today. The yellow papaya is an excellent source of
14 FUTURE MEDICINE I October 2013
How papaya benefits your health •
rejuvenating vitamins, minerals and enzymes which benefit the detoxification of skin. The fruit contains vitamins C, E, and A along with folate and potassium. The extracts of papaya and its seeds are very effective against bacterial problems and it is rich in highly digestible protein and contains the alkaloid carpaine that can enhance the activities of your heart, bronchus, lungs and muscles. The daily intake of this fruit can also cure asthma. Papaya tree bark helps with toothache while the root which is can be cooked as a
tea can be used for jaundice, intestinal parasites and bleeding disorders. The early symptoms of cancer, cardiovascular disease, macular degeneration, and arthritis can be alleviated by papaya consumption. The enzymes in papaya can remove the thick fibrin coating over tumours which allow the killer T-cells to recognise and attack cancer cells, especially in breast, lungs, pancreas, cervix, and liver. Taking into account papaya’s benefits on rejuvenation of skin, this fruit is wildly used in lotions, soaps, facial peels, toners, moisturisers and many other skin related products. Applying the pulp of papaya on face and skin can provide a glowing touch beyond age group. Vitamin E in this fruit acts as an anti-ageing element which prevents the skin from premature ageing.
• • • • • •
•
•
•
• •
Avoids nausea and constipation Protects cardiovascular system Supports the renewal of muscle tissue Prevents cataract formation Increases quality of proteins in whole organism Revitalises the human body and maintains energy and vitality Papaya can be used externally as a treatment for skin wounds that don’t heal quickly, for this you can use papaya peel or ointments made out of papaya Helps with the digestive system, by breaking down the proteins and supporting production of digestive enzymes Can benefit people suffering from colon cancer and other forms of cancer and ailments of cardiovascular and gastrointestinal systems With high vitamin A, papaya lowers the risk of emphysema in smokers and passive smokers Alleviates inflammation Boosts the immune system
Arthritis & Prevention
Ayurvedic remedies for
arthritis Change in lifestyle and food habits can result in considerable relief from the pain impacted by different forms of arthritis, according to Ayurveda
Dr Smita Naram
Co-founder, Ayushakti, Mumbai
A
re you suffering with severe pain in the joints? If yes, then it’s time to check it up seriously. You might be suffering from arthritis. A form of joint disorder, arthritis involves inflammation of one or more joints. There are over 100 different forms of arthritis. The most common form is osteoarthritis (degenerative joint disease). Other forms are rheumatoid arthritis, psoriatic arthritis, and related autoimmune diseases. Septic arthritis is caused by joint infection. Arthritis is one of the most common ailments for which Ayurvedic help is being sought these days. Ayurveda blames excess of vata (air) dosha for pain. An increase in vata movements results in low metabolism and at times blocks the normal functioning of the body. One of the reasons for arthritis and other pains such as neck, body, knee and joint is the swelling in the joints created by the toxic mucous (Aam).
Symptoms • • •
•
•
Stiffness accompanied by acute pain in knee joints, finger joints, shoulders, neck and back. Signs of inflammation and tenderness in joints like ankles, elbow, knee and fingers. Joints deform without inflammation and produce crepitus sound leading to osteoarthritis. Difficulty in climbing steps or sitting down on the floor is common. Some people can get osteoporosis which is a silent killer and can cause sudden fractures in the back, hip or knee joints. You can feel pain in back, hip or knee. Your posture can change to stooped posture. Pain and difficulty in walking, standing for long time or sitting on the floor.
Diet and regimen •
• •
•
Foods which are easily digestible and do not make wind or gas are good. Vegetable juices and soups are good. Juices of carrot, beetroot and cucumber mixed are also beneficial. Green salad with a dressing of lemon juice and a little salt is also good. Fruits like apple, orange, grapes and papaya can be taken. Cooked vegetables like squash, zucchini and pumpkin are good. Cooking with spices like cumin, coriander, ginger, asafetida, garlic, fennel and turmeric is also helps a lot. Avoid eating hot, spicy and fried foods, sweets, windforming foods like cabbage, cauliflower, spinach, broccoli, okra and potatoes. Excess intake of tea,
Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
•
•
•
coffee, alcohol, white sugar, yogurt, chocolate and cocoa, and excessive smoking should be avoided. Sleeping during day time, staying up late in the night and mental tensions like worry, anxiety, fear, stress, grief etc. should be given up. Regular physical exercise and massage with oil once or twice a week should form an important part of lifestyle. Joint pain, swelling and stiffness are caused by the increased vata (air) movements in the body. A moderate diet which decreases vata can help to relieve these conditions. Stop eating all wheat products, curd, tamarind, tomatoes, oily food, raw salad, red meat, fermented foods and gas-forming sprouts like kidney beans, chickpeas, dry peas, and white beans. Vegetables like okra and eggplant, raw mangoes, chilled water, aerated drinks, cold milk and ice-cream. All these, if eaten regularly, increase vata which can adversely affect the digestive power, ultimately producing toxins.
Foods that reduce vata
Rice, roti and bakharis made of green millet, white millet or ragi, mungdaal, red lentils, yellow lentils, pumpkin, gourd, bitter gourd, carrot, beetroot, coriander, onion, fenugreek zuccini, artichoke, squashes, fennel bulb, rucola, celery, spinach, melon and cantaloupe.
Spices: Ginger (Adrak), garlic, clove, cinnamon, black pepper, cumin and cardamom.
Fruits: Avocado, apricot, sweet grapes, sweet apple, rye, amaranth, bananas, coconut, figs, dates, melon and papaya.
Others: Honey, palm sugar, unrefined sugar, ghee,
butter and milk. An occasional intake of chicken, eggs, seafood, cooked vegetables like cauliflower, broccoli, sprouts and cabbage is acceptable. Soaked nuts and nut butter can also be consumed in small portions, but not more than twice a week.
Remedies
•
An estimated 50 million adults in the United States reported being told by a doctor that they have some form of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia •
As ama ( A peculiar concept in ayurveda, orginates from improperly digested toxic particles that clog the channels in your body) and vata are the main causes, efforts should be made to digest the ama and to reduce the vata. Digestion should be improved so that no further ama is produced. Efforts should be made to relieve the pain and inflammation. This is the line of treatment in Ayurveda. Fasting is very beneficial for digesting the ama. The fasting could be complete or partial depending on the strength of the person, season and place. October 2013 I FUTURE MEDICINE 7
Prevention Arthritis
• •
•
•
Two tea spoons of lemon juice mixed in 250 ml of warm water and a tea spoon of honey are good to take twice a day -morning and evening. Body massage with sesame or mustard oil helps to reduce vata, resulting in less pain. The joints affected by pain can be massaged for longer time. Light exercise is useful but you must know your limits. As a general rule if any exercise, including walking, causes pain after one hour, you have crossed your limit. Liberal intake of orange juice or sweet limejuice or vitamin C enhances the efficacy of any antirheumatic drug since vitamin C can reduce skeletal pain. Guggul is a very helpful herb for curing arthritis. It can be taken in one to 3 gm dose twice a day after meals with warm water. Not recommended for the people with kidney disease or acute rashes.
Home remedies
Drinking one teaspoon of castor oil with ginger water before going to sleep is a very effective way of keeping joint pain and arthritis at bay.
Anti-arthritic formula
One teaspoon turmeric, ¼ teaspoon garlic, ¼ teaspoon ajowain, ½ teaspoon coriander seed powder, ½ teaspoon fenugreek with half glass of water twice a day.
Detoxification therapy
Detoxification therapies in Ayurveda are very powerful to cure the root cause of arthritis. It removes toxins from the all parts of the body through purgation therapies and herbal enemas. Detoxification removes blocks and inflammation from the joints, makes it stronger, and improves bone density, resulting in remarkable reduction in pain, swelling, crepitus sound in joints. Detoxification considerably improves conditions like sciatica, spondylitis, osteoarthritis, osteoporosis, back pain and neck pain.
Marma for instant relief
Marma is an ancient Indian pressure therapy which removes blockages at a deeper level and gives instant relief. The ‘Lohitaksha’ nerve is located right in the centre of the armpit. Put pressure on this central point and keep it pressed for a minute and then massage it in a circular motion. It instantly triggers the nerve centre to start functioning. Repeat this Marma at least three times a day.
18 FUTURE MEDICINE I October 2013
October October2013 2013I FUTURE I FUTUREMEDICINE MEDICINE197
COVER STORY Obesity
besity
challenge
20 FUTURE MEDICINE I October 2013
Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
Considered as a ‘killer lifestyle disease’, obesity has now become a global health issue. Lack of exercise, eating junk foods, long working hours and stress are the main causes of obesity. According to the World Health Organisation, 1.2 billion people worldwide are officially classified as overweight. In India, more than three per cent (3 crore) of the population is obese. There is an urgent need to create public awareness about the mechanisms of identification, prevention and treatment of severe obesity By Sumithra Sathyan
O
besity is caused by taking in more calories than an individual can burn over an extended period. These “extra” calories are stored as fat. Although there are several factors that can lead to this energy imbalance in obese individuals, the main contributors are
Genetics
Science shows that genetics also play a role in obesity. Genes can cause certain disorders which result in obesity. However, not all individuals who are predisposed to obesity become obese. Research is currently underway to determine which genes contribute most to obesity.
and respiratory problems • Some cancers (endometrial, breast and colon) • Liver disease • Venous disease • Acid reflux • Menstrual irregularities and infertility Early detection of the morbid obesityrelated diseases is
National Family Heath Survey Obesity Data - 2007 States
Males (%
Males rank
Females (%) Females rank
India
12.1
14
16
15
Punjab
30.3
1
37.5
1
Kerala
24.3
2
34
2
Goa
20.8
3
27
3
Tamil Nadu
19.8
4
24.4
4
habits, environment and genetics.
Habits
In today’s fast-paced environment, it is easy to adopt unhealthy lifestyle that includes food choices, a physical activity and the effort to maintain health. Many people now select foods that are calorie-rich, but nutrient-poor.
Environment
Environment plays a key role in shaping an individual’s habits and lifestyle. There are many environmental factors that can impact your health decisions. Today’s society has developed a more sedentary lifestyle.
Risks of morbid obesity
Many co-morbidities accompany morbid obesity. Once a patient is considered morbidly obese, these conditions become serious health risks. These co-morbidities also negatively impact the quality of life for a patient. The most prevalent morbid obesity-related diseases are: • High blood pressure • High cholesterol • Diabetes • Heart disease • Stroke • Gallbladder disease • Osteoarthritis • Sleep apnea
as important as the treatment itself. The earlier these are detected, the better the advantage a patient may have to keep them under control with the assistance of a physician.
Childhood obesity
One of the most serious public challenges of the 21st century is the childhood obesity. Over 42 million children under the age of five are estimated to be overweight. They are mainly in the developing countries. It affects more than 15 percent of children, making it one of the common chronic diseases of childhood.
Childhood obesity is not just a cosmetic problem. Today, more and more children are being diagnosed with diabetes, hypertension and morbid obesity- related diseases Obesity Skelton
COVER STORY Obesity
Exe
Mildly
Caus rcise an e Dep d ressio n
Cause Depression
The other kids make fun of me
Wellness through
The Eternal Science
Join PAMC
Ensure the better career
Courses Offered P.G Course
MD (Ayurveda)
Rasasastra & Bhyshjyakalpana Degree Courses
BAMS B.Sc- Nursing (Ayurveda) B.Pharm (Ayurveda) Govt. approved Certificate Courses
Pharmacy (Ayurveda) Therapist (Ayurveda)
College Facilities
Well Equipped Class rooms IT & Wi-Fi enabled Campus Central library with the best collection of books & journals Herbal Garden Separate hostel facilities for Girls & Boys Students Co-Operative store NSS Unit
Hospital Facilities
250 bedded hospital Highly talented and specialized Doctors Specially trained Panchakarma therapist Modern diagnosic centre with X-Ray, ECG,Clinical Lab, Ultra Sound Scanning (USG) Well equipped Ano-Rectal Clinic Physiotherapy and rehabilitation center GMP & ISO 9001-2008 Certified Medicine Manufacturing Unit
Parassinikkadavu Ayurveda Medical College & Hospital Affiliated to Kerala University of Health Sciences and approved by CCIM and Govt. of Kerala
Parassinikkadavu, Kannur, Kerala- 670 563 Ph: 0497 2780250, 781453, Fax: 0497 2783631 Email: pamcayur@gmail.com, www.ayuram.com
pulse/knr
Subject to Ayush / CCIM
COVER STORY Obesity
Childhood obesity is not just a cosmetic problem. Today, more and more children are being diagnosed with diabetes, hypertension and morbid obesity- related diseases.
