Medical Tourism Eng 2018 Sep

Vol.3 | Issue No.1 | Jul - Sep 2018

Cover Story

KIDNEY DISEASE

Diabetes: Main cause of Chronic Kidney disease

TOURISM

Kerala Bounces back after floods

KTM FOCUSES RESURGENCE OF TOURISM STRESS CAN AFFECT ORGANS

A Complete Magazine on Healthcare in Asia

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St. Thomas Nagar, Kuttapuzha P.O., Tiruvalla. Kerala. India 2

Medical Tourism Jul. - Sep. 2018

A Complete Magazine on Healthcare in Asia

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Threadbare evaluation of Kidney diseases and treatments

Vol. 3 | Issue No. 1 | Jul - Sep 2018

Medical

tourism RNI No. KERBIL/2016/68979

Editor & Publisher BENNY THOMAS Consulting Editor O.J. GEORGE Editorial Co-ordinator NINU SUSAN ABRAHAM 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 BUSINESS ASSOCIATES India Mumbai : Mohan Iyer, Mob: +91 22 6450 5111 Chennai : C. Shankar, Mob: +91 984 097 8060 Coimbatore : Gurumurthy, Mob: +91 989 460 4804 Eastern India : Sanjay D. Narwani, Mob: +91 983 120 7202 Hyderabad : Ephram Joseph, Mob: +91 939 131 5072 Bangalore : C. Sivakumar, Mob: +91 974 000 4932 Puducherry : K. Ramasubramanian, +91 989 497 7161 Trivandrum : Kuriyan K. Raju, Mob: +91 944 610 6644

CORPORATE OFFICE FM Media Technologies PVT Ltd, Penta Square, Opp.Kavitha, MG Road, Cochin -682016, Kerala, India.

Tel: +91 484 403 4055 Email: director@asianmeditour.com www. asianmeditour.com

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Medical Tourism Jul. - Sep. 2018

There are two main types of kidney diseases, Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD). Acute kidney injury occurs suddenly and recovers completely on most occasions. It is caused by insults to the kidney from infections, drugs, toxins, obstruction to urine flow, to name a few. Once the inciting cause is treated appropriately, the kidneys recover. However, AKI can also lead to chronic kidney disease in a few instances. Temporary dialysis support may be required in some patients with AKI. The major causes of CKD are Diabetes and Hypertension. The other causes include glomerulonephritis, inherited kidney disease (Polycystic Kidney Disease, Alport’s syndrome, Primary Hyperoxaluria), recurrent urinary tract infections, long- standing obstruction to urine flow (stones, prostate gland enlargement) and drugs and toxins.

The main test for kidney disease is measuring the level of creatinine in the blood. The mainstay of treatment is removing the offending agent.

Usual symptoms are back-pain, high blood pressure, blood in urine, and frequent urinary infections. Ultrasonogram is most reliable, inexpensive, and non- invasive mode of diagnosis. CT scan/MRI analysis is at times done to measure volume and growth of kidneys and cysts.

Most of the disease- causing CKD can be to a great extent attributed to the life- style of the population. Sedentary life- style, unhealthy eating habits, obesity, excessive use of over- the-counter drugs, smoking, alcohol intake, and stress are some of the main reasons.

Kidney disease is often silent until it is in very advanced stage. There is no cure for CKD. Prevention is the key. Early detection of kidney disease and referral to a Nephrologist will help thte patient in retarding the disease progression and planning of the treatment of CKD stage 5.

The cover story is about causes of Kidney diseases and how these could be prevented and treated. People at risk for CKD need to get annual screening, or more frequently, as deemed by their Physician. A simple blood and urine test along with BP measurement is enough.

In this issue the side-effect of some of the medications are also included. Many common medications that are readily available over the counter are detrimental to kidney function when used on a long-term basis. There is a dangerous lack of awareness of these adverse effects among the general population all over the world. A major part of evaluating a patient involves detailed reviewing of their medication list and identifying any offending agent that may hamper kidney function.

General practitioners need to be aware of these potential kidney side- effects while prescribing antibiotics and, if worsening of kidney function is noted, the antibiotic needs to be stopped and switched to a safer alternative. In Modern Medicine, there is a lack of understanding of the method of action of the various constituents in these supplements, but one major culprit has been identified that could be causing more harm than good. Many commercially- sold herbal supplements contain high levels of heavy metals (lead, copper, mercury etc.) that are toxic to the kidneys.

Apart from the medical news, rare surgeries from the medical world and news from the travel and tourism sector, this special feature focuses on Kerala Travel Mart scheduled to be held at Kochi from September 27 to 30, 2018, and Oman Health Exhibition and Conference from September 24 to 26, 2018.

All the two conferences are international crowd- pullers with Medical Tourism magazine as media partners at Oman Health Exhibition and Conference. The magazine will be available at the respective venues.

We wish you a happy reading.

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

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Contents

Cover Story:

KIDNEY DISEASE-

1) Events

01

2) Cover Story: KIDNEY DISEASE A silent disorder which can be avoided by

change in lifestyle

22

A silent disorder which can be avoided by change in lifestyle

3) Kidney related ailments are skyrocketing;

Remedial measures are also available in plenty,

Make the most of available medical resources 30 4) Kidney Disease-An unknown side- effect of

some well-known medications

34

5) Lifestyle changes that can help prevent

Kidney disease

36

6) Kidney-friendly diet for chronic Kidney disease 38 7) Hernia- Don’t ignore your groin pain

40

8) Tourism News

42

9) Travel News

56

10) Understanding stress and ways to tackle

debilitating effects

58

11) 60 Yogis from 22 countries discover the

land of Yoga

60

12) Listening to Yoga music or meditation

tunes at bedtime is good for your heart 62 13) Health news

64

14) Rare surgeries

68

15) Sex facts for ageing couples

72

16) Avocado-a prized fruit for the health

conscious generation

74

17) A guide to the Ketogenic Diet

76

6

Medical Tourism Jul. - Sep. 2018

30

KIDNEY RELATED AILMENTS are skyrocketing; Remedial measures are also available in plenty, Make the most of available medical resources.

62

36

LISTENING TO YOGA MUSIC

or meditation tunes at bedtime is good for your heart

LIFESTYLE CHANGES that can help prevent Kidney disease

72

40 HERNIA Don’t ignore your groin pain

SEX FACTS For Ageing couples

58

UNDERSTANDING STRESS

and ways to tackle debilitating effects

74 60

60 YOGIS from 22 countries discover the land of Yoga

76

AVOCADO a prized fruit for the health Conscious Generation

A guide to the

KETOGENIC DIET

A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM HOSPITALS & WELLNESS

MHTC Concierge and Lounge

Vive Medsolutions Hyderabad Ph: +91 984 804 0653 www.vivemedsolutions.com

Malaysia Ph: +6 032 267 6888 www. mhtcorg.my

Email: callcentre@mhtcorg.my

Email: info@vivemedsolutions.com

KIMS Global

Cimar Fertility Centre Kochi, Kerala Ph: 91 904 834 4466 www.cimarindia.org

Thiruvananthapuram Ph: +91 471 304 1000 www.kimsglobal.com

Email: relations@kimsglobal.com

cimarcochin@gmail.com

Narayana Health

Sreedhareeyam Ayurvedic Eye Hospital and Research Centre Bengaluru Ph: +91 998 601 3353 www.nhinternational.org

Koothattukulam, Kerala Ph: + 91 485 225 3007 www.sreedhareeyam.com

Email: international@narayanahealth.org

Email: mail@sreedhareeyam.com

Dhathri Ayurveda Hospital

Almas Hospital Kayamkulam, Kerala Ph: +91 902 002 8888 www.dhathriayurveda.com

Email: hospitals@dhathri.in

Malappuram, Kerala Ph: +91 954 407 0707 www.almashospital.com Email: mail@almashospital.com

Pulp Multi Speciality Dental Hospital

BLK Super Speciality Hospital New Delhi Ph: +91 113 040 3040 www.blkhospitgal.com

Chennai Ph: +91 917 621 0077 www.pulpdentgal.com

Emaiil: dr.gv@pulpdental.com

Email: info@blkhospital.com

Meitra Hospital

Punarnava Ayurveda Hospital Pvt Ltd Kochi, Kerala Ph: +91 484 280 1415 www.punarnava.net

Kozhikode, Kerala Ph: + 91 984 781 1811 www.meitra.com

Email: int.desk@meitra.com

Email: mail@punarnava.net

VPS Lakeshore

Sir H.N. Reliance Foundation Hospital and Research Centre Kochi, Kerala Ph: +91 484 270 1032 www.vpslakeshorehospital.com

Email: info@lakeshorehospital.com

Email: rfh.international@rfhospital.org

Metromed International Cardiac Centre

Lifeline Super Speciality Hospital

Kozhikode, Kerala Ph: +91 495 661 5555 www.micc.in

Email: info@micc.in 8

Mumbai Ph: +91 226 130 5005 www.rfhospital.org

Medical Tourism Jul. - Sep. 2018

Adoor, Kerala Ph: +91 473 422 3377 www.lifelinehospitalkerala.com

Email: info@lifelinehospitalkerala.com

MEDICAL TOURISM HOSPITALS & WELLNESS

PSG Hospitals

Kovai Medical Center and Hospital Coimbatore Tamil Nadu Ph: +91 950 097 0666

www.psghospitals.com

Coimbatore, Tamil Nadu Ph: +91 422 432 3800 www.kmchhospitals.com

Email: getwell@kmchhospitals.com

Ayurgreen Hospitals

Malabar Institute of Medical Sciences Ltd Malappuram, Kerala Ph: +91 494 305 5555 www.ayurgreeenhospitals.com

Kozhikode, Kerala Ph: +91 495 248 8000 www.astermims.com

Email: info@ayurgreenhospitals.com

Email: mimsclt@asterhospital.com

Believers Church Medical College Hospital

Samad IVF Hospital

Thiruvalla, Kerala Ph: 91 469 302 3100 www.bcmch.org

Email: info@bcmch.org

Thiruvananthapuram, Kerala Ph: +91 471 245 1926 www.samadhospital.com

Email: info@samadhospital.com

Sharp Sight Eye Hospital

Santhigiri Ayurveda and Siddha Hospital Delhi Ph: +91 113 005 1818 www.sharpsight.im

Email: info@sharpsight.in

Thiruvananthapuram, Kerala Ph: +91 471 241 9076 www.santhigiriashram.org

Email: communication@santhigiriashram.org

PSRI Hospital

Indo American Hospital New Delhi Ph: +91 113 061 1700 www.psrihospital.com

Email: marketing@psri.net

Vaikom, Kerala Ph: +91 482 921 7800 www.indoamericanhospital.in

Email: info@indoamericanhospital.in

Indian Spinal Injuries Centre

Parathuvayalil Ayurveda Hospital

New Delhi Ph: +91 987 109 3713 www.isiconline.org

Perumbavoor, Kerala Ph: +91 484 265 3875 www.parathuvayalilhospital.com

Email: marketing@isiconline.org

Email: mail@parathuvayalilhospital.com

Star Hospitals

Vinayaka Ayurvedic Nursing Home Hyderabad Ph: +91 404 477 7777 www.starhospitals.in

Thrissur, Kerala Ph: +91 487 234 4789 www.vinayakaayurvedic.co.in

Email: worldhealth@starthospitals.co.in

Email.Dr,mohankumar@yahoo.co.in

ARMC IVF Fertility Centre

Chaithanya Eye Hospital and Research Centre Kochi, Kerala Ph: +91 484 284 5500 www.chaithanya.org

Kozhikode, Kerala Ph: +91 952 688 0680 www.armcivf.com

Email: info@armcivf.com

info.cok@chaithanya.org A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM EQUIPMENT

WRIGHT

Medtronic, Inc.

Kaneka Pharma America LLC

AUGMENT Bone Graft

Medtronic DBS System for Epilepsy

LIPOSORBER® LA-15 System

AUGMENT® Bone Graft is the first and only proven alternative to autograft in ankle and hindfoot arthrodesis. AUGMENT® Bone Graft is a combination of recombinant human platelet derived growth factor BB (rhPDGF-BB), that contributes to mesenchymal stem cell chemotaxis and mitogenesis and angiogenesis; and Beta tri-calcium phosphate (β-TCP) granules, that provide an osteoconductive scaffold to facilitate new bone formation and delivery of rhPDGF-BB.

The Medtronic Deep Brain Stimulation (DBS) System for Epilepsy is a device that delivers controlled electrical pulses to a location inside the brain which is involved in seizures. The system consists of a pulse generator (IPG) implanted under the skin of the upper chest, and two leads implanted in the brain. The Medtronic DBS System for Epilepsy helps reduce the frequency of seizures in epilepsy patients who have frequent, disabling, partial-onset seizures and have not responded well to antiepileptic medications.

www.augmentbonegraft.com

www.medtronic.com

The LIPOSORBER LA-15 System is a blood processing system that collects blood from the patient’s body and removes certain substances such as low density lipoprotein cholesterol (LDL-C, or “bad cholesterol”) and other harmful substances from the patient’s blood. The system also helps slow the progression of an aggressive kidney disease called Focal segmental glomerulosclerosis (FSGS).

The system is comprised of a tubing set, two blood filters, two blood storage columns, and a computer that controls the entire system.

www.kaneka.com/kaneka-americas

Hologic, Inc.

Angel Medical Systems, Inc.

W. L. Gore and Associates, Inc.

ThinPrep Integrated Imager

AngelMed Guardian System

GORE® CARDIOFORM Septal Occluder

The ThinPrep Integrated Imager is a computer-based, bench-top device which combines the functions of slide imaging and review into a single system. It is intended to assist in primary cervical cancer screening for the presence of abnormal cells in cervical samples prepared, stained and coverslipped on glass slides which are called ThinPrep Pap test slides.

The AngelMed Guardian System is a implantable cardiac monitor intended to detect and alert patients of a potential heart attack.

The Guardian System consists of three components: The Implantable Medical Device (IMD), which monitors the heart’s electrical activity (electrograms) and alerts a patient with vibrations if it detects a potential heart attack.

The External Device (EXD) alerts the patient of an potential heart attack with alarms and lights letting the patient know to seek medical attention. Patients must have this part of the system with them in order to be alerted.

The GORE CARDIOFORM Septal Occluder is a device that is permanently implanted in the heart to close a patent foramen ovale (PFO). A PFO occurs when the foramen ovale, a naturally occurring hole located between the two upper chambers of the heart (the right atrium and the left atrium), does not close shortly after birth. If untreated, a PFO can allow a small amount of blood to pass from the right side of the heart to the left side of the heart. In rare cases, a PFO may lead to the occurrence of strokes.

www.hologic.com

www.gore.com

www.angel-med.com

Drager

PHOENIX

Technocare Medisystems

Fabius® GS Premium

Intensive Care Incubator INC 100

Ultrasound & Colour Doppler Machine

The Fabius GS Premium anesthesia machine combines time-tested design concepts with the comfort and utility of modern digital technology. It’s an anesthesia workstation built for today and ready for the future. Export gas flows, concentrations, and more to our Infinity® patient monitors and Innovian® Anesthesia system to enhance monitoring, charting, and networking power. Its intuitive user interface, common to Dräger workstations, enables fast and precise adjustments.

The INC 100 has been specially designed to provide the safest and most stable environment for the critical neonate. With a wide range of accessories, it can be tailored to meet any situation arising in the care of the infant. The excellent nursing facilities, safe and reliable operation, ease of cleaning and sturdy construction of the INC 100 make it a vital part of the equipment in the hospital.

The Ultrasound/Colour Doppler Machine help in the evaluation of blood as it flows through the blood vessel including the body’s major arteries and veins in the abdomen, arms, legs and neck.

The supercomputing power of the Doppler delivers unmatched capabilities. Advanced 3D imaging, panoramic imaging, adaptive system intelligence and leading edge connectivity are certain features of the colored Doppler.

www.draeger.com

10 Medical Tourism Jul. - Sep. 2018

www.phoenixmedicalsystems.com

www.technocarem.com

All-in-one Health Terminal

An innovative device with a multifunction intelligent healthcare management application for primary health care service.

The device supports basic test functions and network transmission methods including Bluetooth, Wi- , 2G /3G/4G and provides data interface for USBs & SIMs .The users can upload the data in cloud through health management platform.The video& audio equipment and built in telemedicine app could be used for conferencing .The device provides function of ECG,heart rate,blood pressure ,blood glucose ,blood oxygen saturation, pulse & body temperature with an extended connectivity to POCT ,Urine analyzer,fetal monitoring device ,palm ultrasound ,blood fat & glycosylated Hb through Bluetooth & USB .

For trade enquiries : kamar@calmove.com

A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM MEDICAL EVENTS

ECIM (AUGUST 30-SEPT 1, 2018), WIESBADEN, GERMANY

The 17th European Congress of Internal Medicine being organised by European Federation of Internal Medicine,a platform for the inter-disciplinary interaction of European internists, including those practising related specialities, as well as for young internists to share their experiences and networking, will be held at RheinMainCongressCenter, Wiesbaden, Germany.

For details contact: wikonect GmbH, HagenauerStrasse 53, 65203 Wiesbaden, Germany Phone: +49 611 204809-17, Email: ECIM2018@wikonect.de, Website: www.wikonect.de

TRADITIONALMED 2018 (SEPT 10-11, 2018), AUCKLAND, NEW ZEALAND

The 3rd World Congress on Traditional and Complementary Medicine on the theme 'Bridging Excellence in Traditional and Complimentary Medicine: A True Devotion to Natural Healing' will be held at Auckland, New Zealand.

For details contact: Riya Richard Phone: 1-650-889-4686, Email: traditionalmed@expertscongress.com Website: https://traditionalmed.conferenceseries.com/

GASTRO EDUCATION 2018 (SEPT 6-7, 2018), LONDON, UNITED KINGDOM

The 14th International Conference on Gastro Education organised under the theme “Exploring Novel Innovations and cutting edge technologies in the field of Gastroenterology’’ will be held in London, United Kingdom.

For details contact: Gastro Education 2018, EuroSciCon Ltd , 40 Bloomsbury Way, Lower Ground Floor, London, United Kingdom, WC1A 2SE Phone: +44 020 3807 3712, Email: gastroenterology@eurosciconconferences.com Website: https://gastroenterology.euroscicon.com

AKI CRRT CONGRESS 2018 (SEPT 21-24, 2018), TAIPEI, TAIWAN

The 2nd Asia Pacific AKI CRRT Congress which highlights some special issues regarding the impact from our environment, including: Heat: AKI caused by heat stroke, Earthquake: AKI due to rhabdomyolysis and crush injury, Explosion: AKI in burn patients and Typhoon: leptospirosis-associated AKI will be held at Taipei, Marriott Hotel, Taiwan For details contact: Secretariat, c/o K&A International Co., Ltd., 2F, No. 100, Zhouzi St, Neihu District, Taipei City, Taiwan 114 Phone: +886-2-8751-3588, Fax: +886-2-8751-2799, Email: info@apcrrt2018.com Website: http://www.apcrrt2018.com/

OMAN HEALTH EXHIBITION AND CONFERENCE

(SEPT 24-26, 2018), MUSCAT, OMAN

The 8th Oman Health Exhibition and Conference organised in partnership with Ministry of Health, an annual international trade event that highlights the rapid and continuous advancements of the health and medical sector in Oman will be held at the Oman International Exhibition Center.

For details contact: Omanexpo, 1st Floor, SABCO Building, Wattayah Muscat, Sultanate of Oman Phone: +968-24660124, +968-24660125/126, Email: info@omanexpo.com, Website: http://www.omanexpo.com

MEDIC EAST AFRICA (SEPT 25 – 27, 2018), NAIROBI, KENYA

Medic East Africa, the largest business platform for the healthcare and medical laboratory market in East Africa, will be held at Visa Oshwal Centre, Nairobi, Kenya.

Phone: +254 20 7640755, Email: mea@informa.com Website: https://www.mediceastafrica.com

11th MEDICAL TECHNOLOGY CONFERENCE (SEPT 28, 2018) NEW DELHI

The Confederation of Indian Industry (CII) will organise the 11th Medical Technology Conference, the annual all-stakeholder platform of repute for the Medical Technology Division in India, will be held at Hotel Le Meridien, New Delhi.

