Medical tourism vol 2 issue 4 by Lalfx

Vol.2 | Issue No.4 | April - June 2018

Cover Story

INFERTILITY Diagnosis And Treatment KIDNEY STONES Rock-Hard Facts Healthy Eating For A Healthy Heart MAINTAIN SEX Post Marriage CARE & CURE Medical Tourism In India A Complete Magazine on Healthcare in Asia

Medical Tourism April.-June 2018

A Complete Magazine on Healthcare in Asia

Vol.2 | Issue No. 4 |Apr. -Jun. 2018

Medical

tourism RNI No. KERBIL/2016/68979

Editor & Publisher Benny Thomas

Executive Editor Byju Aryad Editorial Co-ordinator Ninu Susan Abraham

It is recommended to seek the help of a reproductive endocrinologist if conception has not occurred within 12 months. However, there are various scenarios where one may be advised to seek help earlier.

Layout & Design Lal Joseph Legal Advisor Adv. Biju Hariharan Arabic Translation Dr. A. Aboobacker BUSINESS ASSOCIATES Overseas USA : CHICAGO: Vincent Joseph Mob: 847 299 9954 USA : Houston: Shaju Joseph Mob: 847 899 2232 USA : NEW YORK Vincent Sebastian Mob: 917 992 9629 USA : CALIFORNIA: Wilson Nechikat, Ph: 408 903 8997 Canada : Jose Sebastian, Ph: 416 - 509 – 6265 UK : Dileep Mathew, Ph: 044 787 743 2378 Switzerland : Dr. George Sebastian, Ph: 527204780 Ireland : Thomas Mathew Mob: 00353 87 123 6584 Middle East : Anil Nath, Ph: 506854500 Singapore : Mahesh A, Ph: +65 906 22828 Germany : Gayatri Puranik Ph: 0049 179 127 5002 Austria : Monichan Kalapurackal Ph: 0043 6991 9249829 Korea : Dr. A. Thomas, Ph: 0082 10 5822 5820 Australia : S. Mathew, Ph: 61247026086 Oman : Legihas Ussain, 00968 95383199

: Mohan Iyer, Mob: +91 22 6450 5111 : Gurumurthy, Mob: +91 989 460 4804 : Sanjay D. Narwani Mob: +91 983 120 7202 : Madanan MA, Mob: +91 989 800 2522 : Ephram Joseph Mob: +91 939 131 5072 : C. Sivakumar Mob: +91 974 000 4932 : K. Ramasubramanian, +91 989 497 7161 : Olavo Edviges Lobo - +91 982 258 9237 : Kuriyan K. Raju, Mob: +91 944 610 6644

Medical Tourism April.-June 2018

The cover story is about causes of infertility and how it can be treated. Approximately 8590% of infertility cases are treated with conventional therapies such as drug treatment or surgical repair of reproductive organs. Assisted reproductive technologies such as in vitro fertilization account for the remaining infertility treatment options. In this issue, the causes of kidney stone, consequences, symptoms, diagnosis and treatment are explained in detail. Kidney stones are one of the common causes of severe abdominal pain presented to the Emergency Room. Each year, more than 1.3 million people go to emergency rooms for kidney stone problems. It is estimated that one in ten people will have a kidney stone at some time in their lives. If you’ve ever known anyone who had to endure a kidney stone, or if you’ve had one yourself, the general consensus is that they can be extremely painful. Commonly the pain of passing a kidney stone is compared to the pain of childbirth. In some cases of kidney stones, there is relatively no pain at all, and some patients never even know they have one. The difference in experience all depends on the location of the stone within the urinary tract. Apart from the medical news, rare surgeries from the medical world, this special feature focuses on IMTEC Oman 2018 to be held from April 24 to 26, Kenya Medical Show 2018 to be held from May 10 to 12 and Arabian Travel Market at Dubai from April 22 to 25. All the three conferences and exhibitions are international crowd- pullers and we have pleasure to announce that Medical Tourism magazine is the media partner at IMTEC Oman and Kenya Medical Show. The magazine will be distributed at all the three events. We wish you happy reading.

BUSINESS ASSOCIATES India

CORPORATE OFFICE FM Media Technologies PVT Ltd, Penta Square, Opp.Kavitha, MG Road, Cochin -682016, Kerala, India. Tel/Fax: +91 484 403 4055 Email: director@asianmeditour.com www. asianmeditour.com

Infertility is a widespread condition with psychological, economic and medical implications. The unparalleled publicity given to the fertility issues in the technological era has demanded a rise in the infertility services. Worldwide, the prevalence of infertility is highest in Eastern Europe, North Africa, Middle East, Oceania and Sub-Saharan Africa, even as the problem persists universally. Most people will have the strong desire to conceive a child at some point during their lifetime. Understanding what defines normal fertility is crucial to helping a person, or couple, know when it is time to seek help. Most couples (approximately 85%) will achieve pregnancy within one year of trying, with the greatest likelihood of conception occurring during the earlier months. Only an additional 7% of couples will conceive in the second year. As a result, infertility has come to be defined as the inability to conceive within 12 months. This diagnosis is, therefore, shared by 15% of couples attempting to conceive.

Consulting Editor O.J. George

Mumbai Chennai Eastern India Ahmedabad Hyderabad Bangalore Puducherry Goa Trivandrum

Demand for infertility service on the rise

Editor

Printed, published and owned by Benny Thomas FM Media Technologies Pvt. Ltd, Penta Square, Opp.Kavitha, MG Road, Cochin -682016, Kerala, India. Editor: Benny Thomas

Printed at Sterling Print House Pvt Ltd, Door No. 49/1849, PonekkaraCheranellur Road,Aims, Ponekkara P.O, Cochin-682041, Ph: 0484 2800406.

Disclaimer: The statements in this magazine have not been evaluated by the Food and Drug Administratin of USA or any other country. Information provided in this magazine are not intended to diagnose, treat, cure or prevent any disease. If you have a medical condition, consult your physician. All information is provided for research and education purpose only.

A Complete Magazine on Healthcare in Asia

Contents 1) News

2) Surgery

3) Hospitals & Wellness

4) Equipment

5) Medical events

6) Events

7) Cover story: Infertility: â&#x20AC;&#x2039;Diagnosis and Treatment

9) Monsoon Tourism in Kerala is the Best Ayurveda Vacation

10) Number of people Coming to India for

Treatment will Double in Four Years

Cover Story:

Infertility: â&#x20AC;&#x2039; Diagnosis and Treatment

11) Interview: Care & Cure is the Medical Tourism in India

12) Kidney Stones: Rock-Hard Facts

13) Live in lavish style, unmindful of exercise,

and then wait for losing precious life

14) How to maintain sex life post marriage

15). Healthy eating for a healthy heart

16) Managing diabetes using new technology

17) Learn to breathe easier

18) Chemotherapy The treatment that kills cancer cells

40 Monsoon Tourism in Kerala is the Best Ayurveda Vacation

Medical Tourism April.-June 2018

64 Managing diabetes using new technology

48 Kidney Stones:

Rock-Hard Facts

52 Live in lavish style, unmindful of exercise, and then wait for losing precious life

68 Learn to breathe easier 72

Chemotherapy: The treatment that kills cancer cells

56 60

How to maintain sex life post marriage

Healthy eating for a healthy heart

A Complete Magazine on Healthcare in Asia

Medical Tourism News

KIMS group raises $200 million from True North

Australian university UNSW research holds out hope for thalassemia patients

esearchers at the University of New South Wales (UNSW) in Sydney, Australia, have used CRISPR gene editing technology to introduce beneficial natural mutations into blood cells to boost production of foetal haemoglobin.

erala Institute of Medical Sciences (KIMS), a hospital chain providing health care services in India and West Asia (Middle East), has raised $200 million from private equity fund True North (formerly India Value Fund Advisors). With this investment, True North will acquire about 40 per cent stake in KIMS, held by Ascent Capital Advisors India Pvt Ltd and OrbiMed Advisors Llc. KIMS will use the capital infusion to fund its growth plans. MI Sahadulla, chairman of the KIMS Group, and his management team will continue to run the company both in India and the Middle East. “Started by a group of professionals, including doctors and management experts, our aim at KIMS has been to provide ethical, high quality health care with focus on patient safety. Together, with a shared value system, we hope to continue our growth and to become one of the largest health care providers in India and the Middle East in the next three to five years,” Sahadulla said. Satish Chander, managing director of True North, said, “We have had the opportunity to evaluate numerous organisations in this space and have made nine investments across our different funds. We are excited about the health care potential in India and the Middle East (West Asia), and believe that KIMS would be a good addition to our health care portfolio.” KIMS, founded in 2002 by Sahadulla and founding promoters, claims to be the largest corporate hospital chain in Kerala. The group has a presence in the Middle East across five countries, with two hospitals and six medical centres, besides one managed hospital. The group’s combined turnover is over Rs 1,100 crore with a profitability of 11.5 per cent and employs more than 6,000 health care providers, including 600 doctors. True North has successfully launched five separate investment funds with a combined corpus of over $2 billion.

Medical Tourism April.-June 2018

The method could lead to new therapies for sickle cell anaemia and other blood disorders, says the university. The research solves a 50-year-old mystery about how these mutations -- which are naturally carried by a small percentage of people -- operate and alter the expression of human genes. The details of the study, carried out by an international team led by UNSW scientist Professor Merlin Crossley, is published in the journal Nature Genetics. Genome editing or gene editing gives scientists the ability to change an organism’s DNA. These technologies allow genetic material to be added, removed or altered at particular locations in the genome. “Our new approach can be seen as a forerunner to ‘organic gene therapy’ for a range of common inherited blood disorders, including beta thalassemia and sickle cell anaemia,” said Professor Crossley, who is also UNSW Deputy Vice-Chancellor Academic. “It is organic because no new DNA is introduced into the cells. Rather, we engineer in naturally occurring, benign mutations that are known to be beneficial to people with these conditions. It should prove to be a safe and effective therapy, although more research would be needed to scale the processes up into effective treatments,” he added. People with thalassemia or sickle-cell anaemia have defective adult haemoglobin -- the vital molecule that picks up oxygen in the lungs and transports it around the body -- and require life-long treatment with blood transfusions and medications. According to UNSW, it has engaged in a series of initiatives with the Indian government, higher education institutions, and corporations for sharing and transfer of its vast pool of tech expertise. This sets UNSW apart from host of other institutions that see India as a one-way street to train Indian students. UNSW is home to more than 52,000 students from nearly 130 countries.

A Complete Magazine on Healthcare in Asia

Medical Tourism News

New Technologies to make healthcare “cost effective”:

To a great extent, the real medical care in the country remained the same as it was 50 years ago . He, however, noted that the situation has started changing now. According to Duleep Sahadevan, Member High Power IT Committee, Kerala, creation of an intelligent network is crucial to make healthcare affordable and approachable. Prashant Warrier, CEO, Qure.ai, areas like pathology where the procedures were completely manual is getting automated due to the advent of new technology. Turning the discussion to a key area impacting the health of the entire society, Bhagvan Choughule, CTO & Co-founder, Treeni Sustainability Solutions, said addressing externalities like quality of air and water, management of waste and promotion of organic food cultivation are important aspects to ensure a good life.

Healthcare system the world over is bound to become “democratic” and “cost effective” as the digital technology is set to revolutionise this vital sector, said experts at a panel discussion on the “digital future of health and sustainability” at the two-day global digital summit #Future held at Kochi.

he best part of the digital technology is that it will make healthcare “predictive” rather than “reactive” and change it to patient-centric from provider-centric, said Dr Ajith Thomas, Professor, Harvard Medical School, setting the tone for a lively debate, moderated by Zakka Jacob, Deputy Executive Editor, CNN- News 18.

The panel discussion was followed a lively interaction during which the assembled posed questions relating to a wide range of health related issues, to which the experts on the panel replied. Chief Minister Pinarayi Vijayan inaugurated the big-ticket conclave being attended by top leaders of knowledge industry, technocrats , academics and influencers from across the globe

Narendra Modi launches Ayurvedic Centre of Excellence in UK

Saying that digital innovations helps democratise healthcare by its patient-centric approach, he said continuous data feed will help decisions and patient himself can modify his or her behaviour. Referring to Kerala, known for its excellent social development indices including a strong public healthcare infrastructure, Dr Thomas said the state could be a prime target for health apps considering its high internet and mobile penetration. Noting that ageing population is another big “health tsunami” in store, the professor said the new technology could play a vital role in taking care of the health challenges of the elderly. Taking the debate to genomics, Anuradha Acharya, Founder & CEO-Mapmygenome, said by having enough genomic data one can resolve many health issues that await one, thereby enabling people save much of the cost spend on healthcare. Noting that genomics is bound to play a lead role in healthcare in the future, she said it will also help arrive at better decisions than human beings can draw by other methods. The real challenge in healthcare in a country like India is how to take down to the grassroots by creating a strong link so as to ensure that the entire social spectrum benefited from the new and emerging technologies, said Dr Azad Mooppen, Founder Chairman, Aster DM Healthcare. 10 Medical Tourism April.-June 2018

Prime Minister Narendra Modi, at an event hosted by Prince Charles, inaugurated a new Ayurveda Centre of Excellence at London, during his visit to the UK from April 17 to 20, 2018. The Centre is established aimed at creating a first-ofits-kind global network for evidence based research on Yoga and Ayurveda involving Indian and British academics and medical professionals. Modi’s visit was for bilateral collaborations as well as to attend the Commonwealth Heads of Government Meeting (CHOGM).. The idea of the Centre was mooted during the Prince of Wales' visit to India in November 2017. The APPG (All Party Parliamentary Group) on Indian Traditional Sciences has been at the forefront of raising the profile of Ayurveda in the UK and welcomed the Ayurvedic Centre of Excellence.

A Complete Magazine on Healthcare in Asia

Medical Tourism

rare surgeries surgeries

Doctors Fix Delhi Man’s Ruptured Heart

n a rare and difficult surgery, doctors repaired a ruptured heart - a complication that occurs in 2 per cent of cardiac arrest patients. Fifty five-year-old Vinod Kumar, an accountant, fainted while at work on Christmas day. He was rushed to Delhi’s Apollo Hospital where the doctors in the emergency unit resuscitated him and immediately put him on ventilator support. His heart had sustained a wound causing blood loss and compression over the heart - a condition that can be fatal even before detection. A senior cardio thoracic and vascular surgeon and his team immediately began operating on Kumar.

A Rare Surgery to Overcome Colostomy Performed at Sunrise Hospital

rare surgery to prevent colostomy where the whole large intestine was removed and a small pouch was created with the patient’s own small intestine and attached to her anus was performed at Sunrise Hospital, Kochi. This allows her to have a normal life without the discomfort of colostomy, including wearing a bag externally to collect faecal matter.

During the operation, the surrounding layer of the heart (pericardium) was removed to evacuate the fluid that had collected around his heart. But the problem was far from over, Kumar’s heart had a rupture. He was immediately put on a heart-lung machine that took over the functions of his heart and lung to facilitate the cardiac surgery.

The unique keyhole surgery was performed by Dr Baiju Senadhipan, well-known surgical gastroenterologist and laparoscopic cancer surgeon at the hospital. The patient, who hails from Karunagapally, has been suffering from a chromosomal anomaly, which is passed on to generations of the family. Polyps that look like a bunch of grapes in the inner walls of large intestine turns into cancer when it is untreated or undiagnosed. Two members of the family now live with the effects of colostomy.

Vinod Kumar has made a full recovery without any complications. But doctors have a word of advice, “Heart attack can manifest in multiple ways and even just feeling unwell should not be ignored, especially if one is above 40. Heart attack and cardiac diseases can be ruled out via a simple ECG and blood test,” Dr Goel said.

Removal of the large entire intestine is performed to prevent it from turning into cancer. After the removal of the large intestine, the pathway for the faecal matter to be excreted is done by bringing the end of intestine to the exterior, by fixing it to the abdominal wall and the faecal matter is collected in a bag (colostomy).

Omani boy undergoes rare surgery at KIMS Twelve-year-old Said Ahmad Said Al Hadidi from Oman had been in distress, owing to severe hypertension and a cardiac problem. That was, until he flew to Kerala and got admitted to KIMS Hospital, Kochi. An evaluation of Said’s condition revealed his problem. He had large tumours of adrenal gland on both sides. While it is rare for children to have the tumours which are called Pheochromocytoma, it is rarer to have the tumour on both sides. Till date, he was being given large doses of three types of drugs to temporarily control his blood 12 Medical Tourism April.-June 2018

pressure, a sudden increase in which due to the tumours could lead to heart attack, stroke and sudden death. Taking matters into their hands, the anaesthesiology team led by Dr Rajeev of KIMS, Kochi, took care of his vitals during a complex surgery lasting for five hours. The team led by laparoscopic surgeon Dr R Padmakumar successfully removed the tumours completely without blood loss. Dr Madhukar Pai, Dr Khaleel, Dr Zuhail, Dr Arun and Dr Anurag were also actively involved in the major, high-risk surgery. “The patient was kept in ICU for five days to counter the fall in blood pressure with medicine. “It is happy to note even foreigners are choosing our hospitals and experts for such advanced and complex procedures,” said Dr Ashok Thiakarajan, COO of KIMS, Kochi.

Surgery helps patient open his mouth after 38 years

man suffering from a rare condition called Temporomandibular joint (TMJ) ankylosis was able to fully open his mouth after 38 years. This became possible after a rare surgery performed at a Pune hospital recently.

Doctors remove 97 pellets from 27-year-old’s chest in rare surgery

Temporomandibular joint (TMJ) ankylosis is a condition in which the face joint gets fused to the skull. Patients suffering from this deformity need a surgery.39-year-old, Rajendra Panchal had an accident when he was one year old. After the accident, Panchal faced problems while opening his mouth and was unable to open it completely for 38 years. Doctors from MA Rangoonwala College of Dental Sciences and Research Centre, department of oral and maxillofacial surgery performed a successful surgery helping Panchal open his mouth for the first time. Doctors said that due to the condition, Panchal was not able to eat solid food items which was affecting his overall health. Dr Aruna Tambuwala, head of the department of oral and maxillofacial surgery at MARDC, said that the surgery was conducted free of cost considering the financial condition of the patient. “The surgery took four hours and the fusing of the skull bone was removed helping the patient open the mouth by up to 45mm. The surgery was done by Dr JB Garde and Dr Gaurav Khutwad,’’ said Tambuwala. Dr Manisha Bijlani, said “ The patient was discharged and the surgery helped him eat solid food.”

Big tumours removed from Tanzanian man

n a rare surgery, doctors at Sir Ganga Ram Hospital (SGRH), New Delhi, removed two large tumours — the size of a football — from a Tanzanian national. Omar Salim, 32, had sought tumour resection in his home country but due to the potential risks, doctors there did not attempt it. Dr Vivek Mangla, consultant gastrointestinal and hepatobiliary surgeon at SGRH, said it took nearly seven hours to remove the tumours. “One of the tumours — 15x14cm in size and weighing 1.2kg — was resected from the liver. The other — 24x13cm in size and weighing 1.9kg — was removed from the patient’s rectum,” he said. Dr Mangla added that usually such tumours are smaller in size. “The patient has recovered and discharged from the hospital,” he said. The doctors said there were multiple risks involved in the surgery, including risk of major blood loss, damage to vital structures in the area and nerves supplying the muscles which work to ensure proper urinary function.

elieve it or not, doctors in India have reportedly removed as many as 97 pellets from a 27-year-old man’s chest in a rare surgery, nearly four years after he was shot from pointblank range. The surgery on Aarif Hussain of Moradabad town in India’s largest state of Uttar Pradesh, took place at All Indian Institute of Medical Sciences (AIIMS) in Delhi. In fact, it was a single bullet that got disintegrated into 97 pellets on impact and spread in and around the chest though it did not affect the heart or any other vital organ, after Hussain was shot while he was sleeping in his home in his native place over a property dispute. Doctors said that they decided to remove the pellets, the size of papaya seeds, after four years as all of them have now become a source of potential infection. “If he wasn’t operated on soon, the infection would have spread to other organs. It’s fatal,” Dr. Biplab Mishra of AIIMS trauma centre, who headed a team of doctors that conducted the rare surgery said. The surgical team got the confidence only after Hussain expressed his willingness to take a chance though his life was at stake. “Theoretically, it looked like an impossible task. I even told the patient that there was a likelihood of death on the table. But he was willing to take a chance, which gave me confidence to go ahead,” Dr. Mishra said. “We slowly, and very carefully, took each one out. The bullet case was also lying inside and was removed successfully,” he added. Hussain thanked the doctors for getting the new lease of life from almost being on the brink of death. “I am better now thanks to the AIIMS doctor. He has given me a new life and I want to make the most of it by working hard,” he said. The rare surgery has earned the doctors praise from fellow doctors as well. “It was a near impossible task, but Dr. Mishra proved that nothing is impossible. They saved the patient from a slow and painful death,” said Dr. Pratip Chaudhury, a Delhi-based chest specialist. A Complete Magazine on Healthcare in Asia

Medical Tourism hospitals & wellness

Amala Instiute of Medical Sciences

Breach Candy Hospital Mumbai Ph: +91 22 2367 1888 www.breachcandyhospital.org

Thrissur Ph: +91 487 2304000 www.amalaims.org

Email: info@amalaims.org

Email: info@breachcandyhospital.org

Ananthapuri Hospitals and Research Institute

Care IVF Kolkata Ph: +91 766 866 6633 www.careivfkolkata.com

Thiruvananthapuram Ph + 91 471 2579900 www.ananthapurihospitals.com

Emial: ananthapurihri@vsnl.net

Email: helpdesk@careivfkolkata.com

Almas Hospital

Chinmaya Narayana Superspeciality Centre Bangalore Ph: +91 80 7122 2684 www.narayanahealth.org

Malappuram, Kerala Ph:+91 483 2809100 www.almashospital.com

Email: mail@almashospital.com

Email. info.nics@narayanahealth.org

Aster Medcity

Craft Hospital and Research Centre Kochi Ph: +91 484 66 99 999 www.astermedcity.com

Thrissur Ph: +91 480 2800200 www. craftivf.com

Email: astermedcity@dmhealthcare.com

Email: drashraf@craftivf.com

Ayurgreen Hospitals

Dhathri Ayurveda Hospital Kayamkulam, Kollam, Kerala Ph: + 91 9745425888 www.dhathriayurveda.com

Malappuram, Kerala Ph: +91 93882 92232 www.ayurgreenhospitals.com

Email: info@ayurgreenhospitals.com

Email: hospital@dhathri.in

Baby Memorial Hospital

GEM Hospital & Research Center Coimbatore Ph: +91 422 232 5100 www. gemhospital.co.in

Kozhikode Ph: +91 952 605 5566 www.babymhospital.org

Email: info@babymhospital.org

Email: info@geminstitute.in

Bangalore Baptist College

Hiranandani Hospital Mumbai Ph: +91 22 2576 3300 www.hiranandanihospital.org

Bangalore Ph: +91 80 2202 4700 www.bbh.org.in

Email: bdo@bbh.org

Email: wecare@hiranandanihospital.org

Bombay Hospital and Medical Research Centre

Indraprastha Apollo Hospital New Delhi Ph: +91 11 2987 1090 www.delhi.apollohospitals.com

Mumbai Ph: +91 22 -22067676 www.bombayhospital.com

helpdesk@bombayhospital.com 14 Medical Tourism April.-June 2018

infodelhi@apollohospitals.com

A Complete Magazine on Healthcare in Asia

Medical Tourism hospitals & wellness

Jaslok Hospital and Research Centre

Medical Trust Hospital

Mumbai Ph: +91 22 2353 3333 www.jaslokhospital.net

Kochi Ph: +91 484 235 8001 www.medicaltrusthospital.com

Email: online@jaslokhospital.net

Email: info@medicaltrusthospital.org

King Edward Memorial Hospital

Mohak Bariatrics & Robotics

Mumbai Ph: +91 22 2410 7000 www.kem.edu

Email: kemwebsite@kem.edu

Indore Ph: +91 97373 67367 www.indiaobesity.in

Email: mohakbariatric@gmail.com

Lakeshore Hospital and Research Centre

Punarnava Ayurvedic Hospital

Kochi Ph: +91 484 2701032 www.lakeshorehospital.com

Kochi Ph: +91 94469 05065 www.punarnava.net

Email: info@lakeshorehospital.com

Email: mail@punarnava.net

LivLife Hospital

Nagarjuna Ayurveda Hyderabad Ph: +91 40 3088 8888 www.livlifehospitals.com

Email: life@livlifehospitals.com

Kalady, Kerala Ph: +91 99618 83340 www.nagarjunaayurveda.com

Email: treatments@nagarjunaayurveda.com

Lilavati Hospital and Research Centre

PK DAS Institute of Medical Sciences

Mumbai Ph: + 91 22 2666 6666 www.lilavatihospital.com

Ottapalam, Kerala Ph: + 91 466 234 4500 www.pkdims.org

Email: info@lilavatihospital.com

info@pkdashospital.com

Lourdes Hospital

Rajagiri Hospital Kochi Ph +91 484 4121101 www.lourdeshospital.in

Aluva, Kerala Ph: +91 484 665 5000 www.rajagirihospital.com

Email: lourdesinternationaldesk@gmail.com

Email: mail@rajagirihospital.com

Malabar Institute of Medical Sciences Ltd

Sreedhareeyam Ayurveda Eye Hospital

Kozhikode Ph: + 91 495 3911 400 www.astermims.com

Koothattukulam, Kerala Ph: +91 485 2253007 www.sreedhareeyam.com

Email: mimsclt@mimsindia.com

Email: customercare@sreedhareeyam.com

Manipal Hospital

Sir Ganga Ram Hospital New Delhi Ph: + 91 011 4225 4000 www.sgrh.com

Bangalore Ph: +91 80 4011 9000 www.manipalhospitals.com

Email: appointment.helpline@manipalhospitals.com 16 Medical Tourism April.-June 2018

Email: gangaram@sgrh.com

A Complete Magazine on Healthcare in Asia

Medical Tourism Equipment

Stryker F1™

Abbott

Boston Scientific

Small Bone Power System

CardioMEMS heart failure monitoring system

SpyGlass DS direct visualization system

Stryker’s Instruments launched of the Stryker F1™ Small Bone Power System, providing surgeons with a cordless, balanced, lightweight solution for procedures of the extremities. Until now, extremities surgeons have, for the most part, used cord-and-console set-up. While a console delivers the requisite power for working with small bones, it also comes with unavoidable compromises. It reduces manoeuvrability, may break the sterile operating field and with multiple components, can make both operation and trouble-shooting less efficient. The Stryker F1 System allows for the elimination of cords, hand switches, and consoles and provides a much more efficient way to perform distal extremity procedures.

The CardioMEMS heart failure monitoring system is designed for comprehensive heart failure care. It is the only FDA-approved heart failure monitoring system. It has been proven as being free of 98.6% freedom of device or system complications and has reduced heart failure admissions by 33% over an 18- month period, according to the company. The system is also personalized and can directly monitor PA pressure and titration of medications. The system’s implantable sensor actually draws inspiration from the types of sensors used to measure pressure inside jet engines.

SpyGlass DS direct visualization system from Boston Scientific is used for cholangiopancreatoscopy – the examination of the bile ducts using an endoscope. It is designed to optimize procedural efficiency and productivity with improved set-up, ease of use and image quality. A single operator can perform a procedure, and guide devices that can examine, diagnose and treat pancreaticobiliary conditions, according to the company.

www.bostonscientific.com

www.sjm.com

www.stryker.com

Boston Scientific

BrainScope Co

Insightec

Watchman left atrial appendage closure device

BrainScope One

ExablateNeuro

Boston Scientific’s Watchman left atrial appendage closure device can potentially reduce the risk of stroke in non-valvular atrial fibrillation (NVAF) patients. It has been proven to be safe and an effective alternative to oral anticoagulants. It also reduces the risk of bleeding with warfarin use. The company says the device is designed to reduce the risk of thromboembolism from the left atrial appendage in patients who have NVAF and who have an increased risk of stroke and systemic embolism.

BrainScope One is an FDA-cleared comprehensive head injury assessment device developed by BrainScope Co. The device enables urgent care physicians to objectively assess brain injuries, including concussions. It is hand-held, easy-to-use and is based off of EEG technology. It is non-invasive and painless and can be used on patients aged 18–85 years old within three days of a head injury, according to the company. The device measures and interprets brain electrical activity and neurocognitive function for physicians to make clinical diagnoses.

Insightec’sExablateNeuro is an ultrasound device that has been approved the by FDA to treat medication refractory essential tremor patients using non-invasive MR-guided focused ultrasound thalamotomy. It targets and treats deep within the brain through the skull, according to the company. ExablateNeuro ultrasound transducers focus 1024 ultrasound waves to create enough heat to be able to ablate a targeted tissue. When performed, there has been shown to be an immediate and significant reduction in hand tremors.

www.bostonscientific.com

www.brainscope.com

www.insightec.com

Integra LifeSciences

Johnson & Johnson

Koning Corp.

Omnigraft dermal regeneration matrix

DePuySynthes: Attune knee system

Koning Breast CT 1000

The Omnigraft dermal regeneration matrix from Integra Lifesciences is an advanced bilayer dermal regeneration matrix that treats diabetic foot ulcers. It is the only FDA-approved product that can regenerate native dermal tissue, according to the company. The patch has a built-in silicone layer that serves as a temporary epidermal layer and provides immediate coverage for wound protection. It can be removed between two and three weeks. Under the silicon layer is a collagen/chrondroitin-6-sulfate matrix that acts as a dermal replacement layer. It is a bioengineered scaffold that promotes dermal regeneration and is designed with a controlled porosity and degradation rate.TheOmnigraft dermal regeneration matrix is designed to be used for treating partial and full thickness neuropathic diabetic foot ulcers that are more than six weeks old with no capsule, tendon or bone showing.

The Attune knee system is a total knee reconstruction system that has a high level of stability and motion. It features technologies from DePuySynthes to help patients regain full movement in their knees, according to the company. It uses Attune Gradius Curve to reduce femoral radius and give a smooth transition from stability to rotational freedom through a range of motion with the patient. It also uses GlideRight articulation to accommodate to a patient’s variation and soft tissue interaction while optimizing patella tracking and maintaining bone coverage. The total knee system also uses LogicLocktibial base as a central locking design that helps the architecture of the system optimize kinetics and reduce backside micromotions. Intuition instruments are also featured in the total knee system. The intuition instruments combine the surgical process with efficient instruments to help the surgeon balance soft tissue and control the implant position in patients.