Causes
Although the causes of childhood obesity are varied, certain factors are considered as major contributors to this disease. Causes of childhood obesity include: • Environment • Lack of physical activity • Hereditary • Dietary patterns • Socioeconomic status
Environment • 24 FUTURE MEDICINE I October 2013
It is estimated that
•
•
more money is spent on food outside home, at restaurants, cafeterias, sporting events, etc. In addition, quantities also increase. When people eat out, they tend to eat a larger quantity of food (calories) than they eat at home. Carbonated soft drinks and juice boxes also greatly contribute to childhood obesity. Children show less interest in overall physical activity. Growing use of computers, increased television-watching and decreased physical
education in schools make children lead a sedentary lifestyle.
Hereditary Studies show that genetics play a role in obesity. It has been proven that children with obese parents are more likely to be obese. Hereditary contributes between 5 and 25 per cent of the risk of obesity. However, genes alone do not always dictate whether a child is overweight or obese. The habits learned from parents are a major contributor.
Courtesy: Dr Ravindran Kumeran and Dr Koshy George
From overweight to
super obese The number of people with overweight is increasing rapidly and lifestyle changes are found to be the main cause of this ‘fatty’ issue By Dr Koshy George Success rate • • • • •
K
Most patients (95-97%) regain most or all of the weight that was lost within 2-5 years following diet or drug treatment. The average amount of weight loss is relatively small – 5 to 10 kg. Drug therapy may be associated with severe complications Very difficult for most people to maintain these programmes in the long term. “Yo-Yo” effect of many different programmes leads to significant weight fluctuations.
erala is fast becoming the diabetes capital of India. Obesity and diabetes are very closely related. A large number of obese diabetics come off insulin and drugs for diabetes once their obesity is resolved. Although there are several scales to quantify obesity, the most commonly used is the body mass index (BMI). • BMI= Weight in kilograms/height in metre2. BMI less than 18 is considered underweight, between 18 and 25 normal. • Between 25 and 30 is considered overweight. • Above 30 is classified as ‘obese’ • Above 40 qualifies as ‘morbid obese’
Prevention
An obese child is most likely to grow up to become an obese adult. Hence, it is most important that preventive measures are made effective in children as well. • Adequate exercise combined with a healthy diet. • A diet low on fat, with plenty of fruits and vegetables, adequate proteins and less direct sugar is ideal. • Bakery products, fast food, aerated sweetened drinks, ice-creams, chocolates, thick soups etc. should be avoided. • Don’t skip breakfasts. The healthy way is to have a heavy breakfast, a working lunch and a light supper. • It is always best to take an early supper (about two hours before going to bed)
(The writer is the Director of Obesity Solution, Kerala) October 2013 I FUTURE MEDICINE 25
COVER STORY Obesity
Surgery,
the best option Medications, diet and exercise can be helpful in losing weight, but surgery is the best option to treat obesity in the long term By Dr Ravindran Kumeran
I
n the 1950s, the Metropolitan Life Insurance Company (US) developed height and weight tables which listed “normal” weight ranges for height and body type. People who fell within the
in losing weight using medical treatments such as diet, exercise and medications, surgery is the treatment of choice and the only treatment that has been proven to be successful in the long term.
the body without being digested.
Advantages of laparoscopy
Five to six small incisions are made to allow the surgeon to place a camera and instruments into the abdomen to complete the surgical procedure. The benefits of using these small incisions are: • Less pain • Quicker recovery and return to normal activity • Fewer complications • Less noticeable scar • Shorter hospital stay
Benefits • • •
“normal ranges” statistically had longer lives and fewer problems with their health. When obesity is so severe that it threatens one’s health and affects the lifespan of an individual, then it is morbid or severe obesity. For some people, it’s a matter of life and death.
Surgery
Surgery has proven to be the most effective method to treat severe obesity. According to the National Institute of Health (US), for the patients who have been unsuccessful
26 FUTURE MEDICINE I October 2013
Different types of surgery
The term bariatric surgery encompasses more than 60 different surgical procedures meant for weight loss. Bariatric surgery as a treatment option for obesity is considered only when the BMI is above 33, especially if he or she is suffering from complications of obesity.
Malabsorptive
A large percentage of the small intestine is “bypassed” leading to poor absorption of the food which is eaten, especially fats. Food passes through
• •
Prevention of debilitating diseases such as arthritis, diabetes and sleep apnea More energy and stamina Improved sense of wellbeing and self-esteem Extended life-span Actually cures medical problems such as diabetes, sleep apnea, high blood pressure, etc.
Ideal age group for surgery
The international guidelines for obesity surgery include patients between 18 and 62 years of age. Women can have a normal pregnancy following obesity surgery.
(The writer is a laparoscopic obesity surgeon and the founder of Obesity Foundation India. He can be contacted at ravindrankumeran@gmail.com)
CELEBRATING SEX
Conjugal Bliss Small, small things which may not be noticed by partners in their married life can make a huge difference in their sexual life. It could be the smell in the bedroom, the type of bedspread or your hygiene- all these and many others can create an ambience for perfect love making. An enjoyable sexual life is what every couple really needs to make their relationship stronger and lasting By R Joseph
28 FUTURE MEDICINE I October 2013
N
eha Aggarwal, a 24-year-old housewife hailing from Gurgaon, has been married for seven months. Her married life with Kunal Aggarwal, an IT professional, was nothing short of blissful. Yet, there is something amiss between the couple – a spark, perhaps one may call it. What could they possibly be doing wrong? The truth lies in the lack of healthy sex. The duo has never seized the opportunity to get intimate with each other. The Neha-Kunal duo is only one amongst a thousand other couples in the nation. In a land where the legendary Kamasutra was conceived, it is an embarrassment that the population shows a diminished libido.
Reality
A recent global survey reveals that Indian men are the least sexually active. Indian men are sexually active less than once a week. One obvious reason for this could be lack of a proper understanding. There are a multitude of subtle aspects that most people tend to miss out when it comes to dealing with sex. Something as vague as creating the right ambience before getting into the act can be an absolute game changer. Good communication between partners is also just equally essential. Verbal communication in the form of soothing words or exchange of new ideas, or simply communicating with each other using just your eyes can escalate the whole affair to an entirely new level.
Know Your Partner’s Needs
How important is it to understand the needs of your partner? It is just as important as fulfilling your very own needs. Rajesh, 28, from Kanpur proudly claims that his only
criterion while engaging in intimacy is an expected level of cleanliness and hygiene from his spouse. What he is quite bluntly forgetting is that his partner also expects the same level of hygiene from him. In every right, this could lead to a lack of interest on his spouse’s part, and there begins Rajesh’s sexually dormant life. Vatsyayana, of Kamasutra fame, depicted in his book that sensually massaging each other is the best way to attain an optimum level of comfort. With a few aromatic candles and scented oils, you have a romantic setting right out of a fairy tale. Once the right ambience is created, the big next step is foreplay. More often than not, people tend to forget its importance. If you play your cards right, foreplay hands you the opportunity to multiply yours and your partner’s levels of satisfaction! Foreplay, however, comes in many different forms. You can choose to be creative and invent your own methods of foreplay, or there is always the option to fall back on traditional techniques. The advantage of exploring new methods on a frequent basis is that it kills the monotony and does not cause you boredom of doing the same thing over and over again. But then, there comes the catch – ensure that your partner enjoys your creativity too! If you end up putting your partner in an uncomfortable state, you might just land back to square one. Hence, as a precaution, take some time out to discuss and understand their priorities and what they are comfortable with.
Verbal communication in the form of soothing words or exchange of new ideas, or simply communicating with each other using just your eyes can escalate the whole affair to an entirely new level
CELEBRATING SEX
Choose your next actions based on what both of you have agreed upon.
Right Position
Choosing the right position depends on a variety of factors such as physique, age, external conditions and stamina levels. While there are several positions to choose from, all of them might not necessarily work out with the desired results. Reading reference materials such as the Kamasutra or other sexual guides may throw open a plethora of options in front of you. It is up to you and your partner to decide and choose wisely from amongst them. So what’s next after opting for the right position? Change. Everybody loves variety. You give a child an icecream, he would love it. But you give him the same ice-cream every day, he would eventually begin to lose the taste for it. The same applies to sex too. You could choose to play safe and go for the traditional positions – the
ones that don’t tax your body much. But if you plan to stick on to the same positions, you might just be headed in the wrong direction. Understanding what position is right for you is a simple problem that has to be dealt with patience. First and foremost, talk to your partner about their priorities and the extent to which they are ready to experiment with the flexibility of their body. In many cases, you might be surprised at what your partner is capable of doing, and perhaps even more surprised at the way you are able to complement whatever they do. An important fact to bear in mind is that at least a minimum level of flexibility on both the partners’ parts is a necessity. Of course, in the current scenario of working days and
sleepless nights, staying fit becomes a tall task. Go on a diet, or better still, find an hour to sneak into the gym and burn all those calories. It may help you in getting rid of that belly and replacing it with well-toned abs.
Cleanliness First
In the movies it may look rather exciting to watch a couple with sweaty palms and smothered in grease stains but in reality, it is far from pleasant. Mind you, perspiration during intimate encounters does not come under this category. A good shower and a splash of cologne could turn your partner on before you even hit the lights! Most acts of intimacy are pleasurable to both the partners only if both of them have gone through the trouble of cleaning up. Cleanliness also applies to what you decide to wear. Undergarments that are not fresh can be more
Once the right ambience is created, the big next step is foreplay. More often than not, people tend to forget its importance. If you play your cards right, foreplay hands you the opportunity to multiply yours and your partner’s levels of satisfaction! 30 FUTURE MEDICINE I October 2013
COLD LASER THERAPY LOUNGE Inner Healing & Healthy Living...!
INDIAN HEALTH CARE EXCELLENCE AWARD WINNING COLD LASER LOUNGES IN BANGALORE & MANGALORE
IT’S A NATURAL & FAST CURE FOR ARTHRITIS CERVICAL PAIN DISC PROLAPSE SPONDYLITIS SCIATICA DIABETIC - NEUROPATHY FROZEN SHOULDER MIGRAINE SINUSITIS VERICOSE VEINS PSORIASIS WEIGHT LOSS / GAIN HAIR LOSS ALOPECIA HERPES SIMPLEX ACNE DARK CIRCLES SAGGING SKIN SCAR PIMPLES DIABETIC FOOT ULCER SUTURES LIGAMENT TEAR STRETCH MARKS SPORTS INJURIES STRESS REDUCTION ANXIETY DISTURBED SLEEP SEXUAL PROBLEMS QUIT ADDICTIONS (DRUGS / ALCOHOL / SMOKING / GUTKA...ETC)
WHY SREE SANJEEVINI COLD LASER LOUNGE? FIRST & BEST COLD LASER LOUNGE IN KARNATAKA ESTD.3 JUNE 2010 THE BEST SUPER PULSED DIODE BASED LASER TECHNOLOGY IN THE WORLD THERALASE IS A RESEARCH BASED ENGINEERING COMPANY-AND CONDUCTS REGULAR RESEARCH AT UNIVERSITY OF TORONTO, UNIVERSITY OF BUFFALO, PRINCESS MARGARET HOSPITAL AND VIRGINIA TECH RD
ISO 13485: 2003 QUALITY MANAGEMENT COMPANY SREE SANJEEVINI SOLUTIONS IS AN AUTHORISED DISTRIBUTOR FOR INDIA DOCTORS / COLD LASER SPECIALISTS SPECIALLY TRAINED IN CANADA & US 90% EFFICACY & SUCCESS FOR CHRONIC PAINS AND QUIT DRUGS / ALCOHOL NO. OF CENTRES IN KARNATAKA: 06
NO. OF DOCTORS / COLD LASER SPECIALISTS: 20 NO. OF MACHINES AVAILABLE FOR TREATMENT: 10 PATIENTS TREATED AS ON DATE: 22636 AWARDS & ACHIEVEMENTS: PRIDE OF INDIA AWARD, RASHTRIYA RATTAN AWARD, INDIAN HEALTH CARE EXCELLENCE AWARD & SHREE RAJIV GANDHI SHIROMANI AWARD NO. OF EMPLOYEES: 60; WOMEN: 80% MEN: 20% PHYSICALLY CHALLENGED EMPLOYEES: 30% NO. OF WOMEN ENTREPRENEURS IN OUR TEAM: 05
BENEFITS OF COLD LASERS
Regeneration of cartilage Restoring the joints & movements Repair & regeneration of cells & tissues Replacement of damaged cells Restoration of blood circulation Removal of pains, pimples, strains, scar & addictions Relaxation & rejuvenation of body, mind & soul Redefining of GOOD HEALTH, naturally
Malleshwarm: 9538022816 / 8884493270 / 080-42288079 Koramangala: 9060465420 / 080-41142201 / 080-40974944 Basavanagudi: 8884493273 / 8884493280 / 080-41207058
Indiranagar: 98453 66244 / 99722 52247 / 080-25252323 JP Nagar: 99013 46636 / 95380 21350 / 88844 93280 Mangalore: 8884493278 / 9900129575 / 8884493280
Approved & Support (R&D) by USA
E-mail: info@sreesanjeevini.com
Web: www.sreesanjeevini.com October 2013 I FUTURE MEDICINE 31
CELEBRATING SEX
repulsive to your partner than you can imagine. Once you have made sure that you are clean in every manner possible, the next step is to check on your surrounding environment. Even if your idea is to ruffle under covers, make sure that the bed spread is neatly laid out. An untidy bed spread may not be practically as exciting as you may imagine. And while you are at it, check your ventilation too – you wouldn’t really want the either of you running out of breath, though metaphorically it sounds great. If you have air conditioning, maintain the room
temperature at a tolerable level, and not too cold. Position your blinds in such a way that streamlines of sunlight waft through the gaps. This could be a great and soothing way to wake up the next morning. The key is to limit the inflow of sunlight– a sun stroke wouldn’t exactly be something you would want after a great night. Now that we have discussed most cleanliness concerns to be taken care of before your sexual encounter, let us now take a look at what needs to be done post the occasion. Most people prefer to break into a slumber right after they are done. Something worth considering after a night of intimacy is a quick shower. Though it may appear harmless, residual fluids in your private parts can cause irritation, and on worse
occasions, infections too. Wash your private areas with utmost care, and attend to the call of nature without any sort of inhibitions – this helps get rid of any sort of bacterial infections in your urinal tract.