For details contact: Elizabeth Jose, Deputy Director, Confederation of Indian Industry, India Habitat Centre (IHC), Core 4A, 4th Floor, Lodi Road, New Delhi-110003, India Phone : +91-11-24682230–35 ; 41504514-19, Fax :91 11 24682226, Email : elizabeth.jose@cii.in, Website: www.cii.in 12 Medical Tourism Jul. - Sep. 2018

MEDICAL TOURISM MEDICAL EVENTS

KTM 2018 (SEPT 28 – 30, 2018), KOCHI, KERALA INDIA KTM 2018, the tenth edition of the Kerala Travel Mart, will be held from 27th to 30th September, 2018 at Samuedrika Convention Centre, Kochi, India For details contact: Kerala Travel Mart Society, 8/1912, Elamkulam Road, Kaloor - Kadavanthara Road, Ernakulam, Kochi, Kerala 682017 Phone: +91 484 220 3156, Website: www.keralatravelmart.org

UNION FOR INTERNATIONAL CANCER CONTROL

(OCT 1-4, 2018), JAQLAN PINANG, MALAYSIA

World Cancer Congress Malaysia 2018 will be held at Kuala Lumpur Convention Centre, Jaqlan Pinang, Malaysia.

For details contact: Union for International Cancer Control, 31-33 Avenue, Giuseppe Motta, 1202 Geneva,Switzerland Phone: +41 22 809 1834, congress@uicc.org Website: https://www.worldcancercongress.org

IPVC 2018

(OCT 2-6, 2018), SYDNEY, AUSTRALIA

The 32nd International Papillomavirus Conference & Clinical and Public Health Workshops will be held in International Convention Centre Sydney, 14 Darling Drive, Sydney, NSW 2000, Australia.

The conference theme is 'Towards Global Control of HPV Disease'.

For details contact: Kenes Group,, Londres 17, Madrid, SC, 28028, US Phone: +41 22 9080488, Email: rmarcovici@kenes.com Website: https://go.evvnt.com/163106-0

ESGAR/ESCP (OCT 4-5, 2018), LAGOS, NIGERIA

The European Society of Abdominal and Gastrointestinal Imaging (ESGAR) and the European Society of Coloproctology (ESCP) are organising together a multidisciplinary course on GI tract tumour at The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, Netherlands For details contact: ESGAR Phone: +431 535 8927, Email: office@esgar.org Website: http://www.esgar.org

MEDIC WEST AFRICA (OCT 10-12, 2018), AMSTERDAM, NETHERLANDS

Medic West Africa Exhibition and Congress an opportunity for the healthcare industry’s leading manufacturers and distributors to showcase the latest innovative products and services will be held at Eko Hotel Convention Centre, Lagos, Nigeria.

For details contact: ESGAR Phone: +971 4 4072445, Email: amogh.wadwalkar@informa.com Website: https://www.medicwestafrica.com

CONGRESSMED (OCT 11-14, 2018), MELBOURNE, AUSTRALIA

Melbourne International Breast Congress will be held at Melbourne Convention and Exhibition Centre, 1 Convention Centre Pl South Wharf, Melbourne, 3006, Australia For details contact: CongressMed, 75 Rue de Lyon, C.P. 502 CH-121,1 Geneva 13 Phone: +41 22 33 99 985, Email: ilana.rabinoff@cg-med.com Website: http://congressmed.com/

APAAACI AND APAAARI 2018

(OCT 11-14, 2018), BANGKOK, THAILAND

The Joint Congress of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology and the Asia Pacific Association of Pediatric Allergy, Respirology and Immunology with the theme 'Novel Therapies, Prevention and Integrated Action: Towards Improved Patient Care,' will be held at Central Grand Hotel and Convention Center, 999/99 Rama 1 Road, Pathumwan, Bangkok, 10330, Thailand.

For details contact: Kenes Group, Londres 17, Madrid, SC, 28028, US Phone: +41 22 9080488, Email: rmarcovici@kenes.com Website: http://go.evvnt.com/157966-0 A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM EVENTS

OMAN HEALTH EXHIBITION & CONFERENCE ADDRESSING HEALTHCARE CONCERNS

H

ealth sector all over the world is facing changes due to technology and changing patterns of life-styles. To cater to these changes, Oman Health - Exhibition & Conference will be organised ensuring participation of all stake-holders in the health sector. This annual event will highlight the continued development of the healthcare sector in Oman. It targets all aspects of the health and wellness industry, opening doors for health products, services and facilities, and opportunities for new developments and trends, and trade and investment. It was launched in 2009 and is now on its Seventh edition. It was certified as a UFI-approved event in 2013.

14 Medical Tourism Jul. - Sep. 2018

The Oman Health Conference also aims to address the present and future of the Sultanate's healthcare sector. It serves as platform for industry experts and stakeholders to share and discuss tangible solutions to the variety of healthcare issues and encourage collaborative efforts for the development, improvement and growth of the Sultanate's healthcare industry.

The event will also provide participants with an excellent opportunity to network with government, regulatory authorities, colleagues, and learn upto-date information, emerging trends, strategies, innovative approaches, management techniques and technol-

ogies that would help them enhance the quality of healthcare services in the country.

This event will take place in conjunction with Oman Medical Association Scientific Conference from 24 to 26 September 2018. It will take place at the New Oman Convention & Exhibition Centre from 11:00 am to 8:00 pm Medical Tourism magazine is the media partner for Oman Health Exhibition and Conference

A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM EVENTS

IMTEC OMAN 2018 BECOMES A MEDICAL HUB FOR TOURISM INDUSTRY

W

hen the medical stakeholders from the healthcare services and medical tourism industry gathered at International Medical Tourism and Exhibition (IMTEC) Oman 2018, it has transformed into a medical hub of tourism industry.

Oman’s one and only Trade Event for Medical Tourism and Healthcare conference, under the patronage of Ministry of Health, was held at Oman Convention & Exhibition Centre, Muscat, from April 24 to 26. Medical and professionals across Oman, Middle East, Africa, Asia, Europe and US markets participated offering a range of medical marketing solutions to all clients involved in the healthcare sector.

As many as 100 medical institutions took part in the fifth edition of the IMTEC Oman 2018. The Expo was inaugurated by Dr Saleh bin Salim al Rahbi, secretary general of His Majesty the Sultan’s Advisor’s Office, in the presence of Indian Ambassador to Oman Indra Mani Pandey and other dignitaries.

At the conference, lectures related to medical tourism and other advancements in the sector were prominent.

Lectures were held on health insurance, diseases, modern methods of treatment, neurosurgery and medicine.

The expertise of India, Malaysia, Thailand, the US, the UK and Iran in the

Dr Saleh bin Salim al Rahbi, secretary general of His Majesty the Sultan’s Advisor’s Office, Muscat, visiting the stall of Ayurveda Magazine and Medical Tourism at International Medical Tourism and Exhibition (IMTEC) Oman 2018.

healthcare sector was presented at the conference.

The conference on Medical Tourism and Healthcare examined international, regional and national ‘best practices’ towards achieving the goal and charted a way forward towards achieving this objective. It was the only global trade show on Medical Tourism, targeted at Hospitals, Medical fraternity, Medical travel segments and allied services.

The Expo offered attractive and reasonable medical and travel combo packages for patients wishing to seek medical treatment in world-class healthcare facilities in the representing countries.

The medical tourism exhibition was held to attract patients and health care seekers from Oman and Middle East in need of healthcare advice and advanced treatment. IMTEC Oman provided a perfect platform for hospital groups, medical travel organisations and health services companies to increase their international presence and patient network.

India hosted the largest India pavilion at IMTEC Oman, with leading hospitals, doctors and medical consultants showcasing the strength and presence covering diverse medical treatment and healthcare solutions in General and Advanced Medicine, Wellness and Ayurveda - the ancient science from India.

The special editions of Ayurveda Magazine and Medical Tourism were released by Indian Ambassador to Oman Indra Mani Pandey on the occasion

16 Medical Tourism Jul. - Sep. 2018

MEDICAL TOURISM EVENTS

ADVANTAGE HEALTH CARE INDIA 2018

TO BE HELD AT DELHI

A

dvantage Health Care India 2018 programme being organised to promote India as a Premier Global Healthcare Destination and to enable streamlined medical services exports from India, will be held at India Expo Centre and Mart, Greater Noida (NCR), from December 4 to 6, 2018.

There will also be Reverse Buyer Seller Meeting and planned B-2-B sessions with hosted delegates from more than 60 identified countries of Africa, Middle East, CIS and Asia (including SAARC). There will be visitors and hosted delegates delegations from over 60 countries.

This is the 4th International Summit on Medical Value Treatment organised

by Ministry of Commerce and Industry, Government of India, Federation of Indian Chambers of Commerce and Industry and Service Export Promotion Council (SEPC).

There will be organized hospital visits

by State Governments for the visiting foreign delegations to provide them utmost exposure of the Indian hospital infrastructure. In the Health Ministers’ Round Table Session, Health Ministers invited from the selected 60 countries will discuss issues encompassing Medical Value Travel and formulating a way forward.

The Exhibition with focus on Hospitals, Healthcare centres, AYUSH Hospitals, Educational institutions (Medical colleges, Nursing colleges & AYUSH colleges), Medical devices and Electronics and associated infrastructure – medical tourism facilitators, Hotels, Airlines, Tour and travel companies. The exhibitors will present and promote exclusive medical services and expertise.

This is an opportunity for the state governments to showcase their healthcare and wellness industry and provide excellent brand visibility to the exhibitors.

At the knowledge sharing program internationally renowned Indian doctors and AYUSH experts will deliver lectures on different topics and International Conference on Medical Value Travel (MVT).

Advantage Health Care India 2018 will be a platform where all the Indian healthcare providers and Global healthcare stakeholders coming under one platform. There will be a showcase medical devices sector which is an opportunity for encouraging foreign companies to start manufacturing in India with local partners.

The Exhibition will showcase training capabilities of India in medical, pharma and nursing sector. It will also engage with international partners for imparting training courses and short education programs.

research and trials and establish global business contacts and connects.

Business cooperation agreements with international stakeholders sending patients to India will also be signed.

The MVT industry has emerged as one of the fastest growing segments of tourism industry despite the global economic downturn. According to the FICCI – IMS Report, India is one of the key MVT destinations in Asia with over 500,000 foreign patients seeking treatment. MVT can be a 9 billion USD opportunity by 2020 through adequate focus and effective execution.

India needs to focus on dual objectives of “tourism friendliness” and “patient centricity”. However, achieving the stated vision of being “The Provider to the World” would necessitate coordinated efforts by all key stakeholders.

The endeavour, through the “Advantage Health Care – India 2018,” is to showcase India and its immense pool of medical capabilities as well as create opportunities for healthcare collaborations between the participating countries

At the Advantage Health Care India 2018 Medical Tourism magazine is the media partner

There will be a great opportunity to get into business tie- up for clinical A Complete Magazine on Healthcare in Asia

17

18 Medical Tourism Jul. - Sep. 2018

A Complete Magazine on Healthcare in Asia

19

MEDICAL TOURISM EVENTS

AMBASSADOR RELEASES MEDICAL TOURISM MAGAZINE The special editions of Ayurveda Magazine and Medical Tourism, publications of FM Media, were released by Indian Ambassador to Oman Indra Mani Pandey at International Medical Tourism and Exhibition (IMTEC) Oman 2018 which is one of the biggest Medical Tourism and Healthcare conferences, under the patronage of Ministry of Health, held at Muscat, Oman.

Dr Saleh bin Salim al Rahbi, secretary general of His Majesty the Sultan’s Advisor’s

IMTEC (International Medical Tourism Exhibition & Conference) special editions of Ayurveda & Health Tourism magazine and Medical Tourism magazine being released at IMTEC Oman venue in Muscat by the Indian

Office, Muscat, visited the stall of Ayurveda Magazine and Medical Tourism. The media partner for the event was Medical Tourism

Amassador to Oman, Indra Mani Pandey.

AYUSH CENTRE AT SAINT CHARLES HOSPITAL KENSINGTON, LONDON

P

rime Minister Narendra Modi and HRH The Prince of Wales jointly inaugurated AYUSH Centre at Saint Charles

Hospital, London. SOUKYA, a global pioneer in the field of Holistic and Integrative Medicine, will be providing training, logistics and services at this centre.

This Centre is the first-of-its-kind providing Ayurveda, Home-

opathy, Naturopathy and Therapeutic Yoga primarily for the local patients following their referral by general practitioners.

Saint Charles Hospital was started as an infirmary for the poor in 1879 and has established itself over the years. St. Charles Hospital already has developed facilities for Yoga and Tai chi and has a strong reputation for innovation.

Prime Minister Narendra Modi and Prince Charles jointly inaugurating AYUSH Centre at Saint Charles Hospital, London. Seen along are Amarjeet S Bhamra and Dr. Isacc Mathai, founder of Soukhya HRH Camilla, The Duchess of Cornwall, is a frequent visitor

Dr. Issac Mathai, Founder of SOUKYA, Bangalore is the offi-

of SOUKYA since 2010. Her beneficial experience of Holistic

cial Indian Ambassador of the College of Medicine, London

and Integrated Medicine in SOUKYA has been instrumental

and is also an Advisor to this new AYUSH Centre.

in initiating this new project

20 Medical Tourism Jul. - Sep. 2018

A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM

KIDNEY DISEASE COVER STORY

A SILENT DISORDER WHICH CAN BE AVOIDED BY CHANGE IN LIFESTYLE

The major causes of Chronic Kidney Disease (KCD) are Diabetes and Hypertension.

The other causes include glomerulonephritis, inherited kidney disease (Polycystic Kidney Disease, Alport’s syndrome, Primary Hyperoxaluria), recurrent urinary tract infections, long standing obstruction to urine flow (stones, prostate gland enlargement) and drugs and toxins. CKD can also occur because of variety of immunological disorders like Systemic Lupus Nephritis (SLE), vasculitis, etc. Chronic Kidney Disease is usually silent, and symptoms are very nonspecific. Periodic testing is necessary especially in individuals at risk to detect it early. A number of symptoms can develop in the later stages of kidney disease, says Dr. S. Padmanabhan. Diabetes is the single most common cause of chronic kidney disease.

K

idneys are small bean shaped organs, each about the size of a fist. They are located on either side of the spine at the lowest level of the rib cage in the abdomen. Each kidney consists of about a million filtering units called “Nephrons.” The main function of the kidney is to filter waste products from the blood.Ap-proximately, 150 litres of fluid is filtered by the kidney each day. 148.5 litres of the filtered fluid is recovered and the remaining 1.5 litres is excreted as urine. The urine is sent to the urinary bladder where it can be stored anywhere between one to eight hours.

The production of urine involves complex steps of filtration, secretion, and re-absorption.

22 Medical Tourism Jul. - Sep. 2018

Fig. 1 –Urinary system and cut section of kidney

Fig 2 – The Nephron

FUNCTIONS OF THE KIDNEY 1. Removes waste products from the body 2. Removes drugs from the body 3. Balances the body fluid 4. Releases hormone that regulate blood pressure 5. Produces active Vitamin D needed for bone health 6. Control production of red blood cells 7. Maintenance of acid base balance & electrolyte balance in the body

KIDNEY DISEASE There are two main types of kidney diseases. Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD).

Acute kidney injury occurs suddenly and recovers completely on most occasions. It is caused by insults to the kidney from infections, drugs, toxins, obstruction to urine flow to name a few. Once the inciting cause is treated appropriately, the kidneys recover. However, AKI can also lead to chronic kidney disease in few instances. Temporary dialysis support may be required in some patients with AKI. Chronic kidney disease is defined as having a structural damage or decreased function for three months or longer. The hallmark of CKD is inexorable progression over time and irreversibility. Prevention should be the main focus as there is no cure for CKD.

CAUSES OF CHRONIC KIDNEY DISEASE The major causes of CKD are Diabetes and Hypertension. The other causes include glomerulonephritis, inherited kidney disease (Polycystic Kidney Disease, Alport’s syndrome, Primary Hyperoxaluria), recurrent urinary tract infections, long standing obstruction to urine flow (stones, prostate gland enlargement) and drugs and toxins. CKD can also occur because of variety of immunological disorders like Systemic Lupus Nephritis (SLE), vasculitis, etc.

SYMPTOMS OF CKD Chronic Kidney Disease is usually silent, and symptoms are very nonspecific. Periodic testing is necessary especially in individuals at risk to detect it early. A number of symptoms can develop in the later stages of kidney disease. Symptoms can include

 Weight loss and poor appetite  Swelling of feet or hands  Shortness of breath  Tiredness  Blood in urine  Frequent urination at night  Difficulty in sleeping  Itching  Muscle cramps  Nausea or vomiting  Sexual dysfunction

DIAGNOSIS OF KIDNEY DISEASE Kidney disease can be diagnosed with blood and urine tests.

In many cases, it is picked up because a routine blood or urine test indicates kidney disease. Regular testing is recommend ed if one has:  Hypertension  Diabetes  Heart disease  A close family member has chronic kidney disease  Age over 55 years  Other conditions affecting kidney like kidney stones, enlarged prostate or SLE  Acute kidney injury  Protein or blood in urine without any known cause  People taking long term medications that can affect kidneys such as lithium, NSAIDs, etc.

TESTS FOR KIDNEY DISEASE 1.The main test for kidney disease is measuring the level of creatinine in the blood. Using this result, a calculation that takes into account age, gender, and ethnicity is done to estimate the filtering capacity of the kidney. This is known as estimated glomerular filtration rate (eGFR). Chronic kidney disease is staged based on eGFR.(As shown in table 1) 2. Urine is checked for presence of Protein & Blood

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Stage

Description

eGFR (mL/min/1.73m2)

1

Kidney damage with normal or ↑GFR

≥90

2

Kidney damage with mild ↓GFR

60-89

3

moderate ↓GFR

30-59

4

Severe ↓GFR

15-29

5

Kidney Failure

<15 or dialysis

Table 1 – Stages of Chronic Kidney Disease The other tests include: Ultrasound scan of the kidneys to check how the kidneys look like and whether there is any obstruction to the flow of Urine.

Kidney biopsy – a small sample of kidney tissue is removed using a needle and is examined under a microscope.

DIABETES AND KIDNEY DISEASE Diabetes is the single most common cause of chronic kidney disease. about 30% of patients with Type 1 diabetes (juvenile onset) and 10 to 40% of patients with type 2 diabetes (adult onset) develop CKD. Diabetes causes injury to the small blood vessels of the body.

When the blood vessels in the kidneys are injured, the filtra-tion function is affected and protein leaks into the urine.

Over time, waste products, including salt and fluid, accumulate in the body resulting in leg swelling and kidney failure.

The other ways in which diabetes can cause kidney disease is by damage to the nerves causing difficulty in emptying the urine from the bladder. The resulting pressure from full bladder can back up and injure the kidneys. Recurrent urinary infections can also be cause of kidney damage. It is proven that tight diabetes control reduces the risk of developing kidney disease significantly (Fasting blood sugar < 100mg/dl; Post Prandial blood sugar <140mg/dl; HbA1c < 7%).

HYPERTENSION AND KIDNEY DISEASE Hypertension is defined as blood pressure of over 140/90 mmHg. Hypertension may be the cause or consequence of chronic kidney disease. High blood pressure causes stretching of blood vessels. It is called as shear stress in Physics.

The stretching eventually scars and weakens blood vessels throughout the body, including those in kidneys. This impairs the ability of kidneys to remove waste and fluid from the body.

Extra fluid in the body may then raise the blood pressure even more, creating a vicious cycle. This leads on to kidney disease and ultimately kidney failure. Hypertension is the second major cause of CKD.

OBESITY AND KIDNEY Obesity Obesity is a medical condition marked by accumulation of excessive body fat with negative health impacts. It is generally reported in terms of Body Mass Index (BMI), a value obtained by dividing weight by the square of the height (BBMI=Weight (Kg)/Height(m)2. BMI of over 30 kg/m2 is con24 Medical Tourism Jul. - Sep. 2018

sidered obese and 25-30 kg/m2 is overweight. The cause is a combination of excessive calorie intake, sedentary life style, and genetic susceptibility. It is a risk factor for developing various diseases like type 2 diabetes, osteoarthritis, certain cancers, and depression.