Koning Breast CT 1000 is a system that takes 3D images of the breast with spatial resolution and without painful compression. It is designed to help diagnose breast cancer. The patient is exposed to radiation levels in the range of diagnostic mammograms in a rapid 10-second exposure. Unlike MRI and CT scans, Koning Breast CT is not claustrophobic. It also has a low false-positive rate and a low false-negative rate, according to the company. The Real 3D technology provides isotropic images for the evaluation of tissues from any angle, eliminating overlapping structure.

www.omnigraft.com 18 Medical Tourism April.-June 2018

www.depuysynthes.com

www.koninghealth.com

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Medical Tourism Equipment

Sree Chitra Poised for a Big Leap in Research and development of Medical equipments

Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram,is poised for a big leap in Research and development of medical equipment. The Governing Body and Institute Body of the Institute had approved a Perspective Plan – Vision 2030,The Biomedical Technology Perspective plan, envisages the vision & deliverables of the Institute in the area of Biomedical Technology development during the decade 2021-2030. Vision 2030 for the BMT Wing of the Institute is at a total cost of Rs.350 crores. The project is aimed at developing 30 equipment which can make a drastic change in the medical equipments sector. The goals, infrastructure & resource requirements and other capabilities that need to be developed / augmented are detailed in this plan. It 20 Medical Tourism April.-June 2018

is envisaged that about 50-60 products will be transferred/ready for transfer during this period. There will be an addition of 40 Scientists/Engineers and another 60 Scientific/Technical & Administrative staff. The total outlay of the Plan will be Rs 350 Crore for the period 2021-2030. To take the Plan forward, there is a need to complete the required infrastructure and manpower has to be in place. The Department of Science and Technology, GoI has in principle approved the project cost of Rs.50 Cr. and has allotted the first instalment for the completion of the Combinational Block in the BMT Wing of the Institute. In addition the Governing Body of the Institute has approved appointment of 23 scientists/Engineers in two phases. When the research activities at SCTIMST BMT wing gets completed,

technology of equipment which will be valued at Rs 26,000 crore will be developed. This will help in a vast change in Indian medical equipment market. When the technology for manufacturing of quality treatment equipment comes out of SCTIMST, it could be manufactured here at a very lost cost. There will be a huge reduction in the price of equipment which will reduce the treatment charges of the patients. Activities for developing 33 treatment equipment are in progress at Sree Chitra Institute. The research for the 25 equipment will continue in the next decade also. The guidelines for Vision 2030 had been approved by the governing body of Sree Chitra Institute governing body. There are also plans to start development of another 30 equipment in the next seven years

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Medical Tourism Medical events

NSAN Z ANNUAL SCIENTIFIC MEETING April 6 â&#x20AC;&#x201C; 8, 2018 Sydney, Australia The 2018 Neuromodulation Society of Australia and New Zealand 13th Annual Scientific Meeting will be held at the International Convention Centre, Sydney, Australia. Contact: DC Conferences Pty Ltd, Suite 103, Level 1, 3-5 West Street, North Sydney NSW 2060, Australia PO Box 637, North Sydney 2059. Phone: + 612 9954 4400, Fax: + 612 9954 0666, Email: nsanz2018@dcconferences.com.au, Web:www.neuromodulation.com

PHYSICIANS INTERNAL MEDICINE MEETING 2018 April 19-21, 2018, New Orleans, United states American College of Physicians Internal Medicine Meeting 2018 to discuss Medicine, internal medicine, CME, MOC and Hospital Medicine Track will be held at New Ernest N. Morial Convention Center, Orleans, United States. Contact: American College of Physicians, 190 North Independence Mall West, Philadelphia, PA 19106-1572 Phone: 800 523-1546, Email: custserv@mail.acponline.org, Web: annualmeeting.acponline.org

ICMBPS April 25 - 26, 2018 Pune, India IASTEM -369th International Conference on Medical, Biological and Pharmaceutical Sciences (ICMBPS) will be held at Weikfield IT Park, Pune Nagar Road, Pune, India. Contact: F3/13, Labony Estate , EB Block, Sector 1, Salt Lake, Kolkata 700064,West Bengal. Phone: +91 8339973162, Email: info@iastem.org, Web: www.iastem.org

ICRAMS April

28-29, 2018, Port Louis, Mauritius

The IIER - 394th International Conference on Recent Advances in Medical Science ICRAMS will be held at Port Louis, Mauritius. Contact: F3/13, Labony Estate , EB Block, Sector 1, Salt Lake, Kolkata 700064,West Bengal, India. Phone: +91 9007375847 Email: info@theiier.org, Website: www.theiier.org

RHEUMATOLOGY ANNUAL CONFERENCE May 1-3, 2018 Liverpool, United Kingdom The British Society of Rheumatology annual conference will be held at Exhibition Centre Liverpool, Kings Dock, Liverpool L3 4FP, United Kingdom Contact: British Society for Rheumatology, Bride House, 18-20 Bride Lane, London EC4Y 8EE Phone: +44 (0) 20 7842 0900, Email: bsr@rheumatology.org.uk, Webwww.rheumatology.org.uk

ICRAMMHS May 6, 2018 Chennai, India International Conference on Recent Advances in Medical, Medicine and Health Sciences (ICRAMMHS) will be held at Hotel Sonas Inn Chennai. Contact: Miss. D. Das, Asst. Secretary, WRFER. Phone: +918280862844, Email: contact.wrfer@gmail.com, Web: www.wrfer.org

INNOVATIONS AND NEW PRACTICES IN INTERNAL MEDICINE 2018 May 7 - 11 2018, Boston, United States Harvard Medical School CME program on Innovations and new practices in Internal Medicine 2018 will be held at Boston Park Plaza, Boston, United States. Contact: Harvard Medical School Global and Continuing Education. Phone: 617-384-8600 Email: CEPrograms@hms.harvard.edu, Web: www.im.hmscme.com

IPDC May 10-12 Dubai

The International Paediatric Dermatology Conference will be held at Conrad Hotel, Dubai, UAE. Contact: P.O.BOX 939513, Dubai, United Arab Emirates. Phone: +971 4 361 9616, Fax: +971 4 361 4375, Email: info@paediaderma.com Web:www.maarefah-management.com

22 Medical Tourism April.-June 2018

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Medical Tourism Medical events

ANNUAL PHYSICIANS MEETING

2018 May 11, 12, 2018 Osaka, Japan

Annual Physicians Meeting 2018 to discuss Physicians Advanced touch on Human Medicare will be held at Hyatt Regency Osaka, 1-1311 Nanko-Kita, Suminoe-Ku, Osaka, Japan. Contact: OMICS International Pvt Ltd, Building No. 06, 7th Floor North Block, Divyasree Nsl Infrastructure Pvt. Ltd, Gachibowli, Hyderabad 500032, India. Phone: 1-650-889-4686, Email: physiciansmeet@annualcongress.net, Web:www.conferenceseries.com

ICMHS May 13, 2018 Bangalore, India IACN- International Conference on Medical and Health Sciences (ICMHS) organised to provide an excellent international platform for the academicians, researchers, engineers, industrial participants and budding students will be held Hotel Trinity Isle, # 139, Subedar Chatram Road, Swastik Circle, Sheshadripuram, Bangalore, India. Contact: Academics Conference Network-CAN, Dept of Conferences and Seminars, Institute of Research and Journals, Plot No. 161 (Ground Floor), Dharma Vihar, Jagmara, Bhubaneswar, 751030, India. Phone : :+91-8280047487, Email: papers.academicsconference@gmail.com, Web:www.academicsconference.com

ICMBS May 30 - 31, 2018, Goa, India RW- 385th International Conference on Medical and Biosciences (ICMBS) organised to provide international platform for the academicians, researchers, engineers, industrial participants and budding students will be held at Hotel Manvins, Municipal Gardens(east), Church Square, Panjim, Goa, India. Contact: F3/13, Labony Estate , EB Block, Sector 1, Salt Lake, Kolkata 700064,West Bengal. Phone: +91 7077656338, Email: contact@researchworld.org, Web: www.researchworld.org

23RD WONCA EUROPE CONFERENCE

May 24- 27, Krakรณw, Poland

The 23rd WONCA Europe Conference which will be held at ICE Krakรณw Congress Center in Krakow, Poland. Contact: ZiZ Centrum Edukacji, Garbarska 13/3 Street , 31-131 Krakow, Poland Phone: 00 48 608 336 657 Email: krakow@woncaeurope2018.com, participants@woncaeurope2018.com Web: www.woncaeurope2018.com

3rd ANNUAL KIDNEY CONGRESS June 8, 2018 Maryland, United States The 3rd Annual Kidney Congress will be held at Radisson, North Baltimore 2004, Greenspring Dr, Lutherville-Timonium, Maryland, 21093 United States. Contact: Edward Stanley Radisson North Baltimore 2004 Greenspring Dr, Lutherville-Timonium, MD, 21093 United States. Email: kidney@nephroconferences.com Web: www.kidney.conferenceseries.com

EPC 2018 June 13-16, 2018, Berlin

The Jubilee Meeting of the European Pancreatic Club will be held at Maritim proArte Hotel, Berlin. Contact: Landsberger Straร e 155, 80687 Munich, Germany Phone: +49 89 548234-62, Email: epc2018@interplan.de Web: www.e-p-c.org

INAC 2018 June 22-24, 2018 Ghent Belgium

The 4th International Neonatology Association Conference (INAC) will be had at Hotel NH Gent Belfort, Ghent, Belgium. Contact: Paragon Group, 18 Avenue Louis-Casai, 1209 Geneva, Switzerland Phone: Tel: +41 22 5330 948, Fax: +41 (0) 22 5802 953, Email: secretariat@worldneonatology.com, Web.www.2018.worldneonatology.com

ICRCPSYCH June 24-27, Birmingham, United Kingdom

International Congress of the Royal College of Psychiatrists will be held at International Convention Centre Birmingham, Broad St, Birmingham, B1 2EA, United Kingdom. Contact: The ICC, 8 Centenary Square, Birmingham, B1 2EA Phone: + 44 (0) 203 701 2618, Email: congress@rcpsych.ac.uk Web:www.rcpsych.ac.uk 24 Medical Tourism April.-June 2018

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Medical Tourism events

IMTEC Oman 2018 to be held from April 24 to 26

MTEC Oman 2018 Exhibition and Conference that highlights the continued development of the healthcare sector in Oman will be held at Oman Convention and Exhibition Centre from April 24 to 26, 2018. In the recent years Oman is in the limelight as it outsources billions of healthcare services overseas annually. International players in the medical and healthcare industry are focusing their efforts on exploiting the lucrative Omani healthcare market. IMTEC Oman 2018 targets all aspects of the health and wellness industry, opening doors for health products, services and facilities, and opportunities for new developments, trends, trade and investment. Under the Government’s Health Vision 2050, much could be expected for the industry. IMTEC Oman 2018 provides a global platform for hospital groups, medical travel organizations and health services companies to increase their international presence and patient network, and gain market share in this growing industry. This event will play

26 Medical Tourism April.-June 2018

host to more than 100 regional and international exhibitors, and attract an estimated 20,000 attendees from across the world. It is a common platform that brings together different segments of the health and medical industry to explore new opportunities, showcase the latest technologies, services and facilities, and leverage potential for trade and investment. Those who exhibit at IMTEC Oman 2018 will have direct access to an ever growing market, interact with decision makers, establish contacts for future business, meet existing clients or partners, launch and demonstrate products, raise profile of company/organisation, seek immediate business, look for a local agent, support local existing agent, achieve business to business (B2B) and business to consumer (B2C) objectives and sell products. Exhibiting at IMTEC Oman 2018 provides an exceptional combination of networking and corporate branding opportunities and is a perfect opportunity to boost your company’s profile

amongst influential decision-makers in the Omani healthcare industry. The company’s participation in IMTEC Oman 2018 strengthens global awareness of products and services to an audience of important decision-makers but, more importantly confirms the position as an industry leader. IMTEC Oman 2018 offers a wide portfolio of sponsorship opportunities to maximize the participation impact at the exhibition. Each sponsor has a wide range of benefits and assures great value for your money. IMTEC Oman 2018 also facilitates tailor-made packages and alternative options for our valued sponsors to provide the ideal solution. IMTEC Oman will have numerous exhibitors. The exhibitor profile for this event will include Tourism association, Ministry of Tourism, Clinic, Pool of doctors, Technology and Software Companies, Venture Capitalists, Travel Agencies, Medical Tourism Integrator, Medical tourism facilitator, Insurance company, Healthcare Organizations, Accreditation Bodies etc 

Medical Tourism events

Kenya Medical Show 2018 from May 10 to 12

enya Medical Show, which is a premium show in the East Africa for the entire medical fraternity, will be held at Kenyatta International Conference Centre (KICC), Nairobi, from May 10 to 12. Kenya Medical Show 2018 provides a perfect platform for patients who are looking for better treatment with affordable pricing abroad. Some patients travel out of, while others come into Africa for medical care through a growing global phenomenon referred to as medical tourism. Africa is concurrently a source of patients who form part of a global phenomenon referred to as health tourism or medical tourism. The wealthy middle class in Africa, for instance, regularly seeks advanced medical care abroad. Patients may lack confidence in the ability of home health systems to meet their medical needs and move abroad in relatively large numbers. Kenya Medical Show is best platform for meeting some of the world’s best hospitals professionals. World’s leading hospitals are participating in the show from India and Middle East.

Doctors (Surgeons), Buyers, Government Officials and Trade Suppliers will visit the show from East Africa Region including Kenya, Tanzania, Uganda, Ethiopia & Sudan. The 2nd Kenya Medical Show is the leading destination for Exhibitors to launch and showcase their products and services to an audience of Senior decisions makers from East Africa, neighbouring countries, who are eager to source the very latest that the industry has to offer. Participation in Kenya Medical Show will give both African companies &Non African Companies a new level of recognition in East Africa Sector. Kenya medical device market is expected to grow by a CAGR of 14.4% over the 2013-2018 period, alongside impressive GDP growth and strengthening imports. Almost all medical devices are imported, as domestic production is limited to basic consumable items, a situation that is expected to remain unchanged for the foreseeable future. Demand for medical devices remain high as many facilities require modernization.

In 2013, the Kenyan medical device market was estimated at US$ 122.7mn, the market is expected to expand at a CAGR of 14.4% over the 2013-2018 period, reaching US$ 241 mn by 2018. Around 95% of the medical device market is supplied by imports. Kenya imported medical devices valued at US$ 129.9 mn in 2013; this represented an increase of 46.6% over 2012 and a 2008-2013 CAGR of 18.9%. in the 12 months to June 2014, imports decreased by 1.9%, to US$ 106.9 mn. Kenya exports very little medical equipment, although the total increased by nearly four times from the USD 2.5 mn recorded in 2003 to USD 9.3 mn in 2013. In Kenya, increased public and private expenditure on healthcare, coupled with increasing levels of medical insurance coverage and continued foreign donor funding, are creating significant opportunities for growth within the Kenyan pharmaceutical and medical devices industries 

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Medical Tourism events

Arabian Travel Market at Dubai from April 22 to 25

he 25thArabian Travel Market, which is the global meeting place for the travel trade, will be held at the Dubai International Exhibition and Convention Centre between April 22 and 25, 2018.

Arabian Travel Market is the market leading, international travel and tourism event unlocking business potential within the Middle East for inbound and outbound tourism professionals. Tourism destinations from around the world showcase a diverse range of accommodation options, breathtaking tourism attractions, travel technology and key airline routes. Arabian Travel Market (ATM) is the leading global event for the Middle East inbound and outbound travel industry for the last 25 years. The event generates more than $2.5 billion of travel industry deals. The annual business-to-business (B2B) exhibition showcases over 2,800 products and destinations from around the world to over 28,000 buyers and travel trade visitors across four

28 Medical Tourism April.-June 2018

days at the Dubai International Convention and Exhibition Centre (DICEC). Over 39,000 travel professionals, government ministers and international press, visit ATM every April to network, negotiate and discover the latest industry opinion and trends at Arabian Travel Market. The event continues to help professionals in the Arabian travel industry to drive commercial success with yearround opportunities to make connections and access to industry news and developments, trends and technologies from around the world. Through the industry networks, global reach and regional focus, ATM creates personal and business opportunities providing our customers with quality contacts, content and communities. Arabian Travel Market helps to discover a world of opportunities, all under one roof. The emphasis of the event is firmly on interactivity, encouraging global travel trade to meet, network, negotiate and conduct business through a series of areas, stages and sessions ď&#x20AC;ź

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Medical Tourism events

Kochi to host 10th edition of Kerala Travel Mart September 28-30

illed as the largest gathering of tourism stake-holders in India, the 2018 edition of Kerala Travel Mart (KTM) will kickstart in Kochi on September 27, Kerala Minister for Tourism Kadakampally Surendran has announced at Thiruvananthapuram. The three-day conclave, organised by KTM Society in partnership with Kerala Tourism, will be held from September 28-30. Malabar Tourism promotion will be the main theme of this edition. “The 10th edition of KTM will be inaugurated coinciding with the World Tourism Day (September 27) in Kochi. The inauguration will be followed by three-day business-to-business meetings,” the minister said. “There is a huge scope for tourism growth in Malabar with the inauguration of the Kannur airport next year. The government is planning to implement many projects in the Malabar region, the main one being the “Nadhithada” tourism project that

30 Medical Tourism April.-June 2018

focuses on nine rivers in Northern Kerala,” Surendran said.

comes under one umbrella in KTM,” he added.

“The government has already allotted Rs 38.5 corers for this project and the first phase of the project has already started,” he added.

“KTM is growing into a unique brand position,” he noted.

KTM, the minister noted, has contributed significantly to the development of tourism industry in the state. “As the Responsible Tourism campaign is progressing, KTM’s CSR initiative ‘Agenda 9’ is giving it a fresh impetus,” he said. The Responsible Tourism (RT) Mission has already started activities to spread its objectives to more places and make it a state-wide project instead of concentrating it on a few places. Kerala Tourism Principal Secretary Dr. Venu V. said KTM has emerged as the most prestigious commercial intervention of Kerala Tourism. “There is more to KTM than trade exchanges. Being a wonder in the tourism sector in India, Kerala Tourism’s dynamism, energy, cooperative and brotherhood spirit

The exhibition at KTM will have around 400 stalls featuring a range of products, packages and services offered by businesses and entrepreneurs. Public Private Partnership (PPP) being the main highlight of KTM, it offers a platform for stake-holders, including tour operators, hotels, resorts, homestays, house-boats, Ayurveda resorts and cultural art centres to have fruitful meetings and interactions with buyers from around the world. KTM Society President Baby Mathew recalled that the Society had adopted the comprehensive 9-point charter, ‘Agenda 9’ during KTM 2016, which calls for measures to tackle waste management, promote organic farming, efficient use of energy and extensive use of local produce and products. Other key areas in the checklist are rain-water harvesting, reducing the use of plastics, and improving greenery.

“The latest edition will focus on the Charter’s implementation aiming to make Kerala a sustainable destination. We also aim at exhibiting new Kerala products to the world. Sellers can take part in hundreds of productive business meets,” he said, adding: “KTM is an ideal platform to bring various buyers under one roof.” ‘Agenda 9’ for action calls for measures to tackle waste management, promote organic farming, efficient use of energy and extensive use of local produce and products. Other key areas in the checklist are rain-water harvesting, reducing the use of plastics, and improving greenery. Tourism Director Bala Kiran said KTM is India’s pride and can be placed in the same league with other international tourism fairs like ITB Berlin and FITUR. “KTM is not only a venue for interaction between the national and international buyers, but also a platform to spread Kerala’s geographical space,

expand tourism product bouquet and promote the state as a 365-day tourism destination,” he added. The pre-registration of buyers started in January 2018. Registration for sellers began in March, 2018. A total of 638 domestic buyers from various parts of India and 238 international buyers from more than 57 countries attended the ninth edition of the mart, which also witnessed a large number of business meetings.

Eurasia Beauty Queen Yana Filippova is Goodwill Ambassador for Russia

Eurasia Beauty Queen Yana Filippova is the Goodwill Ambassador for Russia for the upcoming Kerala Travel Mart 2018 (KTM), which gives special emphasis to strengthen the partnership between the two countries in the revenue-generating sector. This is in continuation of the summit meeting between Indian Prime Minister and the President of the Russian Federation last year to celebrate 2018 as the Year of Tourism in India and Russia. Yana Filippova has accepted the invitation of KTM to endorse the Country of Focus of the flagship tourism event. Upping the glamour quotient with the presence of Filippova, KTM 2018 expects active participation of Russian buyers, travel writers and journalists. Along with other countries, Russia will be a big market for tourism industry in Kerala

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Medical Tourism Cover story

Infertility: â&#x20AC;&#x2039; â&#x20AC;&#x2039;Diagnosis and Treatment

Infertility is a widespread condition with psychologic, economic and medical implications. The unparalleled publicity given to the fertility issues in the technological era has demanded a rise in the infertility services. Worldwide, the prevalence of infertility is highest in Eastern Europe, North Africa, Middle East, oceania and sub-Saharan Africa.

32 Medical Tourism April.-June 2018

What is infertility? Infertility is defined as the inability to conceive a pregnancy after 12 months of unprotected sexual intercourse. Causes of infertility are many and varied and involve male, female or a combination of factors. This includes problems with the production of sperm or eggs, the structure or function of male or female reproductive systems; and/or hormonal and immune conditions. In 40% of couples the cause of infertility is attributed to a sperm factor, in another 40% the cause is found within the female reproductive system, and a third will have a combination of male and female factors.

Female fertility can be affected by • A woman’s age • Ovulatory dysfunction • Damage to fallopian tubes • Endometriosis • Cervical factor • Unexplained infertility

Male fertility can be affected by problems with sperm production or the transport process such as: • Blocked / absent vas deferens (tubes) • Low sperm number and/or poor sperm production • High numbers of abnormally shaped sperm • Failure of sperm production • Anti-sperm antibodies • Sperm DNA fragmentation • Genetic diseases such as cystic fibrosis or a chromosomal abnormality

When should I see a doctor? See your doctor if you do not get pregnant after having unprotected sex for 1 year. But if you get worried before then, see your doctor sooner. And if you are older than 35 or not getting your period every month or have a history of endometriosis see your doctor if you can’t get pregnant after 6 months of trying. Both partners need concurrent testing. But don’t be surprised if your doctor cannot tell you what is wrong. It’s not always possible to find out why a woman cannot get pregnant.

Is there anything I can do? • Take your vitamins every day Women should take 0.5mg folic acid supplements daily for at least three months before pregnancy and for three months into the pregnancy. This reduces the risk of neural tube defects (most commonly spina bifida) in babies. • Check your weight If you are significantly overweight or underweight, it can adversely affect your chance of getting pregnant. Use a Body Mass Index (BMI) calculator to check if you have an appropriate body weight. If you have a high BMI, you can improve your fertility dramatically with just a 5% reduction in weight. • Regular moderate exercise Walking, tennis, and other moderate exercise, are good for maintaining a healthy lifestyle. Sperm quality is reduced when men are too sedentary. Sitting on testicles for hours every day can cause them to overheat and halt sperm production. A Complete Magazine on Healthcare in Asia

• Blood tests Blood tests can check female hormone levels. Abnormal hormone levels can make it hard to get pregnant. Blood tests can also be done to check for genetic problems that can make it hard to get pregnant.

• Egg reserve test Women are born with their lifetime supply of eggs, and these gradually decrease in both quality and quantity with age. Anti-Mullerian Hormone (AMH) is a hormone secreted by cells in developing egg sacs (follicles). The level of AMH in a woman’s blood is generally a good indicator of her ovarian reserve.

• Ovulation tests Different tests can be used to check if a woman is ovulating.).

• Caffeine High caffeine intake has been linked with female infertility in some research studies,it is worth considering a moderate coffee intake (not more than two cups per day) if you are trying to get pregnant. Be aware that caffeine is present in other beverages and food, such as Cola drinks and chocolate. • Stop Recreational Drugs and

Steroids

Recreational drugs such as marijuana and cocaine can decrease sperm quantity and increase the number of abnormal sperm while steroid abuse can result in shrunken testicles and halt sperm production. Have frequent sex (or at least frequent ejaculation) Sperm does not become more potent if a man abstains from sex or ejaculation in fact it is the opposite. Ejaculate or have regular sex 2 – 3 times per week so sperm is not stored for too long in the testicles where it can be damaged • Eat a healthy diet Men should eat a balanced diet - try to include more fresh vegetables, fruit and lean meat. Foods particularly rich in antioxidants help improve sperm health such as berries, pumpkin seeds, colourful leafy vegetables and you could consider multivitamin supplements 34 Medical Tourism April.-June 2018

such as Vitamin C and E which are known for their antioxidant qualities. • Stop smoking Active and passive smoking harms sexual and reproductive health in both men and women. For men it can damage sperm DNA and increase the chances of miscarriage and likelihood of childhood cancers. • Limit alcohol intake Daily consumption of alcohol and binge drinking is known to affect your fertility. Try and follow the rule of ‘everything in moderation’

What tests are done for women Women might then have 1 or more of the following tests:

The most fertile days of a woman’s cycle are the days leading up to ovulation, before the egg is released from the ovary. After ovulation the egg survives for just 24 hours, while sperm retain fertilising capability for two to three days in the fallopian tube. Having sex every 2 days during the window period is recommended.

• Urine test For detecting levels of a hormone, when positive indicates ovulation will occur in 18 to 36 hours.

• Blood progesterone levels Progesterone is the pregnancy hormone. Testing for its level 6 to 8 days after ovulation confirms ovulation.

What tests check the uterus and fallopian tubes? Doctors can do different tests to check for problems with the uterus and fallopian tubes. These include:

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• Ultrasound, X-ray, or other imaging tests These tests can create pictures of the inside of the body and can check for blockages or other problems • Pelvic ultrasound In a transvaginal ultrasound, a small ultrasound probe is inserted into the vagina; this provides a clearer image of the uterus and ovaries than ultrasound that is performed through the abdomen. It does not require that the patient is sedated or anesthetized, and has few to no risks. It is used to measure the size and shape of the uterus and ovaries and to determine if there are structural abnormalities (such as fibroids or ovarian cysts). If abnormalities are seen, further testing may be needed. • Hysterosalpingogram It involves inserting a small catheter through the cervix and into the uterus. A liquid that can be seen on x-ray is injected through the catheter, which fills the uterus and fallopian tubes. An x-ray is taken after the liquid is injected, which shows the outline of the uterus and tubes. An abnormally shaped uterus or blocked fallopian tube would be visible on the x-ray.

36 Medical Tourism April.-June 2018

• Tests that look inside the body (Hysteroscopy/ laparoscopy) These tests are not as simple as imaging tests, because they involve procedures. A doctor can look inside the body using a small tube with a camera on the end. He or she can put the tube into the vagina, past the cervix, and up into the uterus to look at the inside of the uterus. During laparoscopy, a thin, lighted tube is inserted through a small incision in the abdomen, allowing the physician to view the uterus, ovaries, and fallopian tubes. Laparoscopy is performed as a day surgery procedure and requires that the patient receive general anaesthesia.

• Genetic tests Genetic testing may be recommended if there is a suspicion that genetic or chromosomal abnormalities are contributing to infertility. These tests usually require a small blood sample, which is sent to a laboratory for evaluation.

Tests for men • Semen analysis You will be required to produce a semen sample by masturbation, after at least three days’ abstinence from

sexual activity. You should collect the entire ejaculated amount in a clean, dry container and bring it to your appointment (within an hour of collection). If you prefer, you can produce the sample in a private room at the clinic. They analyse and measure the number of sperm, their ability to move, their size and shape, and the volume and consistency of the ejaculated sample. A normal sperm count is at least 15 million sperm per ml, with at least a third showing good forward motility. If they find abnormalities, they usually do more tests to identify the nature and degree of any problems.If your sperm count is low, your doctor will repeat the test 1 or more times. If repeat sperm counts are still abnormal, your doctor might do other tests. For example, he or she might do: • Blood tests- for hormonal levels • An exam to measure the size of your testicles • Tests to see if there is a block in your testicles

• Genetic tests A testicular biopsy (collection of a small tissue sample) may be recom-

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mended in men with no sperm on the semen analysis. The biopsy can be done by surgically opening the testis or by fine-needle aspiration (inserting a small needle into the testis and withdrawing a sample of tissue).

What treatments are available? Women who have trouble getting pregnant might choose to have one or more of the following treatments

• A medicine called clomiphene This medicine improves the chances that ovulation will occur. Many times, doctors prescribe this treatment first. Your doctor will tell you how and when to take this medicine. He or she will also tell you when to have sex so the treatment has the best chance of working. If this medicine does not work after a few months, your doctor might recommend trying other medicines to help with ovulation. 38 Medical Tourism April.-June 2018

• Hormone shots Hormone shots are often recommended if a woman does not get pregnant with clomiphene. Hormones improve the chances that ovulation will occur. Your doctor will tell you how and when to do this treatment. • Intrauterine insemination For this treatment, a doctor uses a tube to place sperm directly inside a woman’s uterus. This is done right before ovulation. For some women, this treatment is combined with clomiphene or hormone shots to increase the chance of pregnancy.

• In vitro fertilization, also called “IVF” IVF is a procedure that is usually done if other treatments have not worked. It involves the following: •A woman gives herself hormone shots for a few weeks. These hormones get the ovary ready to ovulate.

•Just before ovulation, the doctor uses a thin needle to remove some eggs from the ovaries. He or she does this through the vagina. •The eggs are put into a test tube with sperm so that the sperm can fertilize one or more eggs. •After 2 to 5 days, the fertilized egg or eggs are put in the woman’s uterus. Hopefully, one of the eggs will attach to the uterus and grow into a pregnancy. •IVF is usually done in women whose fallopian tubes are missing or blocked •With male partners who have too few sperm

What treatments can help men with infertility? Different treatments can help men with infertility still be able to father children. These can include: • Hormone treatment to increase sperm counts – Some men have low

hormone levels and can be treated with hormone shots. • Surgery to open up a block in the testicle – For example, a man who had a vasectomy in the past can have surgery to reopen the tube the sperm travels through. • In vitro fertilization, also called “IVF”. During IVF, a doctor takes an egg or eggs from a woman and sperm from a man. He or she puts them together in a test tube so that the sperm can fertilize an egg. Then the fertilized egg is put into the woman’s uterus to grow. Many times, a doctor will do a treatment called “intracytoplasmic sperm injection,” or “ICSI,” along with IVF. During ICSI, a doctor takes only 1 sperm and injects it into the egg. IVF with ICSI is often used for men who have low sperm counts or abnormal sperm. But this treatment can also be used for men who have no sperm in their sample. This is because these men might still have sperm in their testicles that a doctor can take out and use for the procedure.

Digital High Magnification This is done for men with severely reduced levels of sperm morphology or with high levels of DNA fragmentation. This technique allows the laboratory to

enlarge images of sperm to over 7300x magnification (compared to 200-400x in standard ICSI), and pick the most appropriate sperm based on size and shape for fertilisation to be injected into the egg.

and guilt. In one study, 40 percent of infertility patients suffered from some type of psychiatric disorder; the most common diagnosis was an anxiety disorder (23 percent), followed by major depressive disorder (17 percent) [1].

Do treatments always work? — No. Treatments do not always help a couple get pregnant. The same treatment might help one couple get pregnant, but not another couple.

These problems can be circumvented to an extent by relaxation techniques, stress management, coping skills training, and group support. Evaluation by a psychiatrist may be needed for some persons with significant symptoms of anxiety or depression

What choices you have if you choose to stop or not have treatment? — Couples who choose to stop or not have treatment have other options. They can: • Try to have a baby using another man’s sperm, such as sperm from a sperm bank (called “donor” sperm) • Adopt a child • Not have children of their own Couples can have a tough time making these decisions. You might find it helpful to talk to a counsellor or go to a support group for people who are facing the same issues.

EMOTIONAL SUPPORT DURING INFERTILITY EVALUATION The inability to become pregnant can lead to a variety of emotions, including anxiety, depression, anger, shame,

Dr. Remya V Aryad Registrar, Department of Obstetrics and Gynecology, Blacktown Hospital, Newsouth Wales, Australia. Email. remyaaryad@gmail.com Phone: +61 422 524 912

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Medical Tourism ayurveda

Monsoon Tourism in Kerala is the Best Ayurveda Vacation Monsoon in Kerala and Ayurveda are blended as this is the best season to rejuvenate the mind and replenish the body.

yurveda vacation in the monsoons is the mode of treatment which works best during the rains. During monsoon season, the atmosphere remains dust-free and cool, opening the pores of the body to the maximum, making it most receptive to herbal oils and therapy.