Beyond Boundaries
Anandi Murali, a yoga instructor based in Chennai, says, “Every now and then, my husband brings home sex guide videos, and we take time out to watch them. Some of the moves in these videos are hard to master. We are absolutely open to experimentation. It brings both of us to a common level of thinking, which helps us in our sexual lives and otherwise too.” In our country, experimentation with sexual fantasies has come close to somewhat being a household taboo. People often worry that their spouses will have a degraded opinion about them if they open up their minds about their taste for being kinky. What they don’t realise is the importance of sexual experimentation and how it can rekindle the flame in a relationship. Experimentation can appear in many different forms such as the introduction of sex toys while in bed, trying out new positions, role playing and attempting unique forms of foreplay. Work together as a team. Make the whole experience an enjoyable one. Throw in a spice of humour – being able to laugh while getting intimate
Reading reference materials such as the Kamasutra or other sexual guides may throw open a plethora of options in front of you. It is up to you and your partner to decide and choose wisely from amongst them
helps strengthen the bond with your partner. Experimentation is all about thinking outside the instruction manual and being spontaneous.
Bolster Confidence With Hot Drinks
Alcohol has always been known to be a confidence booster to many a great man who would dare not speak otherwise. A common misconception is that the intensity is poisoned if alcohol is introduced into an intimate encounter. The surprising truth is that, in limited amounts, alcohol has been proved to be an aphrodisiac. However, the substance has entirely different effects on the libido of men and women. While alcohol does help men overcome their shyness, its heavy consumption may not exactly work the same wonders in bed. Due to depreciation in the rate of production of testosterone, sexual arousal and pleasure are drastically reduced. This naturally implies that men will have a tougher time attempting to attain an orgasm while intoxicated. Alcohol, however, is friendlier towards the fairer sex. Although the physiological signs of arousal in women are diminished, a drink or two has the potential to increase sexual arousal and desire in women. However, this cannot be counted as an advantage since women’s bodies take longer to process alcohol. Due to this, they are most likely to pass out faster, and if they do, stay in the
10 ways to
have a healthy
sexual life 1. Cleanliness and hygiene 2. A good ambience 3. Discuss and understand interests 4. Interactive foreplay 5. Respect and recognise partner’s interests 6. Find a suitable position 7. Change positions frequently 8. Explore and share new ways to do sex 9. Avoid taking drugs 10. Avoid alcohol
October 2013 I FUTURE MEDICINE 33
CELEBRATING SEX
same condition for a longer period. Apart from the effect on libidos in individuals, alcohol abuse has several other apparently harmful consequences. Too much of alcohol can lead to impotence and also decreased sexual energy in bed. Being sexually involved while under the influence of alcohol could lead to several complications such as unwanted pregnancies and the spread of sexually transmitted diseases. However, the most prominent problem that India faces due to alcohol consumption is the overly aggressive behaviour towards the opposite sex.
The Naked Verdict
To sum it all up, sex should be considered as a celebration of love between a pair of individuals. It is more of an act that strengthens the bond between the two. Instead of treating it as a subject to be discussed behind closed curtains, people must open their minds and think more liberally about sex. Failing to act responsibly could result in several severe consequences such as rapes, and unprotected sex leading to unwanted pregnancy and sexually transmitted diseases. In a country with a vast treasure cove of historical documents, paintings and sculptures related to sex, it would be a shame if we chose to ignore the beauty of the subject in question.
Go on a diet, or better still, find an hour to sneak into the gym and burn all those calories. It may help you in getting rid of that belly and replacing it with well-toned abs
Disease
Special
Heart Cardiovascular disease has been the leading cause of deaths worldwide, especially after the 1970s. Although the disease usually affects older adults, its antecedents, notably atherosclerosis, begin in early life, making primary prevention efforts necessary from childhood 36 FUTURE MEDICINE I October 2013
DISEASE SPECIAL Heart Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
Why deaths from
heart disease
on the rise It is a fact that the prevalence of coronary artery disease in India is higher today than say, 25 years ago. It is mainly responsible for the increase in mortality from heart disease
T
he main cause of the rise in coronary artery disease is increased life expectancy of people in India and especially in Kerala where individuals can expect to live up to 72 years. Remember, this was less than 40 at the time of Independence. The second reason is
By Dr M S Valiathan harmful changes in lifestyle, including lack of physical activity, obesity, smoking and a hectic pace of life.
Advanced treatments
Heart disease in children is congenital while young women and to a lesser extent men suffer from rheumatic heart disease. Older people get high blood pressure and coronary artery disease. All these can be treated and even cured through medical and surgical procedures. These include new drugs to treat high lipid levels in blood, high blood pressure, heart failure etc., and many advanced techniques such as intervention procedures, open heart surgery, heart transplant etc.
Prevention
Congenital heart disease cannot be prevented while rheumatic heart disease can be prevented by treating streptococcal sore throat in schoolchildren, and giving penicillin injections every three weeks to a child who already had an attack of
rheumatic fever. Coronary artery disease can be prevented by low fat, fruit/vegetable rich diet, regular physical activity, avoidance of smoking and maintaining a relaxed attitude to life.
Curable diet
The details of a diet for preventing heart disease should be worked out for each individual by a dietician or a preventive cardiologist. • In general, a healthy diet should be balanced with carbohydrate, protein and fat. • Red meat should be avoided. Diet should contain plenty of green vegetables and fruits. • It is equally important to remember that the habit of eating snacks and fast foods in between meals is an invitation to the development of obesity.
(The writer is National Research Professor, Manipal University)
October 2013 I FUTURE MEDICINE 37
Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
DISEASE SPECIAL Heart
Heart disease:
The main killer
Know the facts and figures regarding the deaths due to different types of heart disease. Both men and women fall prey to the disease almost in equal numbers •
About 600,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths. One-fifth of the deaths in India are from coronary heart disease. By 2020, it will account for one-third of all deaths. Sadly, many of them will be dying
and 7 % in urban areas, and 50 million are estimated to have this disease. Heart attack and stroke account for 30% of total deaths.
Women and heart disease •
•
•
•
•
young. Heart disease is the leading cause of death for both men and women. More than half of the deaths due to heart disease in 2009 were among men. Heart disease in India occurs 10 to 15 years earlier than in the west. Coronary heart disease is the most common type of heart disease, killing more than 385,000 people annually. There are an estimated 45 million patients of coronary artery disease in India. Every year about 715,000 Americans have heart attack. In India, the prevalence of coronary heart disease is 3% in rural
38 FUTURE MEDICINE I October 2013
•
•
Heart disease is the leading cause of death for women in the United States, killing 292,188 women in 2009—that’s 1 in every 4 female deaths. In India, coronary artery disease (CAD) is mostly seen in post menopausal women. Diabetic women get affected at an even younger age. Despite increases in awareness over the past decade, only 54% of women recognise that heart disease is their number one killer. Almost two-thirds (64%) of women who die suddenly of coronary heart disease have no previous symptoms.
Symptoms •
•
Pain in the neck/jaw/ throat or pain in the upper abdomen or back. Sometimes heart disease may be silent and not diagnosed until a woman experiences signs or symptoms of a heart attack, heart failure, an
• • •
arrhythmia, or stroke. Heart attack: Chest pain or discomfort, upper back pain, indigestion, heartburn, nausea/ vomiting, extreme fatigue, upper body discomfort, and shortness of breath. Arrhythmia: Fluttering feelings in the chest (palpitations). Heart failure: Shortness of breath, fatigue, swelling of the feet/ankles/legs/abdomen. Stroke: Sudden weakness, paralysis (inability to move) or numbness of the face/arms/ legs, especially on one side of the body.
Moving is the best medicine. Keeping active and losing
weight are just two of the ways that you can fight osteoarthritis pain. In fact, for every pound you lose, that’s four pounds less pressure on each knee. For information on managing pain, go to fightarthritispain.org.
Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
DISEASE SPECIAL Heart
Of heart attacks
Heart attacks start slowly with mild pain or discomfort. Often people affected aren’t sure what’s wrong and wait too long before getting help. Here are some signs of heart attack •
• •
• • •
Chest discomfort Discomfort in the centre of the chest that lasts more than a few minutes, or that goes away and comes back. Discomfort in other areas Pain or discomfort in one or both arms, the back, neck, jaw or stomach. Shortness of breath With or without chest discomfort. Other signs Breaking out in a cold sweat, nausea or lightheadedness.
Risk factors
High blood pressure, high LDL cholesterol and smoking are key risk factors for heart disease. Several other medical conditions include: • Diabetes • Overweight and obesity • Poor diet • Physical inactivity
40 FUTURE MEDICINE I October 2013
•
Excessive alcohol use
To reduce the risk • • • • • •
Know your blood pressure Check diabetes Quit smoking Healthy food choices. Limit alcohol Lower your stress level
First-aid • • • • • • • •
Try to relax Loosen tight clothes Take medicines Pain subsides within three minutes of medicine intake Give artificial respiration if required Give cardiopulmonary resuscitation (CPR) 15 pumps are followed by two artificial respiration Continue till ambulance/doctor arrives
3,500 heart transplants a year •
•
•
The world’s first adult human heart transplant was performed by Christian Neething Barnard on December 3, 1967 at the Groote Schuur Hospital in Cape Town, South Africa. Adrian Kantrowitz performed the first pediatric heart transplant in the world on December 6, 1967 at Maimonides Hospital in Brooklyn, New York. Worldwide, about 3,500 heart transplants are performed a year with the majority of them in the US (2,000-2,300 annually).
Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
DISEASE SPECIAL Heart
Pediatric
cardiac care By Dr Smita Mishra
P
ediatric cardiac care in India is growing fast. Yet it’s difficult to find the population-based epidemiological studies. We have no data on congenital heart disease (CHD) prevalence at birth or on proportional mortality from CHD. In a hospital-based study, of the 36,541 children examined, 312 were
in all age groups in India (total population about 1.3 billion) suggests that there are about 2.0 to 2.5 million patients of RHD in the country.
Methods of intervention
Many structural heart diseases can be treated with cath intervention. The cardiac lesions commonly known as ‘hole in heart’ can be treated with
In a hospital-based study, of the 36,541 children examined, 312 were identified as having congenital heart defects
First artificial heart
implantation
identified as having congenital heart defects. The 10 % of neonatal mortality in otherwise healthy term babies is attributed to CHD. Acquired heart diseases, including acute rheumatic fever, rheumatic heart diseases, Kawasaki disease, myocardial diseases, and rhythm disorders also affect children below 15 years of age.
Rheumatic heart disease in India
Rheumatic fever (RF) and rheumatic heart disease (RHD) continue to be a major health hazard in India. The overall prevalence estimated to be about 1.5-2/1000
device closure.
Trained professionals
The existing number of trained personnel for pediatric cardiology and pediatric cardiac surgery is inadequate. Above all, there is no national policy on pediatric heart care. Increasing awareness of the problem amongst the pediatricians through CMEs and seminars is necessary.
