www.medgatetoday.com
Volume I Issue III
Sept.-October 2010
Gateway to Health & Medical World
VASER a new age tool for liposuction
Post delivery...
Glaucoma Awareness
Dental Implants
Physiotherapy a Dynamic Science MEDGATE TODAY ` 75
News update | Doctor Speak | Beauty & Cosmetic | Dental Hygiene | Health & Fitness | Expert Views
ISO 9001:2008
A complete product range of privacy rail systems G-Rail privacy rail system is a strong, functional and fully reversible profile. Comprehensive range of accessories, rotating gliders with SS-hook.IV Hanger (telescopic), curtain holdback etc Synthetic wall and ceiling fittings allow privacy rail to comply with the European NEN-314 standard for special care rooms requiring anti-static facility.
A complete range of privacy curtains: Economical curtains range: WINDOW TECHS offer you the economical range of hospital cubical curtains that are safe, durable and last through out the lifetime. Trevira CS bioactive curtains range: Trevira CS curtains are so effective in resisting fire and bacteria that they can actually help to prevent fire and bacteria from spreading. This flame-resistance is inherent in the specially designed fibers and is therefore permanently effective. Shower curtains range: Shower curtain fabrics are self sanitizing and have fluid proof, flame resistant and non reactive properties that make it more durable and life long. Poly vinyl chloride & its substitutes are the most common methods used in manufacturing of shower curtain fabrics.
Manufactured in India by: WINDOW TECHS RZ-483 / 13A Tuglakabad Extn. New Delhi - 19 (INDIA) Phone No. +91-11-29992146, Telefax +91-11-29992147 E-mail: window_techs@yahoo.co.in, visit us at www.hospitalcurtains.in
* An ISO 9001:2008 Certified Hospital * 24 Hours Emergency Facilities * ICU, ICCU with Ultra Modern Equipment * Non Invasive Cardiac Lab For 24 Hours including Echocardiography TMT, PFT, HOLTER, AMBULATORY BP Monitoring E.C.G. * X-Ray, USG, Pathological Lab * 24 Hours Ready O.T With Ultra Modern Equipment * Free Ambulance with Ultra Modern Emergency Equipment * Heamo - Dialysis etc. * Round the clock medicine counter
Muzaffarpur Heart Hospital & Research Centre Pvt. Ltd. Bank Road, Muzaffarpur (Bihar)
Tel. 0621 - 2245478 (O), 0621 - 2243860 (H) Email: drajay111@yahoo.com
E D ITO R S P E A K
Physiotherapy a dynamic science, is an integral part of Modern ScientiÁc Medicine Physiotherapy is a drugless therapy and has major role in prevention and medical rehabilitation of physically handicapped. Physiotherapy is a healthcare profession concerned with the assessment and treatment to restore the physical function and performance of the body. It is a distinct form of care which can be performed both in isolation or in conjunction with other types of medical management for example surgery. Physiotherapy deals with a wide range of injuries and disease processes and other conditions which include: • • • • • • • • • •
Sports Injuries Back and neck pain Postural Problems Occupational Injuries Arthritis Stroke Rehabilitation Neurological Conditions Impaired Mobility Post Surgical Rehabilitation Cardiac Rehabilitation
The profession is receptive to change and welcomes the increasing focus on rehabilitation within the modernization of healthcare. Emphasis is placed on the development of practical skills and treatment techniques built on sound theoretical and research base. Any thoughts or question you may have mail us: info@medgatetoday.com
Dr. M A KAMAL Editor-in-chief
2
Sept – Oct 2010
Contents N EWS
U P D AT E Ld Technology USA introduces a revolutionary health product in india-esteck complex
6
Mandatory Ă‚u vaccine for all healthcare personnel
6
Dengue fever spreading in Delhi Britain issues travel advisory on dengue in Delhi
8
HbA1c for diabetes diagnosis on its way
H E A LT H &
FITNESS
Drinking Cold Water after a meal = Cancer! anc an nccer n er!!
51
50
Heart H Attacks and A Drinking Warm Water
BEAUTY &
DOCTO R
COSMETIC
EYE
SPEAK
24
VASER A new age tool for liposuction
CARE
32 Post delivery... Bodily Changes & what to expect
36 GLAUCOMA AWARENESS
Volume 1ŕ´ŞIssue 3
EDITOR Dr. M A Kamal EDITORIAL ADVISOR Dr. Ajay Kumar Dr. S L Shah Dr. Shakilur Rahman Dr. Piyush Pankaj CHIEF CORRESPONDENT S A Rizvi Dr. H N Sharma DESIGN & LAYOUT SPRING Design SALES & MARKETING Amjad Kamal Kashif Saigal Nitu Sinha Rahul Ranjan S Firoz SUBSCRIPTION & CIRCULATION Pallavi Gupta All rights reserved by all everts are made to ensure that the information published is correct, MEDGATE TODAY holds no responsibility any unlikely errors that might occur.
D E N TA L
HYG I E N E Dental Implants lan an nts
42
INDEX TO ADVERTISER
PUBLISHED BY ADVANCE MEDIA GROUP
Advance Health Care ...............7 Corporate Gift ........................47 Edrees Medical .......................55 Frontline Systems ...................56 Hospaccx India .......................39 Hospital Infrastructure ... Inside Back Cover Human Diagnostic .................25 LD Technology .......................29 Life Care .................................20 Life Plus ..................................30 M4 Biomedica ........................45 Medicall ..................................14 Modern Treatment .................35 Mohan X-Ray .........................13 Muzaffarpur Heart Hospital ....1 Ranbaxy ...................Back Cover Sharma Diagnostic ...................9 Steelcraft .................................15 Technocare .............................31 Webcon .....................................3 Window Tech ........ Inside Cover World Dental Show ................41
Regd. Office: B 105, DDA FLATS, POCKET 11, JASOLA VIHAR, NEW DELHI-110025 Mob: +91 9289336800 E-mail: info@medgatetoday.com medgatetoday@gmail.com Visit us: www.medgatetoday.com
Circulation Office 92/17, Zakir Nagar, Opp. New Friends Colony Okhla, New Delhi - 110025 Tel.: +91 11 26989438 Fax: +91 11 26982464 Mobile: +91 9289336800
Kolkata Office 74, 2nd Floor. Bentinck Street, Kolkata 700001 Mobile: +91 9088848636
Mumbai Office 7, Ground Floor, Aradhana CHS Ltd, Bal Samant Marg, Bandra (W), Mumbai 400050 Tel: +91 22 26452920
Printed by B.B.Graphic Printer, E-49/8 (2nd. Floor), Okhla Industrial Area Phase-II, New Delhi-110020
N EWS
U P D AT E
Ld Technology USA introduces a revolutionary health product in india-esteck complex Launched body screen test equipment in India Medgate Today spoke to LD Technology: Mahendra Bisawa, CEO of LD TECHNOLOGY INDIA PRIVATE LTD, and is instrumental in bringing this technology to India, spoke to Medgate Today Magazine in Medicall 2010 in chennai “We are proud to say that we are exclusively distribute the equipment and also provide training and technical support. This is a simple body screen test process which is not only alert you about your body movements, but also give indications regarding
your health that you may face in the future as well. This will help you to take care of your health with the easy instructions provided by the test results. This body-screen process has been well accepted all over the world. So far, 4,000 equipments have been installed worldwide. Our main intention to take this technology to benefit the most people in the rural India in a mass level, where the awareness in healthcare is very limited”. For India, this is a new technology, but simple, non-invasive, safe, affordable for all classes of the society, harmless, fearless, no pre-conditions before the tests,
Dr. Albert Maarek (CEO, Ld Tech, USA) with Mr. Mahendra Bisawa (CEO, LD Technology, India Pvt .Ltd.) and the whole process takes only 5 minutes. It has been proved that there is no adverse reaction after the test, and is very effective all over the world in the last 10 years. The equipment is also certified by the U.S.Food and Drug Administration and all the leading international health bodies. We also have an exclusive agreement to promote this medical equipment in Sri Lanka, Bangladesh, Nepal and other neighbouring countries.