Today we have more overweight and obese people than ever before. In the USA, 70% of Americans over 20 years of age are overweight and about a third of them are obese unfortunately the problem is much more common in children too. India is a developing nation. It is struggling with poverty, malnutrition, and disease. Surprisingly, we have the second highest number of obese children in the world (14.4 million). Indian obesity is marked by the thin-fat Indian Phenotype. Abdominal obesity and visceral fat is striking. The BMI threshold should be 25 kg/m2 for Indians.

Obesity is associated with a kidney condition called focal and segmental glomerulosclerosis (FSGS). Of late, the incidence of this disease has increased in tandem with obesity. The cause is likely to be due to the insulin resistance/hyperinsulinemia causing injury to the blood vessels of the kidney.

DRUGS AND KIDNEY DISEASE Kidneys provide the final common pathway for excretion of many drugs. Therefore, they are exposed to high concentrations of potential toxic substances. This causes damage to the renal tubular cells and papillae. Minor damage may pass undetected. Toxicity tends to be dose dependent. The ill effects of drugs are more in patients with pre existing kidney disease.

Drugs can cause both AKI and CKD. The ill effects of drugs on the kidney can be categorized as follows:  Pre renal effects  Obstruction to flow of urine  Allergic or immunological damage  Direct cell toxicity The following groups of drugs are commonly associated with kidney damage:  Antibiotics given for infections (gentamycin, amikacin, quinolones)  Diuretics or water pills  Non-Steroidal Anti Inflammatory Drugs(NSAIDS) or painkillers  Proton Pump Inhibitors giver for gastritis, ulcers etc  Slimming Pills  Radiocontrast Dyes used in CT Scan and Angiograms

TUBULO INTERSTITIAL DISEASE OF THE KIDNEY Tubulo interstitial nephritis (TIN) is a frequent cause of acute kidney injury (AKI) that results in CKD. TIN is a result of immunological injury to the kidney tubules and interstitium which may progress to fibrosis (scarring). The causes include infection, drugs, genetic conditions, idiopathic (unknown cause) or related to a systemic inflammatory condition.

The disease can be silent without any symptoms when caused by an allergic reaction the usual symptoms are fever (27% patients), rash (15% of patients) and enlarged kidneys. About a quarter of them have high levels of eosinophils in the blood.

Urine examination finding include eosinophils, blood, pus cells, and proteins.

The mainstay of treatment is removing the offending agent.

Corticosteroid is employed in allergic acute interstitial nephritis in patients who do not respond to removal of offending agent. The kidney function can be only slightly affected, but at times it may fail completely needing dialysis.

Kidney biopsy is done in patients to diagnose it. In most cases of acute TIN, the kidney function will return back. Chronic TIN has no cure. It progresses over time and eventually patients may require dialysis and transplantation.

POLYCYSTIC KIDNEY DISEASE This disease is characterized by the presence of numerous cysts in the kidneys. These cysts are filled with fluid. If there are too many cysts or if the cysts get too big, the kidneys get damaged. The cysts can replace much of the kidney or can damage by exerting pressure on the tissue resulting in kidney failure. It is a genetic kidney disease. The genes determine the likelihood of developing this disease. It causes about 5% of all kidney failure. Besides the kidney, patients with PKD can develop cysts in the other abdominal organs too. But these cysts do not cause serious problems. Some patients develop a bulging vessel inside the brain called aneurysm. This vessel can burst resulting in a stroke or even death. Floppy heart valves, hernias are also common in PKD. The symptoms usually develop by the third or fourth decade. Usual symptoms are back pain, high blood pressure, blood in urine, and frequent urinary infections. Ultrasonogram is most reliable, inexpensive, and non invasive mode of diagnosis. CT scan/MRI are at times done to measure volume and growth of kidneys and cysts.

Genetic testing for the abnormal gene is now widely available.

It is not recommended for everyone or it is costly and fails to diagnose the disease in 15% of people. However, genetic testing will be useful when Diagnosis is not clear on imaging tests One has family history of PKD and wants to donate kidney

KIDNEY DISEASE IS A LIFESTYLE DISEASE Most of the disease causing CKD can be to a great extent attributed to the life style of the population. Sedentary life style, unhealthy eating habits, obesity, excessive use of overthe counter drugs, smoking, alcohol intake, and stress are some of the main reasons. It is high time that we all change our lifestyle to reduce the burden of such non-communicable diseases. After all “Health is Wealth.”

TREATMENT OF CKD There is no cure for CKD, but treatment can help relieve symptoms and slow progression of CKD. Treatment depends on the stage of CKD. The main treatments are,  Lifestyle changes  Medications – to control associated problems like diabetes, hypertension, high cholesterol, anemia, etc.  Dialysis - it is done in advanced stages (CKD 5) of CKD  Kidney transplantation – it is done in advanced stages of CKD (CKD 5)

LIFE STYLE CHANGES Quit smoking if one is a smoker Restrict salt intake to 4g per day Regular exercise Lose weight if one is obese or overweight Avoid over the counter NSAIDs like ibuprofen Consult doctor and dietician regarding the diet suitable for the stage of CKD

MEDICATIONS There is no medicines specifically for CKD. Medicines are usually prescribed for complaints of existing conditions like hypertension, diabetes mellitus, high cholesterol, phosphate binders, erythropoietin, etc.

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DIALYSIS: This is required when the kidney function is no longer able to sustain the bodily functions. This rarely happens all of a sudden, so there is enough time to plan the treatment. It is advisable to get an AV fistula created as and when advised by the nephrologist. There are two type of dialysis Haemodialysis: The blood is diverted into an external machine, where it is filtered before being returned back to the body. It requires an access to the blood circulation. The main types of access are temporarily (tunnelled and non tunnelled catheter into a central vein) and permanent (AV fistula/AV graft). It is best to start dialysis with a functioning permanent vascular access. The procedure is done thrice weekly. Each session lasts for about 4-5 hours. A blood thinner is used to prevent clotting of blood in the external circuit during the procedure. Haemodialysis is done in the hospital or at home.

PERITONEAL DIALYSIS: A 2-3 litres of fluid is let into the abdo men through a catheter. The dialysis occurs from the blood vessels lining the inside of the abdomen called peritoneum.

It can be performed manually or using a machine. If done manually (CAPD – Chronic Ambulatory Peritoneal Dialysis) 3-4 exchanges are to be done each lasting for 4 - 8 hours each. It is performed by a machine (APD automated Peritoneal Dialysis). It is done overnight for about 10 hours using 10 litres of fluid.

Peritoneal dialysis is done at home.

Dialysis needs to be done lifelong or till one gets a kidney transplantation.

KIDNEY TRANSPLANT: This is the natural treatment of CKD where in a normally functioning kidney from a healthy living donor or a brain dead person is surgically placed in the lower abdomen. It is often the most effective treatment too. Human body has the capacity to identify self from non self. It tries to attack and damage anything that is foreign. Hence medications are given to suppress the immune system to prevent rejection of the transplant kidney. These medications need to be taken for the rest of one’s life. Survival rates for kidney transplants are extremely good. The success rates are 93-95% for the first years, 85% for 26 Medical Tourism Jul. - Sep. 2018

five years, and many functions after 10 years or more.

Living donor kidney transplantation is the most common form of transplant in India. Deceased donor transplant program is slowly on the rise. A few states like Tamil Nadu, Gujarat are performing a lot of deceased donor renal transplants compared to the other states.

Law permits organ donation from blood relatives (parents, siblings, children, grand parents) and from spouses.

Blood group compatibility was a must a few years ago for renal transplantation.

Today, blood group incompatible transplantation is feasible and being done in many centres across India. Except for the increased risk of rejection in the initial 1 month, the long term outcome is comparable to ABO compatible transplants.

To perform a renal transplantation approval is required from the respective state governments. To make the process easier, high volume centres have been given the authority to approve living related donor transplantation. The onus is on the family to give the proof of relationship in addition to the tissue matching and DNA finger printing tests which are done as a routine. The required documents are to be submitted along with all the lab reports to the appropriate authority. The committed then interviews the potential donor and the recipient. If they are convinced of the altruism, a letter or approval is is-sued to the transplant centre to proceed with the transplantation.

Foreign nationals can get living donor renal transplantation in India. A more elaborate procedure is to be done, including approval from the respective nation’s high commission. Once all the testing is done and the donor is found suitable, the documents are sent for approval from the state authorization committee. It is only after approval that the transplantation should be carried. The transplant coordinator of the hospital will be able to guide the patient in the process.

PREVENTION OF KIDNEY DISEASE: Kidney disease is often silent until very advanced. There is no cure for CKD. Prevention is the key. Early detection of kidney disease and referral to a Nephrologist will help patient in retarding

the disease progression and planning of the treatment of CKD stage 5. People at risk for CKD need to get annual screening or more frequently as deemed by their Physician. A simple blood and urine test along with BP measurement is enough. The following are some tips to prevent kidney disease:  Good control of Diabetes and high blood pressure  Take the prescribed medicines without fail  Do not miss appointments with doctor  Quit smoking  Lose weight if overweight or obese  Cut down on salt intake  Regular physical exercise  Ensure adequate fluid intake  Avoid over the counter medications especially pain killers.

UROLOGISTS AND NEPHROLOGISTS: Urologists and Nephrologists both treat kidney problems. Urologists are surgeons who focus on structural disorders of the kidneys and urinary tract. They treat problems like kidney stones, kidney cancer, obstruction to urine passage, prostate diseases to name a few.

They perform surgeries, including kidney transplantation.

Nephrologists are physicians who focus on disorders that affect the kidney function like glomerulonephritis, diabetes, hypertension, Polycystic kidney disease, AKI and CKD. They handle dialysis and manage kidney transplant patients

Dr. S. Padmanabhan DNB (General Medicine), DM (Nephrology) Senior Consultant Nephrologist & Transplant Physician, NU Hospitals, 4/1 West of Chord Road, Near ISKCON Temple, Rajaji Nagar, Bangalore 560010, Karnataka, India E Mail: care@nuhospitals.com Website: www.nuhospitals.com www.nufertility.com Ph. No: +91-80-42489999

Expert Advice - Ethical Treatment

Fertility Specialists

Padmanabhanagar Designated Center of Excellence

“Pediatric Urology & Nephrology”

Rajajinagar NU Hospitals was started in 1999 as a Super Speciality quaternary Care hospital which was also one of India’s first dedicated Hospitals for Kidney care. In the Year 2015 Fertility Care Services were added to existing specialities of Nephrology & Urology.

Many of our Doctors have been an integral part of Karnataka's first Nephro-Urology Centre, for more than 20 years, and have been continuously keeping pace with advances in a field that is progressing rapidly across the globe. This has resulted in the Institution gaining a high level of experience, knowledge and expertise in providing high Quality Kidney disease related care Quality care that is further ensured through their additional strengths which are, to name a few, state-of-the-art technology, strict adherence to quality protocols at all levels, and cutting-edge research. The Doctors over at NU have had a long experience in dealing with diseases arising secondary to Kidney problems like Hypertension, Diabetes, Lupus, Vasculitis, Nephrotic Syndrome and Renal Failure.

Both our Hospitals in Bangalore are NABH (National Accreditation Board of Hospitals & Healthcare Providers ) accredited and this is benchmarked to the highest standards of National Health Care providers. NU Hospitals is also an accredited seat of teaching and prepares Super-specialists in Urology and Nephrology under the National level DNB programme.

NU Hospitals are located in both Padmanabhanagar and Rajajinagar in Bengaluru and offer treatments which are carefully customized to individual patient requirements. At every stage the patient’s well-being is paramount in everyday decision making.

Our surgeons specialize in operating on a wide variety of cases covering all the Sub-specialties in Urology- Pediatric Urology, Uro-Oncology, Neuro-Urology, Uro-gynecology etc. The hospital also has a evolved Renal Transplant Programme and we have done more than 300 successful Renal transplants over the years. Additionally, routine Surgical facilities for treatment of diseases ranging from Kidney Stones, Urinary and Kidney Infections, Urinary incontinence are also available.

( 080 4248 9999 Bengaluru (South) Padmanabhanagar

care@nuhospitals.com Bengaluru (West) Rajajinagar

www.nuhospitals.com, www.nufertility.com

Karnataka Shivamogga

Tamilnadu Krishnagiri & Ambur

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KNOW OUR EXPERTS:

Our Experts have received over 12 individual awards and have presented over 40 publications both internationally as well as in India. With the best of modern infrastructure and trained clinical and non clinical personnel, we ensure that the highest standards of care are available for those who seek it.

Urology

Nephrology

Dr. Venkatesh Krishnamoorthy

Dr. Dilip Rangarajan

Dr. Maneesh Sinha

(Consultant Nephrologist), MD (Gen-Medicine), DM (Nephrology), 23 years of experience.

(Chief Urologist and Chairman), MS (Gen-Surgery), MCh (Urology), FRCS (Glasgow), 30 years of experience.

(Chief Nephrologist), MD (Gen-Medicine), DNB (Nephrology), 24 years of Experience.

Dr. Ramakrishnan S

(Consultant Urologist), MS (Gen-Surgery), MCh (Urology), DNB (Urology), 18 years of experience.

Dr. S. Padmanabhan

Dr. Prasanna Venkatesh M K

(Consultant Nephrologist), DNB (Gen-Medicine), DM (Nephrology), 16 years of experience.

(Paediatric Urologist and Managing Director), MS, DNB (Surgery), DNB (Urology), Fellowship in Paediatric Urology, 13 years of experience.

Dr. Kiran Chandra Patro

Dr. Kumar Prabhu

(Consultant Nephrologist), DNB (Gen-Medicine), DNB (Nephrology), 13 years of experience.

Dr. Krishna Prasad T

(Consultant Nephrologist), MBBS, MD (Paediatrics), 11 years of experience.

(Consultant Urologist), MS (Gen-Surgery), DNB (Urology), 11 years of experience.

Dr. Shakuntala V Modi

(Consultant Urologist), MS (Gen-Surgery), DNB (Urology), 6 years of experience.

Dr. Nitin Nayak M

(Paediatric Nephrologist), MBBS, DCH, DNB (Paediatrics), Fellowship in Paediatrics Nephrology.

Reproductive Medicine (Infertility - IVF) Dr. Ashwini S

Dr.Anitha A

(Sr. Consultant of IVF), MBBS, DGO, DNB (OBGy), and Fellowship in Reproductive Medicine, 11 years of experience.

(Consultant Nephrologist), DNB â&#x20AC;&#x201C; Nephrology.

Dr. Sneha

(Consultant of IVF), MBBS, MD(OBG), Fellowship in Reproductive Medicine, MRCOG.

High End Haemo - Dialysis for End Stage Kidney Failure

( 080 4248 9999 Bengaluru (South) Padmanabhanagar 28 Medical Tourism Jul. - Sep. 2018

care@nuhospitals.com Bengaluru (West) Rajajinagar

www.nuhospitals.com, www.nufertility.com

Karnataka Shivamogga

Tamilnadu Krishnagiri & Ambur

Maldives Male

DID YOU KNOW NU Hospitals is one of the few centres in India to do Paediatric Urological surgeries and have a qualified Paediatric Urologist on board.

NU Hospitals is the first standalone Nephrology & Urology hospitals in the country to be *NABH and *NABL accredited.

NU Hospitals is the first Hospital in India to adopt SafetyNet technology partnering with 'MASIMO' across all the care areas like Wards, Emergency, ICU, Dialysis & Operation Theatres *NABH- National Accreditation Board for Hospitals & Healthcare Providers NABL- National Accreditation Board for Testing and Calibration Laboratories

THE NU ADVANTAGE Infertility/ IVF • Advanced technology for IVF treatment • Specialized IVF Laboratory with state of the art equipments • Experienced Specialists • Systematic Treatment under One Roof • Positive Results

Pediatric Urology • Rare Skill set and Expertise available • Competent Anesthesia Team • Pediatric Specific Imaging and Investigations • Specific Cutting Edge Endo-Uro Instrumentation Reconstructive Urology • Complex Supra Major Surgeries • Referral Center • Expertise in treating Urinary Incontinence

Laparoscopic Urology • Most Advanced Urological Surgeries • Less In-Hospital Stay, Quick Recovery • Specialized State of Art Equipment • Highly Trained Cohesive Team

Neuro Urology & Uro Dynamics • Pediatric Uro Dynamics Capability • Specifically Trained and Experienced Consultant • Special Unit – Nursing and Technician

Preventive Nephrology • Lifestyle Management – Hypertensives-Diabetics • Specialty Education Programs- Renal Disorders

Uro Oncology • Tumor Board Governed • Superior Outcomes/Results • Comprehensive Treatment under one Roof

Competitive Advantage- Optimization & Leveraging of Existing Facility & Resources

Pediatric Nephrology • Centre of Excellence • Committed Resources

•

Kidney Transplantation • Active Cadaver Transplantation Program • Living Donors-Laparoscopic Kidney Retrieval • 400+ Kidney Transplants @ NU – Team

•

•

Abundant Existing Super Specialist Consultant Pool Domain Expertise and Protocols in place resulting in almost zero gestation Centralized Facilities – Laboratory (Advanced Tests), Personnel Training (Medical), Procurement, and Enterprise Function (F&A, HR, Admin, IT etc)

Andrology • End to End Full Spectrum Services leading to Integrated Assisted Reproductive Techniques Seamless Care and Treatment – Beyond Geographical Boundaries NU Hospitals, Rajajinagar, Bangalore has a dedicated wing for its international patients and caters to their need for advanced quaternary care for Nephrology, Urology & Fertility Treatment. Our senior most of internationally qualified doctors well supported by an experienced and skilled set of team members at NU strives to ensure that the patients not only feel at home, but also go back home in good health. Customized care and high quality treatment right from entry to exit is one of the unique features of NU Hospitals.

NU Hospitals (West) Referral Hospital & Transplant Center # 4/1, West of Chord Road, Near ISKCON, Rajajinagar, Bengaluru- 560 010

( 080 4248 9999 Bengaluru (South) Padmanabhanagar

care@nuhospitals.com Bengaluru (West) Rajajinagar

NU Hospitals (South): Referral Hospital & Transplant Center No. 6, 15th Main, 11th Cross, Padmanabhanagar, Bengaluru - 560 070

www.nuhospitals.com, www.nufertility.com

Karnataka Shivamogga

Tamilnadu Krishnagiri & Ambur

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MEDICAL TOURISM REFLECTIONS

KIDNEY RELATED AILMENTS ARE SKYROCKETING;

REMEDIAL MEASURES ARE ALSO AVAILABLE IN PLENTY, MAKE THE MOST OF AVAILABLE MEDICAL RESOURCES

By O.J.George (Consulting Editor)

I usually tell youngsters to visit various hospitals once in a while so that they would come to know the difficulties people face by way of various ailments, curable and incurable, some which could have been preventable and avoidable but lamentably unheeded, as also the mental tension the relatives undergo, not to mention the adverse financial impact and the like.

30 Medical Tourism Jul. - Sep. 2018

O

nce a person comes to terms with the fallibility, the helplessness and total surrender to the fate, there would be impressions of the frailty of the human frame on Planet Earth, etched in the minds of the beholder.

People are hugely suffering one way or other on account of the malfunctioning of various organs.

As time moves on, there would be wonderful opportunities for any kind of patients to prolong their longevity using expertise of doctors and medical specialists, with devices and pieces of modern-day apparatus developed in tune with the times.

Decades ago I had the opportunity to see a kidney patient in a city hospital as I was accompanying a friend of mine whose relative was admitted there for treatment. It seems the patient had been there for quite a long time.

The patient had swollen legs and there were inflammations all over the body.

His wife, a bank employee, was sitting at his bed-side.

On seeing my friend, accompanied by me, the woman burst initially into sobbing, leading to crying and then into uncontrollable spells of bawling.