Kerala is the first place in India to experience the magic of the monsoon season in all its magnificence, and tourists from all over the world travel to enjoy the monsoon tourism in Kerala. Monsoon Tourism in Kerala starts every year on June 1 approximately when the climate is ideal for Ayurveda treatment with maximum impact. The monsoon season from mid-June to mid-August is considered for any type of Ayurveda treatment for any ailments. Ayurveda is the medical side of yoga and it’s India’s traditional natural healing system, which has been practiced for over 5,000 years. Ayurvedic resorts have become popular destinations for relaxation and rejuvenation, while Ayurvedic hospitals cater for people seeking Ayurvedic treatment for more serious health problems. Ayurvedic medicine is most effective for metabolic, stress-related, and chronic conditions. Treatments are also very helpful in relieving the effects of surgery and debilitating treatments such as chemotherapy. Other popular uses of Ayurveda are for general rejuvenation and beauty care. Ayurveda is a pranic system of medicine, which works to balance the body’s life energy -- referred to as the doshas. This is achieved by diet, different types of massage, pouring herbal liquid onto the body, and covering the body with herbal leaves and powders. Generally, at least a couple of weeks are needed to complete a full course of Ayurvedic treatment. However, it’s also possible to get simple renewal treatments, such as Ayurvedic massage. There are two main types of Ayurvedic treatment on offer in India -- general rejuvenation treatments catering to tourists and given by resorts in tourist areas, and intensive medical treatments administered by centers in geographic locations with the most suitable climate.

Ayurveda is the doctrine of longevity and religious based science of how to live one’s daily life. This ancient scheme, invented by wise men who got together at the foot of the Himalaya Mountains looking for methods to cure diseases, recognizes a close relationship between human and a universe where everything (plants, rocks, animals) is inspired Medical Tourism April.-June 2018 40

Dietary tips Apart from treatment, a diet suiting your body constitution also helps. Here are some general tips to follow during the monsoon: Dos • Drink only boiled and cooled water. Adding a little honey is also good • Herbal water is recommended • Drink plenty of water • Eat only moderate quantity of food • Use ginger for easy digestion • Include green gram and plenty of milk in your daily diet • Spices should be in moderate quantity • Wash all fruits and vegetables with warm water • Oil massages are good during the rains • Bathe in warm water • Wear clean and dry clothes. • Keep physical exercise at a moderate level. • Keep surroundings dry and clean. Dont’s • Avoid foods that are hard to digest. • Avoid cold foods and drinks. • Curds is a no-no during monsoon. • Strike out raw vegetables and salads from your menu during the monsoon. • Sleeping during the day is not recommended.

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Medical Tourism health tourism

Number of people Coming to India for Treatment will Double in Four Years By Dr. Azad Moopen, Founder Chairman and Managing Director, Aster DM Healthcare

ndia is one of the fastest growing destinations for medical tourism. According to a recent FICCI report, over 500,000 foreign patients seek treatment in India every year. The industry association predicts that Indian medical tourism bill will soon reach $6 billion and the number of people coming to the country for medical treatment doubling over the next four years. When it comes to healthcare, money is not the first concern but efficiency ofdoctors and standards of medical care. People today have easy access to information about their ailments and are more aware of the choices available in terms of latest lines of treatment. It is a combination of factors that pa42 Medical Tourism April.-June 2018

tients consider before deciding to travel overseas for medical treatment. And, of course, cost-effectiveness is one of the factors. The United Nations World Tourism Organisation (UNWTO) has recognised Kerala’s award-winning ‘Responsible Tourism’. Several international-standard hospitals have established themselves in Kerala, and have taken the initiative to work with the tourism sector to offer medical tourism packages. Easy accessibility by air from several Middle East and African countries is a major reason and Kerala also has a talented pool of qualified and professional doctors, nurses and medical personnel, who are respected in GCC / Africa.

There is scope to increase healthcare revenue manifold from Western countries due to cost differential. Sustained outreach campaigns to spread awareness about the level of care offered in India can go a long way in bringing patients to India – just as Kerala has done in the specific markets that it targets. India has already simplified e-medical visa facility which allows three visits to the country. Exclusive immigration counters and facilitation desks have been set up at various Indian airports to provide required services to people. Kerala must showcase itself as a preferred Health Tourism destination abroad. Hospitals in India offer world-class diagnosis and treatment. This combined

with talented doctors and surgeons – many of whom have trained or worked at some of the best medical institutions in the US, Europe, or other developed nations -attracts patients. Indian nurses are also among the best in the world. The cost in India is only 1/4 th of the expenses levied in Western countries. Accreditation of hospitals by JCI will be a good step to improve the standards of hospitals. It improves the quality of healthcare provided because private chains can bring in world-class medical care facilities and equipment. Retaining talent in India is an issue not just in the medical field but across many other sectors. The ‘brain drain’ has been going on for a while now and it is sad to

see that so many talented doctors, nurses, and technicians still need to look overseas for jobs. In the medical field, I feel this has been changing and can still improve with the entry of high-quality national and international healthcare providers. Being associated with a reputed private company can give young doctors the exposure they are looking for and the opportunity to deliver the latest and best treatment available today. We must promote “Reverse Brain Drain”.

cialized surgeries such as joint replacement (knee/hip), cardiac surgery, dental surgery, cancer treatment and cosmetic surgeries, obesity treatment, and infertility treatment.

Visa on arrival should be extended to more countries as accessibility is important and an easier visa application process is a contributing factor to attracting medical tourists.

Cosmetic surgery is one of the top draws for India’s medical tourism. This can be combined with tour to destinations in Kerala with natural beauty.

India is a culturally rich nation with much to offer. People who are multilingual as well as the supply of food which is liked by foreign patients. Indian surgeons are known for their high level of skill and competence.

Patients travel to India for complex speA Complete Magazine on Healthcare in Asia

Medical Tourism interview

Care & Cure

is the Medical Tourism in India Medical tourism is basically care and cure. The identity of Kerala is that both care and cure is provided by all medical institutions. The combination of modern technology, tradition and cost effectiveness is the service provided in Kerala, says Dr.Saji Kumar, founder of Dhatri Gorup, who was born and brought up in a traditional Vaidyar family hailing from the princely State of Travancore, Kerala. Here are some of the excerpts of the interview with Dr. Saji Kumar

44 Medical Tourism April.-June 2018

Q. What is the role Ayurveda can

Q. Do you think combined treat-

play in attracting more tourists to India?

ment of various disciplines would give better results ?

To understand this question, we need to understand the basic premise of why do people travel in the first place. Getting to know different cultures and people helps them understand themselves and life much more better. And Ayurveda as the complete Science of Life can serve this need much better. Ayurveda teaches you how to take care of the body and mind comprehensively. As you know, India is the birthplace of Ayurveda and Kerala happens to be the domain of Authentic Ayurveda.

The various treatment disciplines should be considered as a one industry. There should be a joint effort for using the digital technology like Artificial Intelligence and robotics for better results. When the medical fraternity move as a group it will help the individuals also.

This has been the true magnet in drawing like minded tourists to India. Medical tourism is basically care and cure. The identity of Kerala is that both care and cure is provided by all medical institutions. The combination of modern technology, tradition and cost effectiveness is the service provided in Kerala. Those who come here for treatment are considered as guests. It is the responsibility for us to ensure leisure and wellbeing for the patients.

Q. Already the Government had come out with several projects to bring in more patients. Is there any more effort needed from the Government ? The government has indeed done a lot to promote tourism. It will be great if they can also promote Ayurveda Wellness tourism. For eg. The govt. of Malaysia is actively involved in promoting Medical Tourism at various levels. It has recently constituted a council christened as Malaysia Healthcare Travel Council (MHTC) to promote and position Malaysia as the frontline tourism destination. A similar initiative for Ayurveda Tourism in India and Kerala is the need of the hour.

Q. Do you think that the facilities now available here can meet the international standards ? Yes, they do meet Global standards in many aspects. But the benchmarks are to keep raising the bar and keep on innovating. The participation and integration of all segments in this field will improve the standards more.

Q. Is there any need to change the tourism policy of the government ? Having a focused Ayurveda Tourism promotion policy. For instance, we have no specific data about the scope and trends of Ayurveda Tourism segment in Kerala or India. This needs to be measured and steps taken to promote them.

Q. How can we improve the quality of ayurveda hospitals ? Âˇ Improving quality is an intrinsic need and has to be carried out by the Ayurveda hospitals themselves. The government has done a great job by encouraging NABH accreditation for Ayurveda Hospitals. However, as on today, there are only around 13 or so

NABH accredited Ayurveda hospitals in Kerala with Dhathri Ayurveda being one of them.

Q. Do you think the ayurveda doctors are equipped to meet the demands ?

Yes

Q. Apart from the Middle East market, how can we attract more people from Europe and US ? Interestingly, the affinity for authentic ayurveda is more among westerners. However most tend to prefer institutions covered by their healthcare insurance. We need a concerted effort to have Ayurveda covered by such Insurance agencies.

Q. Do you think that the road shows being carried out by the government should give more focus for Ayurveda ? Absolutely. The geographical nature of our country including culture, arts, terrain and backwaters should be connected to attract more tourists.

Q. It is seen that there are some fake ayurveda centres functioning in Kerala and how can we have a regulation for the functioning of these centres ? In my opinion, the presence of quacks among ayurveda institutions in Kerala is comparatively less. The ayurveda fraternity and the regulatory mechanism is quite stringent which discourages fraud.

Q. What are the most preferred treatment for the international tourists here ? There has been no authentic information in this aspect. However, speaking for Dhathri Ayurveda Hospitals, we find that most patients come for Skin (psoriasis, Eczema), Neck & Spine (prolapsed disc, spondylitis, spondylosis), Life Style (diabetes, arthritis, CTS) etc. There are also Wellness programs like â&#x20AC;&#x201C; De-Stress and Rejuvenation that are also very popular.

Q. Usually what type of patients comes here for treatment ? Fundamentally, people from three different types of countries comes here for treatment. Those who do not get proper treatment at their country, where A Complete Magazine on Healthcare in Asia

Ayush has 2 certifications – Standard & Premium. Ayush standard certification are given to products that meet with Indian Standards. Ayush Premium certificates are only given to products meeting with world class quality benchmarks – for product and process. For instance, Dhathri Hair Care Plus is the only hair oil which has the prestigious AYUSH Premium certificate. Pre-Clinical trials – products should adhere to this. This rules out any adverse side effects. The user should know that the product is not dangerous. Dhathri products go through stringent pre-clinical trials to rule out any short term or long term damage.

the cost of treatment is very high and those who cannot find solution for their particular disease.

Q. Do you have any advice for the international tourists who come for treatment here ? Ayurveda tends to advocate certain food and lifestyle changes during the course of the treatment. Some tourists have a hard time getting used to this. Also the standard treatment takes around 2- 4 weeks. We need to accept this fact.

Q. How can we ensure that natural herbs and oils used in the therapy are according to the the Vedic literature on Ayurveda ? There is no easy way to it. We need to validate the vendors and products that they supply stringently.

Q. Apart from the rainy season, how can we bring in more people during the other season of the year ? There are various seasonal ailments that can be avoided and one can be at 100% if the right Ayurveda treatment is taken in time. Not many are aware of this. Only a concerted awareness program can help.

Q. It is seen that stress torn population of the modern world is turning towards naturopathic healing. How can Ayurveda give soothing relief and comfort for them ? 46 Medical Tourism April.-June 2018

Ayurveda can indeed provide relief and relaxation. We at Dhathri Ayurveda have customized De-Stress programs that are quite popular. Infact we have gone ahead a step forward with powerful Rejuvenation program which help our patients face and overcome the reasons for their stress.

Q. Do you think that the massaging parlours in Kerala are giving the right kind of therapeutic treatment ? The massage parlours do not impart the true Panchakarma therapy. Each therapy needs to be prescribed by a qualified Ayuveda doctor after doing a comprehensive profiling of the patient based on their prakruti.

Q. What is the market for ayurveda cosmetics ? Ayurveda Home &amp; Personal Care industry is still in growing phase and its industry size cannot to gauged correctly. There is a sizeable population who refrain from chemical cosmetics due to its side effects. There are also others who use home made preparations for hair and Skin care. What could be said is that there is enormous scope that has not been explored yet.

Q. How can we bring in standardisation, documentation and quality control for ayurveda cosmetics ? There are avenues which haven’t been implemented yet – Ayush Certification, Pre- Clinal trials and CTRI accredited Clinical Trials.

Clinically proven according to WTO CTRI norms. Most Dhathri products follow this criteria. The product should deliver what it promises. And this should be properly validated by a recognised 3 rd party agency and be published in reputed WTO agency.

Q. What is the growth potential for ayurveda beauty and personal care industry ? Absolutely unimaginable. The sky is the limit as they say.

Q. As president of the Confederation of Indian Industry, how can you ensure development of ayurveda sector ? My endeavour is first and foremost is to do a proper 5C situation analysis. Only then can we meaningfully promulgate a clear Vision and Mission for the Ayurveda sector.

Q. What can Confederation of Indian Industry do for attracting more tourists to India ? The CII will act as a catalyst in bringing together the various government bodies, the Ayurveda industry, various Medical tourism facilitators, medical tourists and provide a trustworthy platform to encourage Medical and Wellness tourists. We have chalked out a veritable calendar of big ticket events. One such event is the forthcoming IMTEC in Oman where CII is leading a large Indian delegation. We are sure that it will be a huge success. There are more such events to follow.

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Medical Tourism kidney stone

KIDNEY STONES:

ROCK-HARD FACTS Kidney stones are one of the common causes of severe abdominal pain presented to the Emergency Room. Each year, more than 1.3 million people go to emergency rooms for kidney stone problems. It is estimated that one in ten people will have a kidney stone at some time in their lives. If you’ve ever known anyone who had to endure a kidney stone, or if you’ve had one yourself, the general consensus is that they can be extremely painful. Commonly the pain of passing a kidney stone compared to the pain of childbirth. Female patients of mine experienced both have attested to this. However, this is not always the case. In some cases of kidney stones, there is relatively no pain at all, and some patients never even know they have one. The difference in experience all depends on the location of the stone within the urinary tract.

48 Medical Tourism April.-June 2018

What is a Kidney Stone? A kidney stone is a hard object that is made from chemicals in the urine. Urine has various wastes dissolved in it. When there is too much waste in too little liquid, crystals begin to form. The crystals attract other elements and join together to form a solid that will get larger unless it is passed out of the body with the urine. Usually, these chemicals are eliminated in the urine by the body’s master chemist: the kidney. In most people, having enough liquid washes them out or other chemicals in urine stop a stone from forming. The stone-forming chemicals are calcium, oxalate, urate, cysteine, xanthine, and phosphate. After it is formed, the stone may stay in the kidney or travel down the urinary tract into the ureter. Sometimes, tiny stones move out of the body in the urine without causing too much pain. But stones that don’t move may cause a back-up of urine in the kidney, ureter, the bladder, or the urethra. This is what causes the pain. Possible causes include drinking too little water, exercise (too much or too little), obesity, weight loss surgery, or eating food with too much salt or sugar. Infections and family history might be important in some people. Eating too much fructose correlates with increasing risk of developing a kidney stone. Fructose can be found in table sugar and high fructose corn syrup.

Types of Kidney Stones There are four main types of stones:

Calcium oxalate: The most common type of kidney stone which is created when calcium combines with oxalate in the urine. Inadequate calcium and fluid intake, as well as other conditions, may contribute to their formation. Uric acid: This is another common type of kidney stone. Foods such as organ meats and shellfish have high concentrations of a natural chemical compound known as purines. High purine intake leads to a higher production of monosodium urate, which, under the right conditions, A Complete Magazine on Healthcare in Asia

collect your urine for 24 hours to test for calcium and uric acid. There are four types of stones. Studying the stone can help understand why you have it and how to reduce the risk of further stones. The most common type of stone contains calcium. Calcium is a normal part of a healthy diet. The kidney usually removes extra calcium that the body doesn’t need. Often people with stones keep too much calcium. This calcium combines with waste products like oxalate to form a stone. The most common combination is called calcium oxalate.

may form stones in the kidneys. The formation of these types of stones tends to run in families.

Struvite: These stones are less common and are caused by infections in the upper urinary tract. Cysteine: These stones are rare and tend to run in families. Symptoms of Kidney Stones Some kidney stones are as small as a grain of sand. Others are as large as a pebble. A few are as large as a golf ball! As a general rule, the larger the stone, the more noticeable are the symptoms. The symptoms could be one or more of the following:  Severe pain on either side of your lower back  More vague pain or stomach ache that doesn’t go away  Blood in the urine  Nausea or vomiting  Fever and chills  Urine that smells bad or looks cloudy The kidney stone starts to hurt when it causes irritation or blockage. This builds rapidly to extreme pain. In most cases, kidney stones pass without causing damage-but usually not without causing a lot of pain. Pain relievers may be the only treatment needed for small stones. Other treatment may be needed, especially for those stones that cause lasting symptoms or other complications. In severe cases, however, surgery may be required. 50 Medical Tourism April.-June 2018

See a doctor as soon as possible. You may be asked to drink extra fluid in an attempt to flush out the stone out in the urine. If you strain your urine and can save a piece of the stone that has passed, bring it to your doctor. Or, the stone may need to be removed with surgery.

Diagnosis of Kidney Stones Diagnosis of a kidney stone starts with a medical history, physical examination, and imaging tests. Your doctors will want to know the exact size and shape of the kidney stones. This can be done with a high resolution CT scan from the kidneys down to the bladder or an x-ray called a “KUB x-ray’’ (kidney-ureter-bladder x-ray) which will show the size of the stone and its position. The KUB x-ray is often obtained by the surgeons to determine if the stone is suitable for shock wave treatment. The KUB test may be used to monitor your stone before and after treatment, but the CT scan is usually preferred for diagnosis. In some people, doctors will also order an intravenous pyelogram or lVP, a special type of Xray of the urinary system that is taken after injecting a dye. Second, your doctors will decide how to treat your stone. The health of your kidneys will be evaluated by blood tests and urine tests. Your overall health, and the size and location of your stone will be considered. Later, your doctor will want to find the cause of the stone. The stone will be analyzed after it comes out of your body, and your doctor will test your blood for calcium, phosphorus and uric acid. The doctor may also ask that you

Less common types of stones are: Infection-related stones, containing magnesium and ammonia called struvite stones and stones formed from monosodium urate crystals, called uric acid stones, which might be related to obesity and dietary factors. The rarest type of stone is a cysteine stone that tends to run in families.

Long term consequences of Kidney Stones Kidney stones increase the risk of developing chronic kidney disease. If you have had one stone, you are at increased risk of having another stone. Those who have developed one stone are at approximately 50% risk for developing another within 5 to 7 years. Drinking enough fluid will help keep your urine less concentrated with waste products. Darker urine is more concentrated, so your urine should appear very light yellow to clear if you are well hydrated. Most of the fluid you drink should be water. Most people should drink more than 12 glasses of water a day. Water is better than soda, sports drinks or coffee/tea. If you exercise or if it is hot outside, you should drink more. Sugar and high-fructose

corn syrup should be limited to small quantities. Eat more fruits and vegetables, which make the urine less acid. When the urine is less acid, then stones may be less able to form. Animal protein produces urine that has more acid, which can then increase your risk for kidney stones. You can reduce excess salt in your diet. What foods are high in salt? Everyone thinks of salty potato chips and French fries. Those should be rarely eaten. There are other products that are salty: sandwich meats, canned soups, packaged meals, and even sports drinks. You want to try to get to a normal weight if you are overweight. But, high-protein weight loss diets that include high amounts of animal-based protein, as well as crash diets can add to the risk of stone formation. You need adequate protein, but it needs to be part of a balanced diet. Seek guidance from a registered dietitian when embarking on a weight loss diet or any dietary interventions to reduce the risk of kidney stones. Don’t be confused about having a “calcium” stone. Dairy products have calcium, but they actually help prevent stones, because calcium binds with oxalate before it gets into the kidneys. People with the lowest dietary calcium intake have an increased risk of kidney stones. A stone can form from salt, the waste products of protein, and potassium. The most common type of kidney stone is a calcium oxalate stone. Most kidney stones are formed when oxalate, a byproduct of certain foods, binds to calcium as urine is being made by the kidneys. Both oxalate and calcium are

increased when the body doesn’t have enough fluids and also has too much salt. Based on blood and urine tests, your doctor will determine which types of dietary changes are needed in your particular case. Some herbal substances are promoted as helping prevent stones. You should know that there is insufficient published medical evidence to support the use of any herb or supplement in preventing stones.See your doctor and/ or a registered dietitian about making diet changes if you have had a stone or think you could be at increased risk for getting a kidney stone.

Children and Kidney Stones Kidney stones are found in children as young as 5 years. In fact, this problem is so common in children that some hospitals conduct ‘stone’ clinics for pediatric patients. The increase in the United States has been attributed to several factors, mostly related to food choices. The two most important reasons are not drinking enough fluids and eating foods that are high in salt. Kids should eat less salty potato chips and French fries. There are other salty foods: sandwich meats, canned soups, packaged meals, and even some sports drinks. Sodas and other sweetened beverages can also increase the risk of stones if they contain high fructose corn syrup.

Treatment of Kidney Stones The treatment for kidney stones is similar in children and adults. You may be asked to drink a lot of water. Doctors try to let the stone pass without sur-

gery. You may also get medication to help make your urine less acid. But if it is too large, or if it blocks the flow of urine, or if there is a sign of infection, it is removed with surgery. Shock-wave lithotripsy is a noninvasive procedure that uses high-energy sound waves to blast the stones into fragments that are then more easily passed out in the urine. In ureteroscopy, an endoscope is inserted through the ureter to retrieve or obliterate the stone. Rarely, for very large or complicated stones, doctors will use percutaneous nephrolithotony or nephrolithotripsy. The recommendation for every person with kidney stones vary, specific dietary instructions need to be individually by your doctor. Once it’s discovered why you’re forming stones, he or she give you treatment options and personalized tips on how to prevent them in the future. However, as a general rule, following a balanced diet with appropriate amount of water and healthy weight will put you on the right path to healthy and stone-free kidneys.

Santhosh Alex MD Consultant Physician Dept. of Emergency Medicine Jamaica Hospital Medical Center Jamaica New York 11418 Email: salexmd@gmail.com Phone: +1 (914) 309-0601

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Medical Tourism reflections

Live in lavish style, gobbling up all the goodies, unmindful of proper exercise, and then wait for losing precious life â&#x20AC;&#x2DC;Shock and aweâ&#x20AC;&#x2122; is the reaction after confirmation of life-style diseases; for no one expects the dreaded diseases to corner you. Of course, money and modern methods can prolong life.

By O.J.George (Consulting Editor) 52 Medical Tourism April.-June 2018

onfirmation of severe life-style diseases like malignancy of various organs would depress anyone, as people believe that there cannot be complete recovery from the dreaded disease, once it has cornered the body. Soon the mind and the consciousness about this malady which transcends the might of the purse and the otherwise robust physique cave in. Acceptance of the worst form of ailment in the realms of infertility or urology and the like is the in-thing, responding to calls for accepting procedures and protocol for managing the malady which descend down on us like an uninvited guest. India’s External Affairs Minister Sushma Swaraj has successfully undergone a kidney transplant, following which she is brimming with a healthy life. India’s Finance Minister Arun Jaitley has a problem with his kidney, but as he had earlier undergone a bariatric surgery, doctors are mulling all possible avenues to take care of his health. Goa’s Chief Minister Manohar Parikkar is in the US taking treatment for prostate cancer. No one is taking chances, but carefully proceeding with whatever avenues of treatment are available. If it is cancer there can be no alternative to finally undergoing chemotherapy, radiation drills and the like, in spite of serious side-effects these procedures bring to the patient. Whether it is brain tumour, heart attack, prostate problems or other maladies of any organ, life would not be the same again, one naturally would be rattled. Now-a-days even oxygen therapy is resorted to with the aim of alleviating excruciating pain. If it is defective heart condition or allied ailments, there is no alternative to rushing the person to a well-equipped hospital where services of the best doctors and paramedical staff are available. Angioplasty, bypass surgery, implanting of pace-makers and the like have become very common, which prolong the life of the patient. Diagnosed with cancer, one may go in for every available procedure, though costly, to stretch life till the tipping point, although no one is cock sure about the exact time of one’s departure for good. No one wants to abruptly end one’s life whatever ups and downs he/she faced throughout the journey. There remains the feeling that much more has to be done before taking the last breath. Horror of horrors among deadly diseases, cancer lurking near one who doesn’t care about changing life-style, definitely finds its due place among the top killers of mankind.

It has to be studied why animals do not suffer this much from cancer which is nothing but uncontrolled growth of tissues or cells which are unwanted. Studies on minimal attack of cancer on animals should pinpoint the causes that inflict men and women with cancer. No doubt there could be linkage to the way of life, eating, drinking and pulling on without a care for anything in this world. What I found, from intimately and intensely interacting with kith and kin who suffered cancer, is that the pain linked to cancer affliction could be the most rigorous part of the suffering, even as there are modern modes of pain management at various doses, even oxygen therapy is introduced in the menu of cancer care. Be it blood cancer, bone cancer or other variety of malignant attack, excruciating pain is part of the affliction. Decades ago, one of my uncles had blood cancer, and at the terminal stage, he was simply kept in a nursing home where he had to suffer intolerable pain, which he explained as headache. He could not pull on for so long and he had to depart from this world. A few months ago, during a visit to the bank counter, I was introduced to a teen-aged boy brought there by his grandfather to look for money someone had credited to his account for treatment of cancer. The boy was simply clinging on to his father as he could not stay still on account of pain. I asked the grandfather why this boy suffering from blood cancer was not being given anti-pain palliative injection so that he won’t suffer too much. The old man said the injection helps only for a little less than one hour. No doubt, I also contributed to the help fund a little bit. There was an auntie who had contracted bone cancer, her left jaw bone was surgically removed to cut short the affliction. The surgery was done at the prestigious cancer care centre in Mumbai. Definitely she lived a few more years without further affliction. To cut the story short she had to depart this world after a few years, arising from complications which could not be controlled at the hands of some of the best oncologists. We know Apple CEO Steve Jobs had a rare form of prostate cancer which claimed his life at the age of 56 in spite of the best of treatments made available to him. It was a form of neuro-endocrine tumour .This was a rare form of cancer, as opposed to the common pancreatic cancer. He had even a liver transplant done on him to ameliorate the complications which developed otherwise. Money and methods could not stop him from gravitating to the nether world. But the important point is that he pulled on with the disease

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for seven more years after diagnosis. There can be a feeling that all human beings would have to depart, only questions of when and how could not be fixed by even the best of medical professionals, confirming the truism that we are all equal before death. One should ponder over the things one gobbles up, the consumer does not have a choice, for all the items are contaminated with poisonous substances. The fish is being kept in formalin so that it does not decay forthwith. Vegetables are dipped in chemicals before being shipped to far off places. Meat, eggs and what not are subjected to substances that help to outwardly present a picture of freshness, not knowing that eating the same would attract malignancy later. We canâ&#x20AC;&#x2122;t grow everything for our use in the plot of land that is available to us. There are a lot of things that we consume as there is no alternative to picking things over the counter from the market place. Tests and procedures to confirm presence of poisonous sub54 Medical Tourism April.-June 2018

stances in edible matter are not available aplenty.

men during her terminal days of cancerous life.

It would be one of preliminary shock and embarrassment for the victim and the family members when one is marked as having malignant growths anywhere on the body. Gradually, after much thinking and consulting, one may go in for further treatments like chemotherapy, radiation and the like, disregarding the unavoidable side-effects that descend down the sufferer. Reports say there are even capsule forms of these medicines that would reduce the side-effects, to the extent possible.

Almost everyone who contracts cancer is initially frightful, but in course of time, the patient would positively respond to the procedures for the management of the dreadful disease.

I have noticed that many a victim may not be comfortable with visitors calling on them. I had a friend who refused to meet anyone outside family members when oesophagus cancer was confirmed in his case. He had stints of chemotherapy and allied care procedures. Ultimately, he had to call it a day from Planet Earth. Remember there was a versatile actress who refused to be filmed by the lens-

Actor Innocent seems to have been quite realistic about the situation and so he faced the problem in a matter of fact way. On completion of a set of chemotherapy procedures, after a while, the problem relapsed. He did not refuse to undergo another round of the same mode of treatment, and he seems to have overcome the problem. He was most realistic when he announced that his wife also had to undergo this mode of treatment when the disease struck her. Positive response from noted figures would definitely prompt the lesser mortals to take recourse to the most modern procedures of cancer management. (ojgeorge@gmail.com)

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Medical Tourism sex life

The majority of the couples do not experience an exponential drop in their sex lives post marriage. There are several couples who continue vigorous and enjoyable sex lives consistently throughout their marriage.

How to maintain sex life post marriage

here are sections of the people who feel underwhelmed about the loss of sexual encounters within their marriage. Ups and downs are part of life, especially sex life.

 Men and women change after having a baby, therefore the relationship changes, and all too often the man wants the woman to resume her pre-baby self far too soon.

Sex is a symptom- not the main issuerarely do couples report all aspects of their marriage being great with the only exception being sex. Some people even think marriage itself is the culprit for the lack of sex.

 Women take longer than men to resume their pre-baby self. The problem arises when the man expects too much too soon.

If you are worried about what decreases the sex life between couples, here are a few hints and a few helpful tips.  Keep in mind that a decent sex life takes work, there is no quick fix. Just like having good health and a good body takes effort in the way of proper diet and exercise.  Children have a huge impact on a couple’s sex life. The wife is left feeling resentful and the man feels inadequate because he isn’t getting a fair slice of the precious time his wife spends on the baby. 56 Medical Tourism April.-June 2018

 While men feel the pressure of fatherhood, a woman is going through much more, physically and emotionally. She is learning how to re-balance her life, and men need to be patient because the woman usually puts herself and her needs further down on the list than the needs of her partner.  Men should make it easy for your wife to be with you. Don’t be another stressor or remind her how long it’s been since you’ve had sex.  Women get consumed, even obsessive, with their role as a mother and if she doesn’t get to be by herself for decent periods of time, she will forget the

(pre-children) woman inside her- leaving that identity for the role of supermom.  A man will say he is tired and simply be done with his day. But a woman will keep on giving to her children, past the point of exhaustion.  Problems can occur when the husband wonders why she can’t find it within her to give more (ie. sex) to himwhy will she not go above and beyond for his needs?  If husbands are expecting their wives to easily shut off their mother role once the kids are asleep, he’ll be dissappointed. Give her time, on a weekend or during the day sometime, to shut off the mother role- when she is not exhausted already.  Don’t expect to get sex the first week or so of giving her more outings by herself- be patient and show her this is genuinely time she deserves, no strings attached.

her or concentrate on this aspect too much, then she will withdraw further away from the bedroom, and consequently your chances of sex diminish. Women are very mental/psychological creatures, especially concerning sex. They realize when they’ve gained weight, and it affects them mentally. The best thing to do is be an examplestop eating junk around her or focusing activities around eating. Women want to feel close to their husbands so they will partake in activities or even bad habits, like late-night snacking- just to spend time with you. If she gets her connection by eating with you, then she won’t need to engage in other connections, such as sex. There may come a time when your partner says I want less sex or more sex. You would like to acknowledge your partner’s needs, but they aren’t compatible with your needs or maybe you feel like you can’t give more sex unless you get some of your other, non-sexual needs met.  Even if you’re hoping for some sexual favours sometime down the road, you should still be sincere about helping her detach from the kids a little.  Encourage each other to have a life and hobbies outside of the kids. If the kids are your life, your sex life will suffer- of course when you’re done procreating/adding to your family,. After marriage we find accusing spouses for their changing nature. Sometimes it seems they change so much, we lose some of the initial attraction we felt for them. Or maybe we changed so much that our attractions varied as well. The way a woman views her man is crucial to her sexual feelings toward him. A woman feels most attracted to a strong, not necessarily physical, but supportive man- even if a woman is strong and independent, she still wants to know her man represents a safe place to fall back upon. Women have an ideal in their head, from the time they were little girls, about the man they will marry. While it’s important for women to give up their man in the fairytale, it’s also important for men to know what makes their wife attracted to them most. Men seem to complain a lot about their wife’s body changing after marriage, usually gaining weight. If you pressure

One person in the relationship has emotional, spiritual, and psychological needs that must be met before they welcome the idea of sex. If those needs are not met, sex decreases or becomes dissatisfying for that person. The needs should be communicated in the most respectful way with your partner. Then, work on a give and take program- you ask for a date night or a massage (whatever you deserve or helps you feel connected) from your partner and you will give him a favour in return. Lack of sex is a symptom- something else is going on and has been for a while. Since women are mental/emotional creatures, it’s usually a woman who holds resentment or anger about something in the past. This is a mental road block a woman must overcome to get physical again. As a man, you can either talk it out with her or you can get help from a counsellor together. It takes effort to have a sex life with your spouse, and even more effort to have a good one. Couples are surprised at the effort involved to just get away from their routine to have sex or quality time that might lead to sex. Sex doesn’t just happen when married. There are several ways to satisfy a man and a woman, but it takes effort to discover these things- uprooting the usual routine to discover long-term bedroom bliss.