Mandatory flu vaccine for all healthcare personnel Vaccination Should Be Requirement for Continued Employment for Healthcare Personnel, Epidemiologists and Infectious Disease Physicians Say Influenza vaccination of healthcare personnel is a professional and ethical responsibility and non-compliance with healthcare facility policies regarding vaccination should not be tolerated, according to a position paper released today by the Society for Healthcare Epidemiology of America (SHEA). The paper, published in this month’s Infection Control and Healthcare Epidemiology journal and endorsed by the Infectious Diseases Society of America (IDSA), stresses influenza vaccination of healthcare personnel as a core patient safety practice that should be a condition of both 6
initial and continued employment in healthcare facilities. According to SHEA, their recommendations apply to all healthcare professionals in all healthcare settings, regardless of whether the professional has direct patient contact or whether he or she is directly employed by the facility. The policy also applies to students, volunteers, and contract
workers. The only exemptions, say the epidemiologists and infectious disease physicians, should be in cases of medical contraindications. “The transmission of influenza in healthcare settings is a substantial safety concern for both patients and healthcare personnel and deserves our attention and action,” said Neil Fishman, MD, president of SHEA. “Healthcare providers are ethically obligated to take measures proven to keep patients from acquiring influenza in healthcare settings. Mandatory vaccination is the cornerstone to a comprehensive program designed to prevent the spread of influenza which also includes identification and isolation of infected patients, adherence to hand hygiene and cough etiquette, the appropriate use of protective equipment, and restriction of ill healthcare personnel and visitors in the facility.” Sept – Oct 2010
KNEE SUPPORT ANKLE SUPPORT VERICOSE VEIN SUPPORT TENIS ELBO SUPPORT ADVANCE HEALTH CARE
Manufacturer of or tho and Rehabilitation Aids
C-162, Prem Nagar - II, Nangloi, Delhi - 110 041 Mobile: +91 9310039239, +91 9968139239 Email: info@advancehealthcare.in Website: www.advancehealthcare.in
N EWS
U P D AT E
Dengue fever spreading in Delhi Dengue cases cross 1,000 in Delhi N.Delhi is affected by the dengue fever that can sometime be deadly and this is due to the breeding mosquitoes after the monsoon. Dengue fever is a benign acute febrile syndrome occurring in tropical regions, which is the most important mosquito (Aedes aegypti), transmitted viral disease. The virus causes Dengue shock syndrome in 20-30% of infected cases. There are four types (known as “serotypes”) of dengue. Infection and recovery from one type of dengue does not protect a person from another type. Dengue Hemorrhagic Shock Syndrome (DHSS) is a dangerous implication in which fever is followed by the collapse with shock, decreased blood pressure and signs of hemorrhage. The
shock increases the production of the hormone adrenaline, which in turn increases the heartbeat. Blood is pumped faster resulting in more hemorrhage and the heart becomes overworked. Dengue infection weakens the wall of the blood vessels resulting in plasma leakage; disease suppresses the production of platelets that help in the clotting of blood. If the process continues unchecked, the volume of blood decreases due to leakage, the blood pressure drops and the platelet count reduces. Bleeding occurs in patients with severe shock syndrome. “The fever lasts about seven days and the patient has severe body ache. It's in fact known as a bone-breaking fever. But dengue hemorrhagic fever is a far more serious condition, which generally occurs in patients who have already experienced dengue.”
HbA1c for diabetes diagnosis on its way Diabetes will soon be diagnosed using HbA1c measured in mmol/mol despite some imperfections in the technique “so you’d better get used to it,” Professor Peter Colman told a packed audience at the Australian Diabetes Society Annual Scientific Meeting yesterday. The American Diabetes Association, the International Diabetes Federation and the European Association for the Study of Diabetes all recommend the use of the haemoglobin A1C assay for the diagnosis of diabetes. However, one of the main problems with using HbA1c was the standardisation of assays from different labs, said Professor Colman from the Royal Melbourne Hospital.
Britain issues travel advisory on dengue in Delhi Britain issued an advisory to its citizens travelling to New Delhi, saying the capital was currently experiencing a “seasonal outbreak of dengue fever”. “New Delhi is currently experiencing a seasonal outbreak of dengue fever,” Britain's Foreign and Commonwealth Office said in its travel advisory, modified Wednesday evening. 8
“According to Indian Government statistics, the number of confirmed cases to date is significantly higher than for the same period in recent years. The Municipal Corporation of Delhi expects the number of cases to rise in September and October,” the advisory said.
Sept – Oct 2010
All Kind of Laboratory · · · · · · · · · · · · · ·
Haematology Biochemistry Liver Function Test Kidney Function Test Elisa Tests Hiv (Aids) 1&2 Tumour Markers Hepatitis Profile Hormone Assay Bacteriology Cytology & Histopathology Urine Examination Stool Examination For Sputum
SHARMA DIAGNOSTICS Dr. Jagdeo Sharma
Dr. B K Sharma
Dr. Rajiv R Sharma
MD (Path), DCP, FIAMS
MD (Path), DCP, FAMS
MD (Biochemistry), FAMS
Address VIP Road, Bengalitola Chowk Laheriasarai – 846001 Darbhanga (Bihar) Phones 06272-244667, 244608 Mobile 09334921864 E-mail shdiagno@hotmail.com
N EWS
U P D AT E
5 MEDICALL th
T
he 5th edition of MEDICALL expo was inaugurated by the Vice Chancellor of Dr.MGR Medical University, Dr.Mayilvahanan Natarajan at Chennai trade centre on August 6th at Chennai. Concurrent exhibitions on Rehabilitation products, Rehab Expo and laboratory equipments, Medicallab was held during medicall expo More than 8000 visitors including hospital owners, distributors, embassy officials, purchase mangers,
hospital administrators and biomedical engineer visited the three day event. A trade delegation from west Africa and Hong Kong were past of visitors. Around 400 exhibitors from India, China, Taiwan, Germany, Italy and England participated in the show. The exhibitors participated with the objective of meeting new clients, to seek agents, to display new products, to serve existing customers, to assess the market potentials. The visitors came with the objective of purchasing equipments for their hospitals, learning newer technologies, searching for partners and academic exchange. Wide variety of products including Furniture, OT lights, Tables, Building materials, Ambulance, laboratory equipments, Software, Endoscopes, Ventilators, ICU monitors, Modular OT, Hospital garments, Waste management
10
products, Sterilization equipments, Radiology equipments, Rehabilitation equipments etc., were displayed by various exhibitors. Two national and two international seminars were organized during the show. Seminar on Audit in hospitals attracted hospital owners from various parts of the country. Mr. Manivannan from Parama helathcare spoke on Operational audit. He gave a deep insight on the various areas of revenue leaks and methodologies to arrest them. Mr. Ananthapadmanaban from Kovai Medical Center and hospital stressed the importance of energy audit in reducing the power consumption in hospitals. Mr. Sethuraman, Partner, KPMG, deliberated on various aspects of financial audit in hospitals.