After some time, when she could regain her composure, she said they were waiting for a kidney transplant, as one of the patientâ&#x20AC;&#x2122;s family members

had agreed to donate one of his kidneys. There were long procedures to be undergone before fixing the schedule of surgery for both of them.

I believe after a few months the procedure was completed and the surgery was done, much to the relief of the family members.

Much water has flown down the river afterwards and there are dime a dozen surgeries of the kind, with advanced systems of surgical procedures and items of equipment, done on kidney patients throughout the world.

There may be failures of attempts once in a while as well, but these things have to be accepted with equanimity. I could meet a person who had donated one of his kidneys to his ailing brother, but the procedures had ended in failure. The brother who had donated one of his kidneys had given up his job abroad for undertaking this surgery.

Failures do not spur anyone in not attempting to see whether a human being can be saved, it may be for some time, or it may be for a prolonged period of time.

A college girl who had great ambitions to achieve had undergone multi-organ transplants recently, for undertaking the procedures the people at large had contributed immensely for meeting the expenses, and money was not a problem in such situations. One should notice the latest trend, there may be cruelties aplenty done on fellow human beings, at the same time there are instances when the milk of human kindness had not dried up.

A friend of mine who was a senior personnel in Central Government service had a heart problem and advised to fix

a pace-maker. He was not that amenable to the proposal as he felt he had his time coming to pop off. His children and other kin urged him to go ahead with the pace-maker idea. I also told him about a person I know who could pull on for twenty years after having a pace-maker. Ultimately, he is okay after implanting the pace-maker.

One instance of kidney stone affliction would be interesting.

When a 56-year-old woman recently went to a hospital complaining of back pain and fevers, doctors were shocked to discover her right kidney was full of stones - almost 3,000 stones, to be precise. The incident took place at the Wujin hospital in Changzhou, in the Jiangsu province of China. The woman had complained of persistent back pain over a week. On examination, doctors discovered her right kidney was full of kidney stones.

Doctors were able to successfully perform a surgery to remove the kidney stones. After that, it took nearly one hour for a trainee to count the number of stones - and the total was a shocking 2,980 kidney stones.

The woman patient, who has had kidney stones for years, reportedly could not believe number of stones she was carrying in her kidneys.

According to Guinness World Records, the most number of kidney stones ever removed from a patient was 1,72,155 from one in Maharashtra, India.

The removal of such a huge number of stones from the kidney appears to be mind-blogging. Here, the surgeonâ&#x20AC;&#x2122;s scalpel happened to be the only remedial tool. In olden times, such A Complete Magazine on Healthcare in Asia

31

patients would have been told to fend for themselves in the absence of proper equipment and tools. Now-a-days even laparoscopic surgeries could be done on many of the operations.

among VIPs who did have their kidneys transplanted. And they donâ&#x20AC;&#x2122;t have post-operative problems, facilitating them to proceed with the onerous task of good governance.

True, one who has a birth in the world would have to call it a day some time from the Earth, but the end could be prolonged on the basis of modern medical applications.

And going by the pace of research in nanotechnology, it might be only a few more years by when artificial kidneys, pancreas etc would be available for fitment in human bodies.

We know that kidney transplant is the last resort, before which dialysis procedures could propel patients to pull on, may be for a few years, after which a few patients may go in searching for another kidney elsewhere.

The body may have a lot of artificial parts planted inside for them to survive many more years of life. We have heard of various types of chips being implanted on hands etc to give commands to the brain. Likewise we may have many other methods to try out and sustain ourselves. Theoretical reports suggest that it may not be that hard to pull on till one attains the age

In India, External Affairs Miinister Sushma Swaraj and Finance Minister Arun Jaitley are the living examples

of, say, 120 years. Many biblical characters, the patriarchs in earlier times, had pulling power even near to a span of a millennium.

They may not have been decrepit and double-bent as the Leech-gatherer in William Wordsworthâ&#x20AC;&#x2122;s poem.

Leech-gatherer was a person occupied with procuring medicinal leeches, which were used for bloodletting in the 19th Century.

In India, nephrologists and urologists are having a field day as the number of patients in these realms is increasing by leaps and bounds. It could be the same situation in many other countries as well. No doubt, the cost of treatment in India and a few other countries would be substantially less than that in developed countries. Let all avenues be explored for an extensive life on Earthď&#x20AC;ź (ojgeorge@gmail.com)

32 Medical Tourism Jul. - Sep. 2018

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MEDICAL TOURISM

KIDNEY DISEASE

HEALTH

AN UNKNOWN SIDE- EFFECT OF SOME WELL-KNOWN MEDICATIONS

Two major randomized controlled studies that were published in 2016 revealed a strong association between incidence of chronic kidney disease and long-term use of Proton Pump Inhibitors (PPI). They are known to cause Acute Interstitial Nephritis (AIN), which progresses to chronic kidney disease, says Dr Gayatri Devi Nair.

General practitioners need to be aware of these potential kidney side- effects while prescribing antibiotics and, if worsening of kidney function is noted, the antibiotic needs to be stopped and switched to a safer alternative.

Many common medications that are readily available over the counter are detrimental to kidney function when used on a long-term basis. There is a dangerous lack of awareness of these adverse effects among the general population all over the world. As a nephrologist, a major part of evaluating a patient involves detailed reviewing of their medication list and identifying any offending agent that may hamper kidney function. The purpose of this article is to spread this message, as we all know that prevention is way better than cure. ome of the most common medications that can cause kidney injury have been described below:

Non Steroidal Anti inflammatory

Drugs (NSAIDs) are a class of drugs that are largely used over the counter for treating symptoms such as fever, pain and inflammation. Ibuprofen and Naproxen are some examples that fall under this category. Although these medications are highly effective in treating the above-mentioned symptoms, unfortunately many are unaware of the potential harm they can cause to the kidneys when used long-term.

The effects of NSAIDs on kidneys are numerous. They can cause narrowing of the blood vessels to the kidneys, compromising its blood flow and leading to acute kidney injury. Chron-

34 Medical Tourism Jul. - Sep. 2018

ic use of NSAIDs can cause Allergic Interstitial Nephritis (AIN), which is an allergic reaction in the kidneys leading to reduction of kidney function over time if the use of the same medication continues.NSAIDs can also cause a condition called Nephrotic Syndrome, which is characterized by generalized swelling in the body and leakage of protein into urine. Awareness of these risks associated with the chronic use of NSAIDs is very important, as most of these drugs are used worldwide and readily available over the counter.

Acetaminophen is not considered as an NSAID and does not cause kidney problems, thereby is recommended as a safe alternative.

Proton Pump Inhibitors are a group of medications whose main action is reduction of stomach acid production.

They are mainly used to treat conditions like Dyspepsia, Ulcers and Gastro esophageal reflux disease (GERD).

Pantoprazole, Omeprazole, Lansoprazole etc. are some examples of medications that belong to this group.

Two major randomized controlled studies that were published in 2016 revealed a strong association between incidence of chronic kidney disease and long-term use of PPIs. They are known to cause AIN, which progresses to chronic kidney disease. A common

scenario, where long- term use of these medications are seen,is after a patient is discharged from a hospital visit and PPIs are prescribed to be taken along with their other discharge medications in order to avoid heart burn. Although they are intended only for short-term purposes, due to lack of proper followup visits and inadequate instructions many patients end up taking these medications for months and even years. As a medical provider, identifying PPIs on the medication list of a patient and stopping them, if not needed, is necessary. And for patients who have medical indications to be on PPIs long- term, switching to another class of drugs named H2 blockers would be recommended.

 Antibiotics are the most common

class of drugs that cause AIN. A subclass named Aminoglycosides (Gentamycin, Amikacin,Tobramycin, etc.) are on the top of the list, but any class of antibiotics namely Penicillin, Cephalosporin, Quinolones, Sulfonamides etc. can cause similar damage. Amphotericin is an antifungal that is toxic to kidneys and are known to cause acute tubular necrosis (ATN), which is injury and necrosis of the kidney tubules.

Vancomycin is an antibiotic, which can also cause ATN and there have been recent case reports describing a con-

dition called Vancomycin-associated cast nephropathy, which is destruction of kidney tubules due to deposition of vancomycin crystals within the kidney.

General practitioners need to be aware of these potential kidney side- effects while prescribing antibiotics and, if worsening of kidney function is noted, the antibiotic needs to be stopped and switched to a safer alternative.

use anabolic steroids are unaware of its detrimental effect on the kidneys.

Success in preventing medication- induced kidney damage directly depends on how effective we are in educating the population worldwide. Sounds simple, right? Well, the current world population as of June 2018 is 7.6 billion. Enough said!

ď&#x201A;?Herbal supplements are used all

over the world and more predominantly in certain countries like China, India, and Nigeria etc. In Modern Medicine there is a lack of understanding of the method of action of the various constituents in these supplements, but one major culprit has been identified that could be causing more harm than good. Many commercially- sold herbal supplements contain high levels of heavy metals (lead, copper, mercury etc.) that are toxic to the kidneys. They can cause a condition called Fanconiâ&#x20AC;&#x2122;s syndrome, which affects the function of the kidney tubules. Most herbal supplements that are commercially available do not have proper labeling of all the ingredients and lack accurate documentation of the heavy metal content in them. There are innumerable varieties of herbal supplements available in markets today. Consumers of these products need to carefully review the heavy metal content in them, as longterm exposure to these substances can cause kidney failure which may at times is irreversible.

ď&#x201A;?Androgenic Steroids are commonly

used as performance- enhancing drugs by body builders and athletes and includes testosterone, and other synthetic steroids. These agents have numerous side- effects affecting multiple organ systems, including the kidneys. They have been known to cause kidney damage by different mechanisms, namely Rhabdomyolysis, which is a condition of rapid muscle breakdown and release of myoglobin- a protein that accumulates in the kidneys resulting in acute kidney injury. Steroids can also cause scarring of the glomeruli, which are the filtering units of the kidneys and cause Nephrotic syndrome. Most people who

Dr. GAYATRI DEVI NAIR (Nephrologist) Cleveland Clinic, Ohio. USA.

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MEDICAL TOURISM LIFESTYLE

LIFESTYLE CHANGES THAT CAN HELP PREVENT KIDNEY DISEASE

OBESITY IS A LEAD CAUSE

I

f there is one issue that constantly bothers our mind, it has to be our weight. It is a struggle to meet our desired result. While some stay focused and determined to stay fit, several others give up and ignore keeping a check on their weight. Obesity doesn’t just concern the issue of being ‘overweight’, it is one of the major underlying causes of several other diseases such as diabetes, hypertension, heart attack and even kidney failure.

36 Medical Tourism Jul. - Sep. 2018

Obesity is becoming a growing worldwide epidemic, and is expected to affect more people in the years to come.

One’s lifestyle habits, particularly sedentary lifestyle, are adversely impacting health. According to researchers and authors of the study - Obesity and Kidney Disease are Hidden Consequences of the Epidemic, “Obesity is one of the strongest risk factors for new-onset chronic kidney disease, and also for nephrolithiasis and for kidney cancer.”

CUT DOWN ON RED MEAT According to a study done by National University of Singapore, they found

that participants who ate the largest amount of red meat had about 40 per cent greater risk of developing kidney failure compared with people consuming the lowest amounts of meat.

GOOD SLEEP TIME IS CRUCIAL According to a study done by Brigham and Women’s Hospital, shorter sleep duration can lead to a more rapid decline in kidney function. Many of the body’s processes follow a natural daily rhythm or so-called circadian clock that is based on regular sleep-wake cycles.

HYPERTENSION UPS RISK About 20 per cent of India’s youth suffer from hypertension which makes them 40 per cent more vulnerable to kidney damage and cardiac arrest.

There is little understanding in the

country of hypertension, also known as high blood pressure, which usually does not cause symptoms but gradually affects various body parts.

SAY NO TO JUNK FOOD According to a study by Anglia Ruskin University in Britain, a diet that relies mostly on junk food or processed food may cause long-term damage to the kidneys and trigger diabetes. â&#x20AC;&#x153;Type 1 and Type 2 diabetes both induce changes in glucose transport in the kidney but junk food or a diet high in fat causes changes that are very similar to those found in Type 2 diabetes..

CUT DOWN ON SUGAR Most processed food products contain too much sugar, so when it goes

to your system it leads to hormonal imbalance and also your blood profile changes. High consumption of these empty calories can cause obesity and diabetes - diseases that directly impact the functioning of your kidneys.

KEEP A CHECK ON PHOSPHORUS INTAKE Health experts and doctors have issued a warning against excess phosphorus in the human body claiming that it may increase the risk of chronic kidney disease where the phosphate levels in the body shoot up to abnormally high levels.

POLLUTION IS TO BLAME AS WELL According to a study by George Institute for Global Health, climate change may be accelerating the rate of chronic kidney disease caused by dehydration and heat stress. The research paper, published in Clinical Journal of the American Society of Nephrology (CJASN), suggests that a condition called heat stress nephropathy may represent a disease of neglected populations but one that may emerge as a major cause of poor kidney health in the near futureď&#x20AC;ź

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MEDICAL TOURISM HEALTH DIET

KIDNEY-FRIENDLY DIET FOR CHRONIC KIDNEY DISEASE

A

kidney-friendly meal plan should be followed by those who have chronic kidney disease (CKD). Watching what you eat and drink will help you stay healthier. The information has been given by American Kidney Fund for people who have kidney disease but are not on dialysis.

This information has been passed on to affected people for use as a basic guide. Everybody is different and everybody has different nutrition needs. Talk to a renal dietitian (someone who is an expert in diet and nutrition for people with kidney disease) to find a meal plan that works for you.

WHY IS AN EATING PLAN IMPORTANT? What you eat and drink affects your health. Maintaining healthy weight and eating a balanced diet that is low in salt and fat can help you control your blood pressure. If you have diabetes, you can help control your blood sugar by carefully choosing what you eat and drink. Controlling high blood pressure and diabetes may help prevent kidney disease from getting worse.

A kidney-friendly diet may also help protect your kidneys from further damage. A kidney-friendly diet limits certain foods to prevent the minerals in those foods from building up in your body.

HEALTHY DIET BASICS With all meal plans, including the kidney-friendly diet, you need to track how much of certain nutrients you take in, such as Calories, Protein, Fat, Carbohydrates etc.

To make sure you are getting the right amounts of these nutrients, you need to eat and drink in the right proportion. All of the information you need to keep track of your intake is on the “Nutrition Facts” label.

Your body gets energy from the calories you eat and drink. Calories come from the protein, carbohydrates and fat in your diet. How many calories you need depends on your age, gender, body size and activity level.

Protein is one of the building blocks of your body. Your body needs protein to grow, heal and stay healthy. Having too little protein can cause your skin, hair and nails to be weak. But having too much protein can also be a problem. To stay healthy and help you feel your best, you may need to adjust how much protein you eat.

Carbohydrates (“carbs”) are the easiest kind of energy for your body to use. Healthy sources of carbohydrates include fruits and vegetables. Unhealthy sources of carbohydrates include sugar, honey, hard candies, soft drinks and other sugary drinks.

You need some fat in your meal plan to stay healthy. Fat gives you energy and helps you use some of the vitamins in your food. But too much fat can lead to weight gain and heart disease.

Try to limit fat in your meal plan, and choose healthier fats when you can

38 Medical Tourism Jul. - Sep. 2018

LOWER-PROTEIN FOODS: Bread | Fruits | Vegetables | Pasta and rice HIGHER-PROTEIN FOODS: Red meat | Poultry | Fish | Eggs

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MEDICAL TOURISM DISEASE

HERNIA

DON’T IGNORE YOUR GROIN PAIN

“It’s

like when you look at an old tyre on a car and you see kind of a bulge on the sidewall of the tire. That’s because there’s a weakness in the wall of the tire. And the air is pushing the wall of the tyre outward to create that bulge,” says Dr. Dana K. Andersen, an hernia expert, working for the National Institutes of Health.

A hernia developing in the abdomen is extremely common. Babies, children, and adults get them. Most of the time, hernias are found in men over 40.

Can lifting heavy objects give you a hernia? Maybe if you already have a 40 Medical Tourism Jul. - Sep. 2018

weakness in the wall of your abdomen.

“The majority—three-quarters—of abdominal wall hernias are in the groin,” Andersen says. The groin region is the lower abdomen.

The first sign of a hernia is a small bulge from the lower abdomen. You may notice it only when you stand up, cough, jump, or strain. That’s because those activities increase the pressure within your abdomen. That increased pressure can make a part of your intestine pop out of an area of weakness.

When you lie down, the bulge may go away.

If you think you may have a hernia, ask your doctor. A doctor can usually detect a hernia during a physical exam. Your doctor can rule out other conditions that cause bulges or lumps.

If the bulge is very soft, your doctor may be able to massage the intestine back into the abdomen. A small, soft hernia that does not cause pain may not need treatment right away. The doctor may suggest watching and waiting for changes, like pain, to develop. If a hernia is painful or large, your doctor may suggest you see a surgeon for advice. You may need surgery to repair the hernia.

Usually, the wall of the abdomen is strong.

The muscles keep your intestine in place. But if there’s a weak spot, the intestine can push through and form a hernia. A person may be born with a weakness there, or the weakness may develop over time later in life.

If you have a hernia, try to keep it from getting worse: Avoid heavy lifting when you can. Lifting puts stress on the groin.

If your doctor can’t massage the intestine back into the abdomen, that means it’s trapped. A trapped intestine is dangerous because its blood supply can be cut off or strangulated. “The rim of the defect is forming a sort of a noose around the abdominal contents,” Andersen explains. “If that noose is tight enough so that the loop of intestine can’t be eased back through the defect, then the concern is that the intestine itself could be injured by strangulation.”

A strangulated hernia can be very serious and even life threatening

Symptoms include severe pain that doesn’t go away, nausea, and vomiting.

Surgery is usually needed if the intestine is trapped—and emergency surgery if it’s strangulated. A hernia is one of the most common reasons for surgery in the United States. “It’s a successful and low-risk procedure done about 800,000 times a year in the United States,” Andersen says.

If you think you may have a hernia, talk with your doctor.. Keep in mind that anyone with sudden pain in the groin should immediately seek medical help

When you must lift, don’t bend over. Lift objects by using the legs, not the back.

Eat high-fibre foods and drink plenty of water. This helps prevent constipation and straining during bowel movements.

Maintain a healthy body weight. -Wise Choices A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM TOURISM

KTM 2018 TO HIGHLIGHT TOURISM RESURGENCE FROM FLOOD DAMAGE The new products launched by the State Government, like the Malabar River Cruise project, focusing on nine rivers in north Kerala, will be showcased before the delegates.

S

son. Though there was some damage to these areas during floods, everything is back to normal in a record time, said Baby Mathew, president, KTM Society.

Being held in the wake of the devastating floods that rampaged through large swathes of the coastal State, the tenth edition of KTM will focus on measures that would lead to a strong resurgence of tourism, which is the mainstay of Keralaâ&#x20AC;&#x2122;s economy.

The response to this edition of KTM has been overwhelming with 395 overseas buyers and 1,095 domestic buyers having registered as participants. As in its previous editions, KTM will serve as a strong platform to showcase its time-tested as well as new products of Kerala and establish firm business links by bringing together internationally- reputed buyers and sellers and tour operators under one roof, Baby Mathew said.

All the tourism destinations in Kerala are ready to welcome tourists in this sea-

The new products launched by the State Government, like the Malabar River

ending out a strong message that tourism in the flood-battered Kerala is back on the rails in double-quick time, Kerala Travel Mart (KTM), Indiaâ&#x20AC;&#x2122;s largest tourism sector conclave of stake-holders from across the world, will hold its biennial meet in Kochi from September 27 to 30.

42 Medical Tourism Jul. - Sep. 2018

Cruise project, focusing on nine rivers in north Kerala, will be showcased before the delegates.

The buyers who will be attending the KTM will have the opportunity to witness how Kerala has overcome the devastating floods in the tourism sector. As part of its social responsibility mission, KTM Society has set up a Task Force for flood relief and rehabilitation efforts by bringing together 28 organisations from the tourism sector.