Men, if you put out effort, your wife may put out too. Don’t take anything for granted. Since spontaneity and lust are pre-marital luxuries, romance is the replacement now that you’re married. There are biological reasons that lead to a diminishing sex life. Many occur after child birth and in the 50+ age group for men and women. For example, heart and cardiovascular problems can cause impotency in men. After child birth and during menopause, women’s hormones can fluctuate extensively, causing a physical and mental decreased appetite for sex. A doctor’s evaluation and blood tests can uncover the reason for loss of sex drive.

Ways to get things going without focusing on the sex stats?  Focus on making the relationship better in general; communicate more, view each other as partners, share interests and activities together, go through hardships together.  Read or watch something naughty.  Don’t overthink about sex. Let it happen if it happens...it’s perfectly natural.  Take an adventure- do something completely out of your comfort zone together, This is the first thing Tony Robbins uses for couples he counsels.  For women who can’t find the inspiration to have sex with their husbands, here is one incentive: after you have sex with him is when he is feeling closest to you and open to conversation about things you may want to discuss while he’s in a really good mood. If you have sex before bed, though, he will probably be fast asleep so pick a good time not right before bed.  Kiss more  See a romantic or steamy movie together  Go to one of your favourite date places (or activities) before you got married  Talk dirty (over the phone, text or email is good)  Touch each other more  Try a new activity or challenge with your spouse- you may see them in a new light

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58 Medical Tourism April.-June 2018

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Medical Tourism food

Healthy eating for a

healthy heart Heart-healthy eating is an important way to lower your risk for heart disease and stroke.

To get the most benefit for your heart, you should choose more fruits, vegetables, and foods with whole grains and healthy protein. You also should eat less food with added sugar, calories, and unhealthy fats. A look at why is heart-healthy eating important by MT Desk

60 Medical Tourism April.-June 2018

eart-healthy eating, along with regular exercise or physical activity, can lower your risk for heart disease and stroke.

What foods should you eat to help lower your risk for heart disease and stroke? Choose these foods most of the time:

Fruits and vegetables At least half of your plate should be fruits and vegetables.

Whole grains At least half of your grains should be whole grains. Whole grains include:

Whole wheat Whole oats Oatmeal Whole-grain corn Brown rice Whole-grain barley Millet Sorghum Fat-free or low-fat dairy products These include milk, calcium-fortified soy drinks (soy milk), cheese, yogurt, and other milk products. Seafood, skinless poultry, lean meats, beans, eggs, and unsalted nuts

What foods should you limit to lower your risk of heart disease and stroke? You should limit:

Saturated fats Saturated fat is usually in pizza, ice cream, fried chicken, many cakes and cookies, bacon, and hamburgers.

Trans fats These are found mainly in commercially prepared baked goods, snack foods, fried foods, and margarine.

Cholesterol Cholesterol is found in foods made from animals, such as bacon, whole milk, cheese made from whole milk, ice cream, full-fat frozen yogurt, and eggs. Fruits and vegetables do not contain cholesterol. Eggs are a major source of dietary cholesterol, but studies show that eating one egg a day does not increase the risk for heart disease in healthy

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You should limit your sodium intake to less than 1,500 milligrams (about twothirds of a teaspoon of salt) if you: Have high blood pressure Are 51 years or older Have diabetes Have chronic kidney disease

You can lower the amount of sodium you eat each day by: Eating fewer processed foods Most of the salt we eat comes from processed foods rather than salt we add to foods we cook. Seasoning your food with herbs and spices instead of salt. Look for salt-free seasoning combinations in your grocery store. people. You should eat less than 300 milligrams of cholesterol per day..

Sodium Sodium is found in salt, but most of the sodium we eat does not come from salt that we add while cooking or at the table. Most of our sodium comes from breads and rolls, cold cuts, pizza, hot dogs, cheese, pasta dishes, and condiments (like ketchup and mustard). Limit your daily sodium to less than 2,300 milligrams (equal to a teaspoon), unless your doctor says something else.

Sugar Foods like fruit and dairy products naturally contain sugar. But you should limit foods that contain added sugars. These include: Sodas, Sports drinks, Cake, Candy, ice cream, Corn syrup, Corn sweetener, Fructose, Glucose, Sucrose, Dextrose, Lactose, Maltose, Honey, Molasses, Raw sugar, Invert sugar, Syrup, Caramel, Fruit juice concentrates

How many calories should you eat? The number of calories you should eat each day depends on your age, sex, body size, physical activity, and other factors. 62 Medical Tourism April.-June 2018

How does sodium in food affect your heart? Eating foods high in sodium may cause high blood pressure, also called hypertension. Hypertension is a risk factor for heart disease and stroke. You should limit the amount of sodium you eat each day to less than 2,300 milligrams (about 1 teaspoon of salt), including the sodium found in packaged foods that you cannot see.

How does potassium in food affect your heart? Potassium lessens the harmful effects of sodium on blood pressure. Try to eat or drink at least 4,700 milligrams of potassium a day. Good sources of potassium include: Bananas (442 milligrams for a medium banana) Milk, nonfat and low fat (up to 370 milligrams per cup)

Orange juice (496 milligrams per 8-ounce glass of 100% orange juice) Plain yogurt, nonfat or low fat (up to 579 milligrams per 8-ounce carton) Prunes and prune juice (707 milligrams per 8-ounce glass) Spinach (up to 419 milligrams per half cup) Sweet potatoes (542 milligrams for a medium-sized sweet potato) Tomatoes and tomato products (664 milligrams for one-half cup of tomato paste; 405 milligrams for one-half cup of tomato sauce) White potatoes (738 milligrams per small potato)

How does cholesterol in food affect your heart? Cholesterol is a waxy, fat-like substance made by your body. It also is found in foods made from animals, like meat and dairy. Fruits and vegetables do not contain cholesterol. There are two types of cholesterol: HDL, or “good” cholesterol, and LDL, or “bad” cholesterol. Higher levels of total cholesterol

and LDL or “bad” cholesterol raise your risk for heart disease. You can lower your cholesterol and LDL or “bad” cholesterol by:

Limiting cholesterol Try to eat or drink less than 300 milligrams of cholesterol each day. For comparison, a fast food double-patty plain cheeseburger has about 100 milligrams of cholesterol.

Is eating seafood good for your heart? Yes. Seafood contains a type of fat called omega-3 fatty acids. Research suggests that eating about 8 ounces of seafood with omega-3 fatty acids per week can lower your risk of dying from heart disease. Seafood that naturally contain more oil and are better sources of omega-3. fatty acids include:

Salmon Trout Mackerel Anchovies Sardines Lean fish (such as cod, haddock, and catfish) have less omega-3 fatty acids.

Is drinking alcohol good for your heart? Maybe. Research suggests that moderate drinkers are less likely to develop heart disease than people who do not drink any alcohol or who drink too much. For women, moderate drinking means up to one drink per day.

One drink is: • One glass of wine (5 ounces) • One can of beer (12 ounces) • One shot of 80-proof hard liquor (1.5 ounces) The reasons behind the benefit of moderate drinking on heart disease are not clear. But, moderate drinking is also linked to breast cancer, violence, and injuries. So, if you do not already drink, you should not start for the potential benefits to your heart. Woman should not drink alcohol if she is pregnant or may be pregnant, as there is no amount of alcohol that is known to be safe during pregnancy. You should not drink alcohol if you have another health condition that makes alcohol harmful Source: women’shealth.gov, National Institutes of Health

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Medical Tourism Diabetes

Managing

diabetes using

new technology

Your body takes care of countless tasks for you. You might not notice all it’s doing to keep you healthy until something goes wrong. Medical Tourism Desk here looks at how new technologies can help manage diabetes easier

iabetes is a serious disease that happens when your body has trouble managing and using blood glucose, a sugar that your body uses as fuel. When you have diabetes, you must actively take on this process yourself. New technologies are being tested to make it easier for you to control diabetes and to help you stay healthy. Millions of people across the world are living with diabetes or prediabetes, a condition where blood glucose levels are higher than normal, but not high enough to be considered diabetes. People with diabetes must frequently check their blood glucose (or blood

64 Medical Tourism April.-June 2018

sugar) and take quick action if it gets too high or low. They must also constantly consider how all meals, physical activity, and things like stress will affect their blood glucose.

Types of Diabetes How people with diabetes manage their blood glucose levels depends, in part, on the type of diabetes they have. The most common are type 1, type 2, and gestational diabetes. With type 1 diabetes, your body doesn’t make enough of a hormone called insulin. Insulin signals the body’s cells to let glucose inside. The

body can’t produce enough insulin because the immune system, your body’s defense against germs and foreign substances, mistakenly attacks and destroys the cells in your pancreas that make insulin. Type 2 diabetes is the most common. It occurs when either your body’s cells have trouble using insulin or your body doesn’t produce enough insulin to handle the glucose in your blood. Both types can develop at any age. Type 1 is most often diagnosed in children and young adults, while type 2 shows up most in middle-age and older people. Gestational diabetes occurs

manage their blood glucose with injections of synthetic insulin. A missed, or miscalculated, dose can lead to serious complications, immediately and over time. Diabetes increases your risk for blindness, heart disease, stroke, kidney failure, and amputation. “It’s a significant burden to self-test sugar levels several times a day, count carbohydrates with each meal, take into account the impact of physical activity, and then calculate the amount of insulin you need to inject multiple times a day with a syringe or the help of an insulin pump,” explains Dr. Guillermo Arreaza-Rubín, who heads the US’s National Institutes of Health (NIH)’s Diabetes Technology Program. Any error in this management may lead to life-threatening complications like severe hypoglycemia, which is very low blood glucose. “Hypoglycemia is one of the main reasons people with type 1 visit hospital emergency rooms every day,” Arreaza-Rubín says. “It happens more frequently during the night and is a major cause of fear and anxiety among people with diabetes and their families.”

Help from technology

only during pregnancy, but increases your chances of developing type 2 later in life. Diabetes symptoms can vary by type. Some shared symptoms include increased thirst, hunger, and urination. Symptoms of type 1 can start quickly, over a few weeks. Type 2 symptoms tend to develop slowly over years, making them less noticeable.

Blood Glucose Control Many people with diabetes check their blood glucose with a blood glucose meter. This portable machine measures how much glucose is in the blood. You get a drop of blood by pricking the side of your fingertip with a small, specialised needle. Then you apply the blood to a test strip. The meter shows you how much glucose is in your blood at that moment. People with type 1 diabetes, and some people with type 2, correct and

NIH funded-scientists are testing promising technologies to help people better manage diabetes. For example, “artificial pancreas” systems monitor blood glucose levels and provide insulin, or a combination of insulin and another important hormone, automatically. The devices vary in how easy they are to set up and use. “Our device, called the iLet, is designed to minimize the guesswork and time drain that comes with managing type 1 diabetes,” says Dr. Edward Damiano, a biomedical engineering expert at Boston University who’s co-founded a company to further develop the technology. The device only requires that you type in your body weight to get started. “The system does the heavy lifting of regulating blood glucose, freeing up the user to live a less burdened and more spontaneous life.” Previous studies have shown that artificial pancreas systems can be safer than the current standard for insulin delivery. Several different devices are now being tested in more people for

longer periods of time. Researchers are looking at safety, user-friendliness, the physical and emotional health of the participants, and cost. Safety is a priority for researchers. “When people with type 1 exercise, their blood glucose can respond in unpredictable and potentially dangerous ways,” explains University of Virginia engineer Dr. Marc Breton. He led a recent study that showed an artificial pancreas system improved glycemic control and reduced hypoglycemia in adolescents with type 1 diabetes as they participated in winter sports, like skiing and snowboarding. “The artificial pancreas performed very well in an extremely challenging environment,” he says. “Eventually, it may allow people with diabetes the freedom to participate safely in physical activities that they likely avoided in the past.” One FDA-approved artificial pancreas is already available for people with diabetes. Devices that are more fully automated may become available to the public within the next couple years. Researchers are considering how to use these systems for people with type 2, gestational diabetes, and other conditions involving elevated blood glucose levels. Other scientists are taking different approaches to replace insulin more effectively. For example, “smart insulins” would become active only when needed. Researchers are also looking for ways to regenerate or replace insulin-producing cells—and to stop the body from attacking them. “These technologies will help make managing diabetes easier and will help make people who use them healthier,” says Damiano. “I see them as a bridge to a cure for type 1 diabetes.” While future tools may make it easier to manage your diabetes, you can learn how to manage diabetes with the tools we have now to live a long, healthy life. Medications, glucose monitors, and insulin pumps are all available now to help people with diabetes. If you have diabetes, talk with your health care provider about your options Source:NIH NEWS IN HEALTH A Complete Magazine on Healthcare in Asia

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Medical Tourism Asthma

Learn to breathe easier

Most people have little trouble climbing a flight of stairs or taking a brisk walk, but these simple activities can be tough for someone with asthma. Although thereâ&#x20AC;&#x2122;s no cure, you can breathe easier by knowing how to keep the condition under control. Medical Tourism Desk looks at the reasons and prevention

68 Medical Tourism April.-June 2018

ajor symptoms of asthma include wheezing (a whistling sound when breathing), shortness of breath, coughing that’s worse at night and early morning, and chest tightness. These symptoms arise from reactions that narrow the airways, the tubes that carry air into and out of your lungs. When symptoms flare up, it’s called an asthma attack. The airways of people with asthma are prone to inflammation, which causes the airways to swell and narrow. They become extra sensitive to certain substances that are breathed in. These are called “triggers.” Asthma triggers can worsen inflammation and cause the muscles around the airways to tighten, further shrinking air passages and making it harder to breathe. Cells in the airways might also produce excess mucus (a sticky, thick liquid), making the airways even narrower. Common asthma triggers include cigarette smoke, air pollution, mold, house dust mites, and furry animal dander. Other asthma triggers include weather changes, exercise, stress, and respiratory infections like common colds. “Preventing such infections is important,” stresses Dr. Stewart Levine, an asthma expert at National Institutes of Health ( NIH). “People who have

asthma should also obtain a flu shot, as they may be at higher risk for flu-related complications.” Asthma is one of the most common causes of chronic (long-term) illness in children—and some symptoms appear more often in children than in adults. “Children have smaller airways, so if they have asthma, they tend to wheeze more often, particularly during the night,” says Dr. Robert Lemanske, Jr., a paediatric asthma expert at the University of Wisconsin. Some preschool age children frequently wheeze when they get colds but don’t A Complete Magazine on Healthcare in Asia

Controlling Asthma G e t r e g u l a r c h e c k u p s f o r y o ur asthma. Make a written asthma action plan with your health care provider and follow it. Use asthma medicines exactly as prescribed. Identify which triggers make your asthma worse such as dust mites, mold, air pollution, or secondhand tobacco smoke and try to avoid them. Exercise can trigger asthma attacks in some people, but physical activity is important to your health; ask your doctor about medicines and other options that can help you stay active.

go on to develop chronic asthma. “But some kids start wheezing at age 3, and the problem continues,” says Lemanske. “These kids also tend to be more allergic.” A doctor will test for asthma by doing a physical exam and asking about your medical history to learn when and how often your symptoms occur. Your doctor may also ask you to breathe in and blow out into the tube of a spirometer. This device measures how much air you can breathe out and how fast you can do it. “It’s sometimes tough to do a spirometry test on young children,” says Dr. Michelle Freemer, an NIH asthma expert. For youngsters, a doctor will do a physical exam and may perform other tests to identify possible asthma triggers. Whether you’re young or older, it’s important to know how to manage your asthma. Work with your doctor to develop a written asthma action plan. Your action plan should spell out the daily treatment plan to help control your asthma. This may include recommendations for medications and for avoiding exposure to your triggers. The action plan should also give specific instructions for what to do when asthma symptoms start and what actions to take if symptoms worsen, including when to seek medical attention, go to the hospital, or call an ambulance. For some patients, Freemer notes that a hand-held device called a peak flow meter can help you monitor your 70 Medical Tourism April.-June 2018

asthma. You blow into the device to measure how strongly your lungs can force air out. If the meter shows that your air flow is lower than normal, you can use your action plan to adjust your treatment.

wheeze more, wake more throughout the night, and are at greater risk for breathing failure and trips to urgent care. If your asthma is severe, see a specialist to identify the most appropriate, personalized treatment.

“There are 2 main types of medicines for managing asthma: quick-relief and long-term controllers,” says Levine. Quick-relief medicines—such as short-acting bronchodilator inhalers— are used to relax the muscles in the airways to make it easier to breathe within a few minutes. If exercise is an asthma trigger, doctors may recommend taking this medicine 5 to 15 minutes before exercise or strenuous activity.

The underlying causes of asthma are still unclear. Researchers believe asthma is caused by a combination of your genes and environmental factors. If you have allergies or a parent who has asthma, you’re at increased risk for the disease. Obesity and exposure to cigarette smoke may also raise the risk of developing asthma. NIH scientists are continuing to investigate the causes of this disease.

Long-term control medicines—such as inhaled corticosteroids—are used every day to help control symptoms and prevent asthma attacks. “Inhaled corticosteroids are recommended as the preferred long-term control medications for most children and adults,” says Freemer. “Taken daily, they help reduce inflammation to control the disease.” If young children have trouble taking inhaled medications, there are masks and other devices that can help. Some kids are given a nebulizer, a portable machine that releases medicine in a mist. A small percentage of people with asthma have a hard time controlling their symptoms even when they take their medicines regularly. Their airways become extremely inflamed and particularly sensitive to asthma triggers. They

Researchers are also working to develop new approaches to help prevent and treat asthma. Levine’s team is studying the effects of house dust mites inside the home. While exposing mice to dust mites, the researchers identified a protein in the lung that blocked the development of asthma. With further research, the finding may eventually lead to new approaches for preventing or controlling asthma symptoms in people. If you or your loved ones have asthma, identify your triggers and try to avoid them. Monitor your symptoms, and take prescribed medications regularly. “For most people with asthma, if you take your prescribed medicines and stay away from the triggers, you’ll do well,” Levine says. Keep your asthma under control so you can keep living life to the fullest Source: NIH news in health

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Medical Tourism

Chemotherapy

cancer

The treatment that kills cancer cells

72 Medical Tourism April.-June 2018

hemotherapy is a cancer treatment where medication is used to kill cancer cells.

There are many different types of chemotherapy medication, but they all work in a similar way. They stop cancer cells reproducing, which prevents them from growing and spreading in the body.

When chemotherapy is used

a course of medication at home, with regular check-ups in hospital

Chemotherapy may be used if cancer has spread or there’s a risk it will.

The patient may be treated with one type of chemotherapy medicine or a combination of different types.

It can be used to cure the cancer completely (curative chemotherapy) Make other treatments more effective for example, it can be combined with radiotherapy (chemoradiation) or used before surgery (neo-adjuvant chemotherapy) Reduce the risk of the cancer coming back after radiotherapy or surgery (adjuvant chemotherapy) Relieve symptoms if a cure isn’t possible (palliative chemotherapy) The effectiveness of chemotherapy varies significantly. Ask doctors about the chances of treatment being successful for the patient.

Types of chemotherapy Chemotherapy can be given in several ways. Your doctors will recommend the best type for you.

The patient will usually have several treatment sessions, which will typically be spread over the course of a few months.

Side effects of chemotherapy As well as killing cancer cells, chemotherapy can damage some healthy cells in the body, such as blood cells, skin cells and cells in the stomach. This can cause a range of unpleasant side effects, such as:  Feeling tired most of the time  Feeling sick and vomiting  Hair loss  An increased risk of picking up infections  A sore mouth

The most common types are:

 Dry, sore or itchy skin

Chemotherapy given into a vein (intravenous chemotherapy) – this is usually done in hospital and involves medicine being given through a tube in a vein in your hand, arm or chest

 Diarrhoea or constipation

Chemotherapy tablets (oral chemotherapy) – this usually involves taking

Many of these side effects can be treated or prevented and most, if not all, will pass after treatment stops -MT Desk. Source:NHS S Choice.

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76 Medical Tourism April.-June 2018

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Medical Tourism

Ayurveda Beyond Expectations

hen the 70- year- old mother of Jamal Al Mutarreb, an Yemeni entrepreneur based in Dubai, was diagnosed with stage 2 herniated disc, he was aghast. “We had explored all avenues with around 6 – 8 months of intensive treatments and medicines,” he says. “Nothing helped. Her problem worsened, and she could not walk. As a last resort, we were asked to go for a surgery which was very risky. I explored extensively for a better option and consulted with various experts in this field. They advised me to go to Dhathri Ayurveda Hospital in Kerala, India. My experience was absolutely beyond what I had expected. My mother underwent a one- monthlong treatment at Dhathri Ayurveda. Even before completion of the treatment, she was able to walk again and lead a normal life. Alhamdulillah, she is back with me in Dubai and is still enjoying a normal life. Luckily, we did not have to resort to any other type of medication and surgery. I wish to thank Dhathri Ayurveda for this miracle treatment. I recommend highly the treatment at Dhathri, their excellent staff, and the excellent location.”

Dhathri began its journey when one of the forefathers of the Dhathri Group, Sri Parameswara Vaidyar, laid the foundations for a long, illustrious tradition of Ayurveda medicines and healing in the small town of Kayamkulam in Kerala. The initial objective was simple - provide expert, holistic care to everyone who needs healing. Following the footsteps of Sri Parameswara Vaidyar, Dr Saji Kumar now heads the Dhathri Ayurveda Hospital and has become one of the most trusted names in traditional Ayurveda health care. The endeavour is to offer top- quality Ayurvedic healthcare service that seek to not merely cure ailments but inculcate a culture of healthy living in an individual. Dhathri is the first of its kind to be certified for quality and clinical excellence by the National Accreditation Board for Hospitals and Healthcare Providers (NABH) in Alappuzha District of Kerala.

 Wide range of ayurvedic therapies offered at Dhathri are fine- tuned to harmonize body, mind and soul.  Panel of efficient Doctors and welltrained and experienced paramedical team  Dhathri’s very own manufactured – classical & patented medicines  Treatments are administered based on a Dhathri’s very own patented Soukhyavedaphilosophy

What are some of Dhathri signature treatments?  Neck, Spine, Lower back and knee joints – eg spondylosis, spondylitis, herniated and prolapsed discs  Arthritis & Rheumatic Treatments  Obesity management, Diabetes & PCOD

Ayurveda with a difference. What sets apart Dhathri Ayurveda ?

 Skin : expert solutions for Psoriasis, Eczema and other allergic skin conditions

 It is an authentic Ayurveda hospital where expert Ayurveda physicians administer treatments based on customized prakriti analysis. It is just not a resort providing wellness therapies.

 Hair : proven treatments for various hair disorders by expert trichologists

 Treatments are designed with proper Ahara, vihara, Oushadha and kriya protocols to ensure maximum possible result for patients.

 Specialized wellness programs designed to de-stress, rejuvenate and instil a sense of mindfulness

 Treatment methodologies also inculcate physiotherapy, yoga and meditation sessions Advertorial

Similar stories and testimonials abound at Dhathri. Spread across a wide expanse of greenery in Kerala, the Dhathri Hospital & Panchakarma Centre, is a get-away destination for those in search of an authentic Ayurvedic experience away from the cacophony of city life. Dhathri has emerged as one of the front-runners in encouraging a culture of honest & trustworthy Ayurvedic treatment. The serenity of the facility by the backwater, goodness of traditional

Ayurvedic therapies and a healthy diet routine help people recuperate here.

For More details: care@dhathri.com hospitals@dhathri.in +91 902 002 8888 +91 8129 22 5555 www.dhathriayurveda.com 78 Medical Tourism April.-June 2018

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‫العالج الكيميائي هو عالج السرطان حيث‬ ‫يستخدم الدواء لقتل الخاليا السرطانية‪.‬‬ ‫هناك العديد من أنواع مختلفة من العالج‬ ‫الكيميائي‪ ،‬ولكن كلها تعمل بطريقة مماثلة‪.‬‬ ‫وتوقف الخاليا السرطانية عن التكاثر‪ ،‬مما‬ ‫يمنعها من النمو واالنتشار في الجسم‪.‬‬

‫عندما يتم استخدام العالج‬ ‫الكيميائي‬ ‫يمكن استخدام العالج الكيميائي إذا انتشر‬ ‫السرطان أو هناك خطر ذلك‪.‬‬ ‫ويمكن استخدامه لـ ‪:‬‬ ‫محاولة شفاء السرطان تماما (العالج‬ ‫الكيميائي الشفائي)‬ ‫أن يجعل العالجات األخرى أكثر فعالية ‪-‬‬ ‫على سبيل المثال‪ ،‬يمكن الجمع بين العالج‬ ‫اإلشعاعي (العالج اإلشعاعي الكيميائي) أو‬ ‫استخدامه قبل الجراحة (العالج الكيميائي‬ ‫الجديد المساعد)‬ ‫الحد من خطر السرطان يعود بعد العالج‬ ‫اإلشعاعي أو الجراحة (العالج الكيميائي‬ ‫المساعد)‬ ‫تخفيف األعراض إذا كان العالج غير ممكن‬ ‫(العالج الكيميائي الملطف)‬ ‫فعالية العالج الكيميائي تختلف اختالفا‬ ‫كبيرا‪ .‬اسألوا األطباء عن فرص نجاح العالج‬ ‫للمريض‬ ‫أنواع العالج الكيميائي‬ ‫يمكن إعطاء العالج الكيميائي بعدة طرق‪.‬‬ ‫سوف يوصي أطباؤكم أفضل نوع بالنسبة‬ ‫لكم‪.‬‬ ‫األنواع األكثر شيوعا هي‪:‬‬ ‫العالج الكيميائي المعطى في الوريد (العالج‬ ‫الكيميائي عن طريق الوريد) ‪ -‬وهذا عادة ما‬ ‫يتم في المستشفى‪ ،‬ويشمل إعطاء الدواء من‬ ‫خالل أنبوب في الوريد في يدكم أو ذراعكم‬ ‫أو صدركم‬

‫أقراص العالج الكيميائي (العالج الكيميائي‬ ‫عن طريق الفم) ‪ -‬وهذا عادة ما ينطوي على‬ ‫أخذ مسار الدواء في المنزل‪ ،‬مع الفحوص‬ ‫المنتظمة في المستشفى‬ ‫قد يعالج المريض بنوع واحد من أدوية‬ ‫العالج الكيميائي أو مزيج من أنواع مختلفة‪.‬‬ ‫وعادة ما يكون للمريض عدة جلسات‬ ‫العالج‪ ،‬والتي عادة ما تنتشر على مدى‬ ‫بضعة أشهر‪.‬‬ ‫اآلثار الجانبية للعالج الكيميائي‬ ‫فضال عن قتل الخاليا السرطانية‪ ،‬يمكن‬ ‫للعالج الكيميائي أن يضر ببعض الخاليا‬ ‫السليمة في الجسم‪ ،‬مثل خاليا الدم وخاليا‬ ‫الجلد والخاليا في المعدة‪.‬‬ ‫هذا يمكن أن يسبب مجموعة من اآلثار‬ ‫الجانبية غير سارة‪ ،‬مثل‪:‬‬ ‫الشعور بالتعب معظم اوقت‬ ‫الشعور بالمرض والقيء‬ ‫تساقط الشعر‬ ‫زيادة خطر التقاط العدوى‬ ‫الفم القرحة‬ ‫الجلد الجاف أو الملتهب أو بالحكة‬ ‫اإلسهال أو اإلمساك‬ ‫العديد من هذه اآلثار الجانبية يمكن عالجها‬ ‫أو منعها‪ ،‬ومعظمها إن لم يكن كلها سوف‬ ‫تغيب بعد توقف العالج‪.‬‬ ‫مكتب السياحة الطبية‪ .‬المصدر‪ :‬اختيار‬

‫‪NHS S‬‬

‫‪80 Medical Tourism April.-June 2018‬‬ ‫‪41‬‬

‫العالج الكيميائي‬ ‫العالج الذي يقتل الخاليا السرطانية‬

‫‪81‬‬ ‫‪40‬‬

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82 Medical Tourism April.-June 2018

‫السيطرة على داء الربو‬ ‫قوموا بالفحوصات المنتظمة لداء‬ ‫الربو الخاص بكم‪.‬‬ ‫وضع خطة عمل مكتوبة لداء الربو‬ ‫مع مقدم الرعاية الصحية الخاص‬ ‫بكم ومتابعتها‪.‬‬ ‫قوموا باستخدام أدوية داء الربو‬ ‫تماما كما هي موصوفة‪.‬‬ ‫قوموا بتحديد العوامل التي تجعل‬ ‫داء الربو أسوأ من ذلك مثل عث‬ ‫الغبار أو العفن أو تلوث الهواء‬ ‫أو دخان التبغ السلبي ‪ -‬وحاولوا‬ ‫تجنبها‪.‬‬

‫الخاصة بكم خطة العالج اليومية للمساعدة‬ ‫في السيطرة على داء الربو‪ .‬قد يتضمن هذا‬ ‫توصيات لألدوية ولتجنب التعرض للمسببات‬ ‫عندكم‪ .‬يجب أن تعطي خطة العمل أيضا‬ ‫تعليمات محددة حول ما يجب القيام به عند‬ ‫بدء أعراض داء الربو وما هي اإلجراءات‬ ‫التي يجب اتخاذها إذا تفاقمت األعراض‪،‬‬ ‫بما في ذلك متى تقوم بالتماس العناية الطبية‬ ‫أو الذهاب إلى المستشفى أو استدعاء سيارة‬ ‫إسعاف‪.‬‬ ‫بالنسبة لبعض المرضى الحظ فريمر أن‬ ‫جهاز محمول باليد يسمى مقياس تدفق‬ ‫الذروة يمكن أن تساعدك على مراقبة داء‬ ‫الربو‪ .‬تنفخ في الجهاز لقياس مدى قوة‬ ‫الرئتين أن تخرج الهواء خارجا‪ .‬إذا أظهر‬ ‫المقياس أن تدفق الهواء الخاص بكم أقل من‬ ‫المعتاد يمكنكم استخدام خطة العمل الخاصة‬ ‫بكم لضبط العالج‪.‬‬ ‫يقول ليفين‪" :‬هناك نوعان رئيسيان من‬ ‫األدوية لعالج داء الربو‪ :‬أدوية اإلغاثة‬ ‫السريعة والتحكم طويل األمد"‪ .‬وتستخدم‬ ‫أدوية اإلغاثة السريعة مثل أجهزة االستنشاق‬ ‫القصبي قصيرة المفعول السترخاء العضالت‬ ‫في الشعب الهوائية لتسهيل التنفس خالل‬ ‫بضع دقائق‪ .‬إذا كانت ممارسة التمارين‬ ‫الرياضية من مسببات داء الربو قد يوصي‬ ‫األطباء بتناول هذا الدواء من ‪ 5‬إلى ‪15‬‬ ‫دقيقة قبل التمرين أو النشاط المضني‪.‬‬ ‫‪83‬‬ ‫‪38‬‬