Sept – Oct 2010
N EWS
U P D AT E
Expo 2010 Dr. Ramsubramanian from Apollo Hospitals, enumerated various strategies to reduce infection in hospital The second day seminar on cost control in cost hospitals was well received by hospital administrators. Mr. Ramesh Emani’s lecture on role of IT in hospitals, threw light on various departments which benefit from IT integration. Dr. Deepali, Inlakhs Budhani hospital spoke on reducing waste using lean management techniques in healthcare, this technique, which was earlier used by manufacturing sector is now found useful in healthcare to rescue the treatment cost. Dr.Manivannan from KMC hospital spoke on optimizing resources and gave few examples of how Business
Sept – Oct 2010
intelligence helps to keep hospitals healthy. Mr.Manivannan’s lecture, on Analyzing financial reports, enlightened the audience on the complicated topic. The visitors felt the seminars helped them to update their hospital management skills and the exhibition helped them to upgrade their hospital. The next MEDICALL show is planned in Kolkata in February 2011 and at Chennai in August 2011.
In conjunction with MEDICALLAB 2010, we had an interactive Seminar on Molecular Diagnostics. The Seminar was attended by more than 100 delegates from India, USA, UAE and Mauritius. The delegates were keen to know more about the latest developments in this field. The Seminar was inaugurated by Dr Suchirta Mannivannan, leading Gynecologist and Dr CN Srinivas,Leading Pathologist. Dr Rekha Pai from Molecular Biology
Post Seminar Report: Seminar on Molecular Diagnostics. The 5th edition of the MEDICALL 2010 and 2nd Edition of MEDICALLAB 2010 began on Aug 6th 2010.
11
N EWS
U P D AT E
Dept, CMC Vellore introduced to all the basics of the Molecular Biology, diagnostics and the history. Her main keep points were that the dept of Molecular diagnostics are rapidly developing in field of Diabetes and communicable diseases. Dr Rajan Dewar from Harvard Medical School, USA enlightens the delegates on how to set up a Molecular Diagnostics lab in under sourced Country like India. He also delivered session on the utility of the Molecular Diagnostics in haemato-Oncology. His main stress was to build upon the needs of the Physician and Oncologists who can support the Basic Science Lab and also develop Research lab. In this way the Demographical differences can be highlighted to World and Also put Protocols for practice of Personalised medicine. As an Active member of Association of Molecular Pathology and College of American Pathologists, he enlightened how the Association of Indian Pathologists of North America (AIPNA) helps Lab professionals from India to develop the Molecular labs, implement quality assurance and develop centres of Excellence in Research. He informed that The Members of AIPNA were readily accessible to Indian Lab professionals to host scientific activities and educational events like CME and Workshop.
12
He also introduce to lot of Cost effective ways of Doing Molecular Diagnostics like having network of Lab heads in city, state in bringing centralisation of efforts to cut down costs on these expensive tests. The layout of the labs and also the design are very important to prevent cross contamination which alters the report. He agreed that the Current costs of these tests are expensive but can be subsidised if group of Scientists pool the resources and sign an under standing. Dr Todd Barry,Director of Clarient Diagnostics,USA was another international speaker who helped us to understand Basics of FISH and Genetics in Solid tumours. He summarised the new ASCO guidelines on utility of the FISH (Fluorescent in Situ hybridisation) techniques for the Breast Cancers. The HeR2 receptor study is very important in Prognostication. He also educated the delegates on the ideal requirement for processing Breast cancer specimens. The Solid tumour FISH and utility of the same in Lymphomas, Multiple Myeloma, small cell tumours and Gastric Carcinomas were also discussed. Dr Camilla Rodrigues,Microbi ologist,Hinduja hospital,India gave an insight of the emerging Drug resistant Tuberculosis strain in normal and AIDS patient. She spoke on the new Rapid Confirmatory TB test which was patented by her lab and is going commercial in next few months. She insisted a personal
discussion with the clinician and Microbiologists when a case of drug resistant Tuberuculosis is met with. The Personalisation of the medicines for the Infectious disease like TB is important so that we curtail the spread of Antibiotic resistant strains. Her talk also included the minimum Requirement for Biosafety in Mycobacteriology lab. Dr Ira Goud,Cytogeneticist from Hyderabad motivated and touched everyones’ heart by depicting about fifteen cases of pediatric cytogenetics abnormality. She also insisted on Good Counselling services which are much essential in practice of Cytogenetics. Very important diagnosis can be missed if the cytogenetics is not done on dysmorphic children was her motto of her talk. The most important aspect of the seminar was that Every speaker took the delegates to world of Personalised medicine, demystified that Molecular diagnostics are Too expensive and educated how to network to other to have a common platform to discuss issues in India. They also proposed to have a small forum for networking. The Multimedia of each speaker was excellent with video clippings, animations and photos of their lab and work. The seminar concluded with Vote of thanks and question and Answer session.
Sept – Oct 2010
MOHAN® X-RAY LAB.
X-Ray (Contrast & Plain) Ultrasound (With Ivt, Irt, Hf, Linear Probes) Color Doppler Echo & Peripheral Studies E.C.G., E.E.G., EMG+, NCV Clinical Lab With Blood Gas Analyser Coagulation Analuser, Ion Analyser, Chemistry Analyser, Cell Counter, Hormones (By Ria & Irma) All Elisa Tests, Torch, Hepatitis, Cancer Markers Etc.
All Kind of X-Rays
Laboratory
• I.V+P. • MCU-RGU • Ba.Meal & • Ba.Meal F.T. • Ba Swallow • Dental X-Ray / OPG • HSG • CT Scan / MRI
• • • • • • •
Pregnancy Test
Mantoux Test
Haematology Biochemistry Liver Function Test Kidney Function Test Elisa Tests Hiv (Aids) 1&2 Tumour Markers
• • • • • • •
Hepatitis Profile Hormone Assay Bacteriology Cytology & Histopathology Urine Examination Stool Examination For Sputum
Semen Analysis
* FREE SAMPLE COLECTION & REPORT DELEVERY Contact Person Nitin Ahuja 9868226611
Ajinder Pal 9818200824
12A, (FF) Main Market, Yusuf Sarai, Above Jaina Mobile, New Delhi - 110 016 Tel.: 26184748, 26174708 E-mail: nitin.mohanxray@gmail.com
COVE R
STORY
Physical Physiotherapy aims to get you back to your normal physical state following an accident, surgery or any other trauma. This can be done by relieving pain, restoring normal movement and then teaching you how to maintain this healthy state through advice and exercise to keep you fit
16
Sept – Oct 2010
COVE R
STORY
therapy
(physiotherapy)
P
hysical therapy (also physiotherapy) is a health profession that assesses and provides treatment to individuals to develop, maintain and restore maximum movement and function throughout life. This includes providing treatment in circumstances where movement and function are threatened by aging, injury, disease or environmental factors. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation. This encompasses
Sept – Oct 2010
physical, psychological, emotional, and social well being. It involves the interaction between physical therapist (PT), patients/clients, other health professionals, families, care givers, and communities in a process where movement potential is assessed and goals are agreed upon, using knowledge and skills unique to physical therapists.Physical therapy is performed by either a physical therapist (PT) or an assistant (PTA) acting under their direction. PTs use an individual's history and physical examination to arrive at a diagnosis and establish a management plan and, when necessary, incorporate the results of laboratory and imaging
studies. Electrodiagnostic testing (e.g., electromyograms and nerve conduction velocity testing) may also be of assistance. Physical therapy has many specialties including cardiopulmonary, geriatrics, neurologic, orthopaedic and pediatrics, to name some of the more common areas. PTs practice in many settings, such as outpatient clinics or offices, inpatient rehabilitation facilities, skilled nursing facilities, extended care facilities, private homes, education and research centers, schools, hospices, industrial workplaces or other occupational environments, fitness centers and sports training facilities.