The Task Force has already sent teams for the clean-up operations in various places and successfully roped in around 1500 people to carry out the relief and rehabilitation work in Munnar and near-

by tourism spots, which are the prime destinations of Kerala.

The task force has pledged its total support to the State Government’s mission of rebuilding the infrastructure, severely battered by the floods. It has also mobilised several teams to actively participate in cleaning up works, restoration of roads and mobilisation of relief material for the affected people, Baby Mathew said.

Major topics to be deliberated at the KTM seminars will include enhancing the green cover of the State, rainwater harvesting and reduction of the use of plastic. In its previous edition, the key themes of discussion included promotion of organic products, attaining energy efficiency and garbage management, Baby Mathew said.

Tourism in Kerala has started recovering fast from the grim blow dealt by the calamitous floods. Traffic to major destinations across the State has resumed and bookings ahead of the peak season have picked up, he said.

The upcoming edition of KTM is intended to send a strong signal to the

world that the State has the resilience and an indomitable spirit to take in its stride any adverse challenge and move forward. The event will send this message to the world through the delegates from as many as 73 countries arriving to attend it.

Meticulous plans have been made for the accommodation of the participants, with over a 1,000 rooms having been booked in top hotels in the city.

“Special arrangements have also been made for the large media contingent reaching the city to cover the event, including fully hosted tours to prime destinations across the State from September 23 to 27. As many as 20 mediapersons from abroad and 26 from different parts of the country will be reporting the event from the spot,” said Abraham George, Former President and expert member of the National Tourism Advisory Committee (NTAC).

Separate tour packages for the business delegates have also been planned, the itinerary of which includes visit to top Ayurvedic spas.

The strength of KTM is its public- private sector collaboration and it also serves as a forum for meaningful interactions with international buyers and sellers and clinching business deals by tour operators, hotels, resorts, home- stays, houseboats, Ayurveda retreats and art and cultural institutions.

This year, there will be more participation of international buyers from USA, Russia and its neighbouring countries.

The event will be an ideal avenue for buyers and sellers to expand their business territories and attract potential buyers

BABY MATHEW President, KTM Society

Donate to Flood Relief Fund Dear readers, Kerala, the southern-most State in India, has been devastated by the century’s worst flood disaster, killing and disabling a few hundred people, displacing at least eight lakh families, destroying or severely damaging a lot of their houses, and literally decimating all their belongings. It will be a humongous task to rebuild the infrastructure and enable them to start afresh, as everything has been lost for them. All-round global efforts are essential to sustain their lives, for which you are requested to contribute your mite to the Chief Minister’s Relief Fund.

Editor Medical Tourism Magazine FM Media Technologies PVT Ltd, Penta Square, Opp.Kavitha, MG Road, Cochin -682016, Kerala, India.

Chief Minister’s Relief Fund ACCOUNT DETAILS A/c Number : 67319948232 A/c Name: Chief Minister’s Distress Relief Fund Bank: State Bank of India Branch: City Branch, Thiruvananthapuram IFSC : SBIN0070028 | SWIFT CODE : SBININBBT08 Account Type: Savings | PAN: AAAGD0584M A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM TOURISM

TOURISM REGULATORY AUTHORITY WILL BE FORMED TO ENSURE QUALITY SERVICE FOR TOURISTS: P Bala Kiran Kerala Tourism would promote monsoon tourism amongst domestic and international travelers. While promoting experimental tourism, Kerala Tourism would provide travellers with the opportunity to experience rural life for a raw travelling experience, says P Bala Kiran, Director, Department of Tourism, Kerala, to Medical Tourism Magazine. He speaks about the initiative of the Kerala Tourism Department in promoting tourism in Kerala.

From adventure tourism, responsible tourism to medical/wellness tourism, Kerala Tourism has been working towards exploring the potential of all spheres of tourism. Kerala Tourism has also been promoting the State across the globe, emphasizing Kerala as a preferred destination for affordable quality medical service provider. Through roadshows and trade fairs, the tourism department aims to position the state as one of the best Ayurveda treatment providers.

As part of the tourism policy of the Kerala Government, which are the areas that the tourism department is giving more focus to attract more tourists?

The new tourism policy of the state envisages creation of new customized products to attract young travellers, professionals, students and artists to the state. The Department of Tourism has proposed to establish a Kerala Tourism Regulatory Authority (KTRA) to ensure quality service for tourists and curb unhealthy practices in the tourism sector. The supreme authority would be responsible in monitoring the functioning of different stakeholders. An investment cell would also be formed to help potential investors, especially NRIs. In order to promote the stateâ&#x20AC;&#x2122;s tourism, Kerala Tourism plans to strengthen 44 Medical Tourism Jul. - Sep. 2018

its overseas campaign. Additionally, the department has plans to develop select locations with public-private participation (PPP) on the lines of the Jadayupara Tourism Project. Following the lining up of new marketing strategies, the department has proposed to establish 1,000 new classified homestays to promote homestays and rural tourism. The policy also emphasizes on the active participation of the differently-abled and the transgender community, while implementing the Responsible Tourism Mission across the State to drive the growth of tourism industry.

Do you think that along with the roadshows being conducted by the tourism department, medical tourism too should be given importance?

Owing to the better infrastructure facilities that the state has to offer, Kerala has witnessed a surge in the growth of medical tourism. Through travel trade meets, Kerala Tourism emphasizes on the major attractions of the state, including medical tourism. The Tourism Department has planned to conduct 15 B2B meets for Phase -1 2018-2019 across domestic markets to attract the maximum number of domestic travellers to Kerala.

Which are the countries from where more tourist arrivals are expected during this tourism season?

The State has hosted the highest number of tourists from the UK, with an increase of 16.35% at 1,80,975 visitors. There has been a significant rise in travellers from North American

countries, with the US (5.83%) and Canada (17.77%) posting considerable growth. The number of travellers from four Asian countries - China, Japan, Maldives and Indonesia - also registered growth.

Additionally, Kerala Tourism has been witnessing tremendous response from domestic tourists from across the country. The State has attracted the maximum number of travellers from southern states of Tamil Nadu, Karnataka, Andhra and Telangana. Tamil Nadu accounts for the maximum footfall with 12.72 lakh visitors. Karnataka holds the second position with 9.33 lakh tourists, while the third slot went to Maharashtra with 5.47 lakh tourists.

There has also been a significant increase in tourist arrivals from Delhi with 2,40,672 visitors (18.67%) and Gujarat with footfall of 2,39,228 with 24.48% increase. This tourism season, Kerala Tourism expects to attract the maximum number of travellers from these high-potential markets.

Kerala Tourism is targeting up to 15 percent growth in the number of tourist arrivals in 2018 with a slew of initiatives undertaken to promote the State as 365-days destination. Further, the aim is to double the foreign tourist arrivals and increase the domestic tourist arrivals by 50%, by 2021. Kerala had hosted 1,46,73,520 domestic tourists in 2017 with an increase of 11.39% as compared to the figures of last year. Besides, Kerala had witnessed a growth of 5.15% in foreign tourist arrivals (FTAs), while attracting 10,91,870 foreign tourists in 2017.

Apart from the regular tourism spots, which are the newly developed areas in Kerala?

Kerala Tourism has planned to launch the Jatayu Earth Centre - World’s largest functional bird sculpture, in Quarter 2 2018. ‘Adventure Rock Hill’ at the Jatayu Earth Centre has been operational for the public in groups.

Located at Chadayamangalam in Kollam district of Kerala, the center offers

attractive tour packages for visiting the centre and they include 15 challenging adventure activities. It has a separate adventure zone, which provides over 20 different games such as paintball, archery, laser tag, rifle shooting, rock climbing and rappelling for the tourists.

The centre allows tourists to have thrilling and refreshing experiences, while exploring the natural beauty of the place. The much-awaited tourism spot is split into two sections. While the first section focuses on climbing activities, the second portion covers activities such as Burma bridge crossing, valley crossing and paintball.

Additionally, the State is all set to witness the blooming of Neelakurinji (Strobilanthes Kunthiana) in Munnar district soon. Kerala Tourism is expecting over 800,000 travellers to the picturesque hill station during the July -October 2018 period. During these months, Neelakurinji flowers will blossom after 12 years across the hills of Munnar in Idukki district. Last time, the plants had blossomed in 2006.

Further, the state government plans to develop 10 eco-tourism circuits to connect various forests in a bid to promote green tourism. The Government of Kerala has also envisioned a Rs 300-crore project for nine rivers in Kannur and Kasaragod to promote river tourism.

It will also launch a host of adventure and activity-based tourism projects in Alappuzha, the Malabar region, Wayanad, etc, and they would include paragliding, paddling and kayaking.

Moreover, there are plans to start the Alappuzha-Kollam boat service along the Kayamkulam lake, offering sightseers an opportunity to visit Kumarakodi.

Kerala Tourism has been working with various agencies and District Tourism Promotion Councils (DTPCs) in order to promote adventure tourism across the state. Destinations such as Wayanad offer a wide range of adventurous activities like cycling, rafting, trekking in the rain, and mountaineering to showcase the picturesque beauty of the state across the globe.

Besides, Kerala Tourism has been promoting the rich cultural heritage and handicraft industry to woo tourists.

Owing to the efforts made by the Tourism Department towards promoting art and culture, Sargaalaya has become a major tourist destination in Kerala.

How is the Kerala Travel Mart (KTM) going to help the tourism industry in Kerala?

Kerala Travel Mart is one of the leading events of the tourism industry. The event has been witnessing a maximum gathering of tourism stakeholders in India. Malabar Tourism promotion would be the main theme of the 2018 edition of the KTM, which would coincide with the World Tourism Day this year. KTM is expected to contribute significantly in driving the growth of the State Tourism sector. Through such prestigious events, we aim to establish new trade connections across the potential markets. The event provides an opportunity for the tourism trade in the respective markets, and would help to interact and develop business relationship with tourism industry players from Kerala.

This would also help in showcasing the rich cultural heritage of the state across the country.

Has Responsible Tourism shown positive results in Kerala? How do you think you can expand this to more parts of the State?

The Department of Tourism has been focusing on implementing the master plan for the Responsible Tourism Mission across the state. Significantly, the United Nations World Tourism Organisation has described Responsible Tourism program as a model for other destinations to replicate. The Government of Kerala had allotted Rs. 4,50,00,000 to the Department of Tourism for fiscal 2017-18 to take Responsible Tourism initiatives ahead.

The objective is to promote the state’s tourism in a responsible manner across the globe

A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM ADVERTORIAL

Preventing Blindness through Ayurveda

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he loss of sight results in humongous suffering for the individuals affected, and their families. According to WHO estimates, about 80% of global blindness is avoidable: either it results from the conditions that could have been prevented or controlled if the available knowledge and interventions had been applied timely (e.g. trachoma and river blindness); or it can be successfully treated with the sight restored (e.g. cataract). In adherence to this view, World Health Organization has come up with “VISION 2020 -- the right to sight”: a global Initiative for the elimination of avoidable blindness.

Ayurveda is the oldest medical science with a specialized view on eye diseases.

Over centuries, this medical system has created prophylactic and therapeutic counter-measures to eye ailments which are not widely understood or recognized in the current era. The potential of Ayurveda, or in specific Shalakya tantra (the branch of Ayurveda which deals with diseases affecting all organs above the neck), in providing remedies and

46 Medical Tourism Jul. - Sep. 2018

preventive measures to conditions of blindness is potentially enormous.

SREEDHAREEYAM: THE PIONEER IN AYURVEDIC EYE TREATMENTS Sreedhareeyam Ayurvedic Eye Hospital in the state of Kerala, in India, has successfully leveraged three centuries of traditional Ayurvedic wisdom inherited from “Nelliakkattu Mana”, an illustrious family of Ayurvedic physicians. Generations of dedicated physicians explored the depths of Ayurveda to unearth the treasures in ayurvedic eyecare and the knowledge was multipled as handed down through generations. As modern technological advancements began to take shape, the physicians of the mana explored options to take professional training and also find ways to benefit from the technology revolution. Thus they excelled in the modern diagnostic methods, bringing the best of both worlds together for the benefit of ophthalmology as a science.

Sreedhareeyam is reckoned as one of the largest Ayurvedic eye hospitals in

the world. Its 48-acre campus today houses an Ayurvedic eye hospital accommodating 400 patients, Government approved Ayurvedic Research Centre, GMP certified Ayurvedic medicine manufacturing plant, Ayurvedic Village, Ayurvedic paramedical college, a Yoga club and herbal farms.

Combining this profound knowledge of diseases and extensive clinical experience with the most modern technological advancements propelled Sreedhareeyam to achieve incomparable results in the field of ophthalmology.

Sreedhareeyam Hospital is the recipient of NABH (National Accreditation Board for Hospitals) which is the most stringent quality measure of hospitals in India. It has also been recognized as the “Centre of Excellence” by the AYUSH ministry of Government of India.

Ayurveda in Eye Disease Management Diabetic Retinopathy Even though controlling the occurrence of Diabetic Retinopathy is interlinked

to the proper maintainace of diabetes, Ayurveda can offer specific systemic and eye specific measures to slow down and repair this condition. Eye specific Ayurveda treatments have proved to be effective in arresting further proliferation of the disease as well as dissolving the cotton wool spots and mild hemorrhages. It is effective in both early and advanced stages. The observational studies conducted at Sreedhareeyam has shown significant improvement in visual acuity, central retinal thickness and reduction in symptoms of Diabetic Retinopathy such as flashes and floaters after undergoing Ayurveda treatment.

REFRACTIVE ERRORS Visual impairment due to refractive errors is the second leading cause of treatable blindness. It is estimated that globally 153 million people over 5 years of age are visually impaired as a result of uncorrected refractive errors, of whom 8 million are blind. The spectacles, which are used to correct the refractive errors neither cures nor checks the progression of pathology. Ayurveda offers an

effective combination of measures in such cases.

GLAUCOMA Primary open angle glaucoma (POAG) is a subset of the glaucoma defined by an open angle and raised intraocular pressure (IOP), with no other underlying disease and presents with characteristic optic nerve damage.

Ayurvedic management involves medicines to control pressure, conservation of visual field and rejuvenation therapy (rasayana) for the optic nerve.

Sreedhareeyam Ayurvedic Eye Hospital provides treatment for 8500 in-patient cases in a year, of which around 6800 patients are eye diseases. Among these 57.5% cases are Refractive Errors, Diabetic Retinopathy and Glaucoma.

The treatments have showed a positive outcome of approximately 70%. The remaining 42.5 % cases include all other possible eye diseases such as Uveitis, Retinitis Pigmentosa, Age related Macular De-generation, Optic Neuropathy, Keratoconus etc. The

continuous evaluation and improvement of the methods and combinations is what propels Sreedhareeyam as a model to the medical world which has already taken a turn towards integrated medicinal systems. There is no limit to the potential benefits that Ayurveda can offer in the management of eye diseases. The need of the hour is to take the light offered by Ayurveda along with the current advancements so as to fulfill the promise of VISION 2020.

SREEDHAREEYAM AYURVEDIC EYE HOSPITAL & RESEARCH CENTRE (P)LTD. NELLIAKKATTU MANA Kizhakombu P O, Koothattukulam, Ernakulam Dist, Kerala, INDIA, Pin: 686 662

+91 485 2253007 mail@sreedhareeyam.com

A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM TOURISM

KERALA TOURISM INDUSTRY AN EXAMPLE FOR SUSTAINABLE DEVELOPMENT OF TOURISM IN INDIA The international visitors were welcomed at the airport at a reception function that included Panchavadyam and KathakaliPachaVesham. The arrival of the chartered flight, consisting mostly tourists from Australia, had sent out a definitive message that the tourism sector in Kerala is all geared up to welcome the visitors.

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he setback suffered by Kerala Tourism industry in the wake of the recent floods should serve as an example for sustainable development of tourism in the country.

The damage suffered by the tourism industry in Kerala in the wake of the floods was among a range of issues that came up for deliberations recently at the Parliamentary Consultative Committee of the Ministry of Tourism at its meeting in Kovalam. K J Alphons, Minister of State for Tourism (Independent Charge), Govt. of India, while addressing the meeting, spoke about the setback being faced by Kerala Tourism industry in view of the recent massive floods in the State.

He also told the members that such an adversity “should be taken as an example for development of tourism in a sustainable manner in the country.”

Kerala Tourism and those in the industry had sent out a message that most of tourism locations in Kerala have survived the onslaughts of the recent calamitous floods and God's Own Country is ready to welcome domestic and international guests during the upcoming tourism season.

Kerala Tourism is quickly bouncing back from the flood-related damage which has not affected most of the tourism locations in the State, and the State Government has accorded priority

48 Medical Tourism Jul. - Sep. 2018

to speedy restoration of roads connecting major destinations.

Munnar, Thekkady and Wayanad, the three prime locations which were affected due to rains and landslides, are now open for tourists and the public.

Also, all sightseeing spots across the State are now accessible to tourists.

Eravikulam National Park reopened on September 01 and eco-tourism activities in Thekkady are operational.

Giving out the strong message that Kerala Tourism is springing back into action after the recent floods, this season’s first chartered flight from Australia arrived in Kochi in September.

The chartered flight, with 60 tourists on board, was headed from Australia which landed in Nedumbassery International Airport.

The tourism trade associations in Munnar conducted a day-long ‘Car and Bullet Rally’ from Kochi to Munnar, aimed at inviting tourists to experience the hill station in all its grandeur. The rally was organised to send out the message that all tourist destinations in Kerala, including the hill station of Munnar, are geared up to embrace tourists.

Offering big relief to the tourism sector, the hills of Eravikulam National Park and Marayoor areas in Munnar in Idukki district have unending rows of Neelakurinji (Strobilanthes kunthiana), a flower that blooms once in 12 years.

With the mass-blooming of the flower, the famed hill station is now open to the tourists

MEDICAL TOURISM TOURISM

KERALA TOURISM WINS TWO PATA GOLD AWARDS FOR MARKETING

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erala Tourism’s vigorous efforts to get back on track in the wake of recent devastating floods got a shot in the arm as it walked away with two prestigious gold awards of the Pacific Asia Travel Association (PATA) for its innovative marketing campaigns.

The awards were presented at a glittering function in Langkawi, Malaysia during PATA Travel Mart 2018.

Sudeshna Ramkumar, Assistant Director, India Tourism, Singapore received the award on behalf of Kerala tourism.

Kerala Tourism got the first gold for its ‘Yalla Kerala’ travel advertisement print media campaign in the Gulf countries. It showcased the state’s greenery and backwaters, a different world from the Gulf, just four hours away. With the punch line, ‘Yalla Kerala’, the campaign triggered a lot of interest for God’s Own Country as a tourism destination in the Gulf countries.

“This is a huge honour for Kerala Tourism. Winning two much sought after gold medals of PATA will give a fillip to our ongoing efforts for a robust rejuvenation of tourism in the state,” said Kerala Tourism Minister Kadakampally Surendran.

“Our efforts have already started paying off. Most of our tourist destinations are ready to welcome the visitors from India and abroad. In fact, the first chartered flight of tourists from Australia in this season has arrived in Kochi on September

Sudeshna Ramkumar, Assistant Director, India Tourism, Singapore, receiving the PATA GOLD AWARDS won by Kerala Tourism for Travel Advertisement, Print Media and Travel Poster on behalf of Kerala Tourism at the presentation ceremony in Langkawi, Malaysia.

15,” he said, adding: “The state government has accorded top priority to restoring roads leading to tourist places.”

Kerala Tourism Secretary Rani George said the prestigious gold awards are a testament to the undiminished charm of tourist destinations in the state, which attract visitors in droves

KERALA READY TO RECEIVE TOURISTS: MINISTER KADAKAMPALLY SURENDRAN business with a renewed vigour, demonstrating its inherent resilience and determination to overcome the traumatic aftermath of the floods," Tourism Minister Kadakampally Surendran said.

Asserting that things are back to normal, he said restoration and rehabilitation activities are in full swing. “Road connectivity has been re-established. Flights are operating. Hotels and resorts are up and running. Kerala is back on track.

God’s Own Country is ready to welcome tourists once again,” he added.