(The writer is a Senior Consultant, Fortis Escorts Heart Institute, New Delhi)
The world’s first total artificial heart implantation was done by Dr Jeng Wei at Cheng-Hsin General Hospital in the Republic of China (Taiwan) in June 1996. It was received by a 46 years old Taiwanese American, Yao ST. This technologically advanced pneumatic Phoenix-7 Total Artificial Heart was manufactured by a Taiwanese dentist. Kelvin K Cheng, Chinese physician TM Kao and colleagues at the Taiwan TAH Research Centre in Tainan. As of March 2013, Yao is still very well and is currently living in San Francisco, the US. He is the world’s first successful combined heart and kidney transplant patient.
An artificial heart exhibited at the London science museum
October 2013 I FUTURE MEDICINE 41
Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
DISEASE SPECIAL Expert Interview
‘Encourage prevention centres
rather than hospitals’ “My dream is to be able to serve the needy till I die,” says Dr Chris Vijay, President of the Cardio Renal Society of America, in an interview with Future Medicine. Here, Dr Vijay talks about his academic and professional life, and evaluates current cardiology practices in India and America. He chaired the cardiovascular track for the Global Health Summit 2013 By Sumithra Sathyan Let’s start with your academic background. How is your journey so far as a doctor?
My journey as a doctor is interesting. I was lucky to have diverse experience, both culturally and medically. From St Xavier’s College in Mumbai to KMC in Manipal and Mangalore to the postgraduate training in Mumbai and Delhi, I was exposed to different languages and had some amazing colleagues. I did postgraduate training in Oxford region in Kettering, then diabetes and endocrinology training in Southampton . The Master’s degree provided a chance to get into the Cardiology Fellowship Programme in Arizona where I had an exceptional experience that led to my first job as a cardiologist and the director of Heart Failure Programme at Arizona Heart Institute. I learned a lot while on the job at AHI and was asked to step up as the director of research.
What’s been the most important change since you joined the medical profession?
Advancement in technology has been a major change. It is good and bad in many ways. Certainly, it has allowed us to diagnose better, faster and more efficiently. At the same time, these diagnostics come with a big price tag. Is spite of the technological advances, we have not seen significant change in mortality. If anything, the prevalence of chronic diseases is only growing and it looks as if by 2030, a quarter of the population of the world will be more than 65 years of age and will suffer many chronic ailments.
Are you happy with the quality of doctors coming out of the medical colleges in India and the role played by the MCI? I was appalled by a recent article
42 FUTURE MEDICINE I October 2013
published in the Health Affairs journal. This article reports on the quality of care delivered by private and public providers of primary healthcare services in rural and urban India. Correct diagnoses were rare, incorrect treatments were widely prescribed, and adherence to clinical checklists was higher in private than in public clinics. There appears to be an urgent need to measure the quality of healthcare services systematically and to improve the quality of medical education among other policy changes.
What measures should be taken by the government to bridge the gap between the demand and supply of cardiologists?
The healthcare workers can be trained to obtain a certification in cardiodiabetes or noncommunicable disease prevention. Primordial and primary prevention is urgently needed both in rural and urban setting. A low cost insurance plan should be implemented to facilitate patients to seek attention for risk assessment even when they have no symptoms.
How do you evaluate practice of cardiology in India and America?
In many parts of the US, the winds are indeed headed for practices merging with hospitals. An enfeebled economy, combined with declining insurance reimbursements and rising costs, is still driving more cardiologists to engage in conversation with hospitals discussing integration. Insurance coverage for smoking cessation/counseling is being addressed in
legislature in the US. I hope this will happen in India as well. In the US, cardiovascular quality programmes are active, including H2H (Hospital to Home in Heart Failure) and D2B (Door to Balloon Time for acute heart attacks.
What are the major issues of a healthy society in India?
The major challenge for the governments in low income countries such as India is to develop cost-effective strategies to respond to the threat from cardiovascular disease and its risk factors such as hypertension, diabetes, abdominal obesity, smoking, lack of physical exercise and high cholesterol. The medical curricula need to be extensively revised to incorporate these diseases into the main stream.
Your dream and message to society?
Last week, we were in Ladakh on a medical mission helping the needy Tibetan refugees. It brought so much of spiritual happiness that is indescribable. My dream is to be able to serve the needy till I die. I do believe that we can surmount the progression of atherosclerosis and prevent diabetes, heart attacks and strokes. Being nice, being constructive in the problem solving mode and not in problem dwelling mode, being value driven and tolerant and develop a personal sense of righteousness or dharma while serving others at all times would be my message to society that will bring individual peace and social harmony. October 2013 I FUTURE MEDICINE 43
NOW 3 MONTHS
FREE!
Yes, I wouild like to subscribe Future Medicine 1 Year (12 issues)
2 Year (24 issues)
` 600 $ 90
` 1000 $ 180
3 Year (36 issues)
3 MONTHS
` 1500 3 MONTHS $ 280
FREE
FREE
Name Company Name Address
City
State
Pin
E-mail: Payment Enclosed
Bill me later
Future Medicine publishes 12 issues a year I Please allow 4-6 weeks for delivery of your first issue Cheques/ DD to favour: DC Books Pvt Ltd. I Add Rs 40 if the cheque is not at par. I Mail:info@dcmediacorp.com. Post: DC Media, Dc Books Pvt Ltd., 235/C, Adjacent to YMCA, Chittoor Road, Cochin-35, Kerala, India. Ph: 0484 3047405
Wellness Ayurveda is the only medical system in the world that emphasizes the ‘living with Nature’ principle. It also nourishes a treatment combining medication and the recognized lifestyles in harmony with Nature
WELLNESS Ayurveda
Rejuvenate with
Ayurvedic massages Ayurveda is more than a mere healing system. It is a science and an art of appropriate living which increases longevity. Ayurvedic therapies and massages can rejuvenate your body and mind by removing toxins. Here are two massages- Sirovasthi and Shiroabhyangawhich will strengthen your nervous system By FM Bureau
Sirovasthi
Sirovasthi is an ayurvedic treatment giving importance to the head. In this medical process, the medicinal oil is poured onto the head and is kept there for sometime by tying a band or towel around the head. Lukewarm herbal oils are used for shirovasti. The oil is kept on the head for 15-60 minutes, and the treatment will last 7-14 days.
Procedure
Before practising sirovasthi, the patient need to apply warm oil all over the body. It helps rejuvenate the nerve endings and prepares the body for the main treatment. Thereafter, a cylindrical leather cap with a height of 10 inches will be fitted around the patient’s head. A mixture of the lukewarm herbal oils which is prescribed by the physician according to the individual body type is poured into the cap. The oil is kept inside the cap until the oil is discharged through his nose and mouth. In the meantime, palms, shoulders, ears etc. must be made warm by gently rubbing. Later, fresh oil is applied to the head and body and then a bath. The oil used for sirovasthi is a combination of gingerly oil, staff tree, castor oil, ghee, milk and medicated herbs like black gram, winter cherry, bala, bacopa etc.
Benefits • • • • • • • •
Diseases of the eye due to the weakening of nerves Effective against cervical spondylosis Conditions of mental disorder and insanity For facial paralysis Highly recommended for the treatment of head diseases Cures ENT problems Dryness of the scalp and itching on the head Cures headache
Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
Shiroabhyanga
Shirobhangya, the Ayurvedic massage on the head, mainly focuses on rejuvenating the sholders, neck and face. It makes the patient free from stress and tension. It increases concentration and makes your mind stable and also creates a state of calmness, tranquillity and peace. Moordha thaila is the main process in shirobhyanga, in which Ayurvedic oil will be kept on the head for a suitable period. This is a unique method used for relieving mental stress and nervous tension.
Benefits • • • • •
• • • • • • • •
It is a mental and emotional relaxation therapy. Highly helpful for insomnia and schizophrenia. Good for many diseases connected with the head, neck, eyes, ears, nose and throat. Gives firmness to the body by stimulating the nervous system. Highly useful for many diseases of the nervous system like nerve disorder, facial palsy, paralysis and drooping of eyelids. Strengthens the neck and head. Reduces headache and burning sensation of the head. Revitalises the pituitary glands and cools the body. Improves digestion and also the health of the skin. Brings you spiritual awakening and increases intuition. Controls mood swings and depression. Removes worry lines on the face. Quality of voice is improved.
The specialised forms of shiroabhyanga are tailadhara, ksheeradhara, takradhara and jaladhara.
October 2013 I FUTURE MEDICINE 47
WELLNESS Yoga Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
Some yoga postures to
tone your tummy Is your belly fat bothering you or are you uncomfortable in your party wears? Unhealthy lifestyle, indulgence in junk food, lack of exercise, and above all unpredictably high stress levels give rise to a flabby tummy.The wider your abdomen, the higher the level of risk is. And, there are no shortcuts to get rid of the abdominal fat. Proper diet combined with a good fitness routine can definitely help you reduce this fat to a greater level. Here are some yoga postures which will help regain your shape. Yoga not only helps in lessening the abdominal fat but also allows you to control your body and mind thus thwarting the risks associated with a wider abdomen
By FM Bureau
48 FUTURE MEDICINE I October 2013
Marjariasana (Cow cat pose or cat pose) The forceful contraction experienced in the abdominal muscles while holding the posture helps in melting the fat and thus, reducing the belly size. This pose is also beneficial to enhance the flexibility of the spine. • Sit in vajrasana. • Breathing normally, rise from the position and allow your body to come parallel to the floor in such a way that your body rests on your knees and palms. • While knees should be placed beneath your hips, palms go under your shoulders facing the floor. Keep the head straight. Space out the knees slightly so that your weight is spread out evenly. • Taking a deep inhalation, lift your head while pushing your back down so that your body resembles a concave structure. • Expand the abdominal region to the maximum possible
• •
• •
level so as to suck in as much air as possible. Holding the breath, maintain the posture for about 15 to 30 seconds. Exhale deeply and lower the head, while arching your back upwards. Hold the buttocks and abdomen firm until you experience the contraction. Your head should be between your hands. Breathing deeply, hold the pose for about 15 to 30 seconds, working up to 60 to 90 seconds gradually. Exhale and slowly come back to vajrasana. Relax for 15 seconds.
Repeat this pose for 10 times to begin with, working up to 30 times gradually. Relax for 15 seconds after each repetition.
Bhujangasana (Cobra pose) Give your abdomen a good stretch with this yogasana. The regular practice of this pose aids in strengthening the back muscles, and hence, is one of the most advised poses to alleviate post-partum back pain. • Lie down on the mat in prone position, legs slightly spaced out, and toes touching the floor. • Keep the hands on either side of the body, palms facing the floor. • Bring your palms beneath your shoulders. • Taking a deep inhalation slowly lift your chest and head off the floor, your gaze fixed on the ceiling. Tuck in your pubis towards your navel, while holding your buttocks firm. • Hold the position for a period of 15 to 30 seconds, while breathing normally. • Take a deep breath and try to lift your body from the waist upward, bending backward as much as possible. Nevertheless, make sure that you are not hurting your back in the process. • Hold the posture for 30 to 60 seconds, breathing normally. • Exhale and slowly bring your body down – chest, neck, and forehead – to return to the prone position. Stretch your arms slowly to the front. A word of caution: Bend backward only till you experience the stretch on your abdomen, thighs, and backs. Please relax even if you experience a slight pain while stretching. In such cases, you can do just ardha bhujangasana. Repeat this pose for 10 times to begin with, working up to 30 times gradually. Relax for 15 seconds after each repetition.
October 2013 I FUTURE MEDICINE 49
WELLNESS Food
Healthy breakfasts
the most is t s fa k a er, bre eat Rememb kfast. Most of us d ? y a d to oate brea kfast your brea . Never skip your pastries, sugar-c s e v a h u o y Did y to eat the da it make t meal of very day. We tend esity is rampant, n ta r o t for p im ose to ea althy akfast e ociety where ob o e r h b c e u o m y a t s he a the s , but in a eating habits. Wh lth. Here are ‘five s g g e r o r hea e our cereal -examin difference for you r day e r to e s sen ff you a big an kick o t makes s c fa u k o y a e h r b hic ts’ with w breakfas
By FM Bureau
Idlis
A common South Indian breakfast, idlis are made without oil! One idli contains 65 calories. Idlis are low in fat, easily digestible and are a great source of carbohydrates and proteins.
Calories: 137, Fat:0.5g, Carbs:25g, Protein:7.6g
Oat meal
Add your favourite nuts and fruits with a steaming bowl of freshly cooked oatmeal. This is the perfect way to start your day, especially if you are trying to prevent or are currently dealing with heart disease or diabetes. A very good source of manganese and selenium, Oat meal gives you strength and energy to carry on through a hectic morning schedule. In addition, oats are a good source of dietary fibre, magnesium, zinc and phosphorus.