17
COVE R
STORY
Carrer as a Physiotherapy & Scope‌
P
hysiotherapy is one of the popular course in modern medicine world over and through the academic era is spread over decades. Physiotherapy is health caring profession, which views human movements as central to the health and well being of individuals. The core skills used
18
Sept – Oct 2010
COVE R
STORY by Physiotherapy include manual therapy, therapeutics exercise and the application of electro therapeutic modalities.
Scope of Physiotherapy - Physiotherapist are employed in all general hospitals and also in specialty and super specialty hospitals run by the government and non-government organizations, with a role also in critical care, early intervention
Sept – Oct 2010
programs with the national health delivery system, emphasizing community based rehabilitation. Physiotherapists are also working at district levels and community health centers and will be engaged in primary health Centers in near future. - Today majority of Physiotherapists are engaged in Private Practice in poly clinics or their own clinics and carry out referral as well as first contact practice.
- Foreign employment and professional up-gradation program are accessible to qualified physiotherapists.
19
COVE R
STORY
8th September International Physiotherapy Day Physiotherapy peace of mind and soul.
I
f you are thinking that physiotherapy helps only to maintain physical fitness & internal pain, then you are wrong .Dr.Zahid Jamal (P.T) a young physiotherapist from Nopani Institute of healthcare (Kolkata) says physiotherapy is a3rd stage of Medical science .which not only helps to heal the injury and pain its also protect heart & mind.
As physiotherapy is drugless therapy so, its side effects is nothing. There is misconception that physiotherapy is only for athlete’s .Physiotherapy has wide scope in almost branches of medical like: • Cardio respirator • Neuroscience • Pediatrics • Sport Physiotherapy • Women’s Health
Dr. Zahid Jamal BPT Nopani Institute of Health Care, Kolkata
Worlld Ph hysiicall Th herapy Day World federation for physical therapy was established on 8th sept 1951 so this day is celebrated as world physiotherapy Day P ys Ph y io ioth ther th erap er ap py is rec ecog oggni nize zed ze d an and d va vali lid li d in 101 cou ount ntri nt ries ri es.. es
About the impact of physical therapy on problems associated with ageing Research has shown that the type of exercise and training prescribed by physical therapists can reduce: • risk of falls • functional decline • cardiovascular disease, such as heart disease and stroke • blood pressure • osteoarthritis • osteoporosis • depression • anxiety… and improve • balance • strength World Physical Therapy Day falls on 8th September every year, and is an opportunity for physical therapists from all over the world to raise awareness about their crucial role in keeping people well, mobile and independent. The day was established by WCPT in 1996, and marks the date on which WCPT founded. wass fo wa foun unde ded. d.
20
Sept – Oct 2010
Delhi & Mumbai I A Khurshid Mob: +91 9289336800
Kolkata S Firoz Mob: +91 9088848636
Bihar & Jharkhand Ashraf Kamal Mob: +91 9931949886
92/17, Zakir Nagar, Opp. New Friends Colony, Okhla, New Delhi - 110025 Tel.: +91 11 26989438 Fax: +91 11 26982464 Mobile: +91 9289336800 Email: info@medgatetoday.com medgatetoday@gmail.com Website: www.medgatetoday.com
A complete Magazine by doctors for doctors. Information & updates on Hospital furnitures, Medical Equipments, Pharmaceuticals, Diagnostics
BEAUTY &
COSMETIC
VASER
A new age tool for liposuction Vaser is an acronym for Vibration Amplification of Sound Energy at Resonance.
V Dr. Amit Gupta He is a Plastic & Cosmetic Surgeon offering specialized Cosmetic Surgery in Delhi, Gurgaon, Noida
22
aser is an acronym for Vibration Amplification of Sound Energy at Resonance. To put it simply the Vaser lipsuction or liposelection process utilizes the sound energy for liquification of fat and then the liquefied fat is aspirated with liposuction in a more gentle and complete manner. The process is more comfortable and satisfying than conventional tumescent liposuction. Vaser is more gentle to the tissues, more specific for fat, produces great results even in difficult areas, and is now being used for obesity management because of the possibility of doing megaliposuctions more safely than before. Most of the procedures Sept – Oct 2010
BEAUTY &
COSMETIC are done as day care procedures, with patients going home on the same evening of their procedure. most patients will resume their office work between 3-7 days of the procedure. Vaser also works brilliantly for revision surgeries also plays a role in reducing cellulite due to more even fat removal.
Procedure VASER is a surgery and it is important to emphasize to the patient this point. It is associated with a recuperation period of 2-5 days. The procedure involves a primary consultation to assess the indications (discussed below), counsel the patient, discuss pros and cons and then plan the areas for the procedure. subsequently measurements for pressure garments are taken, and preoperative testing is performed. These are in the form of blood tests and other investigations (discussed below). Once all these are in order, a preanesthetic check up is performed to discuss anesthesia related factors. Then the patient is dated for the surgery The procedure begins with marking of the areas to be treated. This is proceeded by induction of anesthesia, introduction of tumescent solution. Then the most vital step of Vaser is performed. Here the surgeon needs to be an artist as well as a scientist. Great care needs to be taken during vasering step to avoid complications and carry out sculpting of the body. It is important to stick to guidelines for the use of VASER for best results. Subsequent liposuction aspirates all the fat. The procedure ends with wearing of pressure garments on the table itself to get the best results. Most patients are admitted in day care facility, allowing them to go home and rest on the same evening of the procedure.