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‫وتستخدم أدوية السيطرة على المدى الطويل‬ ‫ مثل الكورتيكوستيرويدات المستنشقة ‪ -‬كل‬‫يوم للمساعدة في السيطرة على األعراض‬ ‫ومنع نوبات داء الربو‪" .‬ينصح الكورتيزون‬ ‫المستنشق كأدوية مراقبة طويلة األجل‬ ‫المفضلة لمعظم األطفال والبالغين"‪ ،‬ويقول‬ ‫فريمر‪" .‬إذا كانت تتناول يوميا أنها تساعد‬ ‫على تقليل االلتهاب للسيطرة على المرض"‪.‬‬ ‫إذا كان األطفال الصغار لديهم صعوبة في‬ ‫تناول األدوية المستنشقة‪ ،‬هناك أقنعة وغيرها‬ ‫من األجهزة التي يمكن أن تساعد‪ .‬يعطى‬ ‫بعض األطفال البخاخات‪ ،‬وهي آلة محمولة‬ ‫تطلق الدواء في ضباب‪.‬‬ ‫وهناك نسبة صغيرة من المصابين بداء الربو‬ ‫لديهم صعوبة في السيطرة على أعراضهم‬ ‫حتى عندما يأخذون أدويتهم بانتظام‪ .‬تصبح‬ ‫مجاري الهواء شديدة االلتهاب وحساسة‬ ‫بشكل خاص لمسببات الربو‪ .‬وهم يصفرون‬ ‫أكثر ويستيقظون أكثر طوال الليل وتكون‬ ‫في خطر أكبر لفشل التنفس والرحالت إلى‬ ‫الرعاية العاجلة‪ .‬إذا كان داء الربو شديدا‬ ‫راجعوا أخصائيا لتحديد العالج األنسب‬ ‫والشخصي‪.‬‬ ‫ال تزال األسباب الكامنة وراء داء الربو غير‬ ‫واضحة‪ .‬ويعتقد الباحثون أن داء الربو يسببه‬ ‫مزيج من الجينات والعوامل البيئية‪ .‬إو�ذا كان‬ ‫لديكم حساسية أو أحد الوالدين الذين يعانون‬ ‫من داء الربو فتكون في خطر متزايد لهذا‬

‫ممارسة الرياضة يمكن أن تؤدي‬ ‫إلى نوبات داء الربو في بعض‬ ‫الناس‪ ،‬ولكن النشاط البدني مهم‬ ‫لصحتكم‪ .‬اسأل طبيبكم عن‬ ‫األدوية والخيارات األخرى التي يمكن‬ ‫أن تساعدكم على البقاء نشطا‪.‬‬ ‫المصدر‪ :‬أخبار المعاهد الوطنية‬ ‫للصحة في مجال الصحة‬ ‫المرض‪ .‬قد تؤدي السمنة والتعرض لدخان‬ ‫السجائر إلى زيادة خطر اإلصابة بداء الربو‪.‬‬ ‫ويواصل علماء المعاهد الوطنية للصحة‬ ‫التحقيق في أسباب هذا المرض‪.‬‬ ‫ويعمل الباحثون أيضا على تطوير نهج‬ ‫جديد للمساعدة في الوقاية من داء الربو‬ ‫وعالجه‪ .‬يقوم فريق ليفين بالدراسة عن آثار‬ ‫عث الغبار المنزلي داخل المنزل‪ .‬وفي حين‬ ‫كشف الفئران لعث الغبار حدد الباحثون‬ ‫بروتين في الرئة التي منعت تطور داء‬ ‫الربو‪ .‬ومع مزيد من البحث فإن النتيجة قد‬ ‫تؤدي في نهاية المطاف إلى نهج جديد للمنع‬ ‫أو السيطرة على أعراض داء الربو لدى‬ ‫الناس‪.‬‬ ‫إذا كنتم أو أحبائكم لديهم داء الربو حاولوا‬ ‫على تحديد المسببات وتجنبها‪ .‬وقوموا‬ ‫بمراقبة األعراض الخاصة بكم وتناولوا‬ ‫األدوية الموصوفة بانتظام‪.‬‬ ‫"بالنسبة لمعظم الناس الذين يعانون من داء‬ ‫الربو إذا كنتم تتناولون األدوية الموصوفة‬ ‫واالبتعاد عن المسببات فتكون في حالة‬ ‫حسنة" يقول ليفين‪ .‬قوموا بالحفاظ على داء‬ ‫الربو تحت السيطرة حتى تتمكنوا من الحفاظ‬ ‫على معيشية الحياة على أكمل وجه‪.‬‬

84 Medical Tourism April.-June 2018

‫تعلم التنفس‬ ‫أسهل‬

‫معظم الناس لديهم القليل من المتاعب عند تسلق درجات‬ ‫السلم أو القيام بالمشي السريع‪ ،‬ولكن يمكن أن تكون هذه‬ ‫األنشطة البسيطة صعبة لشخص مع داء الربو‪ .‬على الرغم‬ ‫من عدم وجود عالج يمكنكم التنفس أسهل من خالل معرفة‬ ‫كيفية الحفاظ على الحالة تحت السيطرة‪ .‬مكتب السياحة‬ ‫الطبية يبحث في األسباب والوقاية‬ ‫داء الربو هو مرض شائع وطويل األمد‬ ‫يؤثر على الرئتين‪ .‬ويمكن أن يبدأ في مرحلة‬ ‫الطفولة أو مرحلة البلوغ‪ .‬وبدون الرعایة‬ ‫المناسبة یمکن أن یصبح داء الربو خطی ار‬ ‫وحتی قاتال‪ .‬ولكن معظم الناس الذين يعانون‬ ‫من داء الربو يتعلمون عالج المرض حتى‬ ‫يكون لديهم أعراض قليلة أو ال شيء على‬ ‫اإلطالق‪.‬‬ ‫وتشمل األعراض الرئيسية لداء الربو الصفير‬ ‫(صوت الصفير عند التنفس) وضيق في‬ ‫التنفس والسعال الذي هو أسوأ في الليل‬ ‫وفي الصباح الباكر وضيق الصدر‪ .‬تنشأ‬ ‫هذه األعراض من ردود الفعل التي تضييق‬ ‫الشعب الهوائية واألنابيب التي تحمل‬ ‫الهواء داخل وخارج الرئتين‪ .‬وعندما تشتعل‬ ‫األعراض يطلق عليه نوبة الربو‪.‬‬ ‫تكون الشعب الهوائية لألشخاص الذين‬ ‫يعانون من داء الربو عرضة لاللتهاب‪ ،‬مما‬ ‫يسبب الشعب الهوائية أن تتضخم وتتضيق‪.‬‬ ‫ويصبحون بحساسة جدا لبعض المواد التي‬ ‫تنفس داخال‪ .‬وتسمى هذه "مشغالت"‪.‬‬ ‫يمكن أن تؤدي محفزات داء الربو إلى‬ ‫تفاقم االلتهاب وتسبب في تشديد العضالت‬ ‫حول الممرات الهوائية‪ ،‬مما يزيد من تقلص‬ ‫الممرات الهوائية ويجعل من الصعب على‬ ‫التنفس‪ .‬وتنتج الخاليا في الشعب الهوائية‬ ‫‪85‬‬ ‫‪36‬‬

‫‪A Complete Magazine on Healthcare in Asia‬‬

‫أيضا المخاط الزائد (سائل سميك ولزج) مما‬ ‫يجعل الشعب الهوائية أكثر ضيقة‪.‬‬ ‫وتشمل مسببات الربو الشائعة دخان السجائر‬ ‫وتلوث الهواء والعفن وعث الغبار المنزلي‬ ‫وبرد الحيوان الفروي‪ .‬وتشمل مسببات داء‬ ‫الربو األخرى تغيرات الطقس وممارسة‬ ‫التمارين الرياضية واإلجهاد والتهابات الجهاز‬ ‫التنفسي مثل نزالت البرد الشائعة‪.‬‬ ‫يقول الدكتور ستيوارت ليفين‪ ،‬وهو خبير‬ ‫في داء الربو في المعاهد الوطنية للصحة‬ ‫(‪" :)NIH‬إن الوقاية من هذه العدوى مهمة‬ ‫ويجب على األشخاص الذين يعانون من داء‬ ‫الربو أيضا الحصول على انفلون از ألنهم قد‬ ‫يكونون في خطر أكبر للمضاعفات المرتبطة‬ ‫باالنفلونزا‪".‬‬ ‫إن داء الربو هو واحد من أكثر األسباب‬ ‫شيوعا للمرض المزمن (على المدى الطويل)‬ ‫في األطفال‪ ،‬وبعض األعراض تظهر في‬ ‫كثير من األحيان في األطفال أكثر من‬ ‫البالغين‪ .‬يقول الدكتور روبرت ليمانسك‬ ‫الصغير‪ ،‬خبير في طب الربو لدى األطفال‬ ‫في جامعة ويسكونسن‪" :‬األطفال لديهم‬ ‫مجرى هواء أصغر ولذلك إذا كانوا مصابين‬ ‫بداء الربو فإنهم يميلون إلى الصفير في‬ ‫كثير من األحيان‪ ،‬وخاصة خالل الليل"‪.‬‬

‫بعض األطفال في سن ما قبل المدرسة في‬ ‫كثير من األحيان يصفرون عندما يشكون‬ ‫من نزالت البرد ولكن ال تستمر في تطوير‬ ‫داء الربو المزمن‪ .‬ويقول ليمانسك "لكن‬ ‫بعض األطفال يبدأون الصفير في سن‬ ‫‪ 3‬والمشكلة مستمرة‪ .‬هؤالء األطفال أيضا‬ ‫يميلون إلى أن يكونوا أكثر حساسيا"‪.‬‬ ‫سيقوم الطبيب باختبار الربو عن طريق‬ ‫إجراء الفحص البدني والسؤال عن تاريخكم‬ ‫الطبي لمعرفة متى تحدث األعراضاحيانا‪ .‬قد‬ ‫يطلب منكم طبيبكم أيضا أن تتنفسوا وتنفخ‬ ‫في أنبوب جهاز قياس القدرة التنفسية‪ .‬هذا‬ ‫الجهاز يقيس كمية الهواء الذي يمكن أن‬ ‫تتنفس ومدى السرعة التي يمكن أن تفعل‬ ‫ذلك‪.‬‬ ‫يقول الدكتور ميشيل فريمر‪ ،‬وهو خبير في‬ ‫داء الربو من المعاهد الوطنية للصحة‪" :‬من‬ ‫الصعب أحيانا إجراء اختبار قياس التنفس‬ ‫على األطفال الصغار"‪ .‬وبالنسبة للناشئين‬ ‫سيقوم الطبيب بإجراء فحص جسدي ويمكن‬ ‫إجراء اختبارات أخرى لتحديد محفزات داء‬ ‫الربو المحتملة‪.‬‬ ‫سواء كنتم صغا ار أو كبا ار فمن المهم أن‬ ‫تعرفوا كيفية عالج داء الربو‪ .‬يرجى القيام‬ ‫بالعمل مع طبيبكم لتطوير خطة عمل داء‬ ‫الربو المكتوبة‪ .‬يجب أن توضح خطة العمل‬

86 Medical Tourism April.-June 2018

A Complete Magazine on Healthcare in Asia

‫"إنه عبء كبير الختبار مستويات‬ ‫السكر بنفسكم عدة مرات في اليوم‪ ،‬عد‬ ‫الكربوهيدرات مع كل وجبة‪ ،‬تأخذ في‬ ‫االعتبار تأثير النشاط البدني‪ ،‬ومن ثم حساب‬ ‫كمية األنسولين تحتاج إلى حقن عدة مرات‬ ‫في اليوم مع حقنة أو مساعدة من مضخة‬ ‫األنسولين "‪ ،‬يوضح الدكتور غييرمو أريازا‪-‬‬ ‫روبين‪ ،‬الذي يرأس برنامج تكنولوجيا السكري‬ ‫في المعاهد الوطني للصحة (‪ )NIH‬في‬ ‫الواليات المتحدة‪ .‬أي خطأ في هذه اإلدارة‬ ‫قد يؤدي إلى مضاعفات مهددة للحياة مثل‬ ‫نقص السكر في الدم الشديد‪ ،‬وهو منخفض‬ ‫جدا في مستوى السكر في الدم‪.‬‬ ‫"نقص السكر في الدم هو واحد من األسباب‬ ‫الرئيسية التي يقوم لها الناس مع نوع ‪ 1‬بزيارة‬ ‫غرف الطوارئ في المستشفى كل يوم"‪ ،‬يقول‬ ‫أريزا‪ -‬روبين‪" .‬يحدث ذلك بشكل متكرر‬ ‫خالل الليل وهو سبب رئيسي للخوف والقلق‬ ‫بين المصابين بداء السكري وأسرهم"‪.‬‬ ‫المساعدة من التكنولوجيا‬

‫تميل إلى التطور ببطء على مر السنين مما‬ ‫يجعلها أقل وضوحا‪.‬‬ ‫السيطرة على الجلوكوز في‬ ‫الدم‬ ‫كثير من المصابين بداء السكري يتحققون‬ ‫من مستوى السكر في الدم مع متر السكر‬ ‫في الدم‪ .‬هذا الجهاز المحمول يقيس مقدار‬ ‫الجلوكوز في الدم‪ .‬تحصل على قطرة من‬ ‫الدم عن طريق وخزة بالجانب من األنملة مع‬ ‫إبرة صغيرة متخصصة‪ .‬ثم تقوم بتطبيق الدم‬ ‫على شريط االختبار‪ .‬يظهر المقياس لكم‬ ‫مقدار الجلوكوز في الدم في تلك اللحظة‪.‬‬ ‫يقوم الناس الذين يعانون من مرض السكري‬ ‫من النوع ‪ ،1‬وبعض الناس مع نوع ‪2‬‬ ‫بتصحيح وسيطرة الجلوكوز في الدم مع حقن‬ ‫األنسولين االصطناعية‪ .‬إن الجرعة الفائتة‬ ‫أو الخاطئة‪ ،‬يمكن أن تؤدي إلى مضاعفات‬ ‫خطيرة على الفور وبمرور الوقت‪ .‬يزيد‬ ‫مرض السكري من خطر العمى وأمراض‬ ‫القلب والسكتة الدماغية والفشل الكلوي‬ ‫والبتر‪.‬‬

‫ويقوم العلماء لدى معهد الصحة الوطنية‬ ‫‪ NIH‬باختبار التقنيات الواعدة لمساعدة‬ ‫الناس على عالج مرض السكري بشكل‬ ‫أفضل‪ .‬على سبيل المثال‪ ،‬نظم "البنكرياس‬ ‫االصطناعي" يقوم بمراقبة مستويات السكر‬ ‫في الدم وتوفير األنسولين أو مزيج من‬ ‫األنسولين وهرمون آخر مهم تلقائيا‪ .‬تختلف‬ ‫األجهزة في مدى سهولة إعدادها واستخدامها‪.‬‬ ‫يقول الدكتور إدوارد داميانو خبير الهندسة‬ ‫الطبية الحيوية في جامعة بوسطن الذي‬ ‫شارك في تأسيس شركة لمواصلة تطوير‬ ‫التكنولوجيا‪" :‬إن جهازنا الذي يسمى إيليت‪،‬‬ ‫مصمم لتقليل تصور التخمين وفوات الوقت‬ ‫الذي يصيب بعالج مرض السكري من النوع‬ ‫األول"‪ . .‬الجهاز يتطلب فقط أن تكتب وزن‬ ‫الجسم للبدء‪" .‬النظام يفعل الرفع الثقيل من‬ ‫تنظيم الجلوكوز في الدم وتحرير المستخدم‬ ‫للعيش حياة بأقل أعباء وأكثر عفوية"‪.‬‬ ‫وقد أظهرت الدراسات السابقة أن جهاز‬ ‫البنكرياس االصطناعي يمكن أن تكون أكثر‬ ‫أمنا من المعيار الحالي لتسليم األنسولين‪.‬‬ ‫ويجري اآلن اختبار عدة أجهزة مختلفة‬ ‫في عدد أكبر من الناس لفترات أطول‬ ‫من الزمن‪ .‬يبحث الباحثون في السالمة‬ ‫وسهولة االستخدام والصحة البدنية والعاطفية‬ ‫للمشاركين والتكلفة‪.‬‬ ‫السالمة هي األولوية بالنسبة للباحثين‪.‬‬ ‫ويقول الدكتور مارك بريتون مهندس‬

‫جامعة فيرجينيا‪" :‬عندما يتمكن األشخاص‬ ‫الذين يعانون من ممارسة النوع األول يمكن‬ ‫للجلوكوز في الدم أن يستجيب بطرق ال‬ ‫يمكن التنبؤ بها وربما تنطوي على مخاطر"‪.‬‬ ‫وقد قام بالرئاسة لدراسة حديثة أظهرت أن‬ ‫جهاز البنكرياس االصطناعي يحسن التحكم‬ ‫في نسبة السكر في الدم وخفض نسبة السكر‬ ‫في الدم لدى المراهقين المصابين بداء‬ ‫السكري من النوع األول حيث شاركوا في‬ ‫الرياضات الشتوية مثل التزلج والتزحلق على‬ ‫الجليد‪.‬‬ ‫يقول‪" :‬قام البنكرياس االصطناعي باألداء‬ ‫بشكل جيد للغاية في بيئة صعبة للغاية‪،‬‬ ‫وفي النهاية قد يسمح لألشخاص المصابين‬ ‫بمرض السكري بحرية المشاركة بأمان في‬ ‫األنشطة البدنية التي من المحتمل تجنبها في‬ ‫الماضي"‪.‬‬ ‫يكون واحد من البنكرياس االصطناعي‬ ‫الموافقة عليها من قبل ادارة االغذية والعقاقير‬ ‫( ‪ )FDA‬هو متاح بالفعل لألشخاص‬ ‫الذين يعانون من مرض السكري‪ .‬قد تصبح‬ ‫األجهزة المؤتمتة بالكامل متاحة للجمهور‬ ‫خالل العامين المقبلين‪ .‬وينظر الباحثون‬ ‫في كيفية استخدام هذه األجهزة لألشخاص‬ ‫الذين يعانون من النوع ‪ ،2‬والسكري الحملي‬ ‫وغيرها من الحاالت التي تنطوي على ارتفاع‬ ‫مستويات السكر في الدم‪.‬‬ ‫ويتخذ علماء آخرون نهجا مختلفة الستبدال‬ ‫األنسولين على نحو أكثر فعالية‪ .‬على سبيل‬ ‫المثال "األنسولين الذكية" لن تصبح نشطة‬ ‫إال عند الحاجة‪ .‬يبحث الباحثون أيضا عن‬ ‫طرق لتجديد أو استبدال الخاليا المنتجة‬ ‫لألنسولين‪ ،‬ووقف الجسم عن مهاجمتها‪.‬‬ ‫يقول داميانو‪" :‬ستساعد هذه التقنيات على‬ ‫تسهيل عالج مرض السكري وتساعد على‬ ‫جعل األشخاص الذين يستخدمونها بأكثر‬ ‫صحة وأراها جس ار لعالج مرض السكري من‬ ‫النوع األول"‪.‬‬ ‫في حين أن األدوات المستقبلية قد تجعل من‬ ‫السهل عالج مرض السكري الخاص بكم ‪،‬‬ ‫ويمكنكم معرفة كيفية عالج مرض السكري‬ ‫مع األدوات لدينا اآلن للقيام بحياة طويلة‬ ‫وصحية‪ .‬وتتوفر األدوية وأدوات مراقبة‬ ‫الجلوكوز ومضخات األنسولين اآلن لمساعدة‬ ‫المصابين بداء السكري‪ .‬إذا کنتم تعانون‬ ‫من مرض السکري يرجى التحدث مع مقدم‬ ‫الرعایة الصحیة عن خیاراتكم‪ .‬المصدر‪:‬‬ ‫اخبار في الصحة للمعاهد الوطنية للصحة‬ ‫‪88 Medical Tourism April.-June 2018‬‬ ‫‪33‬‬

‫عالج مرض السكري‬ ‫باستخدام التكنولوجيا‬ ‫الجديدة‬

‫يعتني جسمكم المهام التي ال تعد وال تحصى بالنسبة لكم‪ .‬وأنتم ال تالحظون كل ما‬ ‫يفعله للحفاظ على صحتكم حتى يكون شيئ خاطئ‪ .‬مكتب السياحة الطبية هنا ينظر‬ ‫في كيفية التكنولوجيات الجديدة يمكن أن تساعد في عالج مرض السكري أسهل‬ ‫مرض السكري هو مرض خطير يحدث‬ ‫عندما يكون جسمكم لديه صعوبة في إدارة‬ ‫واستخدام الجلوكوز في الدم‪ ،‬وهو السكر‬ ‫الذي يستخدمه الجسم كالوقود‪ .‬عندما يكون‬ ‫لديكم مرض السكري‪ ،‬يجب عليكم أن تأخذوا‬ ‫هذه العملية بنفسكم بنشاط‪ .‬ويجري اختبار‬ ‫التكنولوجيات الجديدة لتسهيل السيطرة على‬ ‫مرض السكري ومساعدتكم على البقاء في‬ ‫صحة جيدة‪.‬‬ ‫يعاني الماليين من الناس في جميع أنحاء‬ ‫العالم من مرض السكري أو ما قبل مرض‬ ‫السكري‪ ،‬وهي حالة تكون فيها مستويات‬ ‫السكر في الدم أعلى من المعتاد‪ ،‬ولكنها‬ ‫ليست عالية بما فيه الكفاية ليعتبر مرض‬ ‫السكري‪ .‬يجب على األشخاص المصابين‬ ‫بمرض السكري التحقق من مستوى السكر‬ ‫في الدم احيانا (أو نسبة السكر في الدم)‪،‬‬ ‫واتخاذ إجراءات سريعة إذا كانت مرتفعة‬ ‫‪89‬‬ ‫‪32‬‬

‫‪A Complete Magazine on Healthcare in Asia‬‬

‫جدا أو منخفضة‪ .‬كما يجب عليهم النظر‬ ‫باستمرار في كيفية تأثير كل الوجبات‬ ‫والنشاط البدني وأشياء مثل اإلجهاد على‬ ‫مستوى السكر في الدم‬

‫داء السكري من النوع ‪ 2‬هو األكثر شيوعا‪.‬‬ ‫يحدث ذلك عندما يكون لدى خاليا الجسم‬ ‫مشاكل في استخدام األنسولين أو أن جسمكم‬ ‫ال ينتج ما يكفي من األنسولين للتعامل مع‬ ‫الجلوكوز في الدم‪.‬‬

‫ويعتمد كيف يعالج مرضى السكري مستويات‬ ‫السكر في الدم جزئيا على نوع السكري‬ ‫لديهم‪ .‬األكثر شيوعا هي نوع ‪ ،1‬نوع ‪،2‬‬ ‫والسكري الحمل‪.‬‬

‫يمكن أن يتطور كال النوعين في أي عمر‪.‬‬ ‫وغالبا ما يتم تشخيص النوع األول في‬ ‫األطفال والشباب‪ ،‬في حين أن النوع ‪2‬‬ ‫يظهر أكثر في منتصف العمر وكبار السن‪.‬‬ ‫يحدث مرض السكري الحمل فقط خالل فترة‬ ‫الحمل‪ ،‬ولكن يزيد فرصكم في تطوير نوع ‪2‬‬ ‫في وقت الحق في الحياة‪.‬‬

‫أنواع مرض السكري‬

‫مع داء السكري من النوع ‪ 1‬جسمكم ال ينتج‬ ‫ما يكفي من الهرمون يسمى األنسولين‪.‬‬ ‫األنسولين يعطي اإلشارات إلى خاليا الجسم‬ ‫لسماح الجلوكوز في الداخل‪ .‬ال يستطيع‬ ‫الجسم إنتاج ما يكفي من األنسولين ألن‬ ‫الجهاز المناعي وهو دفاع جسمكم ضد‬ ‫الجراثيم والمواد األجنبية‪ ،‬يهاجم عن طريق‬ ‫الخطأ ويدمر الخاليا في البنكرياس التي‬ ‫تنتج األنسولين‪.‬‬

‫يمكن أن تختلف أعراض مرض السكري‬ ‫حسب النوع‪ .‬وتشمل بعض األعراض‬ ‫المشتركة زيادة العطش والجوع والتبول‪.‬‬ ‫يمكن أن تبدأ أعراض النوع ‪ 1‬بسرعة‪،‬‬ ‫على مدى بضعة أسابيع‪ .‬أعراض النوع ‪2‬‬

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‫األطعمة التي نقوم بطهيها‪.‬‬ ‫إضافة التوابل إلى طعامكم باألعشاب‬ ‫والتوابل بدال من الملح‪.‬‬ ‫ابحثوا عن تركيبات التوابل الخالية من الملح‬ ‫في متجر البقالة‪.‬‬ ‫‪White potatoes (738 milligrams‬‬ ‫‪)per small potato‬‬ ‫كيف يؤثر البوتاسيوم في‬ ‫الطعام على قلبكم؟‬ ‫البوتاسيوم يقلل من اآلثار الضارة للصوديوم‬ ‫على ضغط الدم‪ .‬حاولوا تناول الطعام أو‬ ‫اشربوا ما ال يقل عن ‪ 4 ،700‬ملليغرام من‬ ‫البوتاسيوم يوميا‪ .‬وتشمل المصادر الجيدة‬ ‫للبوتاسيوم ما يلي‪:‬‬ ‫الموز (‪ 442‬ملليغرام للموز المتوسط)‬ ‫الحليب غير اللذيذ والدهون المنخفضة‬ ‫(تصل إلى ‪ 370‬ملليغرام لكل كوب)‬ ‫عصير البرتقال (‪ 496‬ملليغرام لكل كوب‬ ‫من ‪ 8‬أوقية من عصير البرتقال ‪)100٪‬‬ ‫الزبادي العادي غير اللذيذ أو منخفضة‬ ‫الدهون (تصل إلى ‪ 579‬ملليغرام لكل‬ ‫الكرتون من ‪ 8‬أوقية)‬ ‫البرقوق وعصير الخوخ (‪ 707‬ملليغرام لكل‬ ‫‪ 8‬أوقية)‬ ‫السبانخ (يصل إلى ‪ 419‬ملليغرام لكل‬ ‫نصف كوب)‬ ‫البطاطا الحلوة (‪ 542‬ملليغرام للبطاطا الحلوة‬ ‫متوسطة الحجم)‬

‫الطماطم ومنتجات الطماطم (‪ 664‬ملليغرام‬ ‫لنصف كوب من معجون الطماطم؛ ‪405‬‬ ‫ملليغرام لنصف كوب من صلصة الطماطم)‬

‫أوقية من المأكوالت البحرية مع األحماض‬ ‫الدهنية أوميغا ‪ 3‬في األسبوع يمكن أن يقلل‬ ‫من خطر الموت من أمراض القلب‪.‬‬

‫البطاطا البيضاء (‪ 738‬ملليغرام لكل‬ ‫بطاطس صغيرة)‬

‫األطعمة البحرية التي تحتوي على المزيد من‬ ‫الزيت وبطبيعة الحال هي مصادر أفضل‬ ‫ألوميغا ‪ .3‬وتشمل األحماض الدهنية‪:‬‬

‫كيف يؤثر الكوليسترول في‬ ‫الطعام على قلبكم؟‬ ‫الكولسترول هو مادة شمعية تشبه الدهون‬ ‫مصنوعة من جسمك‪ .‬كما أنها موجودة‬ ‫في األطعمة المصنوعة من الحيوانات‬ ‫مثل اللحوم واأللبان‪ .‬ال تحتوي الفواكه‬ ‫والخضروات على الكوليسترول‪ .‬هناك نوعان‬ ‫من الكولسترول‪ HDL :‬أو الكولسترول‬ ‫"الجيد" ‪ ،‬و ‪ LDL‬أو الكولسترول "السيئ"‪.‬‬ ‫مستويات أعلى من الكولسترول الكلي و‬ ‫‪ LDL‬أو الكولسترول "السيئ" يزيد من خطر‬ ‫اإلصابة بأمراض القلب‪ .‬يمكنكم خفض‬ ‫الكولسترول و ‪ LDL‬أو أو الكولسترول‬ ‫"السيئ" عن طريق‪:‬‬ ‫الحد من الكوليسترول‬ ‫حاولوا تناول الطعام أو اشربوا أقل من ‪300‬‬ ‫ملليغرام من الكولسترول كل يوم‪ .‬على سبيل‬ ‫المقارنة‪ ،‬يحتوي جبن شيك برجر عادي ذو‬ ‫مذاق مزدوج على حوالي ‪ 100‬ملليغرام من‬ ‫الكوليسترول‪.‬‬ ‫هل يكون تناول المأكوالت‬ ‫البحرية جيدا لقلبكم؟‬ ‫نعم فعال‪ .‬األطعمة البحرية تحتوي على نوع‬ ‫من الدهون تسمى األحماض الدهنية أوميغا‬ ‫‪ .3‬وتشير البحوث إلى أن تناول حوالي ‪8‬‬

‫سمك السالمون‬ ‫سمك السلمون المرقط‬ ‫سمك األسقمري البحري‬ ‫سمك األنشوجة‬ ‫السردين‬ ‫األسماك الخالية من الدهون (مثل سمك القد‬ ‫وسمك الحدوق والقرموط) لديها أحماض‬ ‫أوميغا ‪ 3‬الدهنية أقل‪.‬‬ ‫هل يكون شرب الكحول جيدا‬ ‫لقلبكم؟‬ ‫ممكن‪ .‬وتشير البحوث إلى أن الشاربون‬ ‫المعتدلين هم أقل عرضة لتطور أمراض‬ ‫القلب من الناس الذين ال يشربون أي كحول‬ ‫أو الذين يشربون كثيرا‪ .‬بالنسبة للنساء‪،‬‬ ‫الشرب المعتدل يعني ما يصل إلى مشروب‬ ‫واحد في اليوم الواحد‪.‬‬ ‫مشروب واحد هو‪:‬‬ ‫• كوب واحد من النبيذ (‪ 5‬أوقية)‬ ‫• يمكن للمرء من البيرة (‪ 12‬أوقية)‬ ‫• طلقة واحدة من ‪ 80‬واقية من الخمور‬ ‫الثابت (‪ 1.5‬أوقية)‬ ‫األسباب وراء االستفادة من الشرب المعتدل‬ ‫على أمراض القلب ليست واضحة‪ .‬ولكن‬ ‫الشرب المعتدل مرتبط أيضا بسرطان الثدي‬ ‫والعنف واإلصابات‪ .‬لذلك إذا كنتم ال تشربون‬ ‫بالفعل يجب أن ال تبدأ من أجل الفوائد‬ ‫المحتملة لقلبكم‪.‬‬ ‫يجب على المرأة أن ال تشرب الكحول إذا‬ ‫كانت حامال أو قد تكون حامال‪ ،‬حيث ال‬ ‫توجد كمية من الكحول المعروف أنها آمنة‬ ‫أثناء الحمل‪ .‬يجب أن ال تشربوا الكحول إذا‬ ‫كان لديكم حالة صحية أخرى تجعل الكحول‬ ‫ضارة‪ -.‬المصدر‪women'shealth.gov :‬‬ ‫المعاهد الوطنية للصحة‬