Calories: 150, Fat: 2.5g, Carbs: 27g, Protein: 6g 50 FUTURE MEDICINE I October 2013
Whole-wheat bread sandwich Boiled eggs
One of the simplest, healthiest and easiest of all to prepare, boiled eggs which not only a good source of protein, selenium and riboflavin but also let you stay full for longer, help you in managing your weight (if you are a weight conscious person). Dice it to make it juicy and make an omelette by adding some chopped vegetables, a slice of wheat toast, a slice of low fat cheese, salt, turmeric (a pinch though ) and pepper to make it tasty and spicy and you have your Indian healthy breakfast ready. Check your cholesterol level. If it’s high, then it is best to stay away from yolk.
Calories: 77, Fat: 5.28g, Carbs: 0.56g, Protein: 6.26g
A must for vegetarians, add vegetables like tomato, onion, low fat paneer and cucumber and you are ready to go. Add a pinch of salt and pepper for taste. For nonvegetarians, add some smoked/boiled boneless chicken and mustard sauce or mayonnaise. Wholemeal bread contains B vitamins, vitamin E, fibre and a wide range of minerals. White bread also contains a range of vitamins and minerals, but it has less fibre than wholegrain, wholemeal or brown bread. Whole-wheat is a very good source of dietary fibre, manganese and magnesium.
Curd
Add some chopped bananas and apple to a bowl of curd and you have your healthy breakfast ready in no time. Curd is a delicious and highly nutritious breakfast. Curd helps to improve your digestive system and strengthen the immune system.
Calories: 98, Fat: 4.3g, Carbs:3.4g, Protein 11g
Calories: 70, Fat: 1.0g, Carbs: 12.0g, Protein:3.0g
Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
October 2013 I FUTURE MEDICINE 51
BEAUTY CARE
N
ice buttock:
ot too big, ot too small
Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
Food
F
Do exercise and take healthy diet before you want others to give a good look at your beautiful round buttock
emale buttocks have been a sign of fertility and exquisiteness since early human history. Is there anyone who doesn’t long for a buttock like, Jennifer Lopez, Halle Berry, Lara Dutta or Malaika Arora Khan? The majority of women would give a yes to the question. You have to really work better to sculpt your butt. Healthy diet, exercises and yoga are the ways to get a better booty.
Eat food with low fats
Yes, people who want to reduce the size of their caboose should avoid food with high fat content. A healthy low fat diet and proper workout will help you to tone and restructure your muscles and achieve the look you are longing for.
Your diet should include • • •
Complex carbohydrates like whole grain bread and sweet potatoes Fresh fruit and vegetables Fish, chicken, egg whites, cottage cheese and low-fat protein shakes
What to avoid? • • • •
Bad fats Fried foods High oil sauces Remove the skin from your meat
BEAUTY CARE Exercise
For
Perfect butt By FM Bureau
Some simple exercises which you can do at home will give your buttocks perfect, attractive shape. It is not necessary that you do these exercises every day, 3-5 days a week can make the difference
Stand with feet parallel and shoulder-width apart. Slowly lower your hips, making sure not to let your knees go past your toes. A great variation for beginners is ball squats: Standing with your back to a wall, put an exercise ball between your low back and the wall, then squat, keeping your feet out in front on you.
Standing lunges
Beginning with your feet parallel and hip-distance apart, take one giant step forward. Slowly, lower your body, bending both knees. Bend your knees no farther than 90 degrees, keeping your front knee aligned over your front ankle. Then repeat with the other leg in front. A more advanced version is stepping lunges, in which you move forward after each lunge, alternating legs. But Roget believes most people don’t use proper form on this exercise, which can put undue stress on knee joints and low backs.
Prone leg lifts over a ball Courtesy: webmd.com
Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
Squats
Lie stomach-down on an exercise ball with hands on the floor. By tightening your glute muscles, lift one of your legs slightly off the floor, keeping leg straight. Then alternate sides. As you get more fit, try lifting both legs simultaneously but only if you can
do it without straining your back.
Prone hip lift over a ball
Lying stomach-down over an exercise ball, rest your forearms on the floor and stabilise the ball under your hips and tops of your thighs. Using the arms and trunk muscles as support, bend your knees to 90 degrees, and put your feet together. Squeezing your glutes, slowly move your thighbones slightly away from the ball, being careful not to use the low back muscles. This is a very small move -- you should raise your legs no more than about two inches off the ball.
Bridge
Lie on your back with knees bent, feet on the floor and hip-width apart. Slowly peel your spine off the floor from the bottom, one vertebra at a time, tightening the glutes and hamstrings (backs of the thighs) until you’ve created a diagonal line from your shoulders to your knees. Return to the floor slowly with one vertebra at a time.
Side leg raises
Lying on your side at the rear edge of a mat, place your feet at the front edge of your mat, then lift your upper leg and turn it out it in the hip socket. Keeping your hips stacked and your torso as still as possible, lift and lower the leg, reaching out from the top of the thigh. Repeat on the other side. October 2013 I FUTURE MEDICINE 53
BEAUTY CARE
s t t u b s for
Dress
e h t o l ight c
R
The first and foremost rule you have to follow while shopping for yourself is that know your body type and buy the right kind of clothes. Here are some dressing tips to beautify your booty
•
• •
• •
Cargo pants and Bermuda shorts make the butt look larger. Pants and jeans that have big pockets in the back will help to give an impression that you have a bigger butt. Choose more of light blue denims than darker blue ones. Fabrics like velvet, corduroy, suede, faux leather give the illusion of “more” when worn, so buy trousers/pants/capris/shorts/skirts or any other lowers in these materials. They will help your booty look big. Wear pants or skirts that have big and bold prints and checks because it adds volume. Jodhpur cut pants and high waist jeans will also help a lot in looking your butt big
Those who have small butts try to avoid short tops with tight jeans. If possible, hide your butt with longer tops or shirts.
Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
Make your butt look bigger
AGAINST THE ODDS Subhasini Mistry Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
The woman who dared to
dream big
Subhasini Mistry with Delhi Chief Minister Sheila Dixit
A young widow with four small children, Subhasini Mistry in the midst of poverty took a path that no one dared to tread. She toiled for years as vegetable vendor, manual labourer and domestic help to fulfill her dream of building a hospital in her village. She is now a happy woman after having taken reins and defined her own destiny By Neethu Mohan
56 FUTURE MEDICINE I October 2013
O
n April 13, 1971, Sadhan Chandra Mistry, aged 35 years, a vegetable vendor in the murky village of Hanspukur, District South 24-Parganas, West Bengal, died in poverty, of a minor ailment which was curable, but he did not get any medical help. The poor man left behind his young, illiterate wife Subhasini, two sons and two daughters. After his death, the family plunged into abject poverty and Subhasini was forced out of her home within a month of her husband’s death to sell vegetables in the hamlet market. That day, when she sat under the scorching sun selling vegetables and worrying about her children, she took a vow that one day she will build a hospital in the village so that no poor villager would die for want of medical attention. The other vendors in the market and those who heard of her vow just laughed at and made fun of her. How can she build a hospital when she cannot even mend her own thatched hut? They booed. “Plus she has to feed a family of five, all humbug and pure day dreaming,” they said. “She have lost her mind” was the conclusion made by the village elders. For 20 years, day in and out, Subhasini went on selling vegetables silently, looking after her children and never allowing the fire in her frail body to die down even for a moment. She worked as a domestic help, a brick layer, and a vegetable vendor. Her elder children helped her out in various chores while her younger son Ajoy studied well with the support of community workers and neighbours. “I did everything. My children used to earn Rs 1 while I used to get Rs 1.25 per day. I never spent on myself. I saved most of my earning,” she says. With her savings over 20 years that was around Rs 1 lakh, she bought a plot of land (approx 1,600 sq. yd.) at her village Hanspukur. One of the Babus (landlords) was selling off his land. “I went to him and fell at his feet to let me buy the plot for a lesser amount. He relented, and finally a part of my dream came true,” she says. Subhasini went around asking people to contribute in whatever way they could. Some donated money, others supplied wood and the materials needed for
construction and many volunteered for the construction work. Ajoy worked hard and went around seeking help from friends, well-wishers and any person/ organisation he had access to and could raise Rs 50,000 for his mother’s mission. Firstly, a one-room hut clinic came into being and at Mistry’s behest, three doctors from nearby areas started treating the sick free of cost. Week after week, when poor patients got medical attention from this lone clinic in the region, Subhasini became the most popular household name in her village. Her fellow vendors and all others started respecting her. That was enough of a support for her. In the meantime, her children grew up. The daughters were married off. The eldest son chose to be an agricultural labourer. Ajoy was identified by Subhasini to carry on her mission. He successfully completed his secondary education and passed the All India Medical Entrance Test. Aided by the German scholarship, he joined Calcutta Medical College where he completed his medical course. In 1993, Ajoy Mistry formed the Trust Deed of Humanity trust with his mother Subhasini Mistry as the Founder Trustee, and he as the Managing Trustee. On February 5, 1995, the foundation stone for a hospital was laid and on March 9, 1996, the hospital was inaugurated. Within a year, the Trust could raise 10 times the initial money to complete the first structure of the hospital. Soon, more donations followed and today, Subhasini Mistry can say with pride that she has fulfilled her pledge made to her husband two and half decades ago. For its dedicated services to the rural poor in Hanspukur as well as Sunderbans, Subhasini Mistry and Humanity Trust have been honoured with many prestigious awards, including the Paul Harris Fellow by the Rotary International in 1996, Service Above Self by Rotary International in 2005, Real Heroes by CNN-IBN in 2009, Swami Vivekananda Award in 2012, etc. However, Subhasini and Dr Ajoy are not moved by these awards. They feel that their real award is the opportunity to serve lakhs of people who desperately need their help.
Humanity Hospital during initial days
October 2013 I FUTURE MEDICINE 57
Brain Death
Brain death determination
Dr M Pradeep MD, DM
Neurosonology USA, FINR (Switzerland) Senior consultant and Interventional neurologist
Brain-dead patients are insensitive to sensory stimuli. The application of bright light, loud noises and noxious stimuli are entirely without response. Motor posturing cannot be evoked. Deep tendon limb reflexes are usually absent but may be retained. Because deep tendon limb reflexes are integrated purely at spinal cord level, their presence or absence is not directly relevant to brain functioning.
Apnea
B
rain death is a commonly accepted name for human death determined by tests showing the irreversible cessation of the clinical functions of the brain. A consensus has evolved in most western countries and in many other parts of the world that a person whose brain’s clinical functions have permanently ceased is medically and legally dead, irrespective of the presence of artificially supported respiration and maintained systemic circulation. The prevalence of brain death practice is expanding internationally. The World Federation of Neurology Ethics Committee has proposed an attempt to standardise brain death determination throughout the world. A similar international effort sponsored by the World Health Organisation is underway. The concept of whole ‘brain
58 FUTURE MEDICINE I October 2013
death’ embodies the most useful and widely accepted criterion of death. The ‘whole brain’ criterion of death requires that the clinical functions of all portions of the brain, including the brainstem, must have ceased irreversibly. The cardinal diagnostic criteria for brain death are: a) Profound coma, with total unresponsiveness, b) apnea despite induced hypercapnia, c) absence of all reflexes subserved by the brain stem and cranial nerves, d) presence of a structural brain lesion sufficient to produce the clinical findings and e) irreversibility by excluding potentially reversible metabolic and toxic factors.
Coma and unresponsiveness
The coma of brain death is the deepest coma possible. Patients make no spontaneous movements and lie absolutely motionless and flaccid when not being ventilated.
Apnea is cardinal sign of brain death. Merely turning off the ventilator for a few minutes and observing the absence of respiratory effort is an inadequate test for apnea. Such a test is inadequate because in all patients, except in those with chronic lung diseases who chronically retain Co2, hypercapnia, not hypoxemia, is the primary stimulus to breathe.
Brainstem areflexia
Areflexia of those reflexes sub-served by the cranial nerves must be present for brain death to be determined. There can be no pupillary light or dark reflexes, vestibuloocular reflexes, corneal reflexes, gag reflexes or cough reflexes. The absence of these reflexes must be ascertained accurately.
Irreversibility
A pre-requisite for brain death determination is that significant levels of CNS – depressing drugs and neuromuscular blocking agents must be absent and that the patient is not severely hypothermic. These pharmaceutical agents as well as hypothermia can induce a set of clinical findings similar to those seen in brain death, yet be potentially reversible with supportive treatment.
Causes of brain death
In adults, brain death is caused most commonly by massive head trauma, hypoxic – ischemic neuronal damage suffered during
Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
cardio pulmonary arrest, and massive intracranial hemorrhage. In children, brain death is commonly produced by traumatic brain injury, bacterial meningitis, asphyxia and drowning.