Principle VASER utilizes sound waves to emulsify fat. It is a simple physics principle. The sound waves as they Sept – Oct 2010
pass fat cells cause them to expand and contract with each passing sound waves. Once the surface tension of the fat cells is exceeded, these break and liquefy, while not damaging blood vessels and nerves. This accounts for the selectivity of VASER (liposelection)
Indications VASER is indicated in all areas that were previously tackled by liposuction. Even difficult areas like the breast, thighs, male breast, back, are easily tackled with VASER, because of the liposelection property. There is minimum damage to fibrous tissue, and earlier recovery is ensured. VASER is suitable for even whole body liposuctions, involving megaliposuctions of over 10 litres of fat in single sessions. In summay VASER is indicated for 1) Liposuction of abdomen, flanks and back 2) Liposuction of breast 3) Liposuction of male breast 4) Liposuction of thighs 5) Liposuction of buttocks 6) Liposuction of arms, underarms 7) Liposuction of the neck, and face 8) Liposuction of calf, knees and ankles 9) Hi-def VASER
Advantages The procedure is essentially bloodless, hence making it safer than conventional tumescent liposuction. The main advantages are 1. megaliposuctions – procedures with over 10 litres of fat removal are safe and regularly being performed 2. Skin contraction and skin tightening – it has been shown that VASER promotes collagen formation, leading to tighter skin and lesser sagging as compared to liposuction. Thus VASER is excellent in loose abdominal skin, thigh liposuctions where the incidence of sagging is the maximum. 3. difficult areas – areas like the female breast, male breast, thighs, back, which are difficult to tackle with conventional liposuction are very easily treated with VASER with excellent results 4. excellent skin shaping and body contours 5. 6-pack appearance of the abdomen with Hi-def VASER
Side effects and complications of VASER procedure VASER is essentially a very safe procedure. there are no long term 23
BEAUTY &
COSMETIC side effects associated. A number of patients are worried about implications on future pregnancy, breast feeding etc. it is reiterated that VASER does not have any implications on a long term basis 1. there is swelling over all the VASER areas , that last for a period of 7 days to 21 days. However this will not be a problem in carrying out normal work. 2. bruising is often seen. These generally disappear in the first week 3. stiffness in the muscles occurs, particularly over the back, and thighs. These are managed with ultrasound treatment and massages 4. failure to tighten the pressure garments leads to development of seromas which are fluid collections. If proper pressure is applied to them, they absorb on their own. 5. an uncommon occurrence is that of fibrosis, which is seen as tight
24
Before
After
Before
After
bands or hard nodules. This is an intrinsic response overhealing by the body. These are managed with ultrasound therapy and steroid injections. 6. some patients have hyperaesthesia on the treated area for a few weeks after surgery. This is normal and self resolving.
Sept – Oct 2010
BEAUTY &
COSMETIC
C-278/3, A. F. Enclave Part IEnclave I , New Delhi +91-11-64562268 C-278/3, Ab AAbul bul Fazal Fazal Enclave Part Part-rIrI110025, ttII,II,New NewTel: Delhi-110025 Delhi-110025 25 25Ph: Ph:Mob: 011011-+91-9717085785 64562268 64562268
PRODUCT
LINE
A new way to investingate the
body signals
T
oday medicin provides to doctors a variety of supplementary examinations. These test (Lab test, Imagery) help to understand the patient conditions and help in the decision of therapeutic plan. ESTECK Complex could increase these possibilities by adding a new kind of supplementary examinations and therefore increase the chances of
Cost Effective clinical assessment NonInvasive bio-electrical Impedance body measurement Assessment 26
success of Doctors by providing new tool to estimate the homeostasis in health screening. The goal of the combination of devices is to estimate the homeostasis in health screening (internal medium and the mains regulatory mechanisms of the human body). The American physiologist Walter Cannon introduced the concept of homeostasis and the existence of steady conditions of regulatory mechanisms. Changes in cell function always occur in the context of a whole organism, and different tissues and organs affect one another. The estimation of the homeostasis is necessary: • To screen the pathologies or dysfunctions with another way, in
adjunct with the signs, symptoms, labs tests and imagery and to have data of the diseases not from a classification, but from the body responses. • To screen the effectiveness and / or the side effects in case of treatment in adjunct of signs, symptoms, labs tests and imagery with the body responses data. Therefore, the use of the ESTeck complex results need to be taken as specific supplementary examinations and combined with others test like lab test and imagery, rather then be compared. ESTeck results are specific to the understanding of the body responses and the patient homeostasis potential. This is a very important adjunct in the therapeutic plan management and follows up. Sept – Oct 2010
PRODUCT
LINE
Features of ESTECK complex: Esteck complex is a medical device comprising 5 features in 1 system. • This non-invasive test, • With results immediately available, • Only 5 minutes test, at low cost • Give a unique chance to doctor to understand the pathologies, treatments, or life style of their patients.
The benefits of the ESTECK complex are simple: 1. Adjunct supplementary examination to the existing ones 2. Understanding of the Homeostasis: Understanding of the capacity of the body to answer & manage the aggressions, and therefore, the capacity of the body to react to pathologies, Stress, Life style changes AND treatment effectiveness or side effects. 3. Treatment follow up and regular monitoring 4. Quick understanding of patient emergency conditions and therefore better management of patient's hospitalization volume 5. Reduction of treatment cost 6. Telemedicine opportunities by providing patients with the technology and operate remote consultation, support, or by proving alternative to remote areas where population need to be tested.
With the help of esteck complex we can investigate 69 physiological parameter, with 94% accuracy.
These are some main parameters: 1. Digestive system results integration and modeling: Stomach and colon tissue indicators, Liver gallbladder and pancreas's function indicators
2. Cardiovascular system results integation and modelling: HRV (Heart rate variability), Blood pressure indicators Ischemic risk and heart failure indicators Left ventricle function
3. Brain system results integration and modeling: Brain tissue state indicators Neural excitability indicators Neurotransmitter indicators
Concept of ES TECK Complex Device is Invented by Dr Albert Maarek, and Manufactured by LD Technology Miami, USA with Certification of FDA, KEMA, EURO CAT, and HEALTH CANADA. The ES Teck Complex Systems is a combination of 2 biosensor technologies with 5 features and signal processing analysis managed by software. Here with the help of 6 tactile electrodes and biosensor plate for hands and feet’s we are sending 1.28 dc volt through the interstitial fluid which shows 69 physiological parameter, within 4 min. with 94% of accuracy. Sept – Oct 2010
4. ANS system results integration and modeling: Sympathetic and parasympathetic system activity indicators
5. Harmonal system results integration and modeling: Indicators of Thyroid & Parathyroid Adrenaline nor adrenaline, Hypothalamus and pituitary activity indicators
6. Respiratiory system results integration and modeling: Gasses balances Respiratory rate
7. Metabolic general function from results: Electrolytes Acid base balance Lipid profile (cholesterol and triglyceride) Glucose secretion Water balance Metabolic syndrome indicators
8. Ginitourinary system results integration: Genitourinary tissue indicators Kidney function indicators
9. Cross analysis summary: 10. Follow up to visit: 11. BIA (Body index analysis): Estimation of body composition Body msaa index Fat mass Fat free mass Total body energy expenditure Water balance Basal metabolic rate 27
PRODUCT
LINE
®
M.4 OA off-loader brace for Varus/Valgus relief Ideal for unilateral osteoarthritis and all indications requiring pressure relief of one side of the knee joint. 4-point knee orthosis for control of anterior and posterior tibial translation. 3-point off-loader for varus/valgus pressure relief. Indications • conservative treatment of complex ligamentous instability, particularly in combination with unilateral osteoarthritis • conservative treatment of advanced unilateral osteoarthritis • post-operative pressure relief and compartmental protection after fractures of the tibial head, cartilage surgery, meniscus refixation, correction osteotomy • instability of the cruciate ligaments with pressure relief of the medial or lateral compartment • for functional pre- or post-operative care of knee instabilities
3-point off-loading
Mode of action Protection, stabilisation, pain relief and restoration of mobility by:
clear labelling
• pressure relief of the medial or lateral joint compartment by the 3-point-principle which off-loads the affected compartment into a varus or valgus position • stabilisation of the knee joint by the 4-point principle to counteract knee instability which often causes osteoarthritis • safeguards against hyperextension and offers limitation of flexion and extension
Ultraflat frame design
for protecting, stabilising, relieving pain and restoring your patients’ mobility Exact and effective valgus or varus pressure exerted close to the knee joint • Wide, well cushioned frame padding for the 3-point pressure relief system • Malleable frame design to re d u c e t o r s i o n a l f o rc e s • Ultraflat, very light weight and non-protruding frame and hinge construction • Pressure relief of the medial or lateral hinge compartment by the 3-point principle which offloads the knee into a varus or valgus position • Stabilisation of the knee by the 4-point system to counteract knee instability which often causes osteoarthritis • Extension limitation at : 0o, 10o, 20o, 30o, 45o • Flexion limitation at : 0o, 10o, 20o, 30o, 45o, 60o, 75o, 90o, 120o • Immobilisation at : 0o, 10o, 20o, 30o, 45o •
•
Accessories : pneumatic condyle cushion with pump
Diagnosis and choice of the appropriate orthosis VARUS right/left
1. Anatomical
VALGUS right/left
shape of the legs 2. Affected side 3. Therapy 4. Off-loading hinge 5. Push principle applied
medial off-loading of the medial joint compartment lateral valgus force applied
medial osteoarthtitis
varus/valgus adjustment
off-loading of the medial compartment with M.4®OA
lateral off-loading of the lateral joint compartment medial varus force applied
optimal prevention of migration-4 key M.4® features 1
28
1
2
3
4
1 Physioglide® hinge
2 AIR SUPRA condyle pad
3 Soft-grip padding
4 Easy and correct fitting
The mechanical movement of the physioglide® hinge closely matches the physiological roll glide - movement of the knee joint. The shifting of the inner and outer hinge plates (see above diagram) lengthens the physioglide® hinge at flexion and shortens it at extension. This effect reduces the “downward pressure” on the brace.