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‫كم من السعرات الحرارية يجب‬ ‫أن تأكلها؟‬ ‫عدد السعرات الح اررية التي يجب أن تأكلها‬ ‫كل يوم يعتمد على عمركم والجنس وحجم‬ ‫الجسم والنشاط البدني وعوامل أخرى‪.‬‬ ‫كيف يؤثر الصوديوم في الطعام‬ ‫على قلبكم؟‬

‫الكولسترول‬ ‫توجد الكوليسترول في األطعمة المصنوعة‬ ‫من الحيوانات مثل لحم الخنزير المقدد‬ ‫والحليب الكامل الدسم والجبن المصنوع من‬ ‫الحليب الكامل الدسم واآليس كريم والزبادي‬ ‫المجمد الكامل الدسم والبيض‪ .‬ال تحتوي‬ ‫الفواكه والخضروات على الكوليسترول‪.‬‬ ‫البيض هو مصدر رئيسي للكوليسترول‬ ‫الغذائي‪ ،‬ولكن الدراسات تبين أن تناول‬ ‫بيضة واحدة يوميا ال يزيد من خطر اإلصابة‬ ‫بأمراض القلب في األشخاص األصحاء‪.‬‬ ‫يجب أن تأكل أقل من ‪ 300‬ملليغرام من‬ ‫الكولسترول في اليوم ‪..‬‬ ‫الصوديوم‬ ‫يوجد الصوديوم في الملح‪ ،‬ولكن معظم‬ ‫الصوديوم الذي نأكله ال يأتي من الملح الذي‬ ‫نضيفه أثناء الطهي أو على الطاولة‪ .‬يأتي‬ ‫معظم الصوديوم لدينا من الخبز واللفات‬ ‫والقطع الباردة والبيت از والمقانق المقلية والجبن‬ ‫وأطباق المعكرونة والتوابل (مثل الصلصة‬ ‫والخردل)‪ .‬يرجى تحديد الصوديوم اليومي‬ ‫إلى أقل من ‪ 2300‬ملليغرام (يساوي ملعقة‬ ‫صغيرة) إال إذا قال طبيبكم شيئا آخر‪.‬‬ ‫السكر‬ ‫األطعمة مثل الفواكه ومنتجات األلبان تحتوي‬ ‫بشكل طبيعي على السكر‪ .‬ولكن يجب أن‬ ‫تحد من األطعمة التي تحتوي على السكريات‬ ‫المضافة‪ .‬وتشمل هذه المشروبات الغازية‬ ‫والمشروبات الرياضية والكعك والحلوى‬ ‫واآليس كريم‪.‬‬

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‫شراب الذرة‬ ‫مادة تحلية الذرة‬ ‫سكر الفواكه‬ ‫جلوكوز‬ ‫سكر القصب‬ ‫سكر العنب‬ ‫الالكتوز‬ ‫الملتوز سكر الشعير‬ ‫عسل‬ ‫دبس السكر‬ ‫السكر الخام‬ ‫سكر محول‬ ‫شراب مركز‬ ‫الكراميل‬ ‫مركزات عصير الفواكه‬

‫تناول األطعمة عالية الصوديوم قد يسبب‬ ‫ارتفاع ضغط الدم وتسمى أيضا فرط ضغط‬ ‫الدم‪ .‬إن فرط ضغط الدم هو عامل خطر‬ ‫ألمراض القلب والسكتة الدماغية‪ .‬يجب أن‬ ‫تحد من كمية الصوديوم الذي تأكله كل يوم‬ ‫إلى أقل من ‪ 2300‬ملليغرام (حوالي ‪ 1‬ملعقة‬ ‫صغيرة من الملح) بما في ذلك الصوديوم‬ ‫الموجود في األطعمة المعلبة التي ال يمكنك‬ ‫رؤيتها‪.‬‬ ‫يجب أن تحد من تناول الصوديوم إلى أقل‬ ‫من ‪ 1500‬ملليغرام (حوالي ثلثي ملعقة‬ ‫صغيرة من الملح) إذا كنتم ‪:‬‬ ‫بارتفاع ضغط الدم‬ ‫في العمر ‪ 51‬سنة أو أكثر‬ ‫بمرض السكري‬ ‫يكون مرض الكلى المزمن‬ ‫يمكنكم خفض كمية الصوديوم الذي تأكلونه‬ ‫كل يوم عن طريق‪:‬‬ ‫تناول كمية قليلة من األطعمة المصنعة‬ ‫معظم الملح الذي نأكله يأتي من األطعمة‬ ‫المصنعة بدال من الملح الذي نضيفه إلى‬

‫يمكن لتناول الطعام الصحي للقلب جنبا إلى جنب‬ ‫مع ممارسة التمارين الرياضية بانتظام أو النشاط‬ ‫البدني أن يقلل من خطر اإلصابة بأمراض القلب‬ ‫والسكتة الدماغية‪.‬‬ ‫ما هي األطعمة التي يجب أن تأكلوها‬ ‫للمساعدة في تقليل خطر اإلصابة‬ ‫بأمراض القلب والسكتة الدماغية؟‬ ‫اختر هذه األطعمة معظم الوقت‬ ‫الفواكه والخضراوات‬ ‫يجب أن يكون نصف الطبقة على األقل الفواكه‬ ‫والخضروات‪.‬‬ ‫الحبوب الكاملة‬ ‫يجب أن يكون نصف الحبوب على األقل حبيبات‬ ‫كاملة‪ .‬وتشمل الحبوب الكاملة‪:‬‬ ‫القمح الكامل‬ ‫الشوفان الكامل‬ ‫دقيق الشوفان‬ ‫حبوب الذرة الكاملة‬ ‫أرز بني‬ ‫حبوب الشعير الكاملة‬ ‫الدخن‬ ‫الذرة‬ ‫منتجات األلبان الخالية من الدهون أو‬ ‫قليلة الدسم‬ ‫تشمل هذه منتجات الحليب ومشروبات فول‬ ‫الصويا المقواة بالكالسيوم (حليب الصويا) والجبن‬ ‫والزبادي ومنتجات األلبان األخرى‪.‬‬ ‫األسماك البحرية والدواجن بدون جلد واللحوم‬ ‫الخالية من الدهون والفاصوليا والبيض والمكسرات‬ ‫غير المملحة‬ ‫ما هي األطعمة التي يجب أن تحددها‬ ‫للحد من خطر اإلصابة بأمراض القلب‬ ‫والسكتة الدماغية؟‬ ‫يجب أن تحدد‪:‬‬ ‫الدهون المشبعة‪ .‬الدهون المشبعة عادة ما تكون‬ ‫في البيت از واآليس كريم والدجاج المقلي وكثير من‬ ‫الكعك والكبسكويت ولحم الخنزير المقدد والهمبرغر‪.‬‬ ‫الدهون المتحولة‬ ‫هذه توجد أساسا في المخبوزات الجاهزة تجاريا‬ ‫واألطعمة الخفيفة واألطعمة المقلية والسمن‬ ‫‪94 Medical Tourism April.-June 2018‬‬ ‫‪27‬‬

‫األكل الصحي من‬ ‫أجل قلب صحي‬

‫تناول الطعام الصحي للقلب هو وسيلة هامة لخفض خطر اإلصابة بأمراض القلب‬ ‫والسكتة الدماغية‪.‬‬ ‫وللحصول على أكثر فائدة لقلبكم يجب عليكم اختيار المزيد من الفواكه‬ ‫والخضروات واألطعمة مع الحبوب الكاملة والبروتين الصحي‪ .‬يجب عليكم أيضا تناول‬ ‫أقل كميات من الطعام مع إضافة السكر والسعرات الحرارية والدهون غير الصحية‪.‬‬ ‫نظرة على لم يكون األكل الصحي للقلب مهما من قبل مكتب السياحة الطبية‬

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‫‪A Complete Magazine on Healthcare in Asia‬‬

96 Medical Tourism April.-June 2018

‫عالج حصى الكلى‬ ‫يتشابه عالج حصى الكلى عند األطفال‬ ‫والكبار‪ .‬قد يطلب منك شرب الكثير من‬ ‫الماء‪ .‬يحاول األطباء السماح للحجر‬ ‫بالمرور دون جراحة‪ .‬يمكنك أيضا الحصول‬ ‫على الدواء للمساعدة في جعل البول أقل‬ ‫جدا أو‬ ‫حامضا‪ .‬ولكن إذا كانت كبيرة ً‬ ‫إذا كانت تمنع تدفق البول أو إذا كان‬ ‫هناك عالمة على اإلصابة ‪ ،‬فستتم إزالتها‬ ‫بالجراحة‪.‬‬

‫على التكون‪ .‬ينتج البروتين الحيواني البول‬ ‫الذي يحتوي على حامض أكثر والذي يمكن‬ ‫أن يزيد من خطر حصوات الكلى‪.‬‬ ‫يمكنك تقليل الملح الزائد في نظامك الغذائي‪.‬‬ ‫ما هي األطعمة الغنية بالملح؟ الجميع يفكر‬ ‫في رقائق البطاطا المقلية والبطاطس المقلية‪.‬‬ ‫ينبغي أن تؤكل تلك نادرا‪ .‬هناك منتجات‬ ‫أخرى مالحة‪ :‬لحوم ساندويتش وشوربة‬ ‫معلبة ووجبات معلبة وحتى مشروبات‬ ‫رياضية‪.‬‬ ‫أنت ترغب في محاولة للوصول إلى الوزن‬ ‫الطبيعي إذا كنت تعاني من زيادة الوزن‪.‬‬ ‫ولكن الوجبات الغذائية الغنية بالبروتينات‬ ‫التي تحتوي على نسبة عالية من البروتينات‬ ‫التي تعتمد على الحيوانات باإلضافة إلى‬ ‫الحمية القاسية يمكن أن تزيد من خطر‬ ‫تشكل األحجار‪ .‬أنت بحاجة إلى البروتين‬ ‫المناسب ولكن يجب أن يكون جزًءا من نظام‬ ‫غذائي متوازن‪ .‬يرجى طلب التوجيه من‬ ‫أخصائي تغذية مسجل عند الشروع في اتباع‬ ‫نظام غذائي لفقدان الوزن أو أي تدخالت‬ ‫غذائية للحد من مخاطر حصى الكلى‪.‬‬ ‫ال تكن في الخلط حول وجود حجر‬ ‫"الكالسيوم"‪ .‬تحتوي منتجات األلبان على‬ ‫الكالسيوم ولكنها تساعد بالفعل في منع‬ ‫الحجارة ألن الكالسيوم يرتبط باألكساالت قبل‬ ‫أن يصل إلى الكليتين‪ .‬والناس الذين يعانون‬ ‫من أقل تناول الكالسيوم في الغذاء لديهم‬ ‫خطر متزايد من حصوات الكلى‪ .‬يمكن أن‬ ‫يتكون الحجر من الملح ومنتجات النفايات‬ ‫من البروتين والبوتاسيوم‪ .‬النوع األكثر‬ ‫شيوعا من حصى الكلى هو حجر أكساالت‬ ‫الكالسيوم‪ .‬وتتكون معظم حصى الكلى‬ ‫‪97‬‬ ‫‪24‬‬

‫‪A Complete Magazine on Healthcare in Asia‬‬

‫عندما يرتبط أكساالت وهو منتج ثانوي من‬ ‫بعض األطعمة والكالسيوم عندما يتم إجراء‬ ‫إنتاج البول عن طريق الكلى‪ .‬يزداد كل من‬ ‫األكساالت والكالسيوم عندما ال يكون الجسم‬ ‫يحتوي على ما يكفي من السوائل ولديه‬ ‫أيضا الكثير من الملح‪ .‬يقوم الطبيب بتحديد‬ ‫ً‬ ‫أنواع التغييرات الغذائية المطلوبة في حالتك‬ ‫استنادا إلى اختبارات الدم والبول‪.‬‬ ‫الخاصة‬ ‫ً‬

‫يتم الترويج لبعض المواد العشبية للمساعدة‬ ‫في منع الحجارة‪ .‬يجب أن تعرف أنه ال‬ ‫يوجد دليل طبي ٍ‬ ‫كاف لدعم استخدام أي‬ ‫عشب أو مكمل في منع الحجارة‪ .‬راجع‬ ‫الطبيب و ‪ /‬أو أخصائي التغذية المسجل‬ ‫عن إجراء تغييرات في النظام الغذائي إذا‬ ‫كان لديك حجر أو تعتقد أنه يمكن أن تكون‬ ‫في خطر متزايد لإلصابة على حجر الكلى‪.‬‬

‫إن تفتيت الحصى بالموجات الصدمية هو‬ ‫إجراء غير غزوي والذي تستخدم موجات‬ ‫صوتية عالية الطاقة لتفجير الحجارة إلى‬ ‫شظايا والتي يتم تمريرها بسهولة أكثر‬ ‫في البول‪ .‬وفي تنظير القولون يتم إدخال‬ ‫منظار من خالل الحالب السترداد أو طمس‬ ‫جدا‬ ‫ًا‬ ‫الحجر‪.‬‬ ‫ونادر بالنسبة لألحجار الكبيرة ً‬ ‫أو المعقدة سيستخدم األطباء عالج الكلى‬ ‫عن طريق الجلد أو إزالة كلي الكلية‪.‬‬ ‫تختلف التوصية لكل شخص مع حصوات‬ ‫الكلى ‪ ،‬يجب أن تكون تعليمات النظام‬ ‫الغذائي المحددة بشكل فردي من قبل‬ ‫الطبيب‪ .‬وبمجرد اكتشاف سبب تشكيل‬ ‫األحجار سيقدم لك خيارات عالجية ونصائح‬ ‫مخصصة حول كيفية الوقاية منها في‬ ‫المستقبل‪ .‬ومع ذلك ‪ ،‬كقاعدة عامة فإن‬ ‫اتباع نظام غذائي متوازن بكمية مناسبة من‬ ‫الماء ووزن صحي سيضعك على الطريق‬ ‫الصحيح لكليتين صحيتين وخاليتين من‬ ‫األحجار‪.‬‬

‫االطفال وحصى الكلى‬ ‫تم العثور على حصوات الكلى عند األطفال‬ ‫في سن ‪ 5‬سنوات‪ .‬وفي الواقع هذه المشكلة‬ ‫جدا في األطفال حيث تقوم بعض‬ ‫شائعة ً‬ ‫المستشفيات بإجراء عيادات "حجرية" لمرضى‬ ‫األطفال‪ .‬ترجع الزيادة في الواليات المتحدة‬ ‫إلى عدة عوامل ‪ ،‬تتعلق في الغالب بخيارات‬ ‫األغذية‪ .‬أهم سببين هما عدم شرب كميات‬ ‫كافية من السوائل وتناول األطعمة الغنية‬ ‫بالملح‪ .‬يجب على األطفال تناول رقائق‬ ‫البطاطا المقلية المالحة والبطاطا المقلية أقل‪.‬‬ ‫هناك أطعمة مالحة أخرى‪ :‬لحوم ساندويتش‬ ‫شوربة معلبة وجبات معلبة وحتى بعض‬ ‫المشروبات الرياضية‪ .‬كما يمكن للمشروبات‬ ‫الغازية وغيرها من المشروبات المحالة أن‬ ‫تزيد من خطر الحصوات إذا كانت تحتوي‬ ‫على شراب الذرة عالي الفركتوز‬

‫‪MD‬‬

‫سانتوش اليكس‬ ‫طبيب استشاري‬ ‫قسم طب الطوارئ‬ ‫المركز الطبي لمستشفى جامايكا جامايكا‬ ‫نيويورك ‪11418‬‬ ‫البريد اإللكتروني ‪salexmd@gmail.com:‬‬ ‫الهاتف‪1+ )914( 0601-309 :‬‬

98 Medical Tourism April.-June 2018

‫هذا الكالسيوم مع منتجات النفايات مثل‬ ‫األكساالت لتشكيل الحجر‪ .‬تسمى التركيبة‬ ‫شيوعا أكساالت الكالسيوم‬ ‫األكثر‬ ‫ً‬

‫األنواع األقل شيوعا من الحجارة هي‪:‬‬ ‫الحجارة ذات الصلة باألمراض والتي تحتوي‬ ‫على المغنيسيوم واألمونيا التي تسمى‬ ‫حصوات ستروفايت واألحجار المتكونة من‬ ‫بلورات اليورات أحادية الصوديوم ‪ ،‬وتسمى‬ ‫أحماض حمض اليوريك ‪ ،‬والتي قد تكون‬ ‫مرتبطة بالبدانة والعوامل الغذائية‪ .‬أندر نوع‬ ‫من الحجر هو حجر السيستين الذي يميل‬ ‫إلى الوجود في األسر‪.‬‬ ‫كرة الغولف! كقاعدة عامة كلما كان الحجر‬ ‫وضوحا‪.‬‬ ‫أكبر كانت األعراض أكثر‬ ‫ً‬

‫قد تكون األعراض واحدة أو أكثر من التالية‪:‬‬ ‫ألم شديد على جانبي أسفل ظهرك‬ ‫ألم غير واضح أو ألم في المعدة ال يزول‬ ‫الدم في البول‬ ‫الغثيان أو القيء‬ ‫الحمى والقشعريرة‬ ‫البول الذي يشم رائحة كريهة أو يبدو غائما‬

‫يبدأ حصى الكلى بالتأذي عندما يسبب‬ ‫تهيجا أو انسدادا‪ .‬هذا ينمو بسرعة إلى‬ ‫األلم الشديد‪ .‬وفي معظم الحاالت تمر‬ ‫حجارة الكلى دون التسبب في الضرر ‪،‬‬ ‫ولكن عادة ال تسبب الكثير من األلم‪ .‬قد‬ ‫تكون مسكنات األلم العالج الوحيد الالزم‬ ‫للحجارة الصغيرة‪ .‬وقد تكون هناك حاجة إلى‬ ‫عالج آخر خاصة لتلك الحجارة التي تسبب‬ ‫أعراضا دائمة أو مضاعفات أخرى‪ .‬ومع‬ ‫ذلك قد تكون هناك حاجة لعملية جراحية في‬ ‫الحاالت الشديدة‪.‬‬ ‫يرجى استشاة الطبيب في أقرب وقت ممكن‪.‬‬ ‫قد ُيطلب منك شرب سوائل إضافية في‬ ‫محاولة لطرد الحجارة في البول‪ .‬إذا كنت‬ ‫ترهق البول ويمكن أن تنقذ قطعة من الحجر‬ ‫الذي مر‪ ،‬أحضرها إلى طبيبك‪ .‬أو قد يحتاج‬ ‫الحجر إلى إزالته بالجراحة‪.‬‬ ‫تشخيص حصى الكلى‬ ‫يبدأ تشخيص حصى الكلى بالتاريخ الطبي‬ ‫والفحص البدني واختبارات التصوير‪ .‬سيريد‬ ‫أطباؤك معرفة حجم وشكل حصى الكلى‬ ‫‪99‬‬ ‫‪22‬‬

‫‪A Complete Magazine on Healthcare in Asia‬‬

‫بالضبط‪ .‬ويمكن إجراء ذلك باستخدام‬ ‫فحص االشعة المقطعية عالي الدقة من‬ ‫الكليتين وصوالً إلى المثانة أو أشعة سينية‬ ‫تسمى "‪ ( "KUB x-ray‬أشعة سينية‬ ‫للكلى والحالب والمثانة) والتي ستظهر حجم‬ ‫غالبا ما يتم الحصول على األشعة‬ ‫الحجر ً‬ ‫السينية من قبل الجراحين لتحديد ما إذا كان‬ ‫مناسبا لمعاملة الموجة الصدمية‬ ‫الحجر‬ ‫ً‬ ‫‪.‬يمكن استخدام اختبار ‪ KUB‬لمراقبة الحجر‬ ‫قبل وبعد العالج ‪ ،‬ولكن يفضل التصوير‬ ‫المقطعي المحوسب في بعض األشخاص‬ ‫أيضا تصوير الحويضة‬ ‫‪ ،‬سيطلب األطباء ً‬ ‫الوريدي أو ‪ ، lVP‬وهو نوع خاص من‬ ‫األشعة السينية للجهاز البولي الذي يتم أخذه‬ ‫بعد حقن الصبغة‪.‬‬ ‫ثانيا ‪ ،‬سيقرر أطبائك كيفية التعامل مع‬ ‫ً‬ ‫الحجر‪ .‬سيتم تقييم صحة الكليتين عن طريق‬ ‫اختبارات الدم واختبارات البول‪ .‬سيتم النظر‬ ‫في صحتك العامة وحجم وموقع حجرك‪.‬‬ ‫وفي وقت الحق سوف يريد طبيبك العثور‬ ‫على سبب الحجر‪ .‬سيتم تحليل الحجر بعد‬ ‫خروجه من الجسم ‪ ،‬وسيقوم الطبيب باختبار‬ ‫الدم من الكالسيوم والفوسفور وحمض‬ ‫اليوريك‪ .‬قد يطلب الطبيب أيضا أن تجمع‬ ‫البول لمدة ‪ 24‬ساعة الختبار الكالسيوم‬ ‫وحمض اليوريك‪.‬‬ ‫هناك أربعة أنواع من الحجارة‪ .‬يمكن‬ ‫أن تساعد دراسة الحجر على فهم سبب‬ ‫وجوده وكيفية الحد من المخاطر المزيد من‬ ‫األحجار‪ .‬النوع االكثر شيوعا من الحجر‬ ‫يحتوي على الكالسيوم‪ .‬الكالسيوم هو جزء‬ ‫طبيعي من نظام غذائي صحي‪ .‬عادة ما‬ ‫تقوم الكلى بإزالة الكالسيوم الزائد الذي ال‬ ‫كثير ما يحتفظ الناس‬ ‫يحتاج إليه الجسم‪ً .‬ا‬ ‫بالحجارة بالكثير من الكالسيوم‪ .‬يجمع‬

‫العواقب من حصى الكلى على‬ ‫المدى الطويل‬ ‫حصى الكلى تزيد من خطر اإلصابة‬ ‫بأمراض الكلى المزمنة‪ .‬إذا كان لديك حجر‬ ‫واحد فأنت في خطر متزايد من وجود حجر‬ ‫آخر‪ .‬إن أولئك الذين تشكل فيهم حجر واحد‬ ‫خطر بنسبة ‪ 50٪‬تقر ًيبا لتشكيل‬ ‫يواجهون ًا‬ ‫حجر آخر خالل ‪ 5‬إلى ‪ 7‬سنوات‪.‬‬ ‫يساعد شرب كمية كافية من السوائل في‬ ‫الحفاظ على تركيز البول بشكل أقل مع‬ ‫منتجات النفايات‪ .‬يكون البول األغمق أكثر‬ ‫تركيز ‪ ،‬لذلك يجب أن يظهر البول خفيفًا‬ ‫ًا‬ ‫جدا باللون األصفر للتوضيح إذا كنت مرطًّبا‬ ‫ً‬ ‫جيدا‪ .‬ينبغي أن يكون معظم السوائل التي‬ ‫ً‬ ‫ماءا‪ .‬وعلى معظم الناس أن يشرب‬ ‫تشربها ً‬ ‫يوميا‪ .‬الماء‬ ‫كوبا من الماء ً‬ ‫أكثر من ‪ً 12‬‬ ‫أفضل من الصودا والمشروبات الرياضية أو‬ ‫القهوة ‪ /‬الشاي‪ .‬إذا كنت تمارس الرياضة‬ ‫أو إذا كان الجو ساخنا بالخارج يجب عليك‬ ‫شرب المزيد‪ .‬ينبغي أن تقتصر السكر‬ ‫وشراب الذرة عالي الفركتوز على الكميات‬ ‫الصغيرة‪.‬‬ ‫يرجى تناول المزيد من الفواكه والخضروات‪،‬‬ ‫مما يجعل البول أقل حموضة‪ .‬عندما يكون‬ ‫البول أقل حموضة قد تكون الحجارة أقل قدرة‬

‫ما هي حصوات الكلى؟‬ ‫حصى الكلى هو مادة صلبة مصنوعة من مواد كيميائية‬ ‫في البول‪ .‬يحتوي البول على نفايات مختلفة مذابة فيه‪.‬‬ ‫وعندما يكون هناك الكثير من النفايات في سائل أقل من‬ ‫الالزم تبدأ أن تتشكل البلورات‪ .‬تجذب البلورات عناصر‬ ‫أخرى وتتحد معا لتشكل مادة صلبة تصبح أكبر ما لم‬ ‫يتم خروجها من الجسم مع البول‪ .‬عادة يتم التخلص من‬ ‫هذه المواد الكيميائية في البول من قبل الكيميائي الرئيسي‬ ‫للجسم‪ :‬الكلى‪ .‬وفي معظم الناس فإن وجود ما يكفي من‬ ‫السائل يغسلها أو غيرها من المواد الكيميائية في البول‬ ‫ويمتنع عن تشكيل الحصى‪ .‬المواد الكيميائية المكونة‬ ‫للحصى هي كالسيوم وأكساالت وأويرات وسيستين وزانثين‬ ‫ووفوسفات‪.‬‬ ‫وبعد تشكيله قد يبقى الحجر في الكلية أو يسافر إلى‬ ‫أسفل المسالك البولية في الحالب‪ .‬وفي بعض األحيان‬ ‫تتحرك الحجارة الصغيرة من الجسم في البول دون أن‬ ‫تسبب الكثير من األلم‪ .‬ولكن الحجارة التي ال تتحرك قد‬ ‫تسبب احتياطي البول في الكلية أو الحالب أو المثانة أو‬ ‫اإلحليل‪ .‬هذا ما يسبب األلم‪.‬‬ ‫تشمل األسباب المحتملة شرب القليل من الماء أو‬ ‫ممارسة الرياضة (أكثر من الالزم أو أقل من الالزم) أو‬ ‫السمنة أو فقدان الوزن أو تناول الطعام مع الكثير من‬ ‫الملح أو السكر‪ .‬قد تكون األمراض والتاريخ العائلي مهمة‬ ‫في بعض األشخاص‪ .‬تناول الكثير من الفركتوز يرتبط‬ ‫بزيادة خطر تشكيل حصوات الكلى‪ .‬يمكن العثور على‬ ‫الفركتوز في سكر المائدة وشراب الذرة عالي الفركتوز‬ ‫أنواع حصوات الكلى‬ ‫هناك أربعة أنواع رئيسية من الحصوات‪:‬‬ ‫‪ - 1‬أكساالت الكالسيوم‪ :‬النوع األكثر شيوعا من‬ ‫حصوات الكلى التي تنشأ عندما يتحد الكالسيوم مع‬ ‫أكساالت في البول‪ .‬قد يساهم عدم كفاية كمية الكالسيوم‬ ‫والسوائل باإلضافة إلى حاالت أخرى في تكوينها‪.‬‬ ‫‪ - 2‬حمض اليوريك‪ :‬هذا هو نوع شائع آخر من‬ ‫حصوات الكلى‪ .‬تحتوي األطعمة مثل لحوم األعضاء‬ ‫والمحار على تركيزات عالية من مركب كيميائي طبيعي‬ ‫يعرف باسم البيورينات‪ .‬ارتفاع كمية البيورين يؤدي إلى‬ ‫إنتاج أعلى من اليورات أحادية الصوديوم ‪ ،‬والتي في ظل‬ ‫الظروف المناسبة قد تشكل الحجارة في الكلى‪ .‬تشكيل‬ ‫هذه األنواع من الحجارة يميل للوجود في األسر‪.‬‬ ‫شيوعا وتنتج عن‬ ‫‪ - 3‬ستروفيت‪ :‬هذه الحجارة أقل‬ ‫ً‬ ‫العدوى في المسالك البولية العليا‪.‬‬ ‫‪ - 4‬السيستين‪ :‬هذه الحجارة نادرة وتميل إلى الوجود في‬ ‫العائالت‬ ‫أعراض حصوات الكلى‬ ‫بعض حصوات الكلى صغيرة مثل حبة الرمل‪ .‬البعض‬ ‫اآلخر كبير مثل الحصاة‪ .‬وهناك عدد قليل كبير مثل‬ ‫‪100 Medical Tourism April.-June 2018‬‬ ‫‪21‬‬

‫حصى‬ ‫الكلى‪:‬‬ ‫حقائق صلبة‬ ‫حصوات الكلى هي واحدة من األسباب‬ ‫الشائعة أللم شديد في البطن المقدمة‬ ‫إلى غرفة الطوارئ‪ .‬وفي كل عام يذهب‬ ‫أكثر من ‪ 1.3‬مليون شخص إلى غرف‬ ‫الطوارئ لمشاكل في حصوات الكلى‪.‬‬ ‫وتشير التقديرات إلى أن واحدا من كل‬ ‫عشرة أشخاص سيكون لديهم حصى‬ ‫الكلى في وقت ما في حياتهم‪ .‬إذا كنت‬ ‫قد عرفت أي شخص كان يحمل حصى في‬ ‫الكلى ‪ ،‬أو إذا كان لديك واحدة بنفسك ‪،‬‬ ‫فإن اإلجماع العام هو أنه يمكن أن تكون‬ ‫مؤلمة للغاية‪ .‬عادة ما يكون األلم من تمرير‬ ‫حصى الكلى مقارنة بألم الوالدة‪ .‬وقد‬ ‫شهدت النساء اللواتي خضعن لكال األلم‬ ‫على حد سواء إلى هذا‪ .‬ومع ذلك هذه‬ ‫ليست الحال دائما‪ .‬وفي بعض الحاالت‬ ‫من حصوات الكلى ال يوجد أي ألم على‬ ‫اإلطالق ‪ ،‬وبعض المرضى ال يعرفون أبدًا أن‬ ‫لديهم واحدة‪ .‬يعتمد الفرق في التجربة‬ ‫على موقع الحجر داخل المسالك البولية‪.‬‬

‫‪20‬‬ ‫‪A Complete Magazine on Healthcare in Asia 101‬‬

102 Medical Tourism April.-June 2018

‫"التلقيح االصطناعي" "‪ - "IVF‬خالل التلقيح‬ ‫االصطناعي يأخذ الطبيب بيضة أو بيض‬ ‫من امرأة والحيوانات المنوية من رجل‪ .‬هو‬ ‫أو هي تضعهما معا في أنبوب اختبار بحيث‬ ‫يمكن للحيوان المنوي تخصيب البويضة‪.‬‬ ‫ثم يتم وضع البويضة المخصبة في رحم‬ ‫المرأة لتنمو‪ .‬وفي كثير من األحيان يقوم‬ ‫الطبيب بإجراء عالج يسمى "حقن الحيوانات‬ ‫المنوية داخل الهيولى" أو "الحقن المجهري"‬ ‫إلى جانب التلقيح الصناعي‪ .‬خالل الحقن‬ ‫احدا‬ ‫المجهري (‪ )ICSI‬يأخذ الطبيب حيو ًانا و ً‬ ‫فقط ويحقنه في البويضة‪ .‬وغالبا ما يستخدم‬ ‫التلقيح االصطناعي مع الحقن المجهري‬ ‫للرجال الذين لديهم عدد قليل من الحيوانات‬ ‫المنوية أو الحيوانات المنوية غير طبيعية‪.‬‬ ‫أيضا‬ ‫ولكن يمكن استخدام هذا العالج ً‬ ‫للرجال الذين ليس لديهم حيوانات منوية في‬ ‫عينتهم‪ .‬وذلك ألن هؤالء الرجال قد ال يزال‬ ‫لديهم الحيوانات المنوية في الخصيتين التي‬ ‫يمكن للطبيب إخراجها واستخدامها لإلجراء‪.‬‬ ‫التكبير الرقمي العالي‬ ‫يتم ذلك للرجال الذين يعانون من انخفاض‬ ‫حاد في مستويات مورفولوجيا الحيوانات‬ ‫المنوية أو مع مستويات عالية من تجزئة‬ ‫الحمض النووي‪ .‬تسمح هذه التقنية للمختبر‬ ‫بتكبير صور الحيوانات المنوية إلى تكبير‬ ‫أكثر من ‪( x 7300‬مقارنة بـ ‪200-400‬‬ ‫‪ x‬في ‪ ICSI‬القياسي) ويتم اختيار الحيوان‬