Pathogenesis
In the pathogenesis of brain death, the first phase consists of the primary brain insult such as traumatic brain injury or diffuse neuronal infarction caused by cardio pulmonary arrest. The edema produced by the primary insult raises intracranial pressure to a level greater than that of mean arterial blood pressure. At this point, intracranial blood flow ceases and cerebral herniation usually occurs. During the second phase, the remainder of cerebral hemispheric, cerebellar and particularly brain stem neurons not killed during the primary phase are killed as a result of complete cessation of intracranial blood flow.
Diagnostic work up
Confirmatory laboratory tests may be useful to supplement the clinical examination in four situations a) when an adequate clinical examination cannot be performed,
such as in states of trauma when the eyes, tympanic membranes, or lungs have been damaged; b) when organ transplantation is being entertained, and a more rapid brain death determination is desirable to facilitate organ retrieval c) In medico legal circumstances in which the clinician wishes to have “objective” evidence to submit in addition to his own bedside examination findings and d) when a relatively inexperienced examiner is declaring brain death. The patient is declared dead following the brain death tests. If an organ donor, the patient should be reattached to the ventilator until the procurement of organs is complete. If not a donor, the patient should not be reattached to the ventilator following the second apnea test.
technical problems of maintaining physiological functions in the absence of clinical brain functions.
Key points •
•
•
•
Pregnancy
Several cases have been reported of brain-dead pregnant women whose heart beat and circulation were maintained temporarily to permit the birth of a healthy fetus. These cases raise interesting ethical and legal problems of whether the continued therapy is justified, as well challenging
•
Brain death is human death determined by establishing the irreversible cessation of all clinical functions of brain. Brain death is the legal standard for human death throughout the western world and much of the developing world. The essential criteria for brain death are complete unresponsiveness, brainstem areflexia, apnea, and irreversibility. Tests showing the absence of intracranial circulation can confirm brain death in cases in which examiners are inexperienced or the complete examination cannot be performed. The brain dead patient is the ideal multi-organ donor, and families of brain dead patients should be offered the opportunity for organ donation.
The concept of whole ‘brain death’ embodies the most useful and widely accepted criterion of death. The ‘whole brain’ criterion of death requires that the clinical functions of all portions of the brain, including the brainstem, must have ceased irreversibly
October 2013 I FUTURE MEDICINE 59
Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
HEALTHY FOOD
Organic farming:
Benefits are many and long-term Occupying the second position in the world, India has about 44, 926 certified organic farms producing around 5,85,970 mt of organic products worth $6.8 million a year
conventional farms, the lower yields are compensated by lower input costs and higher margins. According to recent statistics from Federation of Organic Agriculture Movements (FOAM), organic farming is practised in more than 150 countries and growing at a rate of 20%. The new trend of shifting to organic farming has merged following the harmful effects of the current green revolution practices that include high usage of chemical fertilisers, indiscriminate use of hazardous plant protection chemicals, hormones, pollution and contamination of water bodies.
Objectives •
By Dr K Raman
I
n India, the concept of organic farming is not new. It existed in the ancient time at village levels and the villagers had excellent knowledge of not only traditional farming methods but also information on how to make use of the benefits of different herbs and other plant-based products eg. neem, turmeric, sandal, tulsi etc. Presently, India occupies the second position in the world with about 44, 926 certified organic farms and producing around 5,85,970 mt of organic products worth $6.8 million a year. Markets of organic products are growing steadily in Europe, America, South America and Australia. Though the yields from organically managed farms are on an average 10-15% less than
60 FUTURE MEDICINE I October 2013
•
•
• •
Production of high quality food in sufficient quantity in harmony with natural systems and cycles Enhancing biological cycles within the farming system involving microorganisms, soil flora and fauna, plants and animals Maintaining long-term soil fertility and genetic diversity of the production system and its surroundings, including plant and wildlife Promoting healthy use with proper care of water resources and all wildlife Creating a balance between crops production and animal husbandry
How it works •
The use of natural remedies (without causing any harm to people and environment), such as minimum soil disturbances eg. Zero-tillage concept, use
•
of recycled composted crop and animal wastes (eg. cow dung, cow’s urine) Other organic natural manure/ mixtures (eg. neem cake, castor cake) and incorporation of green leaf manures (eg. legumes, crop rotation practices etc.) for the betterment of soil and crop productivity.
Benefits
Organic farming provides long-term benefits to people and environment such as: • Improvement of soil fertility and productivity in a sustainable manner • Improves soil biological activity and maintain high levels of organic matter in soil • Maintain optimum soil pH, Carbon/Nitrogen ratio, and Cation exchange capacity (CEC) • Improves the water-holding capacity of soil • Helps in recycling the natural resources available with farmers resulting in long-term savings • Checks incidences of pests, diseases, and weeds by enhancing multiplication of natural predators and parasites • Promote crop diversity for sustainable agricultural practices
Decentralisation •
•
• •
• •
Encourage decentralisation of distribution of organic-based manures, organic mixtures, bio-fertilisers, and other organic soil conditioners at subsidized rates Education and training at farmer level for creating awareness about improved techniques of `vermin composting’, composting, and recycling of farm wastes eg. cow dung, cows’ urine etc. Promote collection of animal waste, urine and setting-up of bio-gas plant at farm level Promote organic farming practices in `dry land’ areas and also cover a diverse variety of crops such as rice, wheat, cereals, basmati rice, pulses, oil seeds, coconut, oil palm, medicinal plants etc. rather than confining only to plantation crops such as tea, coffee, pepper, vanilla etc. Encouraging sale in domestic markets, rather than concentrating on export markets Introduction of special farm level schemes for promotion of `crop diversification’ and `mixed farming practices’.
(The writer is General Manager, Godrej Agrovet)
Parameters
Farm yard Vermimanure(FYM) compost
Composted Organic manure poultry mixture(Vikas) manure mpost
Organic Carbon %
12.20
30.00
27.43
30 - 40
Total Nitrogen %
0.55
1.92
0.60
4-5
Total Phosphrous %
0.75
1.35
1.34
0.75 -1.25
Total Potash %
1.80
1.55
0.40
0.40 -0.75
pH
7.2
7.1
7.4
6.5 – 7.0
24.40
16.00
45.70
C/N Ratio
8 - 11
THE INTERVIEW Dr Hayder Al Zubaidy
‘Dubai will become
medical hub of Middle East’ With the booming economy, the healthcare sector in Dubai is all set to transform into the medical hub of the Middle East. In an Interview with Future Medicine, Dr Hayder Al Zubaidy, CEO, Canadian Specialist Hospital, talks about the potential of the healthcare sector of the country and the future plans of CSH By Prashob K P
The UAE economy is booming. How is it linked to the healthcare sector?
The economy is booming and the healthcare sector has its share in the growth. Look at the market 10 years back and look at the market today. There is 100 per cent growth in the case of hospitals. We have the privilege of big groups joining this market and investors from outside. We have the support from the government. I think the healthcare sector is booming with the economy. For example, you can see every hospital in Dubai starting at least one
62 FUTURE MEDICINE I October 2013
more project somewhere in Dubai which indicates success and growth of their business.
How can Canadian Specialist Hospital find a unique place in this market? There is a big competition in the healthcare market. But usually, healthcare is not much concerned with the financial profit. In the end of the day, we value the services provided to patients, the mortality rate, the morbidity rate, availability of the specialties and the number of beds occupancy. You have to prove yourself as a quality provider in the
market.
Healthcare provider has to address the needs of all strata of society. How can you provide quality healthcare at affordable rates? This is very critical especially for the healthcare market. You know the cost of running a healthcare institution in Dubai. It is very hard to run a hospital by providing quality healthcare at affordable rates. Compared to other international markets, healthcare cost is much less here.
New lifestyle increases diseases like obesity, diabetes etc. What are the steps taken by CSH on preventative medicine?
I have already mentioned that we are competing by quality. Since we are not a profitable organisation and are considering values, it is our policy to make a health conscious society. Two years back, we started a
project called ‘Health is your performance’ and we visited each and every government organisation and conducted free health checkups. We also provided lectures and medical advice depending on the needs of the organisation.
Dubai Expo 2020 is around the corner. Are you expecting much benefits from this expo for healthcare organisations?
As I said that we are a part of the economy. So, whatever growth Dubai achieves, the healthcare sector will have its share in it.
What are the prime challenges faced by the private healthcare sector in UAE?
Success is a long process and we had to face many difficulties before reaching this position. Our healthcare system has not matured yet. For instance, the insurance schemes are yet to take off in the company.
Do you have any expansion plans?
The owner of the hospital loves to serve his country. He directs us to raise the graph of healthcare services to society. Every year, he gives us some highlights and guides us to serve the people with quality care. At present, we have a project in Dubai that will be one of the biggest healthcare projects in the Middle East. It may take at least five years to complete the project.
As a major player in the healthcare sector, how can Dubai develop as the healthcare hub of the Middle East?
Dubai is the hub of Middle East. Emerging as a hub in the healthcare sector is really a challenge. Health issues can occur in every nook and corner of the country and the healthcare sector has to meet their needs. For this, all public networks should be connected because it’s a country project and it’s not a hospital project. Sheikh Mohammed Bin Rashid Al Maktoum has emphasised that Dubai should be the hub for medical tourism. Looking that we have been telling at various conferences across the world that Dubai is able to become the medical tourism hub.
Canadian Specialist Hospital Canadian Specialist Hospital (CSH) is the largest private acute-care tertiary healthcare provider in Dubai. It is strategically located in Deira near Dubai International Airport, between Dubai Police Headquarters and Dubai Hospital, with ideal proximity for patients in Dubai and from Northern Emirates. Because of the facilities like 24-hour emergency and ambulance services backed by highly sophisticated diagnostics and pharmacy, CSH is the most preferred hospital by wellknown physicians in and out of Dubai. The nine-storey hospital with 200 beds has six operation theatres and stateof-the-art critical and high dependency units (ICU/CCU/NICU) that are supported by highly professional and experienced staff. The Ambulatory Clinics offer multispecialties and an ambience suitable for patients and visitors. Additionally, advanced services such as rehabilitation and dialysis facilitate an array of treatments under one roof, making CSH the ideal healthcare destination in Dubai.
October 2013 I FUTURE MEDICINE 63
FOCUS Al Shifa Hospital
A House of Cure A common man’s hospital, Al Shifa with 350 beds and 25 specialties has become the pride of Perinthalmanna in a short period. Advanced facilities for treatments, particularly knee replacement surgery, were made available at moderate rates in the hospital By FM Bureau
I P Unneen, Chairman&Managing Director
64 FUTURE MEDICINE I October 2013
n every sense, it is a house of cure that is what the name Al Shifa means in Arabic. The name gets more glitter as the hospital located at Ooty Road in Perinthalmanna has been providing treatments at affordable rates. The hospital which began as a tertiary level referral hospital with just 75 beds today has 350 beds and 25 specialties. Now it plans to increase total bed capacity to 550 by the end of 2013 with the functioning of the annex building with 200 beds. The hospital was started in1989 by P Unneen who was working in the Gulf
as an engineer. He thought that there was a need for a specialty hospital in Perinthalmanna and took initiative to start the hospital with support from a group of people. Today, Al Shifa is considered one of the best orthopaedic centres in the state. Headed by Dr EG Mohan Kumar, MS (Ortho), MCh (Ortho), the orthopaedic and trauma care department of the hospital has been providing treatment for many orthopaedic patients. “Our orthopaedic department is one of the biggest in the state with 16 orthopaedic surgeons in
three units and numerous DNB graduates. Even accident cases from the Gulf are referred to the hospital,” says Unneen, Chairman and Managing Director. Al Shifa Hospital was the first hospital to introduce computer navigated surgeries for joint replacement in the state. The medical specialties at Al Shifa include cardiology, neurology, nephrology,
gastroenterology, general medicine, paediatric medicine, pulmonology, dermatology, radiology and neuropsychiatry. Neurosurgery, urology and andrology, orthopaedic, trauma care, micro vascular surgery, obstetrics and gynaecology, ophthalmological microsurgery and anesthesiology are the surgical specialties offered at Al Shifa. Only a few
hospitals in Kerala have the arthroscopy and sports medicine departments which treat sports injuries and injuries in the joints. Led by Dr Abdulla Khaleel who holds a Fellow in knee surgery and arthroscopy from Lyon in France, the department has already created a space of its own in a short period. It is also one of the few FIFA recognised centres in the world.
courses like B Pharm, M Pharm and D Pharm, B Sc Nursing, MSc Nursing, Post basic B Sc Nursing and General nursing. The paramedical college offers B Sc MLT (Medical Laboratory Technology), DMLT, DOTT (Diploma in Operation Theatre and Anastasia Technology), DRT (Radiological Technology) and the newly introduced B Sc Optometry.