The top section of the air filled, halfmoon shaped condyle pad is positioned above the medial condyle of the femur and helps prevent the M.4®OA from sliding.
The M.4 ® OA’s soft-grip padding material offers excellent patient comfort and is slide resistant” to help “ secure the correct fit of the brace.
The numbered straps allow the patient to easily reproduce the correct fit of the brace
Sept – Oct 2010
Features of PLEX ESTEC K COM
PLEX is a ESTEC K COM ng 5 ice comprisi medical dev system. features in 1 nvasive test • This non-i tely lts immedia • With resu available at inutes test, • Only 5 m low cost to ique chance • Give a un derstand the doctor to un treatments, pathologies, of their or life style patients
e h t e t a g i t s e v n i o t y a
A new w
s l a n g i body s
LD TECHNOLOGY INDIA PVT. LTD. A/803, 8th Floor, BSEL Tech Park, Opp. Vashi Railway Station, Vashi, Navi Mumbai - 400705, Maharashtra, INDIA Phone: Fax:
+91 022 6516 1971 / 72 022 27811438
Mobile: +91 9323582268
Email: ldindia.ss@gmail.com / ldindia.mb@gmail.com
PRODUCT
LINE
®
M.3 OA functional knee orthosis for osteoarthrosis Indications
Features
• conservative
• individually adjustable varus and
treatment of pronounced unilateral, medial or lateral osteoarthrosis and arthritis of the knee
valgus angles with a extremely flat joint; during the course of treatment the varus/valgus angles can be readjusted according to the healing process
• permanent care where surgery is contra-indicated
• pneumatic
condyle pads for additional pressure distribution on the joint (using the hand-pump supplied)
• interim
care until decision has been taken on possible surgical procedures such as correction osteotomy or knee joint replacement
• very light construction and easy to put on
• for relieving weight-bearing after
• limitation of extension 0°, 10° • frame is made of new Avional®
surgery for medial or lateral fractures of the tibial head
Mode of action
aluminium
• correction of the lateral or medial joint space by the 3-point principle
• pain relief by reducing weightbearing on the affected side of the joint.
• decreases
further capsule irritation/synovitis
30
15 cm / 6"
Sept – Oct 2010
DOCTO R
SPEAK
DOCTO R
SPEAK
Post delivery...
Bodily Changes & what to expect For the first time mother, childbirth heralds a huge change in your body, your life and your outlook to it. You look and feel different! Of course, the prize is worth it, isn’t it? During pregnancy, your body accumulates a lot of water and fat to take care of your baby’s needs (most of which is sadly wrapped around your middle). Your breasts enlarge and nipples become darker in preparation for breast feeding. In addition, your internal organs (uterus, vagina and kidneys) have undergone adjustments and need to return to their original state. Dr Suman Bijlani MD, DGO, FCPS Gynaecologist & Obstetrician Director, GyneGuide Clinic
32
Sept – Oct 2010
DOCTO R
SPEAK
H
ere is a quick checklist of what to expect immediately after delivery, so you are better prepared!
Your reproductive organs You would bleed for about a week or two after delivery, which would be followed by blood stained discharge known as lochia, which would become lighter and lighter and finally disappear in about 6 weeks time. You would pass a lot of urine in the first few days, as you excrete the excess water you have accumulated. Your uterus which had grown so large comes down to the level of your navel immediately post delivery and continues to shrink daily till it goes down to its original size, the size of a table tennis ball (about 6 weeks time). Your vaginal opening feels a little wider and lax, and may feel sore and bruised immediately post delivery. If
Sept – Oct 2010
you had an episiotomy or tear, you may feel a little pain or discomfort till you heal. You may feel a little dry during intercourse as your estrogen levels are low.
What you can do Delay intercourse till you get the okay from your obstetrician and till you feel physically and emotionally up to it. Use a water based lubricant or a lubricated condom. It sure helps to have a supportive partner! Pelvic floor exercises (Kegel’s exercises) practised through pregnancy and continued into the post delivery period . It is never too late to start!
Weight issues and flab Immediately after the birth of your baby, you lose about 5 to 6 kg. And another 2 to 3 kg in the following week, as you lose the excess fluid. The
accumulated fat tends to stay unless something is done about it! After delivery, one look at your tummy can send you into tears! Flabby and with stretch marks ... your abdominal muscles have got unduly stretched and they would take about 3 months to come back to near normal.
What you can do Take on a post delivery exercise regimen to hasten recovery of your abdominal tone. The sooner you start, the better the results! If you have undergone a caesarean section, consult your obstetrician about when it is safe to start exercise. An ideal post delivery exercise plan should include exercises to prevent excess weight gain - with pelvic floor and chest muscle tightening, abdominal toning and general exercises for flexibility and muscle strength (with emphasis on preventing backache). A sensible diet plan (preferably personalised) would give you the
33
DOCTO R
SPEAK
What you can do Eat a balanced diet with plenty of water and nutrients to tide over this phase.
Mood changes Profound hormonal and physical changes in the mother after delivery along with the focus on the new arrival call for adaptation by the new mother to her new environment, a new role and newer challenges. Meeting her own expectations and that of her husband and in laws can be a daunting task. Many women suffer from sleepless nights, bodyache, backache and lethargy. Fatigue may set in and dampen her enthusiasm. In extreme cases, post partum depression may set in. required nourishment minus the love handles and double chin!
initially purple red and become silvery white and less visible over time.
Breast changes
Melasma (darkened patches over cheeks, nose and forehead) usually lightens over weeks.
Your breasts enlarge further as you breast feed. The milk produced in the first few days is thick and yellowish, known as colostrum. As breast feeding progresses, milk quantity increases. Breast feeding may be accompanied by abdominal cramping, because the hormone oxytocin (released during suckling) causes uterine contractions. Sore nipples and cracks are common during this period.
What you can do Breast feed your baby exclusively for six months. Your breasts need to be well supported to prevent sagging. It is a good idea to change your bra size frequently as per your needs. Proper breast feeding technique is the way to prevent nipple and breast problems. Breast pumps and nipple creams may be used under the guidance of a breast feeding consultant. Report any redness or pain in the breast promptly to your doctor.