‫‪18‬‬ ‫‪A Complete Magazine on Healthcare in Asia 103‬‬

‫المنوي األكثر مالءمة على أساس الحجم‬ ‫والشكل للتلقيح في البويضة‪.‬‬ ‫دائما؟ ‪ -‬ال ‪ ،‬ال‬ ‫‪ ‬هل تعمل العالجات ً‬ ‫زوجا على الحمل‪ .‬قد‬ ‫دائما ً‬ ‫تساعد العالجات ً‬ ‫تساعد نفس المعاملة زوجا آخر على الحمل‬ ‫‪ ،‬ولكن ليس زوجان آخران‪.‬‬ ‫ما هي الخيارات التي لديك إذا اخترت‬ ‫التوقف أو عدم تلقي العالج؟ ‪ -‬األزواج‬ ‫الذين يختارون التوقف أو عدم تلقي العالج‬ ‫لديهم خيارات أخرى‪ .‬يمكن لهم ‪:‬‬ ‫المحاولة أن تكون طفلة باستخدام حيوانات‬ ‫منوية لرجل آخر ‪ ،‬مثل الحيوانات المنوية‬ ‫من بنك الحيوانات المنوية (تسمى الحيوانات‬ ‫المنوية "المانحة")‬

‫في المائة من مرضى العقم من نوع ما‬ ‫من االضطرابات النفسية ؛ كان التشخيص‬ ‫شيوعا هو اضطراب القلق (‪، )23٪‬‬ ‫األكثر‬ ‫ً‬ ‫يليه اضطراب اكتئابي رئيسي (‪)17٪‬‬ ‫يمكن التحايل على هذه المشاكل إلى حد‬ ‫ما عن طريق تقنيات االسترخاء إو�دارة‬ ‫اإلجهاد والتدريب على مهارات التأقلم والدعم‬ ‫الجماعي‪ .‬قد تكون هناك حاجة للتقييم من‬ ‫قبل طبيب نفساني لبعض األشخاص الذين‬ ‫يعانون من أعراض كبيرة من القلق أو‬ ‫االكتئاب‪.‬‬

‫تبني الطفل‬ ‫أن يبقوا بدون أطفال خاص بهم‬ ‫يمكن لألزواج قضاء وقت عصيب في اتخاذ‬ ‫هذه الق اررات‪ .‬قد تجد أنه من المفيد التحدث‬ ‫إلى مستشار أو الذهاب إلى مجموعة دعم‬ ‫لألشخاص الذين يواجهون نفس المشكالت‬ ‫الدعم العاطفي خالل تقييم عدم القدرة‬ ‫يمكن أن يؤدي عدم القدرة على الحمل إلى‬ ‫مجموعة متنوعة من المشاعر ‪ ،‬بما في ذلك‬ ‫القلق واالكتئاب والغضب والعار والشعور‬ ‫بالذنب‪ .‬وفي إحدى الدراسات يعانى ‪40‬‬

‫د‪ .‬رميا في أرياد‬ ‫مسجل ‪ ،‬قسم التوليد وأمراض النساء ‪ ،‬مستشفى‬ ‫بالكتاون ‪ ،‬نيوساوث ويلز ‪ ،‬أستراليا‪.‬‬ ‫البريد اإللكتروني ‪remyaaryad@gmail.com :‬‬ ‫الهاتف‪+ 61 422 524 912 :‬‬

‫القيام بهذا العالج‪.‬‬ ‫التلقيح داخل الرحم ‪ -‬بالنسبة لهذا العالج‬ ‫أنبوبا لوضع الحيوانات‬ ‫يستخدم الطبيب ً‬ ‫المنوية داخل رحم المرأة مباشرة‪ .‬يتم ذلك‬ ‫قبل اإلباضة‪ .‬وبالنسبة لبعض النساء يتم‬ ‫الجمع بين هذا العالج مع كلوميفين أو‬ ‫طلقات هرمون لزيادة فرصة الحمل‪.‬‬ ‫التخصيب في المختبر ‪ -‬وتسمى أيضا‬ ‫"التلقيح االصطناعي" ‪ IVF -‬هو اإلجراء‬ ‫الذي يتم القيام به عادة إذا لم تنجح‬ ‫العالجات األخرى‪ .‬تتضمن ما يلي‪:‬‬ ‫تعطي المرأة نفسها جرعة من الهرمون‬ ‫لبضعة أسابيع‪ .‬هذه الهرمونات تحصل على‬ ‫المبيض جاهزة لإلباضة‪.‬‬ ‫قبل اإلباضة يستخدم الطبيب إبرة رفيعة‬ ‫إلزالة بعض البويضات من المبيضين‪ .‬هو‬ ‫أو هي تفعل هذا خالل المهبل‪.‬‬ ‫ﯾﺘ وﺿﻊ اﻟﺒﯿ ﻓﻲ أﻧﺒب اﺧﺘﺒﺎر ﻣﻊ اﻟﺤﯿان‬ ‫اﻟﻤﻨي ﺣﯿ ﯾﻤﻜ ﻟﻠﺤﯿاﻧﺎت اﻟﻤﻨﯾﺔ ﺗﺨﺼﯿ ﺑﯿ أو‬ ‫أﻛﺜ‪.‬‬

‫تفضل يمكنك تقديم العينة في غرفة خاصة‬ ‫في العيادة‪ .‬يقومون بتحليل وقياس عدد‬ ‫الحيوانات المنوية وقدرتها على الحركة‬ ‫وحجمها وشكلها وحجم وعينة القذف‪ .‬ويبلغ‬ ‫عدد الحيوانات المنوية العادية ما ال يقل‬ ‫عن ‪ 15‬مليون حيوان منوي لكل ملليلتر مع‬ ‫وجود ثلث على األقل ُيظهر حركية جيدة‬ ‫إلى األمام‪ .‬إذا وجدوا حاالت الشذوذ فإنهم‬ ‫عادة يقومون بإجراء المزيد من االختبارات‬ ‫لتحديد طبيعة ودرجة أي مشاكل‪ .‬إذا كان‬ ‫منخفضا فسوف‬ ‫عدد الحيوانات المنوية لديك‬ ‫ً‬ ‫يكرر الطبيب االختبار مرة واحدة أو أكثر‪.‬‬ ‫إذا كان تكرار الحيوانات المنوية ال يزال غير‬ ‫طبيعي قد يقوم الطبيب بإجراء اختبارات‬ ‫أخرى‪ .‬على سبيل المثال ‪ ،‬قد يفعل هو أو‬ ‫هي‪:‬‬ ‫اختبارات الدم ‪ -‬للمستويات الهرمونية‬ ‫اختبار لقياس حجم الخصيتين‬ ‫االختبارات لمعرفة ما إذا كان هناك كتلة في‬ ‫الخصيتين‬ ‫االختبارات الجينية‬ ‫قد ُينصح بإجراء خزعة خصية (جمع عينة‬

‫صغيرة من األنسجة) لدى الرجال الذين ليس‬ ‫لديهم حيوانات منوية على تحليل السائل‬ ‫المنوي‪ .‬يمكن أن يتم إجراء الخزعة عن‬ ‫طريق فتح الخصية جراحيا أو عن طريق‬ ‫شفط إبرة دقيقة (إدخال إبرة صغيرة في‬ ‫الخصية وسحب عينة من األنسجة)‬ ‫ما هي العالجات المتاحة؟ ‪ -‬قد‬ ‫تختار النساء اللواتي يعانين من المشاكل‬ ‫في تحقيق الحمل على واحدة أو أكثر من‬ ‫العالجات التالية‬ ‫دواء يدعى كلوميفين ‪- clomiphene‬‬ ‫يحسن هذا الدواء فرص حدوث اإلباضة‪.‬‬ ‫وفي كثير من األحيان يصف األطباء هذا‬ ‫العالج أوالً‪ .‬سيخبرك طبيبك كيف ومتى‬ ‫أيضا بموعد‬ ‫يتناول هذا الدواء‪ .‬سوف يخبرك ً‬ ‫ممارسة الجنس حتى يحصل العالج على‬ ‫أفضل فرصة للعمل‪ .‬إذا لم يعمل هذا الدواء‬ ‫بعد بضعة أشهر قد يوصي طبيبك تجربة‬ ‫أدوية أخرى للمساعدة في اإلباضة‪.‬‬ ‫غالبا بالطالء‬ ‫لقطات هرمونية ‪ُ -‬ينصح ً‬ ‫بالهرمونات في حالة عدم حمل المرأة‬ ‫للكلوميفين‪ .‬الهرمونات تحسن فرص حدوث‬ ‫اإلباضة‪ .‬سيخبرك طبيبك عن كيفية ووقت‬

‫بعد يومين إلى خمسة أيام يتم وضع‬ ‫البويضة الملقحة أو البيض في رحم المرأة‪.‬‬ ‫نأمل أن يعلق واحد من البيض على الرحم‬ ‫وينمو في الحمل‪.‬‬ ‫عادة ما يتم إجراء التلقيح الصناعي عند‬ ‫النساء‪:‬‬ ‫ إذا كانت قنوات فالوب مفقودة أو مسدودة‬‫ مع الشركاء الذكور الذين لديهم عدد قليل‬‫جدا من الحيوانات المنوية‬ ‫ما هي العالجات التي يمكن أن تساعد‬ ‫الرجال المصابين بالعقم؟ ‪ -‬يمكن أن تساعد‬ ‫العالجات المختلفة الرجال الذين يعانون‬ ‫من العقم على أن يكونوا قادرين على رعاية‬ ‫األب‪ .‬يمكن أن تشمل هذه‪:‬‬ ‫العالج بالهرمونات لزيادة عدد الحيوانات‬ ‫المنوية ‪ -‬لدى بعض الرجال تكون مستويات‬ ‫هرمون منخفضة ويمكن عالجها بالطالء‬ ‫بالهرمونات‪.‬‬ ‫الجراحة لفتح كتلة في الخصية ‪ -‬على‬ ‫سبيل المثال يمكن للرجل الذي أجريت له‬ ‫عملية استئصال األسهر في الماضي إجراء‬ ‫جراحة إلعادة فتح األنبوب الذي تنتقل إليه‬ ‫الحيوانات المنوية‪.‬‬ ‫التخصيب في المختبر ‪ ،‬وتسمى أيضا‬ ‫‪104 Medical Tourism April.-June 2018‬‬ ‫‪17‬‬

‫التي سبقت اإلباضة قبل أن يتم إطالق‬ ‫البويضة من المبيض‪ .‬وثم بعد اإلباضة‬ ‫تبقى البويضة لمدة ‪ 24‬ساعة فقط ‪ ،‬بينما‬ ‫تحتفظ الحيوانات المنوية بالقدرة على‬ ‫التخصيب لمدة يومين إلى ثالثة أيام في‬ ‫قناة فالوب‪ .‬يوصى بممارسة الجنس كل‬ ‫يومين خالل فترة النافذة‪.‬‬ ‫اختبار البول ‪ -‬للكشف عن مستويات‬ ‫الهرمون عندما يشير وجود اإليجابي إلى‬ ‫حدوث اإلباضة في ‪ 18‬إلى ‪ 36‬ساعة‪.‬‬ ‫مستويات البروجسترون في الدم ‪-‬‬ ‫البروجسترون هو هرمون الحمل‪ .‬إن‬ ‫االختبار لمستواه من ‪ 6‬إلى ‪ 8‬أيام بعد‬ ‫اإلباضة يؤكد اإلباضة‪.‬‬ ‫ما هي االختبارات التي تفحص الرحم‬ ‫وقناتي فالوب؟ ‪ -‬يمكن لألطباء إجراء‬ ‫اختبارات مختلفة للتحقق من وجود مشاكل‬ ‫في الرحم وقناتي فالوب‪ .‬وتشمل هذه‪:‬‬ ‫اختبارات الموجات فوق الصوتية أو‬ ‫التصوير باألشعة السينية أو غيرها ‪ -‬يمكن‬ ‫لهذه االختبارات إنشاء صور للجزء الداخلي‬ ‫من الجسم ويمكن التحقق من وجود عوائق‬ ‫أو مشاكل أخرى‬ ‫إختبار الموجات فوق الصوتية الحوضية‬

‫‪16‬‬ ‫‪A Complete Magazine on Healthcare in Asia 105‬‬

‫ في إختبار الموجات فوق الصوتية عبر‬‫المهبل يتم إدخال مسبار الموجات فوق‬ ‫الصوتية الصغيرة في المهبل‪ .‬هذا يوفر‬ ‫صورة أوضح للرحم والمبيض من الموجات‬ ‫فوق الصوتية التي يتم تنفيذها من خالل‬ ‫البطن‪ .‬ال يتطلب ذلك أن يكون المريض‬ ‫مسكنا أو مخد ار ‪ ،‬ولديه القليل من المخاطر‪.‬‬ ‫يتم استخدامه لقياس حجم وشكل الرحم‬ ‫والمبايض وتحديد ما إذا كانت هناك شذوذ‬ ‫هيكلية (مثل األورام الليفية أو الخراجات‬ ‫المبيضية)‪ .‬إذا شوهدت حاالت الشذوذ قد‬ ‫تكون هناك حاجة لمزيد من االختبارات‪.‬‬ ‫هيستيروسالبينغوغرام ‪ -‬يتضمن إدخال‬ ‫قسطرة صغيرة عبر عنق الرحم إو�لى الرحم‪.‬‬ ‫يتم حقن السائل الذي يمكن رؤيته على‬ ‫األشعة السينية من خالل القسطرة والتي‬ ‫تمأل الرحم وقناتي فالوب‪ .‬يتم تصوير‬ ‫األشعة السينية بعد حقن السائل مما يدل‬ ‫على الخطوط العريضة للرحم واألنابيب‪.‬‬ ‫فالرحم على شكل غير طبيعي أو قناة فالوب‬ ‫المسدودة يمكن رؤيتها على األشعة السينية‪.‬‬ ‫االختبارات التي تظهر داخل الجسم (تنظير‬ ‫الرحم ‪ /‬تنظير البطن) ‪ -‬هذه االختبارات‬ ‫ليست بسيطة مثل اختبارات التصوير ‪،‬‬ ‫ألنها تنطوي على إجراءات‪ .‬يمكن للطبيب‬

‫أن ينظر إلى داخل الجسم باستخدام أنبوب‬ ‫صغير بكامي ار في النهاية‪ .‬ويمكنه أن يضع‬ ‫األنبوب في المهبل ويخرج من عنق الرحم‬ ‫ويصل إلى الرحم لينظر إلى داخل الرحم‪.‬‬ ‫أثناء تنظير البطن يتم إدخال أنبوب نحيف‬ ‫مضاء من خالل شق صغير في البطن‬ ‫مما يسمح للطبيب بمشاهدة الرحم والمبيض‬ ‫وقناتي فالوب‪ .‬يتم إجراء تنظير البطن‬ ‫كإجراء جراحة يومية ويتطلب أن يتلقى‬ ‫عاما‪.‬‬ ‫ًا‬ ‫المريض‬ ‫تخدير ً‬

‫االختبارات الجينية ‪ -‬يمكن التوصية بإجراء‬ ‫اختبار وراثي إذا كان هناك شك في أن‬ ‫تشوهات وراثية أو كروموسومية تساهم في‬ ‫العقم‪ .‬هذه االختبارات تتطلب عادة عينة‬ ‫دم صغيرة والتي يتم إرسالها إلى المختبر‬ ‫للتقييم‪.‬‬ ‫االختبارات للرجال‬ ‫تحليل السائل المنوي‬

‫سيطلب منك تقديم عينة من السائل المنوي‬ ‫عن طريق االستمناء بعد ما ال يقل عن‬ ‫ثالثة أيام من االمتناع عن ممارسة الجنس‪.‬‬ ‫يجب أن تجمع كمية القذف بالكامل في‬ ‫حاوية نظيفة وجافة وتحضرها إلى موعدك‬ ‫(خالل ساعة واحدة من الجمع)‪ .‬إذا كنت‬

106 Medical Tourism April.-June 2018

‫توقف عن التدخين‬ ‫يضر التدخين اإليجابي والسلبي بالصحة‬ ‫الجنسية واإلنجابية لدى كل من الرجال‬ ‫والنساء‪ .‬وبالنسبة للرجال يمكن أن يدمر‬ ‫الحمض النووي للحيوانات المنوية وزيادة‬ ‫فرص اإلجهاض واحتمال اإلصابة بسرطان‬ ‫األطفال‪.‬‬ ‫الحد من تناول الكحول‬ ‫من المعروف أن االستهالك اليومي للكحول‬ ‫وشرب الكحول يؤثر على خصوبتك‪ .‬حاول‬ ‫واتبع قاعدة "كل شيء في االعتدال"‬ ‫ما االختبارات التي تتم للنساء‬ ‫قد يكون لدى النساء بعد ذلك واحد أو أكثر‬ ‫من االختبارات التالية‪:‬‬

‫ممارسة التمارين المعتدلة‬ ‫والمنتظمة‬ ‫يعد المشي والتنس وممارسة التمارين‬ ‫المعتدلة األخرى مفيدة للحفاظ على نمط‬ ‫حياة صحية‪ .‬يتم تقليل جودة الحيوانات‬ ‫المنوية عندما يكون الرجال مستقرين جدا‪.‬‬ ‫يمكن أن يؤدي الجلوس على الخصيتين‬ ‫لساعات كل يوم إلى ارتفاع درجة الح اررة‬ ‫ووقف إنتاج الحيوانات المنوية‪.‬‬ ‫كافيين‬ ‫إن ارتفاع تناول الكافيين مرتبط بعقم اإلناث‬ ‫في بعض الدراسات البحثية ‪ ،‬يجدر النظر‬ ‫في تناول القهوة المعتدلة (ال يزيد عن كوبين‬ ‫في اليوم) إذا كنت تحاول الحمل‪ .‬يجب أن‬ ‫تدركي أن الكافيين موجود في المشروبات‬ ‫واألطعمة األخرى مثل مشروبات الكوال‬ ‫والشوكوالته‪.‬‬ ‫أوقف المخدرات الترفيهية‬ ‫والمنشطات (ستيرويد)‬ ‫يمكن للمخدرات الترفيهية مثل الماريجوانا‬ ‫والكوكايين تقليل كمية الحيوانات المنوية‬ ‫وزيادة عدد الحيوانات المنوية غير الطبيعية‬ ‫في حين أن تعاطي الستيرويد يمكن أن‬ ‫يؤدي إلى تقليص الخصيتين ووقف إنتاج‬ ‫الحيوانات المنوية‪.‬‬ ‫ممارسة الجنس بشكل متكرر (أو‬ ‫على األقل القذف المتكرر)‬ ‫‪14‬‬ ‫‪A Complete Magazine on Healthcare in Asia 107‬‬

‫ال تصبح الحيوانات المنوية أكثر فعالية إذا‬ ‫امتنع الرجل عن ممارسة الجنس أو القذف ‪،‬‬ ‫بل هو عكس ذلك‪ .‬القذف أو ممارسة الجنس‬ ‫بشكل منتظم من ‪ 2-3‬مرات في األسبوع‬ ‫حتى ال يتم تخزين الحيوانات المنوية لفترة‬ ‫طويلة في الخصيتين حيث يمكن أن تتلف‬ ‫تناول نظام غذائي صحي‬ ‫يجب على الرجال تناول نظام غذائي متوازن‬ ‫ حاول أن تشمل المزيد من الخض اروات‬‫الطازجة والفواكه واللحوم الخالية من الدهون‪.‬‬ ‫األطعمة الغنية بشكل خاص بمضادات‬ ‫األكسدة تساعد على تحسين صحة الحيوانات‬ ‫المنوية مثل التوت وبذور القرع والخض اروات‬ ‫الورقية الملونة ويمكن أن تفكر في مكمالت‬ ‫الفيتامينات مثل فيتامين ج و هـ التي تشتهر‬ ‫بخصائصها المضادة لألكسدة‪.‬‬

‫اختبارات الدم ‪ -‬يمكن أن تتحقق من‬ ‫مستويات الهرمون األنثوي باختبارات الدم‪.‬‬ ‫يمكن أن تجعل مستويات هرمون غير‬ ‫طبيعية الحمل من الصعب‪ .‬يمكن إجراء‬ ‫أيضا للتحقق من وجود مشاكل‬ ‫اختبارات الدم ً‬ ‫تصعب الحمل‪.‬‬ ‫وراثية قد‬ ‫ّ‬ ‫اختبار احتياطي البيض‬

‫تولد النساء مع إمداد البيض طول حياتهن‬ ‫‪ ،‬وهذه تنخفض تدريجيا في كل من الجودة‬ ‫والكمية مع التقدم في السن‪.‬‬ ‫هرمون مضاد للموليرين (‪ )AMH‬هو هرمون‬ ‫يفرزه الخاليا في تطوير حويصالت البيض‬ ‫(بصيالت)‪ .‬إن مستوى ‪ AMH‬في دم المرأة‬ ‫عموما مؤشر جيد على احتياطيها المبيض‪.‬‬ ‫‪ ‬اختبارات التبويض ‪-‬‬ ‫يمكن استخدام اختبارات مختلفة للتحقق مما‬ ‫إذا كانت المرأة هي تقوم بالتبويض‬ ‫أكثر األيام خصوبة لدورة النساء هي األيام‬

‫ما هو العقم؟‬ ‫شهر من االتصال الجنسي غير المحمي‪.‬‬ ‫عرف العقم بأنه عدم القدرة على الحمل بعد ‪ً 12‬ا‬ ‫ُي َّ‬ ‫تكون أسباب العقم كثيرة ومتنوعة وتشمل الذكور واإلناث أو مجموعة من العوامل‪ .‬ويشمل‬ ‫ذلك مشاكل في إنتاج الحيوانات المنوية أو البيض أو بنية أو وظيفة النظم التناسلية‬ ‫للذكور أو اإلناث ؛ و ‪ /‬أو الظروف الهرمونية والمناعة‪ .‬وفي ‪ ٪ 40‬من األزواج يعزى‬ ‫سبب العقم إلى عامل الحيوانات المنوية ‪ ،‬وفي ‪ ٪ 40‬أخرى يوجد السبب داخل الجهاز‬ ‫التناسلي لألنثى ‪ ،‬والثالث سيكون مزيج من العوامل الذكور واإلناث‬ ‫يمكن أن تتأثر خصوبة النساء من ‪:‬‬ ‫‪ ‬عمر المرأة‬ ‫‪ ‬ضعف اإلباضة‬ ‫‪ ‬تلف قناتي فالوب‬ ‫‪ ‬بطانة الرحم‬ ‫‪ ‬عامل عنق الرحم‬ ‫‪ ‬العقم غير المبررة‬ ‫يمكن أن يتأثر العقم عند الرجال بالمشاكل المتعلقة بإنتاج‬ ‫الحيوانات المنوية أو عملية النقل مثل‪:‬‬ ‫‪ ‬حظر ‪ /‬غياب األسهر (أنابيب)‬ ‫‪ ‬انخفاض عدد الحيوانات المنوية و ‪ /‬أو ضعف إنتاج الحيوانات المنوية‬ ‫‪ ‬أعداد كبيرة من الحيوانات المنوية ذات الشكل غير الطبيعي‬ ‫‪ ‬فشل إنتاج الحيوانات المنوية‬ ‫‪ ‬األجسام المضادة للحيوانات المنوية‬ ‫‪ ‬تجزئة الحمض النووي للمنيه‬ ‫‪ ‬األمراض الوراثية مثل التليف الكيسي أو شذوذ الكروموسومات‬ ‫متى يجب علي زيارة الطبيب ؟‬ ‫‪ ‬راجعي طبيبك إذا لم تحملي بعد ممارسة الجنس بدون حماية لمدة عام واحد‪ .‬ولكن إذا‬ ‫شعرت بالقلق قبل ذلك راجعي طبيبك في وقت أقرب‪ .‬إو�ذا كنت أكبر من ‪ 35‬سنة من‬ ‫العمر أو لم تحصل على الدورة الشهرية أو لديك تاريخ من بطانة الرحم راجعي طبيبك إذا‬ ‫لم تستطع الحمل بعد ‪ 6‬أشهر من المحاولة‪.‬‬ ‫يحتاج كال الشريكين إلى اختبار متزامن‪ .‬ولكن ال تندهش إذا لم يستطع طبيبك أن يخبرك‬ ‫دائما معرفة سبب عدم قدرة المرأة على الحمل‬ ‫بالخطأ‪ .‬ليس من الممكن ً‬ ‫هل هناك أي شيء أستطيع القيام به؟‬ ‫تناولي الفيتامينات كل يوم‬ ‫يجب على النساء تناول ‪ 0.5‬ملغ من مكمالت حمض الفوليك يومياً لمدة ثالثة أشهر‬ ‫على األقل قبل الحمل ولمدة ثالثة أشهر من الحمل‪ .‬هذا يقلل من خطر عيوب األنبوب‬ ‫العصبي (األكثر شيوعا السنسنة المشقوقة) في األطفال‪.‬‬ ‫تحقق من وزنك‬ ‫إذا كنت تعاني من زيادة الوزن أو نقص الوزن بشكل كبير فقد يؤثر ذلك سلباً على‬ ‫فرصتك في الحمل‪ .‬استخدمي آلة حاسبة مؤشر كتلة الجسم (‪ )BMI‬للتحقق مما إذا كان‬ ‫لديك وزن الجسم المناسب‪ .‬إذا كان لديك مؤشر كتلة جسم عالي يمكنك تحسين خصوبتك‬ ‫بشكل كبير مع انخفاض بنسبة ‪ 5٪‬فقط في الوزن‬ ‫‪108 Medical Tourism April.-June 2018‬‬

‫العقم‪:‬‬ ‫التشخيص‬ ‫والعالج‬

‫العقم هو حالة واسعة االنتشار مع اآلثار النفسية‬ ‫واالقتصادية والطبية‪ .‬وقد طالبت الدعاية التي ال نظير لها‬ ‫في قضايا الخصوبة في العصر التكنولوجي بزيادة في‬ ‫خدمات العقم‪ .‬في جميع أنحاء العالم فإن انتشار العقم‬ ‫هو األعلى في أوروبا الشرقية وشمال أفريقيا والشرق‬ ‫األوسط وأوقيانا وأفريقيا جنوب الصحراء الكبرى‪.‬‬

‫‪12‬‬ ‫‪A Complete Magazine on Healthcare in Asia 109‬‬

‫مستشفيات بي إس جي‬ ‫كويامباتور‪ ،‬تاميلنادو – ‪ ،641004‬الهند‬

‫قسم زراعة األعضاء المتعددة ‪،‬‬ ‫جراحات الكبد البنكرياس الكبدية‬ ‫واألبحاث‬ ‫د‪ .‬سواميناثن سامباندام‬

‫‪( ،.MS MBBS‬الجراحة العامة)‪،).MRCS )Edin ،‬‬ ‫زمالة نقل المسنين (الواليات المتحدة األمريكية)‬ ‫مستشار كبير‬ ‫زرع األعضاء المتعددة وجراحة الكبد والبنكرياس‬

‫زمالة نقل المسنين (الواليات المتحدة األمريكية)‬ ‫مستشار كبير‬

‫زرع األعضاء المتعددة وجراحة الكبد والبنكرياس‬

‫‪ ‬زرع الكبد – قام بتأدية أكثر من ‪ 400‬عملية زرع‬ ‫الكبد بما في ذلك زرع الكبد من المتبرع الميت والحي‬ ‫‪ ‬زرع الكلى ‪ -‬قام بأكثر من ‪ 750‬عملية زرع‬ ‫الكلى (المتبرع الميت والحي)‬ ‫‪ ‬زرع البنكرياس – أكمل إجراء مئات من زرع‬ ‫البنكرياس والكلى والبنكرياس‪.‬‬ ‫‪ ‬خبرة واسعة في جراحات الكبد والبنكرياس (‪)HPB‬‬ ‫وأداء أكثر من ‪ 1500‬جراحات ‪ HPB‬معقدة بما في‬ ‫ذلك العمليات الجراحية ‪.HPB‬بأدنى الوصول‬ ‫‪ ‬خبرة واسعة في جراحات الوصول إلى األوعية‬ ‫الدموية والغسيل الكلوي‬ ‫‪ ‬قام بتأليف عدة منشورات و مقاالت‪.‬‬ ‫‪ ‬قدم العديد من األبحاث ‪ /‬األبحاث السريرية وقدم‬ ‫محاضرات مدعوة في المؤتمرات الوطنية والدولية‪.‬‬ ‫الجوائز واإلنجازات‬

‫‪ ‬قام بإجراء أول عملية زراعة الكبد الناجحة في‬ ‫مستشفى القطاع العام في جنوب الهند (مستشفى كلية‬ ‫الطب ستانلي) في يناير ‪.2009‬‬ ‫‪ ‬قام بإجراء أول عملية زرع البنكرياس الناجحة‬ ‫في شمال الهند في مستشفى المهاتما غاندي ‪،‬‬ ‫جايبور (راجستان) في عام ‪.2016‬‬

‫‪ ‬جائزة "أفضل جراح زرع األعضاء لعام ‪ "2017‬من‬ ‫شركة ترانستان تاميلنادو ‪ ،‬الهند) من و ازرة الصحة‬ ‫ورعاية األسرة ‪ ،‬تاميلنادو‪.‬‬ ‫الخدمات والمرافق السريرية‬

‫‪ 1‬زرع الكبد‪ -‬كل من زرع كبد المتبرعالميت والحي‬‫‪ 2‬زرع البنكرياس‬‫‪ 3‬زرع األمعاء الصغيرة لمتالزمة األمعاء القصيرة‬‫والفشل المعوي‬ ‫‪ 4‬جراحات الكبد الصفراوية الرئيسية بما في ذلك‬‫استئصال الكبد لسرطان هيبتو الخلوي وسرطان‬ ‫شوالنغيو وورم القولون والمستقيم الخبيث وأورام‬ ‫الغدد الصم العصبية الخ‬ ‫‪ 5‬اجتثاث التردد الالسلكي (‪ )RFA‬و ‪TACE‬‬‫(االنصمام الكيماوي عبر الشرايين) لـ ‪ HCC‬وغيرها‬ ‫من األورام اإلنتقالية‪.‬‬ ‫‪ 6‬عمليات جراحية للحصى الصفراوية وجروح‬‫إواصابة القناة‪.‬‬ ‫‪ 7‬جراحات بورتو تحليلي الشاملة الرتفاع ضغط الدم‬‫البابي بسبب تليف الكبد غير التليفزيوني وخثر وريد‬