Corporate Social Responsibility
Expansion
Al Shifa Hospital is an approved centre for cochlear implantation in the state. Shifa Charitable Trust spends annually almost Rs 60 lakh for the poor patients through medical camps and free treatments. “We usually provide free treatment to around 15 per cent of patients who attend the camps. An ophthalmology camp was conducted recently in which we provided free treatment to 25 out of 225 patients and for the rest we provided treatments at concessional rates,” says Unneen. “The Kidney Foundation functioning within the hospital provides dialysis for Rs 250 which, I think, is the lowest in the state. The hospital is a recognised centre for kidney transplantation,” he adds.
Shifa Medical Trust
The Trust conducts DNB course in orthopaedic and general medicine. For the first time in Kerala, it introduced a six-year course- Pharm D- in 2010. It also conducts
The new block at Al Shifa which will commence operation by 2013-end is equipped with most modern facilities to provide cardio thoracic and cardio vascular surgeries, interventional radiology, interventional neurology, plastic surgery and MRI scan. The block which boasts of international standards will mainly cater to the patients from the Middle East. “With the completion of the annex building, we will have all types of medical investigations. Plans are there for expanding the medical tourism department. In a month, we receive around 30-35 foreigners. Last year, we had around 400 foreigners, mostly from the Gulf and African nations,” says Unneen. Al Shifa is an ISO 14001–2004, 9001– 2008 certified echo-friendly hospital and has received awards for the best waste treatment plant twice from the state pollution control board. It is also expecting NABH accreditation by this year-end. October 2013 I FUTURE MEDICINE 65
SEXUAL HEALTH
Make yourself an
intimacy expert
LESLEY STEDMON Sexual health educator, Canada
Nourish intimate relationships instead of remaining disconnected in the life. Avoidance of intimate relationships has become a norm in the modern society for the sake of familial responsibilities and official duties. In the long run what awaits you is the collateral damage in the family devoid of emotions
T
he facts that how fruitful you are today and how connected you are now depend on how your life was, say about 20 years ago. You are firmly rooted to the past. You have to consider yourself as an intimacy expert as you evolve through the life. Your intimate relationships will flourish only if you nurture them like a sapling is nurtured with enough water and manure. How you sexually and sensually interact and express yourself in the world depend on this nourishment. Let me share a gardening analogy:
66 FUTURE MEDICINE I October 2013
A tree is only as strong as its roots. It may look perfectly healthy and sturdy from the outside but you need to look deeper. Has this tree been tended since it was a small sapling? Was it given plenty of water and fertilized regularly to grow strong sturdy roots? Was it maintained and pruned so that succulent fruit would grow on new, strong wood or is the fruit shiny but dry and bitter below the surface? Succulent fruit will not appear if the roots and soil are not nurtured. Disconnection from intimacy
becomes the new normal and is a false sense of safety. The avoidance of intimate relationships will surely rear its head one day and will make sure it is noticed. In terms of physical affection in your relationship at this point, there is little, if any, kissing and it feels like the needs of family come before your relationship. So virtually, intimate relationships took a backseat. Such a situation will prove to be detrimental to familial relations in the long run. For instance, a fire that is not fed and nourished with what it needs to thrive
Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
will ultimately burn out and become cold.
The hormonal connection
During the first 18 months of a relationship, the main hormone released in the body is dopamine which is the pleasure chemical, producing a feeling of bliss and giddiness. It is primarily responsible for us wanting to spend all our time with a new partner, the butterflies that come with a new romance. I like to call this the fireworks phase. We find ourselves head over heels in love and very aroused, having lots of great wake the neighbours and peel me off the ceiling sex. After the dopamine high wears off, primary circulating hormone oxytocin is produced through intimate connection. Oxytocin plays many roles like bonding, creating and cementing secure attachment between those who mean a lot to us. Oxytocin is the glue that keeps the embers burning in a love relationship. It is about nurturing, connecting, a deeper emotional intimacy and being able to read the other person without saying a word. By neglecting the embers, we reinforce disconnection and a false sense of fulfillment by filling our physical spaces with external things and material items. The reward of stoking the embers of your love relationship is the safety and reconnection that comes from being emotionally close with a partner and practising intimacy.
Women need intimacy
Men are very visually stimulated whereas most women need the intimacy and sensual connection before we can even consider any form of sexual activity. As our relationships grow, so we do. We become intimacy experts, able to read our lovers and able to meet our need for connection and growth. Emotional closeness allows you to be vulnerable where tremendous growth happens. We will be willing to be a role model for our partners. We will only know true intimate connection if we nurture the gift of our relationship and let it grow with us.
Easy steps you can take to tend your relationship embers: 1. 2. 3. 4.
Spend time with your partner every week to connect away from work, obligations and children. Reserve time together to share successes, what worked for you and what you would like to see more of. Be courageous Enhance your oxytocin levels by genuinely complimenting your partner.
Qa &
Dr Prameela Joji
Sr. Consultant Department of Pediatrics KIMS Hospital, Trivandrum
Pediatric Health
Food refusal I have an 18 months old baby. He suddenly started to refuse all milk drinks for no obvious reason. Should I be concerned? Poornima, Delhi Poornima, you need not worry much. Some kids have the habit of refusing milk drinks as such. Don’t force your baby to take milk for the time being. But at the same time the baby needs enough calcium. So try to give other milk products like yoghurt, buttermilk etc. Did you try ice creams? I am sure that baby wont reject ice creams and later gradually you can give milk drinks with different flavours added. Do food addictions in children cause hyperactivity? Shiji Kumar, Itanagar The cause of ADHD (attention deficit hyperactivity disorder) is unknown,but excessive sugar intake may have an underlying role in ADHD. The bad sugar is the
68 FUTURE MEDICINE I October 2013
refined sugar in cookies, candy and soda. When you consume refined sugar, the effect is immediate, your brain gets flooded with glucose and serotonin is released. Serotonin makes you feel happy.When you eat too much sugar over time you can have problems with processing information, memory, depression and anxiety. Do young children need multivitamins? Pavithra Ravi, Kannur Of course, young children need multivitamins. But it is not mandatory to give multivitamin syrups. Instead make sure that kids take adequate fruits,vegetables,nuts,dried fruits etc. All these are rich sources of vitamins and minerals. How can I get my three-year-old son to eat healthy ? Vahitha Rahman, Malappuram
Your son has already developed likes and dislikes to particular foods. He should be eating whatever that is prepared for the family. Family pot feeding has to be achieved for one year of age. Make sure that his daily food has all colours in it-green, yellow,orange etc.That means he should take adequate colourful vegetables and fruits. Go by the food pyramidless of fat, sugars and oils, little bit of meat and fish and lots of cereals, pulses,vegetable and fruits. My personal mantra for healthy eating is encourage kids to eat at home than out,tell them when you cook, you add a tablespoon of love also to food which is special for them.
Send queries: editorial @ futuremedicineonline.com.
Qa &
Dr Meenakshi T Sahu Sr. Consultant Dept of Obstetrics and Gynecology Fortis la Femme Hospital, New Delhi
Women’s Health
Menopause I’m a 40 years old housewife. These days, I get severe headache and have mood changes. Is it because I’m in menopause? What really happens in menopause? How do I know menopause? Thumpa, Kolkata
This could be because of Perimenopausal transition phase. There is gradual depletion of eggs in ovaries which eventually leads to cessation of menstruation, the sign of menopause. Menopause is accompanied by hormonal changes. The diagnosis can only be made retrospectively after a minimum of one year amenorrhea i.e. no menstruation. Let me know whether menopause causes any changes in women’s voice? Harishree Balan, Kochi Various body tissues including vocal cords rely on the presence of the hormone estrogen to stay healthy. At and after menopause, voice
changes like throat dryness, frequent throat clearing, lower voice frequency level and increase roughness and hoarseness occur.Voice therapy helps to some extent. Is it true that facial hair develops as a result of menopause? What are the methods to remove facial hair and would it damage the skin? Sheena, Chennai The hormonal imbalance at the time of menopause leads to unwanted facial hair. Androgens are male hormones which are suppressed by the female sex hormones, estrogen and progesterone prior to menopause. At the time of menopause, due to female hormone disruption, the testosterone is not suppressed, resulting in an excess of androgens, which in turn can cause the unwanted facial hair growth. For hair removal, one can go for temporary methods like threading, waxing or
bleaching. Permanent method includes laser treatment etc. Skin becomes dry at the time of menopause, proper care in term of diet and hydration is must. One can apply moisturizer to prevent dry skin. Is there any treatment for menopause symptoms? Maihuda Ahmmed, Kozhikode Alternate treatment for menopausal symptoms includes life style measures like calcium rich diet and exercise. Phytoestrogens, soy, red cloves, black cohosh, evening primrose oil and vitamins with minerals are often given to menopausal women. Acupuncture, Reflexology aim to relieve stress or treat health conditions through the application of pressure to specific points.
Send queries: editorial @ futuremedicineonline.com. October 2013 I FUTURE MEDICINE 69
Qa &
Dr Mahesh Kandasamy Research Scientist Department of Psychiatry NIMHANS,Bengaluru
Mental Health
Intelligence Quotient What is Intelligence Quotient (IQ)? How can we test one’s IQ? Swetha, Mumbai
Intelligence Quotient is a test score derived from a set of highly standardised scientificlogical methods developed to judge our cognitive capacity according to the age group in a given time frame. The test scale challenges and interprets the capability of our language skills, attention, screening ability, conceptualisation, three dimension recognition, creativity, planning, logic, problem solving ability, decision-making, learning and memory. The quotient is the ratio between mental age and chronological age multiplied by 100 (Intelligence Quotient (IQ)=Mental Age/Chronological Age X 100). Initially, the psychometrics test was used to evaluate intelligence, based on specific nonverbal sensory and motor outcomes. Can IQ test be done in children for the assessment of their mental skills? Mangalanath, Thane Intelligence Quotient testing in children is very important to assess their educational, mental and clinical status. Children who secure outstanding scores in IQ tests are predicted to achieve
70 FUTURE MEDICINE I October 2013
success in the future. A number of factors, including birth defects (mental retardation), genetic variants (polymorphisms) and diseases like autism, drug addiction, malnutrition, prenatal and perinatal stress, depression, child abuse, harassment, traumatic brain injury, pollution and low socioeconomic status result in lowered IQ or negative intelligence. How does intelligence develop in human? Is it possible to increase our intelligence? Suresh Babu, Kochi According to neurobiological theories, the development of intelligence in human stabilised along with creation of neural connections by the age of 16. From then onwards, the intellectual maturity remains relatively constant. Environmental factors that influence IQ include breast feeding, nutrition, parenting, prejudices and self belief educational system, modern media, working environment and culture. The plasticity of the brain related to intelligence could be increased by physical exercise, meditation, enriched environments. Interestingly the food habits can also have a positive or negative impact on IQ.
Send queries: editorial @ futuremedicineonline.com.
What is the normal score of IQ? Mahendran, Mahi A normal individual will have an IQ score between 85 and 115. IQ score scale and interpretation • A) 1 to 24 - Profound mental disability • B) 25 to 39 - Severe mental disability • C) 40 to 54 - Moderate mental disability • D) 55 to 69 - Mild mental disability • E) 70 to 84 - Borderline mental disability • F) 85 to 114 - Average intelligence • G) 115 to 129 - Above average; bright • H) 130 to 144 - Moderately gifted • I) 145 to 159 - Highly gifted • J) 160 to 179 Exceptionally gifted • K) 180 and more Profoundly gifted IQ score > 140 is considered as a high IQ. An individual with an IQ score >160 is considered as genius. IQ scores with 200 and above are considered as immeasurable genius.
Qa &
Dr Harikumar R Nair Consultant in Gastroenterology&Transplant Hepatology AIMS, Kochi
Men’s Health
Damage caused by
cirrhosis not reversible
I’m a 25 years old Engineering student. My father has the habit of drinking. Let me know what are the symptoms of liver disease? Arun Kumar, Chennai The symptoms are weakness, loss of muscle mass, loss of hair, jaundice (yellowish discolouration of eyes and urine), swelling of legs and ascites (water accumulating inside abdomen). Increased pressure in the liver (portal hypertension) can result in vomiting blood. Brain can get involved which begins as changes in sleep rhythm and impaired intellectual capabilities, and may progress on to liver coma. Symptomatic phase of cirrhosis is mostly a “no go back” situation. Early detection of liver damage
before symptoms start is desirable. I know alcohol damages the liver. What are the other toxic substances which cause damage to the body and liver? Harikrishnan, Harippad Alcohol is the commonest toxin which damages liver. No other recreational agents induce liver specific toxicity. Liver toxicity can occur due to medications in modern medicine (anti-tuberculous medications and drugs for high cholesterol) and herbal therapy. My husband drinks daily. Does it affect his liver? Arunthathi Gosh, Pune Liver disease due to alcohol consumption evolves in stages- starts as alcoholic fatty liver and progresses to cirrhosis liver. Symptoms appear after many years
of silent damage to the liver. Newer non-invasive technologies like fibroscan are available to assess liver damage in the early stages before symptoms manifest. Generally, alcoholics seek medical attention only after the onset of symptoms, precisely the reason why liver transplantation becomes the sole rescue treatment in most cases.