Skin changes Stretch marks over your tummy, breasts, thighs and buttocks are 34
What you can do
What you can do
A comfortable, caring and supportive environment with adequate post natal care, exercise and rest would help her step into her new shoes with relative ease. For her better half, this is the perfect time to show how much he cares! Medical help may be needed for those with depression.
Stretch mark creams and massages have doubtful efficacy. Weight management and exercise is the best way to have your tone back with minimal cellulite. Stretch marks are usually quite invisible by the end of six months although there are large individual variations. For women who are troubled by these, a range of surgical and non surgical options are available with cosmetologists.
For the new mother, the message is very clear. She is going through a tough phase and she needs to care for herself more than ever before. So girl, go pamper yourself, treat yourself to some goodies or a foot and back massage! Get a new hair do! Meet up with friends. Most of all, do not hesitate to ask for favours when you need them. Love yourself and equip yourself to give your baby the right start!
Cellulite may be visible on buttocks, thighs and lower abdomen.
Melasma may be treated with anti pigmentation creams (supervised by dermatologist) while minimising exposure to sun.
Hair loss Hormonal changes during pregnancy and thereafter cause loss of hair immediate post delivery which returns to normal in about 6 months. Sept – Oct 2010
EYE
CARE
GLAUCOMA AWARENESS WHAT IS GLAUCOMA
Dr. Sharad Lakhotia President of Delhi Ophthalmological Society Lakhotia Eye Centre & laser Institute, New Delhi
36
Glaucoma is an eye disease which causes irreversible loss of sight due to damage to the optic nerve. Usually the high pressure inside the eye causes the damages. The optic nerve is like a cable of 1-2million nerve fibers. Eye is like a ball and to maintain the shape of this ball you require a certain pressure. Normal eye pressure is 10-20 mm of Hg. When it becomes higher it causes damage to optic nerve, thereby causing loss of vision. Eye is like a camera. Light first passes through cornea, a clear transparent structure at front of the eye. Behind the cornea is Iris which act like a shutter in a camera. The central hole of Iris is pupil through which light Sept – Oct 2010
EYE
CARE passes through crystalline lens and ultimately forms an image on retina. From the retina, the image is carried by optic nerve to the brain, which interprets these signals as images. The normal eye pressure is maintained by a fluid called aqueous humor. The fluid is continuously being formed & simultaneously being trained out. Nature has provided a very delicate balance between this inflow and outflow so that eye functions in healthy (inflow) or disease in outflow, pressure inside the eye rises. The latter is mainly responsible for glaucoma. Outflow occurs mainly through two channels – trabecular meshwork, a sponge like porous network between Iris & Cornea and located behind it is Uneoscleral outflow, which is responsible for 10%-20% of outflow. Some Facts Some of the facts about glaucoma are simply starling. Over 1 crore Indians are affected by glaucoma as on today and to make things worse- 2/3rd of them do not know they have it. There are total number of 6.5 crore people suffering from glaucoma worldwide. About 2% of population above the age of 40yrs. Suffers from ocular hypertension. All such patients have potential to turn into glaucoma, a silent killer. It usually occurs in both eyes but one eye may be first affected. Peripheral vision is mainly affected so that intelligent patient may notice that when they have to cross the road they have to move head either side more than others. However such patient can have 6/6 on reading distance chart usually used for testing sight. So if one can read the chart fully, it doesn’t give immunity from glaucoma. When central vision gets affected, patient experiences the problem & this may be too late, as irreversible loss of sight has already taken place. By this time has lost majority of sight in one eye & significant loss in the other eye which is irretrievable. Thus the essence of the treatment lies in early detection. If detected early it responds to treatment Sept – Oct 2010
very well & sight can be preserved. In angle closure glaucoma the angle of anterior chamber is narrow or closed. It accounts for about 15% cases of glaucoma. It can occur suddenly as an acute attack, because of sudden rise of eye pressure. It an emergency, because nerve damage& subsequent loss of sight can occur within hours of onset glaucoma. The symptoms are headache, eye pain, nausea & vomiting. Pain is worse may be of high intensity just next to labour pain. These are rainbows around light and blurred vision. High Hypermetropes are more commonly affected because, their eyes have natural structural narrow angle. Such patients if detected in time can be saved from permanent loss of sight. Glaucoma is number one cause of preventable blindness. People over 60 yrs. Are six times more likely to get glaucoma than younger generation. At 70 yrs. 8% population suffers for high intra ocular pressure with varying degree of loss of sight. Those who have family history of glaucoma, they have 4 to9 times greater risk to develop glaucoma. Even in developed countries like U.S, there are about 30 lakhs people suffering from glaucoma and about half of them knowing that they have this serious problem. In terms of social security benefits, lost income tax revenues, the cost to U.S. govt. is estimated over 1.5 billion annually. Types There are basically two types of glaucoma: Primary open angle glaucoma & Angle closure glaucoma. Commonest is primary open angle glaucoma. The cause of this kind of glaucoma is unknown. It is called Open angle because here the angle of anterior chamber remains open (angle between cornea & iris) but the drainage channels in trabecular meshwork gets clogged. It is essentially a plumbing problem. The worst thing about this kind of glaucoma is that
there are no symptoms or warning signals. For 5-10 yrs. Patient may not be aware that he is having glaucoma. Genetic inheritance is common, so that if a family history of glaucoma is there, such cases should have careful eye examination the attack get precipitated by any condition when pupil semidilates, there clogging the tissue at interior chamber and suddenly obstructing the outflow. This happens when entering a dark room or medicine which dilates the pupil is used (used for routine eye examination). There are other kinds of glaucoma due to injury, inflammation. Cataract, Diabetes, and prolonged used of steroid, when they care called secondary glaucoma. In India we have seen earlier lot people waiting for cataract to get mature, suddenly developed glaucoma attack & lose sight. Now in the present technique of phacoemulsifiation for cataract operation, we don’t want cataract to mature. In fact it is advantaged to get operated if cataract immature because then complications are minimal. Prolonged used of steroid particularly for asthma. Skin allergy can cause glaucoma. In Delhi and other cities where there is lot of population, steroid drops are often prescribed. But sometime patient use them continuously for a long period without informing the doctor and can develop glaucoma. That is why it is important to take medicine as per prescribed by 37
EYE
CARE the doctor over advised duration. One should not involve in self medication. Diabetes is more prone for glaucoma. In any case diabetes must have yearly examination of their fundus to rule out diabetic retinopathy. They must ensure that their pressure is also checked. Sometimes Glaucoma damage can occur in eyes without high pressure, they are called normal tension glaucoma. They can be detected by routine fundus examination when the suspicion can be made. That is why fundus examination is a must for everybody after the age of 40 yrs. Even glaucoma can occur in new born (incidence is 1 in 10,000) and young age. Detection Tonometry is the simple way of checking the eye pressure. A drop of anesthetics eye drop is put in the eye to make it less sensitive. Then an instrument placed on the cornea to applanate. In shiotz Tonometry he most commonly used way, patient has to lie down. Then the machine gives the reading. Now there are more sophisticated Non- Contact Tonometer available. There is no need of putting any anesthetic drop nor has the patient to lie down. Just with a puff of air, the checks the pressure. It is called Non – Contact Tonometer as the instrument does not touch the eye ball at all. It is very hygienic as no physical contact is made to eye & no drops are put in eye. The latest brands have autofocus and auto track so that it is very convenient to check eye pressure. It just takes few seconds for the procedure. Normal eye pressure above 21 is a potential problem above 24mm suggestive of glaucoma. Eye pressure checkup should be done routinely after the 40 yr. and thereafter every 1 yrs. Or 2 yrs. Another important test is ophthalmoscopy or fundus copy. Everyone after the age of 40 yrs. have fundus examined. Fundus is an examination of retina and optic 38
disk abnormalities give an indication of glaucoma, so that further tests can be carried out to establish the disease. Besides fundus examination can detect diabetes and hypertensive changes in retina, which are should sometimes detected for the first time. Even brain tumors can be detected by fundus examination. Many degenerative conditions are detected for the first time. In glaucoma side vision is affected first to varying degree ultimately reducing vision as if one is seeing through a tube. Perimetry can record these changes & help to aid diagnosis of this disease. It also helps monitoring the disease process if the condition is stable or further deteriorating. Recently, advanced computerized field analyzers are available which can detect earliest. Field defects, so that glaucoma can be detected earliest. As they are computer controlled, fine changes can be detected. They are very effective for routine screening after the age of 40 yrs. This machine can also detect space occupying lesions, brain tumors. Gonioscopy is method by which one can directly look into angles and find out what kind of glaucoma is there and any abnormality in that area.