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llaying apprehensions about the preparedness of its globally famous destinations, Kerala announced that it is ready to receive tourists in all major places, within a month after the state was convulsed by one of the most devastating floods in recent times.

"Tourism is a major contributor to Kerala’s economy and a significant source for earning foreign exchange. The floods left the tourism industry in a state of disarray and shock, but it was only for a while. Now it has bounced back into

He said there is a need to restore confidence of various stakeholders in the tourism sector, both in India and in major foreign markets, and assure travellers that the state’s tourism and hospitality industry is fast returning to normalcy.

In this connection, he drew attention to a "Tourism Readiness Survey", which was recently conducted by the government with a detailed district-wise and destination-wise analysis of places, roads and other modes of connectivity.

The survey revealed that only a handful of resorts needed to become operational. They too will be ready soon. Based on this readiness, Kerala Tourism has drawn up time-bound action plans A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM TOURISM

DELHI DEBUT OF INDIA TOURISM MART MAKES ITS PRESENCE FELT

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he first ever India Tourism Mart 2018 organised by Ministry of Tourism (MoT) in partnership with the Federation of Associations in Indian Tourism and Hospitality (FAITH) and with support of State /UT Governments was held at New Delhi.

Union Minister for Railways and Coal Piyush Goyal inaugurated ITM 2018 in the presence of Union Tourism Minister K J Alphons and the Tourism Minister of Morocco Mohamed Sajid.

Inaugurating the event, Goyal wished the best to the tourism ministry to reach the ambitious goal of US$100 billion FTA receipts/year within five years. The Minister said that unless the infrastructure /fundamentals are set up, India can’t come up as a well sought- after destination and he said that the present Government has been developing these like ensuring 24- hour power supply, promoting renewable energy forms, and improving connectivity by effectively connecting the remotest destinations.

He also added that the most important element that will help promote tourism in a complete way is the Government’s cleanliness drive, the Swachhta Abhiyan, which will ensure India becoming a preferred destination for all international tourists. Mentioning the income multiplier effect in the tourism sector, the Minister said that tourism generates a number of employment opportunities in formal and informal sectors and can change the destiny of the country.

Goyal added that the youth of the country can be entrepreneurs, service providers, interpreters etc in the sector and ascertained that India with its varied features has tremendous potential and we just need to leverage from it.

Speaking at the event, Alphons announced that ITM will be an annual event hereafter in line with other international tourism marts and it will be held in the month of September. The Minister said that India is so vast that there will be something new for everyone to see and experience in this country with its varied geography, culture, traditions, architectural marvels and religions.

Alphons also added that visiting the country has become easier with the new e-visa regime which is now open to 166 countries.ITM is being held for the first time and the tourism

Union Ministerfor Railways Piyush Goyal inaugurating India Tourism Mart 2018 at New Delhi. Union Tourism Minister for State (independent charge) K J Alphons, Tourism Minister of Morocco Mohamed Sajid and Kerala Tourism Minister Kadakampally Surendran are also seen. industry stakeholders are coming together for such a largescale event with the Ministry’s support.

FAITH is the apex organization of all the important trade and hospitality associations of the country with all the 10 major Tourist organizations like FHRAI, HAI, IATO being involved in this mega event and India Convention Promotion Board (ICPB) is coordinating the whole event. This is a Business to Business event.

The objective of the event was to create an annual global tourism mart for India in line with major international travel marts being held in countries across the world. The Mart provides a platform for all stakeholders in the tourism and hospitality industries to interact and transact business opportunities.

ITM 2018 had participation of around 225 hosted international buyers and media across the world such as North America, West Europe, East Asia, Latin America, CIS countries, etc. The international delegates from overseas markets interacted with Indian seller delegates, and the buyers included current buyers who are already marketing India as a tourist destination as well as potential buyers who are not marketing India as a tourist destination at present but have shown interest in the country.

The event provided an opportunity to the buyers to see the world- class tourism facilities available in our country such as Airports, Hotels, Tourist destinations, upcoming facilities, MICE facilities, possibility in the field of adventure tourism and other niche products.

Around 225 stalls have been provided to the sellers to enable them to interact with the buyers. These included pavilions for States & Union Territories to showcase their unique tourism destinations and products. FAITH and State Government sofferied a pre- and post- event FAM trips (Familiarisation trips) for the buyer delegates from overseas

50 Medical Tourism Jul. - Sep. 2018

MEDICAL TOURISM

ISSUES OF MEDICAL TOURISTS Creating awareness about the disease has been a big issue now where Indian hospitals and a lot of NGOs in developing countries have started creating buzz around it.

By Mihir Vora

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ndia is fast becoming a hub for medical tourism. A rare combination of highly skilled doctors, excellent infrastructure and low cost are fuelling that growth.

We have been working towards getting medical travellers the best healthcare possible for the last 5 years and by now we have been able to look at the challenges from the patients’ perspective. While we look at the entire space with a lot of optimism there are still a lot of challenges faced by the medical traveller and the industry as a whole.

Travel for any kind of treatment is still mainly looked at as a last resort.

This, in a lot of cases do mean that the patient loses precious time. I have personally seen a lot of cases in which patients have spent a lot of money and time in their own countries with less than ideal medical facilities where an intervention earlier would have made a world of difference to their health. The need of the hour is an awareness drive to be able to even portray India as a destination to get a second opinion in major illnesses early in the diagnosis. This will help a lot more patients receive better healthcare.

Many a times lack of awareness and traditions keep patients not to speak

about the disease and it is mostly with women for breast cancer. Fear of not getting support from husband, scare of death make them not to speak about the illness and eventually it becomes late when family knows about the disease. In today’s science, a majority of illnesses can be treated successfully, if detected in early stage of the disease.

Creating awareness about the disease has been a big issue now where Indian hospitals and a lot of NGOs in developing countries have started creating buzz around it. One month’s delay in taking a decision for travel to India for cancer might worsen the patient’s disease from stage 1 to stage 2 and further delay may cause severe damage.

Also with my experience in the industry there are a lot of things that we can also do to create better experience for the traveller. Firstly, I am a strong advocate to create policy to get rid of the Tout Menace. Leaving health- related decisions to unqualified people only looking to make a quick buck is a recipe for disaster. A lot of our patients have also experienced the same and that did scare them to a great extent.

Additionally, we are looking at medical travellers increasingly for a single procedure. There is almost no attempt being made to pursue follow- up care

more accessible. We have to collectively understand that the only way the industry succeeds is with success stories that create an impact.

Medical travel being recognised as an industry is fairly recent. While we have amongst the best healthcare institutions in the world, we have a fairly long way to go in trying to understand different cultures and their attitudes to medicine. As we gain more experience we will understand better what people from different countries expect and what would create an experience for them. Every small thing, including the etiquette shown by the attendant to the access to food etc, adds up and we are on this long journey to understand all the small nuances that go along with it.

Mihir Vora is CEO of Magnus Medi, India’s only accredited facilitator with NABH & IATA both. Mihir has extensively travelled in East Africa and Oman and his company has helped several medical tourists coming from this country. Magnus Medi helps patients to find multiple opinions from different parts of India and takes all the hassles of medical journey of patients and attendant, keeping them focused towards their illness A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM TOURISM

FINLAND the rising star of Europe

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part from boasting the cleanest air you can breathe in the world, Finland promises comprehensive and high-quality healthcare from primary health services to specialised medical care – from newborns to the elderly.

Finland has a longer life expectancy than the EU average and is ranked as one of the leading countries in terms of quality of life. In 2018, Finland topped the World Happiness Report based on factors such as freedom, honesty, wel-

SWITZERLAND the most

preferred snow destination for Indians

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lub Med, the premium all-inclusive operator and global ski holiday leader has unveiled Asia Pacific’s first snow holiday report that highlights that out of a 4 billion millennial population, 64 per cent Indians prefer travelling to snow destinations for their holidays.

For Indians, Switzerland is the most preferred destination for snow holidays, above Japan and France which are the other countries. 200 million people from AsiaPacific have taken a snow holiday in the last three years On average, 34 per cent Indians spent at least US$ 380 per day per person at their snow holiday vacations.

Indians prefer snow-boarding and skiing over exploring local attractions and exploring different locations while on snow holidays

Summer mountain holidays are also growing in popularity with almost 80 per cent Indian’s travelling to summer mountains for the holidays. Millennials are driving the Indian travel market – 64 per cent Indians in the age group of 25-34 take snow holidays For Indian snow enthusiasts, Switzerland was the most popular destination, partly fuelled by the prominence of the country in its Bollywood movie scene. St Moritz in Switzerland was the top long haul destination for Asians looking for a snow get-away 52 Medical Tourism Jul. - Sep. 2018

fare, good health, and generosity. The results achieved by Finnish healthcare are world class in e.g. effectiveness of specialised medical care and decreasing cancer mortality. Finnish research groups have contributed to many breakthroughs in diagnostics, cancer treatment and prevention, cardiovascular diseases and neurological conditions. The quick adaptation of research results and use of latest technology ensure positive results in the treatment of many serious diseases. The Finnish system is based on prevention, early detection and arranging adequate health services for everyone.

UAE travellers spent about 9,900 overnights in Finland in 2017, which is 31 per cent more than in 2016. The number has increased every year

The pristine shores of authentic Ayurveda NABH Accredited & Three-time National Award Winner from the Government of India

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Somatheeram Ayurveda Group is a destination to end the search for authentic Ayurveda and the art of Yoga and Meditation. Baby Mathew has started Somatheeram in the year 1985 with a new idea,“Ayurveda Hospital in a Resort Ambience”. It is the first of its kind in the Whole World. A visit to these Ayurveda resorts are an opportunity to experience the best of Ayurveda, an ancient medical practice originated in India.

Somatheeram has tailor-made traditional Ayurveda treatments to offer the best of everything for your physical, mental, spiritual and emotional wellbeing. The hospitals are giving importance for the curative and preventive treatments of body, mind, soul and provides services and facilities in a resort ambience.

Somatheeram Ayurveda Group is internationally renowned for the efforts taken towards the health of humanity, social responsibility and environmental preservation. Here, Ayurveda treatments comprise therapies, proper diet and herbal medicine, de-stress, weight loss, detox or rejuvenate with a programme of treatments overseen by doctors. For Ayurveda treatment, Somatheeram uses natural herbal medicines and warm oils produced from its own Ayurveda medicine manufacturing unit, combined with a dosha-specific meal plan to help restore the body to its optimum state.

Somatheeram Chairman and Managing Director Baby Mathew, Sarah & Sanamaya receiving the NABH Accreditation certificate from Deputy Speaker V. Sasi & Director NABH, Dr. Gayatri V Mahindroo, in the presence of Minister for Health K. K. Shailaja .

Following resorts belong to Somatheeram Ayurveda Group: 1) Somatheeram Ayurveda Village in Chowara Beach, South of Kovalam, Trivandrum.

Somatheeram Research Centre & Ayurvedic Hospital and Soma Manaltheeram Ayurvedic Hospital & Research Centre both are accredited with NABH (National Accreditation Board for Hospitals and Health Care providers). It is the highest grading in India for hospitals and health care providers. Also it is accredited with Green Leaf (Government of Kerala), HACCP - Food Safety Standards (British Standard Institute - UK) and Ayurveda SPA Europe certificate (European Audit Institute Wellness & SPS e.V. - Germany).

2) Soma Manaltheeram Ayurveda Beach Village in Chowara Beach, South of Kovalam, Trivandrum.

Somatheeram has been chosen three times as ‘India’s Best Ayurveda Resort’ by Government of India. It is a six-time winner of ‘Kerala State’s Best Ayurveda Resort’ title by Government of Kerala. Somatheeram was honoured by 32 major international and national awards for excellence in the Ayurveda & Yoga.

For more information:

The mission of the Group is “to offer the essence and soul of the ancient medical science of Ayurveda and the art of Yoga and Meditation.”

3) Soma Palmshore in Kovalam Beach, Trivandrum.

4) Soma Kerala Palace Ayurveda Lake Resort in Chempu, Kochi – Kumarakom Road.

5) Soma Birds Lagoon River Retreat in Thattakadu, Kochi.

6) Soma houseboats in Alappuzha.

Email: mail@somatheeram.in Web: www.somatheeram.in

Telephone: +91 471 2268101 & +91 471 2266111

Somatheeram Ayurveda Group Chowara P.O, South of Kovalam, Thiruvananthapuram, Kerala, India, PIN 695 501 A Complete Magazine on Healthcare in Asia

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OMAN’S

A discovery of rich wildlife and nature

mammals, including wild goats, sand cats, Nubian ibex and Arabian Oryx. If you time your visit carefully, you can witness an enchanting sight: from June to September, the Ras Al Jinz Turtle Reserve is one of the best places in the world to see green turtles nesting, hatching and escaping to the sea. For divers, snorkelers and birdwatchers, the Damaniyat Islands Nature Reserve is a must visit to experience fabulous coral formations and is a breeding ground for gulls, terns, ospreys and sooty falcons. Rare hawksbill turtles also nest in usually large numbers on the quiet beaches.

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man’s natural reserves and wildlife sanctuaries protect important coastal and desert habitats totalling almost 30,000 km. The sheer diversity of Oman’s landscapes will astonish and inspire you.

Oman’s coastal waters are haven for dolphins, whales and birds. Close to the coast, coral gardens teem with colourful fishes; protected coves act as crucial breeding grounds for endangered marine turtles; mountains and deserts are home to rare land

INDIA extends e-visa facility for

citizens of 165 countries

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eeking to promote tourism, the Government has extended e-visa facility for citizens of 165 countries at 25 airports and five seaports, the Lok Sabha was informed. Tourism Minister K J Alphons also said the Government has launched the ‘Incredible India 2.0’ campaign, marking a shift from generic promotions to market-specific promotional plans. A 24X7 toll- free multi-lingual tourist helpline has also been put in place as part of the efforts.

To promote tourism in India, events such as ‘paryatanparv’ (tourism festival), International Buddhist Conclave and International Tourism Mart too have been organised. He said while development and promotion of tourism is primarily the responsibility of State Governments, the Union Tourism Ministry provides Central financial assistance to states and UTs to organise fairs, festivals and tourism-related events for the promotion of tourism

54 Medical Tourism Jul. - Sep. 2018

Other significant reserves include the Dhofar lagoons for birds and the Jabal Samhan Nature Reserve in the Dhofar highlands, one of the last remaining habitats for Arabian leopards.

Also, Oman’s cool uplands are rich in birdlife, particularly vultures and eagles

A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM TRAVEL NEWS

AIR FRANCE, BRITISH AIRWAYS to halt flights to Tehran

had run connections to the Iranian capital via its low-cost operator Joon, will be axing the route on September 18 and BA would be scrapping the route on September 22.

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ir France and British Airways (BA) will be suspending flights to Tehran next month, it was revealed, with the carriers citing low profitability as the US re-imposes sanctions on Iran, a report said. According to a report in France24, Air France, which

The last outbound flight to Tehran will be on September 22, and the last inbound flight from Tehran will be on September 23, the British flag carrier added. British Airways said its decision was unrelated to US President Donald Trump’s imposition of new sanctions on Iran, which has prompted many foreign businesses to pull out of the country, the report said.

that it was also suspending Tehran flights due to “negative results and financial outlook”.

The airline said it was in discussions with partner airlines to offer customers rebooking options, or would offer full refunds, it said

Dutch airline KLM, part of the same group as Air France, said last month

SPICEJET successfully tests India’s first biofuel-powered flight

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piceJet successfully operated “India’s first ever bio-jet fuel flight” which took off from Dehradun and landed at the airport in Delhi, the national capital. The SpiceJet flight, a Bombardier Q400 aircraft, partially using bio-jet fuel, was powered with a blend of 75 per cent air turbine fuel (ATF) and 25 per cent bio-jet fuel, it said.

“The advantage of using bio-jet fuel as compared to ATF is that it reduces carbon emissions and enhances fuel efficiency. Made from Jatropha crop,

Around 20 people, including officials from aviation regulator DGCA and SpiceJet, were in the test flight. The duration of the flight was around 25 minutes.

the fuel has been developed by the CSIR-Indian Institute of Petroleum (IIP), Dehradun,” SpiceJet said in a statement.

INDIGO announces Kuwait and

Abu Dhabi as new destinations

network. IndiGo will become the first domestic airline to introduce services connecting Port Blair with Hyderabad and Vadodara. These flights will commence from September 2018.

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ndiGo has launched Kuwait and Abu Dhabi as its new destinations, effective October 2018. To provide enhanced connectivity across India, IndiGo has added 24 new flights to its 56 Medical Tourism Jul. - Sep. 2018

In addition, 6E will operate its first daily return flight between Surat and Chennai, daily non-stop return service between Delhi and Imphal, direct flights to Vijayawada from Delhi. The airline will also add two international new routes connecting Doha with

“Bio-jet fuel is low- cost and helps in significantly reducing carbon emissions. It has the potential to reduce our dependence on traditional aviation fuel by up to 50 per cent on every flight and bring down fares,” said SpiceJet Chairman and Managing Director Ajay Singh

Ahmedabad and Trivandrum. These new services will be effective October 2018.

William Boulter, Chief Commercial Officer, IndiGo said, “We will operate the first flight between Kuwait and Chennai and Calicut and Abu Dhabi starting October this year. It also gives us immense pleasure to add 24 additional flights to 6E network. IndiGo has completed 12 years of successful operations in the India market as a lowcost carrier, and adding new flights to its network will further augment the connectivity that we aspire to provide to our customers”

You may be able to make phone calls, use internet on flights from October in add-on revenues and bring them at par with international flights. There is still no clarity on the pricing. However, it is anticipated that the cost will far surpass that of normal rates for mobile services as initial investments will be made by the airlines.

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ndian fliers will finally be able to use internet and make phone calls on their flights. The telecom department will allow calls and internet at 30,000 ft from October this year. An official at the Department of Telecommunications (DoT) said, "We are in the final stages of inflight connectivity licence norms and the service option will be given to carriers and telecom companies within two months."

DoT officials said that they have followed the telecom regulator's recommendations to draft the guide-

lines. Once the department clears the plan, the law ministry's approval will take another two weeks to sanction.

The official said that there have been meetings with telecom operators and airlines with some parties showing interest to offer these services.

The official also said that once the licences are rolled out, the carriers and telecom companies can fight it out to pick the service they want to push out.

Indian carriers are in favour of providing internet services as it would result

However, it is not going to be a simple task for Indian carriers. Each aircraft would require an investment of about $1 million, an executive said. The plane will also have to be grounded for at least 10 days to retrofit the aircraft with the technology. In current circumstances, this revamping may not come across as very welcoming.

The Telecom Regulatory Authority of India (TRAI) had earlier said that Indian and international flights be allowed voice and data services within India's air space above an altitude of 9,850 ft.

It suggested that in-flight service connectivity licences should be provided at Re 1 annually. Except for international flights, the Telecom Commission approved TRAI's recommendationsď&#x20AC;ź

Government Reveals Plan To Extend UDAN Scheme For International Flights

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he Government unveiled a draft scheme for extending the affordable air travel programme UDAN to international circuits, with State Governments identifying the routes for operation.

The draft International Air Connectivity (IAC) scheme predicts to increase the international ticketing to Rs 20 crore by 2027.

"The scheme is to be made operational only for States, which demonstrate their commitment to implement and provide the requisite support for promoting operations under the scheme," the draft reads.

UDAN was launched in 2016 to make air travel affordable for people through

subsidised ticket rates and to provide air connectivity to smaller towns.

According to the draft scheme, State Governments will identify the routes to be connected, and airline operators will assess demand on the identified routes and submit proposals for providing connectivity.

Operations under the scheme will be permitted through fixed-wing aircraft only with more than 70 seats.

"The subsidy support shall be provided to selected airlines only for the passenger seats, which remain unsold at the time of IAC flight operation, from the total number of passenger seats for which subsidy has been requested by the selected airline as part of its proposal," the draft said.

The subsidy support will be extended only up to three years.The Airport Authority of India will be the implementing agency of the schemeď&#x20AC;ź

The scheme has proposed to set up an International Air Connectivity Fund (IACF), a dedicated fund for providing subsidy support under the scheme. It will be created through the contributions of State Governments.