‫‪ 8‬عمليات استئصال البنكرياس الرئيسية ويبل وغيرها‬‫‪ 9‬جراحة البنكرياس الملتهب المزمن‪.‬‬‫‪ 10‬جراحة استئصال الكلية والبنكرياس بالمنظار ‪/‬‬‫الحد األدنى من الوصول إلى الصفاق البريتري‬ ‫(‪ )MARP‬إللتهاب البانكرياس الحاد الناخر‬ ‫‪ 11‬صدمة الكبد والبنكرياس‪.‬‬‫فريق الخبراء لدينا‬

‫‪ ‬نهج متعدد التخصصات للتقييم واإلدراج (اختيار‬ ‫المرضى)‬ ‫زرع مؤهل وذو خبرة مع تجربة تراكمية ألكثر من ‪500‬‬ ‫زرع الكبد‬ ‫بروتوكوالت إدارة قمع المناعة والرفض والعدوى واألخرى‬ ‫حسب المعايير الدولية‬ ‫الرعاية الوجدانية والمهنية ما بعد الزرع حتى إعادة‬ ‫التأهيل الكامل للحياة الطبيعية‬ ‫المتابعة والرعاية في المرحلة ما بعد الزرع طول الحياة‬ ‫أحدث وحدة العناية المركزة للزرع‬ ‫تماما حسب المرحلة‬ ‫غرف الزرع المجهزة ً‬

‫الكبد‬

‫‪110 Medical Tourism April.-June 2018‬‬ ‫‪11‬‬

‫مستشفيات بي إس جي‬ ‫كويامباتور‪ ،‬تاميلنادو – ‪ ،641004‬الهند‬

‫قسم أمراض القلب‬ ‫جراحة القلب والصدر واألوعية الدموية‬

‫د‪ /‬بي‪ .‬آر‪ .‬موروكيشن‬ ‫‪( MS MBBS‬الجراحة العامة)‬ ‫‪( DNB‬الجراحة العامة)‬

‫‪.]M.Ch ]CTVS‬‬

‫‪]DNB ]CTVS‬‬

‫أستاذ واستشاري‬

‫رئيس جراحة القلب وأمراض الصدر و األوعية الدموية‬ ‫‪ ‬قام بأداءه كجراح رئيسي لـ ‪ 5000‬عملية رئيسية‬ ‫للقلب واألوعية الدموية والصدر بما في ذلك‬ ‫‪ CABG‬إواصالح تمدد األوعية الدموية األبهري‬ ‫واستئصال الرئة إواعادة بناء القصبة الهوائية‪.‬‬

‫‪ ‬جراحة التنظير الصدري بمساعدة الفيديو‬

‫‪ ‬زرع جهاز تنظيم ضربات القلب الدائم‬

‫‪ ‬مرض انسداد الشرايين المحيطية‬

‫العيادة الخاصة‪:‬‬

‫‪ ‬إعادة بناء األبهر الحرقفي‬

‫‪ ‬عيادة وصول الغسيل الكلوى‬

‫‪ ‬جراحة تمدد األوعية الدموية األبهري‬

‫‪ ‬عيادة مضادة التخثر الفموية‬

‫‪ ‬يتكون الفريق من جراحين ‪ CTVS‬ذوي المهارات‬ ‫العالية وطبيب المخدرات الصدرية القلبية والموظفين‬ ‫ذوي الخبرة و الفنيين‬

‫أنواع اإلجراءات المنجزة‪:‬‬

‫‪ ‬عيادة سرطان الرئة‬

‫أنواع العمليات الجراحية التي نقوم بها‪:‬‬

‫‪ ‬إصالح فتحة غير طبيعية في الحجاب الحاجز‬

‫‪ ‬جراحة التنظير الصدري بمساعدة الفيديو (‪)VATS‬‬

‫‪ ‬جراحة لتجاوز األوعية الدموية المريضة‬

‫‪ ‬تنظير المناظير (‪)Mediastinoscopy‬‬

‫‪ ‬جراحة القلب األدنى الغازية‬ ‫‪ ‬عملية التجاوز للقلب النابض‬ ‫‪ ‬إجمالي إعادة التوعية للشرايين‬

‫‪ ‬جراحة الظهر الشوكية للعمود الفقري‬ ‫‪ ‬إدخال مضخة البالون األبهري‬

‫قسم جراحة السمنة وجراحة الجهاز‬ ‫الهضمي العلوي‬ ‫د‪ /‬في‪ .‬اس‪ .‬باالشانموغوم‪،‬‬ ‫بكالوريوس في العلوم ‪ )MBBS.، MS‬الجراحة العامة(‪FMAS ،‬‬ ‫أستاذ ومستشار جراحة السمنة‬ ‫وجراحة الجهاز الهضمي العلوي‪.‬‬

‫‪ ‬أول جراح لبدء عملية استئصال المعدة في الهند‬ ‫في يناير ‪.2005‬‬ ‫جﺮاحية للسمنة بعدم‬ ‫‪ ‬أكمل أكثر مﻦ ‪ 500‬عملية‬ ‫ّ‬ ‫الﻮفاة‪.‬‬ ‫علميا لفقدان‬ ‫‪ ‬جراحة السمنة هي منهج ناجح ثابت ً‬ ‫الوزن مقارنة مع الحبوب أو الممارسة الرياضية‪.‬‬ ‫التسهيالت المتوفرة في مركزنا تشمل‪:‬‬ ‫‪ ‬عمل حصري قبل العملية‬ ‫‪ ‬عيادة التحسين التي تشمل النظام الغذائي‬

‫‪10‬‬ ‫‪A Complete Magazine on Healthcare in Asia 111‬‬

‫واالستشارة النفسية من قبل الخبراء‬ ‫‪ ‬مختبر خاص للنوم‪.‬‬ ‫‪ ‬مجموعة ‪ HD‬بالمنظار الحصري مع طاولة جراحة‬ ‫جيدا‪.‬‬ ‫السمنة محاطة بفريق دعم مدرب ً‬ ‫‪ ‬إجراءات عالج البدانة في مركزنا هي ربط المعدة‬ ‫واستئصال المعدة وعملية تجاوز المعدة وعملية تجاوز‬ ‫المعدة البسيطة إواعادة جراحات السمنة وجراحات‬ ‫أحادية المناظير وثنائية المنظار وبالون المعدة‬ ‫بالمنظار‪.‬‬

‫من يمكنه الخضوع لجراحة السمنة‬ ‫لفقدان الوزن (الجراحة االستقالبية)؟‬ ‫خيار حسن لألشخاص الﺬيﻦ ال يستﻄيعﻮن فقﺪان الﻮزن‬ ‫بالﻮسائﻞ التقليﺪية ‪ ،‬وقﺪ ثبﺖ أن لﺪيهﻢ انعﻜاساً للسمنة‬ ‫والمشاكل المتعلقة بها‪.‬‬ ‫المرضى الذين لديهم مؤشر كتلة الجسم (‪ )BMI‬أكثر‬ ‫من ‪ 35‬إلى ‪ 40‬مع األمراض المرتبطة مثل مرض‬ ‫السكري من النوع ‪ 2‬أو أمراض القلب وغيرها من‬ ‫المشاكل الصحية المرتبطة بها‪.‬‬

‫مستشفيات بي إس جي‬ ‫كويامباتور‪ ،‬تاميلنادو – ‪ ،641004‬الهند‬ ‫قسم جراحة األعصاب‬ ‫د‪ /‬بي‪ .‬آر‪ .‬راجكومار‬ ‫‪( MBBS Mch MS‬جراحة األعصاب)‪،‬‬ ‫المدير الطبي‬ ‫أستاذ ورئيس قسم جراحة األعصاب‬

‫‪ 18 ‬سنة من الخبرة في جراحة األعصاب‬

‫‪ ‬سترايكر ناف ‪ 3‬آي المالحة العصبية‬

‫‪ ‬قام بأداء أكثر من ‪ 5000‬إجراءات جراحة‬ ‫األعصاب‬

‫‪ ‬التنظير الداخلي لألعصاب والتنظير الشوكي‬ ‫والتنظير الداخلي للقحف‬

‫‪ ‬خبرة في جراحة األعصاب الموجهة للمالحة‬ ‫وجراحة أورام الحبل الشوكي وجراحة األجهزة للعمود‬ ‫الفقري واستئصال الورم في الدماغ باإلشعاع وجراحة‬ ‫قاعدة الجمجمة بالمنظار ورأب القسطرة‪.‬‬

‫‪ ‬طب جراحة األعصاب‬

‫جراحة المخ واألعصاب مجهزة بما يلي‪:‬‬ ‫‪ ‬كارل زيس بينتيرو ‪ 900 -‬مجهر مع الشدادة ‪3‬‬ ‫د هـ د‬

‫‪ ‬مراقبة العصبية أثناء الجراحة‬ ‫‪ ‬مراقبة الضغط داخل الجمجمة‬ ‫‪ ‬وحدة العناية المركزة المتخصصة في جراحة‬ ‫األعصاب ومسرح العمليات يمكن للمريض مع الشكاوى‬ ‫التالية استشارة جراح األعصاب خالل معرض اكسبو‬

‫‪ ‬صداع الراس‬ ‫‪ ‬تشنج‬ ‫‪ ‬ألم الوجه‬ ‫‪ ‬الم الرقبة‬ ‫‪ ‬آالم أسفل الظهر‬ ‫‪ ‬الخدر‬ ‫‪ ‬ضعف األطراف‬

‫قسم األذن واألنف والحنجرة‬ ‫د‪ /‬آر‪ .‬آناند‬

‫‪( ،MS MBBS‬األذن واألنف والحنجرة) ‪DNB،‬‬ ‫(األذن واألنف والحنجرة)‬

‫ال مزيد من الشخير‬

‫ااحصلوا على الشفاء‬ ‫بال سكين وال دم‪.‬‬ ‫فقط عن طريق إجراء كوبليشن‬

‫جراح توقف التنفس أثناء النوم‬ ‫منسق غرسة القوقعة الصناعية‬

‫هل تشكو من ‪.....‬‬

‫‪‬فقدان الطاقة والتعب‬

‫كيف يتم عالج الشخير أو ‪OSA‬؟‬

‫‪‬النوم المفرط وقت النهار‬

‫‪‬الكآبة‬

‫‪‬نوم مضغوط على اليمين‬

‫‪‬البدانة‬

‫الفحص الكامل من قبلنا هو الخطوة األولى لعالج‬ ‫الشخير‪ .‬ونقوم بفحص بنية الحلق ونقيم العوامل مثل‬ ‫الوزن وضغط الدم ومعدل ضربات القلب قبل التوصية‬ ‫بخطة العالج األفضل لك‪.‬‬

‫‪‬الشخير المشوه بصوت عال‬

‫‪‬زيادة الوزن في النساء عند انقطاع الطمث‬

‫‪‬األشخاص ذوي الرقبة السميكة القصيرة‬

‫‪‬النسيان والتهيج‬

‫‪‬االختناق واللهاث أثناء النوم‬

‫‪‬مشكلة في التركيز‬

‫‪‬صداع الصباح واالستيقاظ بالتعب‬

‫إذا كان الجواب نعم ‪ ...‬استشر طبيبك ‪ ،‬قد‬ ‫يكون انقطاع النفس االنسدادي أثناء النوم‬ ‫(‪)OSA‬‬

‫‪‬توقف طويل في التنفس‬

‫تم تطوير العديد من األجهزة واإلجراءات للتحكم المؤقت‬ ‫في الشخير‪ .‬ومن المحتمل األساليب غير الجراحية‬ ‫مثل فقدان الوزن وتعديل نمط الحياة أو األجهزة الفموية‬ ‫أيضا خيار جراحي‬ ‫إلعادة وضع الفك أثناء النوم‪ .‬هناك ً‬ ‫أكثر جرأة وغازية للمريض الذي ال يحصل على الشفاء‬ ‫من هذه العالجات المحافظة‬

‫‪112 Medical Tourism April.-June 2018‬‬ ‫‪09‬‬

‫مستشفيات بي إس جي‬ ‫كويامباتور‪ ،‬تاميلنادو – ‪ ،641004‬الهند‬

‫أول مستشفى تعليمي‬ ‫في تاميلنادو معتمد من‬ ‫قبل ‪NABH‬‬

‫مستشفى متعدد‬ ‫التخصصات مع ‪ 1300‬سرير‬ ‫للرعاية التخصصية‬

‫تماما‬ ‫تبدو البناية الرئيسية لمستشفيات ‪ PSG‬مبدعة ً‬

‫الواقع قيمنا الدافعة هي‪ :‬األخالق والعلوم والجودة‬

‫إلى المستشفيات وكذلك يتم استقبالهم ومساعدتهم‬

‫إوانما في الواقع ال يعرف الكثير من الناس أن‬ ‫‪ PSG‬قد قررت بناء مبنى جديد بالكامل ‪،‬‬

‫تم وضع بومي بوجا للمبنى األول من ‪PSGIMS‬‬

‫نادو ‪ 641004‬الهند‪ ،‬وهو الرابع للمؤسسة ‪،‬‬

‫تعمل كلية الطب في رحاب من الكلية تضمن‬

‫كما هو الحال مع أمانة بي اس جي وأبناؤه في‬

‫كويمباتور‪ .‬هناك حشد ثابت من الناس يتدفقون‬ ‫مهذبا من مكتب االستقبال‪.‬‬

‫يعترف الدكتور بي آر راجكومار ‪ ،‬المدير الطبي‬ ‫لمستشفيات بي إس جي ‪ ،‬بأن الجناح العام‬

‫للمستشفى الذي يضم ‪ 1300‬سري ار يكاد يكون‬

‫والعناية الشخصية‪.‬‬

‫مستشفيات بي اس جي‪ ،‬كويامباتور‪ ،‬تاميل‬

‫والذي سوف يكون جناحا عاما تماما يضم ‪750‬‬

‫سريرا‪ .‬هذا هو ذرية مباشرة من حقيقة أن هناك‬

‫تساوي أولئك الذين يبقون في أجنحة خاصة"‬

‫متعدد التخصصات بدأت في البداية ككلية‪ .‬ولم‬

‫مستشفى يديرها أمانة حيث يكون المرضى هم‬ ‫أكبر أصحاب المصلحة ‪ ،‬وال يوجد أصحاب‬

‫األسهم يبحثون عن األرباح"‪.‬‬

‫أيضا أن أي دخل يتم‬ ‫ومن الجدير بالذكر ً‬ ‫الحصول عليه في نظام الدفع يتم استخدامه في‬ ‫الدعم المتبادل للجناح العام‪ .‬يتم تعزيز تطوير‬

‫المعهد من حيث البنية التحتية والتكنولوجيا من‬

‫قبل صندوق األمانة بإعادة إحياء هذا النمو‬

‫للجمهور‪ .‬هذا النموذج من تقديم الرعاية الصحية‬ ‫التي تديرها األمانة قد ساعدت المبادئ األخالقية‬

‫الفطرية لصناديق بي اس جي وأبناؤه في الحفاظ‬

‫على أخالق العمل المثالي في المستشفيات‪ .‬وفي‬

‫‪08‬‬ ‫‪A Complete Magazine on Healthcare in Asia 113‬‬

‫وتمكين المجتمع من فهم البيئة االجتماعية للرعاىة‬

‫جميع قطاعات السكان‪.‬‬

‫األحيان قد تكلف ما يصل إلى ‪ 200‬روبية في‬

‫يشرح التسعير المتواضع للعالج الطبي هنا "هذا‬

‫األكاديميين والمستشفيات بتوفير الرعاية الصحية‬

‫يوم في المستشفيات‪ .‬في حين أن الدفعات القليلة‬

‫كلية الطب ‪ PSG‬والمستشفى التي نمت على‬

‫يقول الدكتور اس كارتيكيان المشرف العام الطبي‬

‫و ‪.R‬‬

‫فراغ ضخم في المدينة للحصول على المزيد من‬

‫دائما‪ .‬و يقول‪".‬هذا ألننا نقدم خدمات‬ ‫ً‬ ‫ممتلئا ً‬ ‫للمرضى بسعر ال يقوم به أي مستشفى آخر‪.‬‬

‫اليوم" ومع ذلك ‪ ،‬فإن رعايتهم ال يعلي ‪ ،‬فهي‬

‫للفنون والعلوم بطريق أفيناشي‪ .‬وفي عام ‪1986‬‬

‫الصحية‪ .‬إن تدريب طالب الطب ينطوي على‬

‫الرعاية بأسعار معقولة والمزيد من المساواة بين‬

‫اإلقامة في الجناح العام مجانية وفي بعض‬

‫الواقع أول مجموعة من طالب بكالوريوس في‬

‫الطب والجراحة بدأ درسهم في كلية بي اس جي‬

‫مدى العقود الثالثة الماضية لتصبح مرك از رئيسيا‬ ‫يكن هناك مستشفى خاص بها‪.‬‬

‫ومن الناحية التاريخية كان في عام ‪ 1985‬أن‬

‫رئيس الوزراء آنذاك شري إم جي راماشاندران‬ ‫ٍ‬ ‫حينئذ‬ ‫طلب من السيد جي‪ .‬فاراداراج الذي كان‬

‫أمين إدارة المؤسسة الخيرية بي اس جي وأبناؤه‬

‫أن يبدأ أول كلية طبية خاصة في الوالية‪ .‬وفي‬

‫الواقع قام رئيس الوزراء بوضع حجر األساس‬

‫إلنشاء مبنى الكلية الجديد في عام ‪ .1987‬ولكنه‬

‫تم منح اإلذن لبدء الكلية بمجرد تقديم الطلب ‪،‬‬

‫نظر ألن أمانة بي اس جي وأبناؤه كانت تتمتع‬ ‫ًا‬ ‫بمزايا عالية المصداقية في مجال التعليم ووصلت‬ ‫اليوبيل البالتيني في عام ‪ .1985‬لذلك بدأت‬ ‫الكلية عملها كمشروع يوبيل بالتينيوم في عام‬

‫‪ ، 1985‬وقد شهد التاريخ ‪ 30‬سبتمبر ‪1985‬‬

‫الدفعة األولى من الطالب يدخلون المعهد‪ .‬وفي‬

‫اضط ارره لقضاء نصف يوم على األقل في كل‬

‫األولى كانت تدريباتهم السريرية في المستشفيات‬

‫الحكومية في تيروبور ومستشفيات راماكريشنا‬

‫و ‪ GKNM ، KG‬ومستشفيات أرافيند للعيون‬

‫ومستشفيات مؤسسة نيفيلي ليغنيت‪ .‬وحول هذا‬

‫الوقت بدأت خدمة المرضى الخارجيين في فيال‬

‫السيد جي‪ .‬فاراداراج (حيث تقع مؤسسة راجشري‬

‫فورد الحالية) على طريق أفيناشي‪ .‬وكان في‬

‫عام ‪ 1989‬بدأ مستشفى ‪ PSG‬إلى الوجود‪ .‬وفي‬

‫‪ 15‬نوفمبر من عام ‪ 1989‬تم افتتاح مستشفى‬ ‫‪ PSG‬مع خدمات للمرضى الداخليين‪ .‬وكانت‬ ‫منشأة أساسية مع ‪ 450‬سريرا‪ .‬وكان في عام‬

‫‪ -95 1994‬أن المستشفى بدأ قسم أمراض القلب‬ ‫واألعصاب وكان هذا القدم األول في التخصص‬

‫الفائق‪ .‬وفي عام ‪ 1999‬بدأت جراحة القلب‬

‫والصدر مع أمراض المعدة واألمعاء واألعصاب‬

‫وأمراض الكلى وغيرها من التخصصات بسرعة‬

‫بعد حذوه‪ .‬قام المستشفى بإجراء أول عملية زرع‬ ‫الكبد في عام ‪2014‬‬

‫ويقدم المعهد الذي بدأ في البداية بدورة الطب‬ ‫الجامعي اآلن دورات دراسات عليا في الطب‬

‫والجراحة والتخصص أيضا‪ .‬يجد المرضى‬

‫الذين يأتون إلى المستشفى لديهم حوالي ‪300‬‬

‫طبيب ومن بينهم ‪ 225‬متخصص‪ .‬يقول‬

‫راجكومار‪" :‬يتمتع األطباء بحكم ذاتي متميز مهنيا‬ ‫بمستشفيات بي إس جي"‪ .‬كما تقوم مستشفيات‬

‫‪ PSG‬بالكثير من الخدمات اإلجتماعية من‬

‫خالل المراكز الصحية الريفية في أماكن مثل‬ ‫فيداباتي و كاراديفافي والمناطق الداخلية لـ‬

‫بيالميدو‪ .‬تتمتع المستشفيات التعليمية باحترام‬

‫كبير في جميع أنحاء العالم‪ .‬السبب الرئيسي هو‬

‫أن فن تقديم الرعاية الصحية يتم اشتقاقه بعلم‬

‫الطب ‪ ،‬ويتم التحكم في العملية برمتها عن طرق‬ ‫الدقة من األكاديميين‪ .‬ال يمكن أن ينحرف عن‬

‫المبادئ التوجيهية القائمة على األدلة أو الممارسة‬

‫األخالقية ‪ ،‬ويضمن نظام مراجعة الزمالء مع‬ ‫العديد من الجهات المعنية األكاديمية ذلك‪.‬‬

‫الرؤية المستقبلية لمستشفيات بي‬ ‫اس جي ‪::‬‬ ‫أوضح الدكتور بي‪ .‬آر‪ .‬راجكومار المدير الطبي‬ ‫االتجاه المستقبلي‪ .‬ويقول‪" :‬نحن نخطط لتقديم‬ ‫عدد قليل من الدورات التدريبية الجديدة في‬

‫التخصصات الناشئة مثل طب الغدد الصماء لدى‬

‫األطفال وطب الرعاية الحرجة والرضوخ‪ .‬نحن‬

‫نخطط أيضا لبدء المزيد من البحوث األساسية‬

‫ومتعدية "‪.‬‬

114 Medical Tourism April.-June 2018

‫في لداخل‬ ‫العقم‪ :‬التشخيص والعالج‬

‫‪12‬‬

‫حصى الكلى‪ :‬حقائق صلبة‬

‫‪20‬‬

‫األكل الصحي من أجل قلب صحي‬

‫‪26‬‬

‫عالج مرض السكري باستخدام التكنولوجيا الجديدة‬

‫‪32‬‬

‫تعلم التنفس أسهل‬

‫‪36‬‬

‫العالج الكيميائي العالج الذي يقتل الخاليا السرطانية‬

‫‪40‬‬

‫‪12‬‬

‫‪20‬‬

‫‪26‬‬

‫العقم‪ :‬التشخيص‬ ‫والعالج‬

‫حصى الكلى‪ :‬حقائق‬ ‫صلبة‬

‫األكل الصحي من أجل‬ ‫قلب صحي‬

‫‪32‬‬

‫‪36‬‬

‫‪40‬‬

‫عالج مرض‬ ‫السكري باستخدام‬ ‫التكنولوجيا‬ ‫الجديدة‬

‫تعلم التنفس أسهل‬

‫‪06‬‬ ‫‪A Complete Magazine on Healthcare in Asia 115‬‬

‫العالج الكيميائي‬ ‫العالج الذي يقتل‬ ‫الخاليا السرطانية‬

116 Medical Tourism April.-June 2018

‫الطلب على خدمة العقم في االرتفاع‬

‫المجلد ‪ ، 2‬العدد ‪ ، 4‬أبريل ‪ -‬يونيو ‪2018‬‬

‫العقم هو حالة واسعة النطاق مع اآلثار النفسية واالقتصادية والطبية‪ .‬وقد طالبت الدعاية‬ ‫التي ال نظير لها والتي تُعطى لقضايا الخصوبة في العصر التكنولوجي بارتفاع في خدمات‬ ‫العقم‪ .‬وفي جميع أنحاء العالم فإن انتشار العقم هو األعلى في أوروبا الشرقية وشمال‬ ‫أفريقيا والشرق األوسط وأوقيانوسيا وأفريقيا جنوب الصحراء حتى مع استمرار المشكلة‬ ‫عالميا‬

‫‪RNI No. KERBIL/2016/68979‬‬

‫من المرجح أن يزداد الطلب على عالج العقم زيادة كبيرة‪ .‬زاد متوسط العمر عند والدة الطفل‬ ‫األول ويفترض أيضا متوسط العمر عند المحاولة األولى للحمل‪ .‬وقد أدى ارتفاع معدالت الطالق‬ ‫والزواج الثاني إلى زيادة عدد األزواج الذين يرغبون في بدء أسرة ثانية في عمر متقدم نسبيا‪.‬‬ ‫إذا كان الوقت الذي يستغرقه الحمل مع زيادة العمر كما يبدو ‪ ،‬فإن ارتفاع متوسط عمر المرأة‬ ‫التي تحاول الحمل قد يؤدي إلى زيادة في انتشار العقم والطلب على العالج‪.‬‬

‫‪Editor & Publisher‬‬ ‫‪Benny Thomas‬‬ ‫‪Consulting Editor‬‬ ‫‪O.J. George‬‬ ‫‪Executive Editor‬‬ ‫‪Byju Aryad‬‬

‫معظم الناس لديهم رغبة قوية في إنجاب طفل في مرحلة ما من حياتهم‪ .‬إن فهم ما يع ّرف‬ ‫الخصوبة الطبيعية أمر حاسم لمساعدة الشخص أو الزوجين على معرفة متى يكون الوقت‬ ‫قد حان لطلب المساعدة‪ .‬معظم األزواج (حوالي ‪ )85٪‬سيحققون الحمل خالل سنة واحدة من‬ ‫المحاولة ‪ ،‬مع احتمال حدوث الحمل األكبر خالل األشهر السابقة‪ .‬فقط ‪ ٪ 7‬اإلضافي من األزواج‬ ‫سوف ينجبون في السنة الثانية‪ .‬ونتيجة لذلك يع ّرف العقم بأنه عدم القدرة على الحمل خالل‬ ‫‪ 12‬شه ًرا‪ .‬هذا التشخيص مشترك مع ‪ 15٪‬من األزواج الذين يحاولون اإلنجاب‪.‬‬

‫‪Editorial Co-ordinator‬‬ ‫‪Ninu Susan Abraham‬‬ ‫‪Layout & Design‬‬ ‫‪Lal Joseph‬‬ ‫‪Legal Advisor‬‬ ‫‪Adv. Biju Hariharan‬‬

‫ومن المستحسن الحصول على مساعدة من طبيب الغدد التناسلية إذا لم يحدث الحمل‬ ‫في غضون ‪ 12‬شهرا‪ .‬ومع ذلك هناك العديد من السيناريوهات التي قد ينصح فيها بطلب‬ ‫المساعدة في وقت سابق‪.‬‬ ‫المقالة الرئيسية تدور حول أسباب العقم وكيف يمكن عالجها‪ .‬يتم عالج ما يقرب من ‪90 - 85‬‬

‫‪ ٪‬من حاالت العقم مع العالجات التقليدية مثل العالج من تعاطي األدوية أو اإلصالح الجراحي‬ ‫لألعضاء التناسلية‪ .‬تساعد تقنيات اإلنجاب المساعدة مثل التخصيب في المختبر على خيارات‬ ‫العالج المتبقية في العقم‪.‬‬ ‫وفي هذا العدد يتم شرح أسباب حصوات الكلى والعواقب واألعراض والتشخيص والعالج‬ ‫بالتفصيل‪ .‬حصوات الكلى هي واحدة من األسباب الشائعة أللم شديد في البطن المقدمة‬ ‫إلى غرفة الطوارئ‪ .‬وفي كل عام يذهب أكثر من ‪ 1.3‬مليون شخص إلى غرف الطوارئ لمشاكل‬ ‫في حصوات الكلى‪ .‬وتشير التقديرات إلى أن واحدا من كل عشرة أشخاص سيكون لديهم‬ ‫حصى الكلى في وقت ما في حياتهم‪ .‬إذا كنت قد عرفت أي شخص كان عليه تحمل حصى‬ ‫في الكلى أو إذا كان لديك واحدة بنفسك فإن اإلجماع العام هو أنه يمكن أن يكون مؤلما‬ ‫للغاية‪ .‬عادة يتم مقارنة األلم من تمرير حصى الكلى إلى ألم الوالدة‪ .‬شهدت النساء الالتي‬ ‫تعرضن لكال الحالتين على هذا‪ .‬ومع ذلك فإن هذه ليست الحال دائما‪ .‬وفي بعض الحاالت من‬ ‫حصوات الكلى ال يوجد أي ألم على اإلطالق ‪ ،‬وبعض المرضى ال يعرفون أبدًا أن لديهم واحدة‪.‬‬ ‫يعتمد الفرق في التجربة على موقع الحجر داخل المسالك البولية‪.‬‬ ‫وبصرف النظر عن األخبار الطبية والعمليات الجراحية النادرة من العالم الطبي تركز هذه‬ ‫الميزة الخاصة على معرض ومؤتمر السياحة الطبية الدولية ‪ IMTEC‬عمان ‪ 2018‬الذي سيعقد‬ ‫في الفترة من ‪ 24‬إلى ‪ 26‬أبريل ومعرض كينيا الطبي ‪ 2018‬الذي سيعقد من ‪ 10‬إلى ‪ 12‬مايو‬ ‫عاما‪ .‬جميع المؤتمرات الثالثة عبارة عن‬ ‫وسوق السفر العربي في دبي من أبريل من ‪ 22‬إلى ‪ً 25‬‬ ‫جماهير عالمية ‪ ،‬ويسعدنا أن نعلن أن مجالت السياحة الطبية ومجلة اآليورفيدا والسياحة‬ ‫الصحية هي شركاء إعالميون في معرض ومؤتمر السياحة الطبية الدولية ‪ IMTEC‬في معرض‬ ‫مسقط وكينيا الطبي‪ .‬سيتم توزيع المجالت في جميع األحداث الثالثة‪.‬‬ ‫نتمنى لكم قراءة سعيدة‪.‬‬

‫(نهاية)‬

‫‪Disclaimer: The statements in this magazine have not been‬‬ ‫‪evaluated by the Food and Drug Administratin of USA or‬‬ ‫‪any other country. Information provided in this magazine‬‬ ‫‪are not intended to diagnose, treat, cure or prevent any‬‬ ‫‪disease. If you have a medical condition, consult your‬‬ ‫‪physician. All information is provided for research and‬‬ ‫‪education purpose only.‬‬

‫‪04‬‬ ‫‪A Complete Magazine on Healthcare in Asia 117‬‬

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‫‪Printed, published and owned by‬‬ ‫‪Benny Thomas‬‬ ‫‪FM Media Technologies Pvt. Ltd,‬‬ ‫‪Penta Square, Opp.Kavitha,‬‬ ‫‪MG Road, Cochin -682016,‬‬ ‫‪Kerala, India.‬‬ ‫‪Editor: Benny Thomas‬‬

‫‪CORPORATE OFFICE‬‬ ‫‪FM Media Technologies PVT Ltd,‬‬ ‫‪Penta Square, Opp.Kavitha, MG‬‬ ‫‪Road, Cochin -682016, Kerala, India.‬‬ ‫‪Tel/Fax: +91 484 403 4055‬‬ ‫‪Email: director@asianmeditour.com‬‬ ‫‪www. asianmeditour.com‬‬

118 Medical Tourism April.-June 2018

A Complete Magazine on Healthcare in Asia 119

‫المجلد ‪ ، 2‬العدد ‪ ، 4‬أبريل ‪ -‬يونيو ‪2018‬‬

‫العقم‪:‬‬

‫التشخيص والعالج‬ ‫حصى الكلى‪ :‬حقائق صلبة‬ ‫األكل الصحي من أجل‬ ‫قلب صحي‬ ‫تعلم التنفس أسهل‬

‫‪120 Medical Tourism April.-June 2018‬‬