Can liver damage be reverted? Hadimani, Mumbai Liver damage is reversible in early stages. However, long standing liver damage due to alcohol or other causes like viral hepatitis is not completely curable. Early detection of the disease is the key to reversibility.
Send queries: editorial @ futuremedicineonline.com. October 2013 I FUTURE MEDICINE 71
PRODUCT WATCH
Multiple facets
of CyberKnife CyberKnife radiosurgery is cost-effective and at the same time has less side-effects as compared to the conventional radiation therapy
By Dr Debnarayan Dutta, MD
C
yberKnife radiosurgery is one of the most advanced facilities for cancer treatment. This is a short course, precise, out-patient, minimal toxicity treatment and is now the treatment of choice for many small and localised tumours. Minimal sideeffects and short treatment duration have made this facility attractive to the patients. There are promising data on liver tumour, early lung cancer and inoperable pancreatic cancer. Total treatment duration is only a few days (usually one to five days), whereas it is usually 6 to 7 weeks in conventional radiation therapy treatment. Recently, Apollo Speciality Hospital in Chennai completed treatment of first 1,000 patients with CyberKnife.
Specialty of CyberKnife
Dose delivery in CyberKnife is a method which is highly precise. It delivers high dose to the target while minimal dose to the adjacent structures. CyberKnife is the only radiation therapy delivery system
that takes care of tumour movement during treatment with ‘real time tumour tracking’. It has the unique and effective tumour tracking system (Synergy) and delivers treatment with sub-millimetre accuracy.
CyberKnife treatment. If we consider one-week treatment duration, the lost will be between Rs 2 and Rs 4 lakh.
Common indications Though most of the tumours in any part of the body can be treated with CyberKnife, usual indications are a) lung, prostate, liver, inoperable pancreas and gall-bladder b) benign/ low grade brain tumours and arteriovenous malformations (AVMs) c) brain, liver, bone and lung metastasis and d) recurrent or residual tumours, especially in head & neck region CyberKnife is not used for treatment of microscopic residual disease after surgery and in prophylactic radiation therapy.
Cost of treatment
CyberKnife is relatively new in the developing countries. There are a few centres and a few experts in
(The writer is a Consultant Radiation Oncologist, Apollo Specialty Hospitals, Chennai)
Double Horse launches Diet Payasam Mix Sugar Free
Shobana launching Double Horse Diet Payasam Mix 72 FUTURE MEDICINE I October 2013
Taking into account the demand from a huge chunk of the population affected by diabetes, Double Horse, South India’s leading food brand, has come out with its new product, Diet Payasam Mix Sugar Free. The product was launched by its brand ambassador Shobana, renowned actor and danseuse. With its launch, the company hopes to meet the demand of consumers.
Vinod Manjila, Director, Marketing, said, “The product could be a relief for the people suffering from blood sugar-related health issues and dieters. The payasam which is easy to cook is a healthy option.” Sajive Manjila, Managing Director, said that the new Double Horse product will be widely accepted by people, especially the young health conscious generation.
New nanomedicine for drug-resistant blood cancer
High field
MRI system By Som Panicker
U
S-based Multi Dimensional Technology (MDT), represented in India by Sanrad Medical Systems, Mumbai, presents the world’s highest field strength permanent magnetic resonance imaging system named xStar 7000. The permanent magnet system technology competes with any superconducting MRI system available today with image quality and specification comparable to super conducting MRI. xStar 7000 is manufactured in Beijing.
Largest magnet manufacturing company
In Zhengzhou, at the opening of the China International Medical Equipment
Som Panicker, Vice President, Sanrad Medical Systems, Mumbai
Fair this year, XBOMDT, a joint company of US-based MDT and XBO Medical systems in Beijing, announced the joint venture factory and design facilities with the help of a team of scientists from MIT and Harward, US. manufacturing company XBO. This technology broke the permanent magnet field strength theoretical limit 0.7Tesla permanent magnet system not only means low cost MRI imaging, but also no compromise on the quality of a high field MR system. xStar 7000 from MDT is an attempt for the first time in the world to develop a new technology based on the permanent-magnet system to achieve the quality so far possible only with superconducting systems. At the same time, the new system has the best spatial and contrast resolution achieved among open MR systems, surpassing even high field open (Hybrid) MR systems. Another major breakthrough is reduction in the magnet weight making it very compact and easy to install. MDT aims to become world‘s number one manufacturer of permanent magnet MR systems in next five years.
Kochi-based Amrita Centre for Nanosciences & Molecular Medicine has developed a new nano-medicine that can dramatically improve the treatment of drug-resistant Chronic Myelogenous Leukemia (CML), when used in combination with Imatinib, the standard drug for the crippling disease. “What we have done at Amrita is to take a particular ‘small-molecule inhibitor’ class of anti-cancer drug that is currently available in the market and encapsulate it into a protein nanocapsule,” says Dr Shantikumar Nair, the Centre’s Director. “It allows the drug to be absorbed directly into the cancer cells circulating in the patient’s bloodstream. This has a marked increase on Dr Shantikumar Nair its efficacy in killing the cancer cells. Further, the circulation lifetime of the drug in the blood is increased, which also increases its efficacy,” he says.
MEDICAL DIGEST
A cup of tea can boost brain power Amsterdam (Netherlands): Researchers claim that a cup of tea can boost the brain power and increase alertness. For the research, Dutch scientists studied the brain activity in 44 young volunteers to analyse the effect of key chemicals, an amino acid called L-theanine and caffeine at levels typically found in a cup of tea, News.com. au reported. It was found that the natural ingredients radically enhanced accuracy across a number of switching tasks in those who drank the tea compared with those who didn’t. It was also found that tea drinkers had heightened alertness and were less tired as compared to their non teadrinker counterparts.
Tree bark for AIDS treatment New York (US): Tree bark used in Samoa to make medicinal tea could perhaps lead to a cure for AIDS, says a research at an important scientific conference in the US. The US National Cancer Institute conducted an analysis of the bark and narrowed down on the main ingredient -prostratin. Nearly two decades of research has led to the latest breakthrough of synthesised prostratin. Scientists have also devised novel and effective ways of making prostratin which can treat AIDS and also be of use in the treatment of Alzheimer’s disease and cancer.
74 FUTURE MEDICINE I October 2013
Safety device for women, senior citizens New Delhi (India): A personal safety device which could be used to trigger alarm and send signals to pre-identified phone numbers in case of emergency is being developed by the government. “This can be used by women and elderly citizens to trigger alarms and also send signal to pre-identified phone numbers,” Rajiv Gauba, Additional Secretary, Ministry of Communications and Information Technology, said. “We have roped in Indian Institute of Technology-Delhi and Centre for Development of Advanced Computing (C-DAC),Thiruvananthapuram for this project,” Gauba, who is associated with the e-governance group of the ministry, said while speaking at a conference on ‘Secure Cities 2013’. A ministry official said the device would be a mobile-like gadget. Gauba added that the challenge is to make the device affordable for everyone.
Red grapes, blueberries boost immune system Oregon (US): Researchers in the Linus Pauling Institute at Oregon State University discovered that the resveratrol found in red grapes and a compound called pterostilbene in blueberries have great ability to boost the innate immune system in humans. Both of these compounds work in synergy with vitamin D and havesignificant impact on the human cathelicidin antimicrobial peptide or CAMP gene that is involved in immune function. The findings were made in laboratory cell cultures and do not prove that similar results would occur as a result of dietary intake, the scientists said.
Play music to get sharper brains
Beer can improve health of heart: Study
EDINBURGH (Scotland): Good news for music lovers! People who play musical instruments have sharper brains, points out a new study by researchers at the University of St. Andrews in Scotland. People playing music pick up mistakes in their performance and fix them more quickly than other people. This sharpens their brain functions. Psychologist Doctor Ines Jentzsch and colleagues suggest playing music may help guard against mental decline, either through age or disease. The findings reinforce previous research that links mental ability to playing music.”Our study shows that even moderate levels of musical activity can benefit brain functioning,” says Dr. Jentzsch, Reader in St. Andrews’ School of Psychology and Neuroscience and a keen pianist.
Athens (Greece): Beer lovers! It’s time to cheer. A new study, published in the July 1, 2013 issue of Nutrition Journal, shows that drinking a pint a day can improve the health of your heart. Researchers at Harokopio University in Athens found that blood flow to the heart improved within a couple of hours of drinking two-thirds of a pint, or 400 ml of beer. Aortic stiffness and endothelial (blood vessel) function were assessed one and two hours after drinking. Aortic stiffness was significantly reduced and endothelial function improved after beer consumption.
A hope for infertile women Stanford (US): A study conducted by researchers from the Stanford University School of Medicine has brought out a new method of inducing egg growth in women suffering from infertility. This technique has already resulted in one woman giving birth, while another is pregnant.Doctors from the St. Marianna University School of Medicine in Kawasaki, Japan, tested the method in women suffering from primary ovarian insufficiency, also known as premature ovarian failure. This condition involves a loss of normal function in the ovaries before the age of 40.The findings are published in theProceedings of the National Academy of Sciences.
Orange juice may keep cancer at bay Washington (US): A new research has claimed that drinking orange juice every day may help prevent cancer. Having many potential positive effects, orange juice helps in avoiding cancer, researchers said. Chemo-prevention, including antioxidant, antimutagenic and antigenotoxic, cytoprotective, hormonal, and cell signalling modulating effects are the several biological effects of orange juice, points out the article published in the journal Nutrition and Cancer.
October 2013 I FUTURE MEDICINE 75
Conference
IACCCON 2013 Bangalore: The 4th National Annual Clinical Cardiology Update “IACCCON 2013” will be held in Nimhans Convention Centre, Bengaluru on 18th, 19th and 20th October 2013, for the practicing cardiologists, cardiology trainees, physicians and Primary health care physicians from across the country. This three day conference will feature structured evidence based topic discussions providing the delegates an opportunity to learn preventive, diagnostic and advanced Clinical Cardiology. It is proposed to address latest updates in diagnosis, management and prevention of ischemic heart diseases, dyslipedemia, Diabetes, hypertension, discussions on valvular heart diseases, congenital heart diseases, and devices in heart failure management. In addition the conference will also feature ECG Quiz session, highly educative Echo workshop and training program for primary health care physicians in prevention of CVDs. Eminent national and international faculty representing different institutions across the country will be present for this mega event.
1st International Oncology Conference Abu Dhabi: The first International Oncology Conference will be held in Abu Dhabi, the United Arab Emirates, from October 24 to 25. The two- day conference will cover screening, diagnosis, clinical management and recent advancements in therapies for four different types of cancers such as breast cancer, lung cancer, cervical cancer and colon cancer.
5th Pan Arab Human Genetics Conference Dubai: The 5th Pan Arab Human Genetics Conference (PAHGC) will be held in Dubai, the United Arab Emirates, from November 17 to 19. PAHGC- 2013 combines an innovative, advanced scientific programme and an exciting networking opportunity. Under the theme ‘Genomics into healthcare’, the conference will feature experts from around the world, including Prof. A Brand and Prof. D Cooper.
ICTERM-2013 Odisha: International Conference on Tissue Engineering and Regenerative Medicine (ICTERM) 2013 will be held in Odisha, India, from November 15 to 17. The conference encompasses interdisciplinary research areas, including Biomaterials and Scaffold Engineering, Stem Cell Engineering and Therapy, Genetic Manipulation in Tissue Engineering, Cryo Tissue Engineering, Computational Tissue Engineering, and Ethical Issues and IPR in Tissue Engineering. 76 FUTURE MEDICINE I October 2013
Author: Name: Team Head: Name: Associate Editor: Head-Operations Sign: Sign: Sign: Sign:
Celebrity Fitness
John Abraham Model, actor and film producer Born on December 17, 1972 Known as the most handsome and influential sex symbol in Indian cinema
Diet
Pure vegetarian Breakfast consists of egg white, fruit juice, almonds, a slice of toast and tea. Eat small meals every two hours and munches light food. Lunch includes atta chapatis, dal, tofu, spinach and fried vegetables like potatoes and yams. Supper soups, protein shakes and corn. No crash or speed diet and starving for being fit. Good sleep • •
No drinks No drugs
Workout
Discipline and diet go a long way in helping to get a great body. Daily fitness includes 2-3 hours of rigorous workout. Kickboxing, weight-lifting every day and cardio-exercises.
78 FUTURE MEDICINE I October 2013