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MEDICAL TOURISM STRESS

UNDERSTANDING STRESS AND WAYS TO TACKLE DEBILITATING EFFECTS One of the very important organs that always gets affected while we get stressed is the heart. Stress causes increased blood pressure to the brain and that might cause migraines. Meditation can bring down the stress levels in a person.

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student in Kindergarten came up and said, “I am so stressed”. Wondering what could possibly go wrong in a 4-year-old’s life and inquired further to get the details and she tells, “I have to learn all the 26 letters, that too in the correct order.”

Recently, a mother tweeted about how her child who is studying in a junior school, constantly complains about chest pain and develops a skin rash every alternate month due to the excessive workload and the competition that the students face every day.

The above anecdotes warn us about a very common factor called stress, which is affecting people across age groups.

These days, the number of cases of medical conditions caused by stress is increasing at an alarming rate.

‘Pressure or strain’, defined as stress can be caused by everyday factors that can put a strain on the body. Stress can be mental, emotional or psychological. When we are stressed the body deals with it as if we are in danger, it starts releasing hormones like Cortisol and Epinephrine into the bloodstream. This optimizes our concentration by increasing the heart rate and blood pressure which, in turn, gives us the strength and memory to deal with the supposed ‘danger’. As the danger passes, the body takes time to come back to its normal state.

Different people deal with stress differently. It all depends on how well a person can handle a certain situation.

HOW STRESS AFFECTS DIFFERENT ORGANS? HEART: One of the very important organs that always gets affected while we get stressed is the heart. The first thing that happens when we get stressed is an increased heart rate. And all these false alarms cause wear and tear to the heart which increases the possibilities of getting heart problems like arrhythmias or eventually cause heart attack.

lead to ulcers and makes one more susceptible to stomach infections.

BRAIN: Stress causes increased blood pressure to the brain and that might cause migraines. Over time, the stress hormones can wear down the proper functioning of the brain by killing brain cells and reducing the brain size. And this can lead to Alzheimer’s (It is a neurodegenerative disease).

WHAT ARE THE THINGS WE CAN DO TO RELIEVE STRESS? YOGA: Researchers have proved that meditation can bring down the stress levels in a person. Deep breathing techniques and positive imagery can help reduce stress substantially.

EXERCISE: Physical activity increases blood circulation in the body and mind and helps burn out the excess fat accumulated in the body due to stress.

SLEEP: Sleep helps clear out the toxins in the body and that, in turn, will help the body to come back to its normalcy faster. While we sleep the brain gets sufficient time to rest, and the body gets time to repair itself.

EAT HEALTHY: One has to eat healthy to help the body detoxify faster. Detoxification will help the body absorb the nutrients and minerals in an efficient manner. This way, the body will be able to cope with our day-to-day activities without being drained by the after effects of stress. Some comfort foods also help one to keep anxiety and stress at bay.

MUSIC: Listening to therapeutic music helps reduce stress by decreasing brain activity and it also brings down heart rate to a normal pace.

WRITE IT DOWN: Writing down instances that upset a person or make one stressed, will help one avoid such circumstances in the future.

LAUGH: There are support groups like Laughter Clubs which practice prolonged voluntary laughter.

This releases the so-called happiness hormones, Endorphins, Dopamine and, Serotonin. There is also reduction in Cortisol and Epinephrine.

BODY: Many people who are stressed tend to eat more; it’s a psychological way of dealing with stress for some people. But all these calories don’t get used up as they are not needed, therefore, the body converts these excess calories into fat and stores them causing obesity. Obesity is known to cause increased blood pressure and diabetes.

REDUCE CAFFEINE: Caffeine increases brain activity and heart rate and makes us hyperactive.

Avoiding caffeine substituting it with less intense beverages will help us curb stress.

PANCREAS: People who are stressed are likely to lead an unhealthy lifestyle. An imbalanced diet and consumption of alcohol can increase the risk of getting diabetes. Stress directly increases glucose levels in people who already have diabetes.

In the present scenario, stress-related conditions are on the rise at an alarming rate. But carefully planned life changes a well-furnished daily timetable without the need to meet a deadline, engaging in activities that calm the mind and body. All these contributing factors will provide us an ideal workstation, free of anxiety and stress for a productive future

STOMACH AND INTESTINES: When people get stressed, the central nervous system shuts down the blood flow that is needed for digestion. This causes an increase in stomach acids which might

MASSAGE: Get a massage once in a while. That will relieve the body and mind from stress and help provide full relaxation.

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MEDICAL TOURISM YOGA

60 YOGIS FROM 22 COUNTRIES DISCOVER THE LAND OF YOGA There is tremendous potential to develop a dedicated yoga circuit in Kerala, combining the existing yoga destinations like Shivananda yoga ashram, the meditation centre at Vivekananda Rock in Kanyakumari and the prehistoric sites in Munnar, where meditation was once practised, with related activities like Ayurvedic/Naturopathic cooking, trekking and houseboat cruise. can be easily followed by practitioners of all age-groups), interact with yoga enthusiasts from across the State and visit several yoga hubs and natural beauty spots.”

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group of 60 people from 22 countries united in Kerala as participants of Yoga Ambassador Tour to explore more and study what its benefits are,beyond considering it as regular exercise.

Yoga Ambassador Tour was organised by the Association of Tourism Trade Organisations, India (ATTOI), Ministry of Ayush, and Kerala Tourism from June 13 to 21 aimed at promoting yoga-centric tourism. The participants were enthusiasts, instructors, researchers and disciples of yoga, in addition to tour operators and writers from around the world.

During the seven days, they toured various parts of Kerala, including Thiruvananthapuram, Kovalam, Thekkady, Munnar, and concluded at Kochi on June 21, To coincide with the Yoga International Day. The ambassadors were picked by inviting applications from all over the world and later selecting the suitable profiles.

The aim of the tour, according to Anish Kumar, president of ATTOI, was to 60 Medical Tourism Jul. - Sep. 2018

promote fitness and spirituality while on holidays as well. Elaborating on it, Anish says, “Though our aim was to promote yoga, this entire event also had a tourism angle to it. Almost more than half of the participants were yoga tour operators along with being yoga practitioners, teachers, researchers and disciples”.

“There is tremendous potential to develop a dedicated yoga circuit in Kerala, combining the existing yoga destinations like Shivananda yoga ashram, the meditation centre at Vivekananda Rock in Kanyakumari and the prehistoric sites in Munnar, where meditation was once practised, with related activities like Ayurvedic/Naturopathic cooking, trekking, houseboat cruise etc. This would provide a holistic experience to yoga seekers and project Kerala as a perfect place to practise yoga while travelling,” said Anish Kumar.

ATTOI joint secretary Janeesh Jaleel, said “The tour agenda of the ambassadors included practising the Ayush Ministry’s common yoga protocol (a series of simple asanas (postures) that

Dr Arun Thejaus, who conducted yoga sessions for the ambassadors during the travel said that they were keen to learn more about the scientific aspects behind the practices from everywhere that they go. “From sharing the feedback on how practising yoga feels different while on beaches, hill stations and mountains, to learning the yogic way of eating and life, they explored a lot more than what they already knew. Some of them thought of yoga more as an exercise. Next time onwards, more scientific sessions could be included in the programme, he said.

Yoga Ambassadors Tour was inaugurated by Minister of State for AYUSH Shripad Yesso Naik. Inaugurating the programme Naik said that Kerala’s clean environment and the rich tradition of Ayurveda have contributed to the promotion of tourism. Going beyond Ayurveda, Kerala and its neighbouring Kanyakumari district of Tamil Nadu together have a few renowned Yoga destinations like Shivandanda yoga ashram, the meditation centre at Vivekanada Rock in Kanyakumari and the prehistoric sites of Munnar where meditation was once practiced, he said.

There was already a notable segment of foreign tourists who visit Kerala for taking yoga courses due its rich yoga resources, he said. Kerala State Tourism Minister Kadakampally Surendran said Kerala has become a model for the other destinations by introducing the yoga ambassadors tour

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AYURVEDA HOSPITAL

Website: www.punarnava.net Email: mail@punarnava.net

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MEDICAL TOURISM FITNESS

LISTENING TO YOGA MUSIC OR MEDITATION TUNES AT BEDTIME IS GOOD FOR YOUR HEART Anxiety levels fell significantly after the Yoga music, rose significantly post the pop music, and increased after the no music session. Listening to soothing music before bedtime is a cheap and easy to implement therapy that cannot cause harm.

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istening to soothing, meditative yoga music before sleep may be good for the heart, according to a study by Indian researchers. â&#x20AC;&#x153;We use music therapy in our hospital and in this study we showed that Yoga music has a beneficial impact on heart rate variability before sleeping,â&#x20AC;? said study author NARESH SEN, a Consultant Cardiologist at HG SMS Hospital in Jaipur, Rajasthan.

The study, presented at the ongoing European Society of Cardiology Congress 2018 in Germany, investigated the impact of listening to Yoga music, which is a type of soothing or meditative music, before bedtime on heart rate variability.

It included 149 healthy people who participated in three sessions on separate nights: Yoga music before sleep at night; pop music with steady beats before sleep at night; and no music or silence before sleep at night. At each session, heart rate variability was measured for five minutes before the music or silence started, for ten minutes during the music/ silence, and five minutes after it had stopped.

In addition, anxiety levels were assessed before and after each session using the Goldberg Anxiety Scale. The level of positive feeling was subjectively measured after each session using a visual analogue scale. The average age of participants was 26 years.

The researchers found that heart rate variability in-

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creased during the Yoga music, decreased during the pop music, and did not significantly change during the silence.

Anxiety levels fell significantly after the Yoga music, rose significantly post the pop music, and increased after the no music session. Participants felt significantly more positive after the Yoga music than they did after the pop music. Sen noted that holistic therapies such as music cannot replace evidence-based drugs and interventions, and should only be used as an add-on.

“Science may have not always agreed, but Indians have long believed in the power of various therapies other than medicines as a mode of treatment for ailments,” he said.

“This is a small study, and more research is needed on the cardio-vascular effects of music interventions offered by a trained music therapist. But listening to soothing music before bedtime is a cheap and easy to implement therapy that cannot cause harm,” he added

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MEDICAL TOURISM HEALTH NEWS

Researchers develop potential drugs to help you quit smoking

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re you looking for permanent freedom from smoking? Try these new potential drugs to quit smoking.

Researchers at Washington State University created more than a dozen candidate drugs with the potential to curb smokers' desire for nicotine by slowing how it is broken down in the body.

They hoped that the substances could help people reduce their consumption of tobacco, if not quit altogether.

The discovery targets a liver enzyme, called CYP2A6, which metabolizes nicotine. Researchers found that people who have fewer copies of a gene for the enzyme tend to smoke less and are less likely to be addicted to smoking.

Nicotine triggers the release of dopamine and serotonin, two pleasure-causing chemicals produced by the body.

But as it gets metabolized, users can experience withdrawal symptoms like tingling in the hands and feet, sweating, anxiety, and irritability.

They also designed dozens of molecules that bind to CYP2A6 and inhibit its ability to metabolize nicotine.

So far, the researchers have tested their candidate drugs to make sure they don't disrupt other major enzymes that help the body metabolize other substances. This helped narrow the number of potential drugs down to 18.

The findings appeared in the Journal of Medicinal Chemistryď&#x20AC;ź

"If you inhibit CYP2A6, it shouldn't bother your overall health. If we could specifically target this enzyme, people should be fine, and it will possibly help them stop smoking or at least decrease their amount of smoking," said Philip Lazarus, co-author of the study.

Happy older people live longer Happiness was assessed by asking the survey participants how often in the past week they experienced the following: 'I felt happy', 'I enjoyed life' and 'I felt hope about the future'. Their responses were considered in two distinct ways; a 'happiness score', and a 'binary happiness variable -- Happy/ Unhappy'. A wide range of demographics, lifestyle choices, health and social factors were accounted for in the analysis.

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appy older people live longer, according to researchers at Duke-NUS Medical School in Singapore. In a study published in Age and Ageing, the scientific journal of the British Geriatrics Society, the authors found that an increase in happiness is directly proportional to a reduction in mortality.

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The study utilised data for 4,478 participants of a nationally-representative survey to look at the association between happiness, assessed in the year 2009, and subsequent likelihood of dying due to any cause, until 31 December 2015. The survey was focused on individuals aged 60 years and older living in Singapore.

The researchers found that among happy older people, 15% passed away until 31 December 2015. In contrast, the corresponding proportion was higher, at 20%, among unhappy older people. Every increase of one point on the happiness score lowered the chance of dying due to any cause among participants by an additional nine per cent. The likelihood of dying due to any cause was 19 per cent lower for happy older people. Further, the inverse association of happiness with mortality was consistently present among men and women, and among the young-old (aged 60-79 years) and the old-old (aged 75 years or older)ď&#x20AC;ź

US FDA approves Ortho Dermatologics' Altreno lotion to treat acne hyaluronic acid, glycerin and collagen," said Bill Humphries, president, Ortho Dermatologics. "Altreno lotion spreads easily and is quickly absorbed into the skin allowing acne patients to easily incorporate this once-daily treatment into their skin care regimen."

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rtho Dermatologics, one of the largest prescription dermatology health care businesses in the world and a division of Bausch Health Companies Inc., announced that the Food and Drug Administration (FDA) has approved the New Drug Application for Altreno (tretinoin 0.05%) lotion, indicated for the topical treatment of acne vulgaris in patients 9 years of age and older. Altreno is the

first formulation of tretinoin in a lotion, and has been shown to be effective and generally well-tolerated. Altreno is expected to be available during the fourth quarter of 2018.

FDA approval of Altreno builds upon our strong acne portfolio, providing physicians and patients a trusted retinoid in a lotion formulated to enhance the user's experience with the inclusion of moisturizing attributes of

Extensive clinical data has shown that retinoids are highly effective in treating acne and are considered a cornerstone of topical therapy. However, a common perceived barrier to their use is that treatment with retinoids is associated with skin irritation, such as dryness and peeling, and sensitivity. In clinical trials, Altreno lotion provided the proven efficacy of tretinoin, a retinoid, in a generally well-tolerated formulation with skin dryness, pain, swelling, irritation and peeling reported in 4% of patients

Bid to make ‘Made-in-India’ drugs in foreign lands a non-starter

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move to boost India’s bulk drug production by shifting a sizeable part of the manufacturing capacity to foreign countries that offer generous incentives and tax breaks proves a non-starter in the wake of a steep rise in active pharmaceuticals ingredients (APIs) sourced from China.

Uzbekistan, a former Soviet republic, recently approached the Central Government with a proposal laced with incentives, while Tartarstan and Tyumen Region, members of the Russian Federation, had also evinced interest in setting up joint ventures with Indian manufacturers. A high-level Uzbek business team visited New Delhi and interacted with Indian companies at an event organised by Pharmaceuticals Export Promotion Council of India

(Pharmexcil). Following this, Commerce Minister Suresh Prabhu led a business delegation to Uzbekistan to scout for opportunities in various sectors, including pharmaceuticals.

Despite these efforts, most domestic manufacturers continue to rebuff the idea to produce ‘made-in-India drugs’ at foreign locations and view the current price rise in active pharmaceuticals ingredients (APIs) imported from China as an opportunity to boost domestic industry. Pharmexcil executive director RaghuveerKini, who visited the Uzbek capital Tashkent as part of a joint working group to discuss the proposal, says it is up to the

industry to take the final call. “We are a promotional agency and our job is to facilitate drug exports. We’ve organised the session to enlighten our members about the Uzbek plan. The decision is theirs,” he said

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MEDICAL TOURISM HEALTH NEWS

New method to detect early cancer using malaria protein from UNSW, Sydney

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esearchers have come up with a new method to detect cancer in its early stages by way of a malaria protein that sticks to cancer tumour cells in the blood.

Researchers from UNSW Sydney and the University of Copenhagen said the method can be used as a more effective way to screen for cancer.

UNSW Professor Chris Heeschen said the expectation is that this method, in which malaria protein VAR2CSA sticks to cancer cells, can be used as a more effective way to screen for cancer in the near future.

“We have developed a method where we take a blood sample and with great sensitivity and specificity, we’re able to retrieve the individual cancer cells from the blood,” UNSW Professor Chris Heeschen said.

“We catch the cancer cells in greater numbers than existing methods, which

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offers the opportunity to detect cancer earlier and thus improve outcome for patients.”

According to the research, the new method can be used more broadly to diagnose cancer as it is not limited by cancer type. It also means all that is needed for cancer diagnosis is a blood sample.

Each year, cancer kills approximately nine million people worldwide, and early diagnosis is crucial to efficient treatment and survival.

Professor Heeschen said the new technique could be available in the market within two years if a bio-diagnostic company were to take it on.

Previous methods to detect cancer in blood relied on detecting a particular marker found on the surface of tumour cells. However, not all tumour cells display this marker, which renders these methods unable to detect tumour

cells spread to other organs such as the liver, lungs and bones.

The method based on the malaria protein does not discriminate between cancer types, and can detect all carcinoma cancers, accounting for 95 per cent of cancers detected in humans.

During the development of the new method, the researchers took 10 cancer cells and added them to five millilitres of blood containing millions of red and white blood cells. Magnetic beads coated with the malaria protein were then added to the samples.

The beads stick to the cancer cells only and can then be retrieved with a robotic machine that uses a strong magnet.

This way, they were able to retrieve nine out of the 10 cancer cells which had adhered to malaria protein.

Professor Heeschen said this was a definitive result.

Our method has enabled us to detect cancer at any stages – one, two, three and four,” Professor Heeschen said.

“Based on the number and character of circulating tumour cells we find in someone’s blood, we’ll be able to determine whether it’s a relatively aggressive cancer or not, so can then adjust the treatment accordingly.”

The latest research follows on from work done by researchers led by University of Copenhagen’s Professor Ali Salanti, who discovered in 2015 a new method of treating cancer with the protein VAR2CSA produced by malaria parasites.

The findings of Professor Heeschen and his team were published recently in Nature Communications as “The VAR2CSA malaria protein efficiently retrieves circulating tumor cells in an EpCAM-independent manner”.

UNSW, Australia’s global university ranked among the top 50 Universities in the world offers programs in engineering, business, law, architecture, art and design, medicine and science.

Located in Sydney, a safe and student friendly city, UNSW is home to more than 52,000 students from nearly

130 countries. The new Australian PM-to-be Scott Morrison is UNSW alumnus. UNSW has been attracting a growing number of bright Indian students for Undergraduate and Post Graduate studies. The highest demand for PG students is engineering, within engineering, the highest demand is Information technology and Computer sciences. The second subject area of high demand is the school of business and the third area is the built environment or architecture. The other areas

of interest are law, art and design.

Since 2017, the UNSW has noticed a very strong and growing interest in the under-graduate area. Many students, straight out of school, are going abroad for higher education.

As one of the world's leading research and teaching universities, UNSW's cutting edge research and innovation facilitated by 3,000 faculty - is known for acceptance and successful commercialisation

National health scheme: Focus on system to check fraud

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edicated fraud detection cells in every State and at the national level, 100 per cent death audits and advanced data analytics - these are some of the elements of the zero tolerance policy for fraud in the Pradhan Mantri Jan Arogya Yojana (PMJAY).

The National Health Agency (NHA), which is the implementing authority for the Rs 5 lakh health assurance/ insurance scheme, has drawn up elaborate guidelines for fraud detection.

It is also in talks with some of the world’s biggest data analytics companies like IQVIA, LexisNexis, Optum (UHL), IrisTech and SAS for proof of concept for a system for fraud prevention, detection and deterrence. The companies have offered to provide the proof of concept design pro bono, and, based on those designs, the NHA will call for global tender. The guidelines have already been sent to the States A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM RARE SURGERY

Doctors at Amrita Hospital perform rare surgery

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he paediatric surgeons at Amrita Hospital in Kochi have successfully performed a surgery on a 22-weekold foetus to remove an obstruction in urine flow that was damaging the kidney of the unborn baby. The surgery brings the country on par with developed nations, said Amrita Institute of Medical Sciences (AIMS) paediatric surgery head Dr Mohan Abraham. The 28-year-old patient from Thrissur and residing in Dubai, had arrived in the hospital for a routine check-up.

“The condition may have turned fatal if left untreated. A team of six surgeons from the department of paediatric surgery operated on the foetus,” he said. AIMS Fetal Medicine professor Dr Vivek Krishnan said this was the first time in India a 22-week-old foetus was treated in the mother’s womb

Apollo Hospital performs a rare quadruple joint replacement surgery

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octors at Apollo Hospital, Chennai, have performed a rare quadruple joint replacement surgery on 23-year-old Amit Kar. He started to develop pain in his neck, hips, knees and back at the age of 16.

It rapidly worsened, when his hips and knees became stiff, and extremely painful making him completely immobile. He was diagnosed with Ankylosing Spondylitis, a condition that commonly affects the spine and hips, and sometimes other joints like knees and shoulders. This condition is common in men and occurs in the age group 20-30 years.

Dr. Arun Kannan, orthopaedic surgeon, and his team decided to perform a quadruple joint replacement surgery — replacement of both hips and both knees. “This surgery was performed in two stages in two weeks. In the first stage, the right hip and right knee were replaced and next in the second stage the left hip and left knee were replaced. Both stages required awake fibreoptic intubation — a specialised anaesthetic technique where the airway tube is placed while the patient is awake,” said Dr Kannan.

As he hasn’t walked in four years, specialised rehabilitation techniques were used to help him regain muscle strength

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Surgery for unusual growth of bumps

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octors of MKCG Medical College and Hospital, Berhampur, Odisha, have proved their mettle by performing a rare surgery on a sixyear-old boy, who was suffering from an unusual growth of bumps and black hair on his body.

The boy, Kanha Nayak, is the son of a labourer Ramchandra Nayak of Baghua village under Jagannathprasad block in Ganjam district and has been suffering from the rare disease since birth.

Doctors at Jagannathprasad had given up hope and said that the boy would

not survive. However, Kanha survived but was ridiculed by kids in the village for his unusual appearance.

The boy’s plight was highlighted in the media and the Chief Minister’s Office apprised of the youngster’s condition.

The Block Development Officer of Jagannathprasad, moved by the boy’s plight, took the initiative and admitted him to MKCG Medical. The district administration chipped in and assured to meet the expenses for Kanha’s treatment.

Once the boy was admitted to the premier hospital, several tests were conducted following which the head of plastic surgery department of MKCG Medical, Dr Rajoo Dash, decided to perform a surgery to remove the additional growth from the boy’s body.

He said Kanha is suffering from Giant Congenital Melanocytic Nevus, in which the patient suffers from abnormally dark, non-cancerous patches on the skin since birth.

Dr Dash said it is feasible to operate upon patients who have such patches on 1 to 5 per cent of the body. But 40 per cent of Kanha’s body was covered with bumps and hair. He said in this case, surgery has to be conducted in phases. The first phase of the surgery was conducted by a team of 12 doctors. Dr Dash said the skin collected from Kanha’s thigh was grafted in the affected places. The surgery took around six hours

Tiruchi woman treated for rare tumour

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22-year-old woman from Tiruchi was treated for a rare condition that left her in severe pain while walking.

Iswarya Mohan had been suffering from osteoid osteoma (multiple tumours in her right heel bone) for a decade. She had undergone two surgeries but found no relief.

Iswarya Mohan approached orthopaedic surgeon N. Mayil Vahanan Natarajan in Chennai in July, who referred her to Dr. Navin Gnanasekaran of Westminster Hospital. He said only 13 or 14 cases of multifocal osteoid osteoma had been reported in the world since 1928.

Dr. Navin said although she had taken several scans in various places doctors had missed the five tumours in the calcaneum (heel bone). “The patient did not want another surgery. A 3T MRI scan revealed multiple tumours. We decided to do radio frequency ablation for the most vascular lesions by making two small incisions in the skin.”

“In a three-hour procedure, the benign vascular tumours were removed through radio frequency waves. There were no complications and after an hour of the procedure she was discharged,” he said A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM RARE SURGERY

Doctors give ‘the gift of grip’ to kid with rare condition Though people can survive without thumbs, they are unable to perform day-to-day activities easily and attract humiliating comments from others.

PSRI Institute of Orthopaedics chairperson P.P. Kotwal gave a ray of hope to the parents, who did not want their daughter to suffer. “We decided to reconstruct the thumb from the child's finger using a procedure called as pollicisation. The four-hour-long surgery involved rotating the child's index finger, shortening it, placing it where the thumb would normally be, and restoring the finger’s blood vessels and nerves,” said Dr. Kotwal.

He said the doctors had to ensure that the recreated thumb developed normally so the child would not be stuck with a baby-sized thumb. The new thumb — reconstructed from the index finger — looks like a thumb and also functions like one.

“It is an incredibly challenging operation. It is one of the most complex surgeries I do because a child’s hand is very small. Structures like the blood vessels, nerves, etc., are minuscule,” he said.

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he minute a mother saw the hand of her newborn baby her heart sank.

The newborn had an underdeveloped thumb in the right hand, which meant she would struggle with chores as basic as holding a pencil, fastening a button, tying the shoe-lace, etc. She suffered from a rare condition called radial club hand with hypoplastic 70 Medical Tourism Jul. - Sep. 2018

thumb that affects about one in every one lakh births.

The child's parents were worried about her future. A few months down the line, the child tried to pick up objects using her index and middle fingers as she could not use her thumb at all. She faced extreme difficulty in performing tasks that other children performed with ease.

“This surgery gives best results in terms of function if it is done when the patient is between one-year-old and 1.5-year-old. At this age, the adaptability of the brain to the newly reconstructed thumb is optimum. If an adult were to undergo the same procedure, he/ she would have a hard time learning how to use the new thumb because the mature brain does not have the same adaptability”. The surgery has left the child with one thumb and three fingers but many a times people do not notice that one finger is missing.

Moreover, the thumb is a very important digit that is essentially required in almost every function of the hand. In these children, the goal is to provide them a functional hand

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MEDICAL TOURISM SAFE SEX

SEX FACTS

FOR AGEING COUPLES Many people want and need to be close to others as they grow older. For some, this includes the desire to continue an active, satisfying sex life.

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s we grow old, it’s inevitable to feel depressed as we compare our life with others or with our past.

We need to accept our present and be happy because we can have different experiences (including sex) at different stages of our life.

Age is no bar for indulging in carnal pleasures for those who care to sustain a modicum of positivity in such matters, if we look into the lives of many celebrated figures in the world.

No matter how old you grow, mutual satisfaction is one of the most important factors responsible for a fulfilling sex life. As our body changes with time, we may feel certain inadequacies in our sex life.

feel closer to your age when you grow old, the quality of your sex life will also deteriorate. A lot depends on how interested a person is in having sex as he or she grows old.

For some reason, many people think sex belongs to the young. If that were the case, our whole species would lose all sexual feelings as they age — and we know that doesn’t happen. We are clearly designed to live longer and better if we have an active sex life. Sexual contact correlates to better health, higher relationship satisfaction and easier stress management. So it is far from natural to stop wanting or having sex.

Rather, our lives depend on us keeping our sexual energy and connection in tact.

So, instead of focusing on how long or how often you have sex, it’s more important to concentrate on achieving mutual satisfaction. Like all good things in life, people should worry more about quality than quantity and this includes your sex life too.

Many people want and need to be close to others as they grow older. For some, this includes the desire to continue an active, satisfying sex life. With aging, that may mean adapting sexual activity to accommodate physical, health, and other changes.

No matter how old you grow, you can still have a fulfilling sex life if you feel young at heart. Which means, if you

There are many different ways to have sex and be intimate—alone or with a partner. The expression of your sexuality could include many types of touch

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or stimulation. Some adults may choose not to engage in sexual activity, and that’s also normal.

WHAT CAUSES SEXUAL PROBLEMS? Some illnesses, disabilities, medicines, and surgeries can affect your ability to have and enjoy sex.

Arthritis. Joint pain due to arthritis

can make sexual contact uncomfortable. Exercise, drugs, and possibly joint replacement surgery may help relieve this pain. Rest, warm baths, and changing the position or timing of sexual activity can be helpful.

Chronic pain. Pain can interfere with

intimacy between older people. Chronic pain does not have to be part of growing older and can often be treated. But, some pain medicines can interfere with sexual function. Always talk with your doctor if you have side- effects from any medication.

Dementia. Those with severe de-

mentia may not recognize their spouse or partner, but they still desire sexual contact and may seek it with someone else. It can be confusing and difficult to know how to handle this situation.

Alcohol. Too much alcohol can cause erection problems in men and delay orgasm in women.

CAN EMOTIONS PLAY A PART?

Here, too, talking with a doctor, nurse, or social worker with training in dementia care may be helpful.

Diabetes. Women with diabetes

are more likely to have vaginal yeast infections, which can cause itching and irritation and make sex uncomfortable or undesirable. Yeast infections can be treated.

Heart disease. People who have had

a heart attack, or their partners, may be afraid that having sex will cause another attack. Even though sexual activity is generally safe, always follow your doctor’s advice. If your heart problems get worse and you have chest pain or shortness of breath even while resting, your doctor may want to change your treatment plan.

Incontinence. Loss of bladder control or leaking of urine is more common as people, especially women, grow older.

This can be helped by changing positions or by emptying the bladder before and after sex. The good news is that incontinence can usually be treated.

Stroke. The ability to have sex is

sometimes affected by a stroke. A change in positions or medical devices may help people with ongoing weak-

ness or paralysis to have sex. Some people with paralysis from the waist down are still able to experience orgasm and pleasure.

Depression. Lack of interest in

activities you used to enjoy, such as intimacy and sexual activity, can be a symptom of depression. It’s sometimes hard to know if you’re depressed. Talk with your doctor. Depression can be treated.

Surgery. Many of us worry about having any kind of surgery—it may be even more troubling when the breasts or genital area are involved. Most people do return to the kind of sex life they enjoyed before surgery.

Medications. Some drugs can cause

sexual problems. These include some blood pressure medicines, anti-histamines, anti-depressants, tranquilizers, Parkinson’s disease or cancer medications, appetite suppressants, drugs for mental problems, and ulcer drugs. Some can lead to ED (Erectile Dysfunction) or make it hard for men to ejaculate. Some drugs can reduce a woman’s sexual desire or cause vaginal dryness or difficulty with arousal and orgasm. Check with your doctor to see if there is a different drug without this side- effect.

Many older couples find greater satisfaction in their sex lives than they did when they were younger. In many cases, they have fewer distractions, more time and privacy, no worries about getting pregnant, and greater intimacy with a life-long partner.

Years of sex with the same partner boost happiness. For, elevated happiness quotient is an integral part of emotional and sexual satisfaction.

In addition to containing sperm, semen is also filled with oxytocin and serotonin—two “feel good” hormones that make a beeline for the brain, says Stephanie McClellan, MD, a gynaecologist in Newport Beach, CA. “Multiple studies have shown that women who have been exposed to the same semen on a regular basis actually have lower levels of depression and higher levels of joy and happiness,” McClellan says.

While this fits with the messages we receive from popular culture, which tell us that sex is a young person’s domain, it is somewhat at odds with the fact that older adults continue to explore and enjoy sexuality well into old age.

The majority of men and women over 60 in the U.S. are sexually active, most at least two to three times per month (more often than many younger adults).

They also rate sex as an important part of life A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM FOOD

AVOCADO

A PRIZED FRUIT FOR THE HEALTH CONSCIOUS GENERATION

By Nadine Vattappara

74 Medical Tourism Jul. - Sep. 2018

O

n a hot summer afternoon, I ran into a small juice shop.

Seated casually behind the table, I quickly browsed through the menu searching for something to quench my thirst. I saw an option which said butter-fruit milkshake. Even though it was a sultry hot day, a small laugh escaped my lip because I thought to myself, “what a queer name?”. Determined to try it out, I placed the order and I waited for the order to reach me. Meanwhile, I searched online to know more about the then ‘mysterious fruit’.

Avocados are also called ‘alligator pear’ because of its tough skin and a leathery appearance. But in certain parts of India, this fruit is known as butter-fruit.

Due to the extra research and studies done on this fruit people have started understanding its health benefits and, therefore, the sale of avocado has gone up radically.

One of the amazing facts about avocado is that because of its thick skin preservatives cannot be used on this fruit. The thick skin also provides natural resistance against insects and other pests. It is one of the safest foods which can be consumed on a regular basis. People won’t find a separate category called ‘organic avocado’ because everything about this fruit is organic.

Evidence in caves shows avocados have a long history dating back to centuries. This fruit has been part of Mexico for a really long time. Mayans (they lived in modern-day Mexico during 2600 B.C) and the Olmecs (they lived in modern-day Mexico in 1400B.C) were also its consumers. Later after the colonization, this fruit travelled to America and Europe and later to the rest of the world.

Like most fruits, avocado trees grow well in tropical, sub-tropical and equatorial areas. The fruit can weigh anything between 220 gms to 1.4 kg.

Like banana, this is also a climacteric fruit. Avocados get harvested early and later they ripen over time.

This fruit is rich in mono-unsaturated fats, which make its texture creamy and smooth. It contains a lot of fibre, vitamins, and minerals such as vitamin K, vitamin E, vitamin C and B, potassium, and copper.

HEALTH BENEFITS INCLUDE: Anti-cancer properties- Researchers have proved that this fruit can decrease the risk of breast cancer and a few other types of cancer because this fruit has cell regeneration properties that help clear out the affected cancer cells from the body.

Improves overall health- This fruit improves the nutrient absorption in the body and this way, it helps people keep healthy, in spite of today’s poor dietary habits.

Great for Skin- This fruit has the “good” poly-unsaturated and mono-unsaturated fats that are healthy for your system. It also prevents clogged arteries and bad circulation.

Protects eyes- This fruit is rich in antioxidants like Lutein and Zeaxanthin. These are essential for eye health.

These reduce the risk of cataracts and muscular degradation.

Provides Dental Care- As bad breath is caused by upset stomach or indigestion, antioxidants and anti-bacterial properties in the fruit can help keep the mouth fresh and can also kill the bad- breath causing bacteria in the mouth.

Improves Longevity- This fruit has vitamins that encourage cell-regeneration.

Xanthophylls, a powerful antioxidant within this fruit helps decrease signs of the aging process of different parts of the body.

Strengthens bones- Avocados contain zinc, phosphorous, copper, and trace amounts of calcium and selenium which lowers risks of osteoporosis (a condition in which bones weaken and fracture easily) and these, in turn, improves bone mineral density.

Helps weight loss- The main component of this fruit is fat, therefore, it is not included in calorie- restricted diet.

But most of its fat can be categorized under fibre. This property will help satiate one’s hunger. This fruit does help reduce body weight and it is also low in carbohydrates.

Reduce Arthritis- The anti- inflammatory properties in the fruit can help reduce the inflammation in tissues,

joints and muscles. Arthritis has been a common disease these days and studies have shown that consumption of this fruit in adequate quantity can reduce the pain.

Healthy Heart- When compared to Banana which contains 10% potassium, avocado contains 4% more. Potassium is rarely found in our diet and it is necessary to maintain the electrical gradient between the cells. It keeps a check on the blood pressure levels and reduces the risk of getting a heart attack, stroke or kidney failure.

Lowers cholesterol and triglyceride: Research shows this fruit can lower bad cholesterol (LDL) by 22% and improves good cholesterol levels (HDL) by 11%, if it is consumed for a longer period, Helps liver- Avocados have anti-inflammatory properties because it contains Vitamin E and K, both these together reduce cellular inflammation. And this will support the liver health.

Prevent Bleeding- Vitamin K deficiency causes bleeding disorder and is commonly seen in new born babies. As this fruit is loaded with Vitamin K, intake of this fruit during pregnancy reduces the risk of new-born babies being born with this disorder.

These days we can find several ‘Avocado Delights’ such as milk-shakes, raw avocado soup, avocado mango salad, chickpea and avocado sandwiches, and avocado- filled wraps and dips.

Avocados rose to visibility just a few years ago. Though the old school food experts consider it a super fruit, one cannot consume more than one a day, as it is a high- calorie fruit and certain precautions have to be taken.

Over consumption can cause diarrhoea and nausea and in certain situations, allergies might also develop. People who are found to have allergies to potatoes, tomatoes, and peaches are likely to be allergic to avocado. We all should keep in mind that even though the fruit can be considered to be an elixir, it should be consumed in moderation

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MEDICAL TOURISM DIET

A GUIDE TO THE KETOGENIC DIET

WHAT IS A KETOGENIC DIET? The Ketogenic Diet is a very low-carb, high-fat diet that shares many similarities with the Atkins and low-carb diets.

It involves drastically reducing carbohydrate intake and replacing it with fat.

This reduction in carbs puts your body into a metabolic state called ketosis.

When this happens, your body becomes incredibly efficient at burning fat for energy. It also turns fat into ketones in the liver, which can supply energy for the brain. Ketogenic diets can cause massive reductions in blood sugar and insulin levels. This, along with the increased ketones, has numerous health benefits.

KETOGENIC DIETS CAN HELP YOU LOSE WEIGHT A ketogenic diet is an effective way to 76 Medical Tourism Jul. - Sep. 2018

lose weight and lower risk factors for disease. In fact, research shows that the Ketogenic Diet is far superior to the often recommended low-fat diet.

Whatâ&#x20AC;&#x2122;s more, the diet is so filling that you can lose weight without counting calories or tracking your food intake.

One study found that people on a Ketogenic Diet had lost 2.2 times more weight than those on a calorie-restricted low-fat diet. Triglyceride and HDL cholesterol levels also improved.

Another study found that people on the Ketogenic Diet lost 3 times more weight than those on the diet recommended by Diabetes UK.There are several reasons why a Ketogenic Diet is superior to a low-fat diet, including the increased protein intake, which provides numerous benefits.

The increased ketones, lower blood sugar levels and improved insulin sensitivity may also play a key role.

A SAMPLE KETO MEAL PLAN FOR 1 WEEK To help get you started, here is a sample Ketogenic Diet meal plan for one week:

MONDAY Breakfast: Bacon, eggs and tomatoes.

Lunch: Chicken salad with olive oil and feta cheese.

Dinner: Salmon with asparagus cooked in butter.

TUESDAY Breakfast: Egg, tomato, basil and goat cheese omelet.

The Ketogenic diet (or keto diet, for short) is a low-carb, high-fat diet that offers many health benefits. In fact, over 20 studies show that this type of diet can help you lose weight and improve your health.

Ketogenic diets may even have benefits against diabetes, cancer, epilepsy and Alzheimerâ&#x20AC;&#x2122;s disease.

Lunch: Almond milk, peanut butter, cocoa powder and stevia milkshake.

Dinner: Meatballs, cheddar cheese and vegetables.

WEDNESDAY Breakfast: A Ketogenic milkshake. Toss in the coconut milk, half a ripe avocado, coconut oil, raw cacao, cinnamon, and stevia (if using), and pulse for five minutes for a silky smooth texture.

Lunch: Shrimp salad with olive oil and avocado.

Dinner: Pork chops with Parmesan cheese, broccoli and salad.

THURSDAY Breakfast: Omelet with avocado, salsa,

peppers, onion and spices.

Lunch: A handful of nuts and celery sticks with guacamole and salsa.

Dinner: Chicken stuffed with pesto and cream cheese, along with vegetables.

FRIDAY Breakfast: Sugar-free yogurt with peanut butter, cocoa powder and stevia.

Lunch: Beef stir-fry cooked in coconut oil with vegetables.

Dinner: Bun-less burger with bacon, egg and cheese.

SATURDAY Breakfast: Ham and cheese omelet with vegetables.

Lunch: Ham and cheese slices with nuts.

Dinner: White fish, egg and spinach cooked in coconut oil.

SUNDAY Breakfast: Fried eggs with bacon and mushrooms.

Lunch: Burger with salsa, cheese and guacamole.

Dinner: Steak and eggs with a side salad.

Always try to rotate the vegetables and meat over the long term, as each type provides different nutrients and health benefitsď&#x20AC;ź

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