they should be used with caution in patients suffering from heart & lung diseases, particularly asthma. Xalatan has the convenience of once day regime. They are very effective but are expensive. Some of the side effects include redness itching, change in color of Iris & eye lashes become darker. Pilocarpine was used earlier extensively. It constricts the pupil causing near sightedness and also vision become dim. Patient may find difficulty in darkened room & at night, driving can be hazardous.
Treatment There is no cure of glaucoma. However most of the glaucoma can be well controlled on drops & sight can be preserved.
Brimonidine (alpthagan) decrease production of aqueous and increase Uveoscleral outflow. The important thing about this drug is that it protects the nerve fibers’. Some of the side effects include dry mouth, altered taste; allergic reaction and lethargy Carbonic Anhydrate are used as drops and oral tablets. Oral pills can cause tingling sensation in fingers & toes, sleepleness, stomach upset, fatigue and kidney dysfunction. That is why these pills can’t be given for a long time.
Beta blockers are most commonly prescribed drops of glaucoma. They may produce, reduce sex drive, anxiety nausea etc. It is important to inform the treating doctor whenever any side effect appears. Moreover
Laser Laser has a very important role to play. In laser peripherical iridotomy,a small hole is made in the peripheral Iris with the help of Yang Laser. This is particularly useful in patient with Sept – Oct 2010
EYE
CARE Angel Closure Glaucoma, so that aqueous drains through the hole into anterior chamber. Argon laser trabeculoplasty is done in Open angle glaucoma’s. It reduces pressure by 1/3rd in 70-97% of patients need eye drops to control pressure. In 2-5yrs., half of the patients need surgery or medication. Surgery When eye drops and laser can no longer control intraocular pressure, surgery is prescribed. The most commonly prescribed operation is Trabeculectomy. This makes a passage of fluid directly into canals and through a flittering bleb it controls the eye pressure. It is done as an outpatient procedure. Vision may be blurred for 6 weeks after surgery. However in patient using pilocarpine earlier, vision may improve as pupil is of normal size now. Peripheral Iridectomy is helpful in narrow angle glaucoma. In case of glaucoma associated with cataract, triple procedure is the procedure of choice. Through a clear cornel temporal incision, Cataract is operated by the latest technique of Phacoemulsifiation and a foldable lens is implanted. There are no stitches for this procedure. Glaucoma surgery is then performed at 12’0’ clock position. MYTHS One of the common myths is that Glaucoma happens to older people. The truth is though older people are more susceptible to glaucoma, it occurs even in young individual and also in new born even. Another Myth is Glaucoma is curable. Glaucoma is not curable but it can be controlled and loss of sight can be prevented. Most of the glaucoma’s are to be treated for life. Another myth is symptoms will warn you for Glaucoma. The truth is that the most common form of glaucoma is open angle glaucoma and there are no symptoms. Loss of peripheral vision occurs which may not get noticed. When significant 40
loss of vision occurs, these patients start having difficulty & then it may be too late. Another myth is that glaucoma does not cause blindness. The fact is that glaucoma ultimately causes loss of sight if it is untreated. Who is at Risk Every one is at risk. But some people are at higher risk than others. People above 60yrs, and those with a family history of glaucoma are more prone for glaucoma. High hypermetropes because of configuration of their eyes are prone for Angle Closure Glaucoma. If oral steroid therapy is required for a long time, some patients may develop glaucoma as it happen in treatment of Asthma, skin diseases etc. In a study it was observed that there is 40 % increase in incidence of ocular hypertension & open angle glaucoma, which require 14-35 puffs of steroid inhaler to control asthma. Long term use of steroid drops can cause glaucoma in some people. Blow to head or direct eye injury can cause glaucoma immediately or years later. In certain sports like baseball or boxing or a penetrating injury can cause traumatic glaucoma. Once detected, How can I take care of my self One should be very regular with medicine and its frequency. Follow up visits, special tests for glaucoma, and regular pressure measure as advised by the ophthalmologist should be strictly adhered to. If any side effects occur due to medicine it should be promptly reported to the eye surgeon. Pay attention to emotional & psychological aspects. Share your feeling and talk about your fears. One should have confidence in spouse, friend or a close relative & should not get into depression. One should not limit one’s life. New plan and new venture are to be explored to give more meaning to life. What life styles changes help manage glaucoma Regular exercise is good for health
more so for glaucoma. Those who exercise regularly atleast 3 days a week reduce intraocular pressure by an average of 20%. One study says that those who walked briskly 4 times in a week for 40 min. were able to go off their medication. Antioxidants Vit. C, E, A and mineral like zinc and copper have beneficial effects for glaucoma patients and prevention for others. Drinking large quantity of water over short interval may cause sudden rise in eye pressure. Water should be consumed in small quantity over regular interval. Meditation by relaxing mind and body has good effects. Bilberry, a European blue berry is sold as a glaucoma remedy, has some beneficial effects particularly in improving night vision and glare. Herbal medicine Ginkgo Biloba increase ocular blood flow but these have not been well documented. How can I Prevent Glaucoma Glaucoma can’t be prevented but loss of sight can be prevented if one takes proper care of eyes. One should have routine eye examination at 5-15yrs. One should ensure that eye pressure is checked & fundus examination is done to see the health of optic disc. One should know about family history of the disease if somebody is suffering from glaucoma in the family it should be reported to the eye surgeon. If anytime you see holes around light, headache, eye ache, blurring of vision, it should be reported to the eye specialist. If one find that side vision is deteriorating or one has to change reading glasses frequently, Glaucoma must be ruled out. One should protect the eye and prevent injuries which can cause glaucoma and other damage. Avoid self medication particularly steroid eye drops. If you are diabetic or hypertensive, have routine fundus examination regularly. If one takes all these precaution sight can be preserved for life. Sept – Oct 2010
D E N TA L
HYG I E N E
Dental Implants
Replacement Teeth that look and feel like your own A dental implant is an artificial toothh root used in dentistry to support restorations that resemble a tooth or group of teeth.
42
Sept – Oct 2010
D E N TA L
HYG I E N E
V
irtually all dental implants placed today are root-form endosseous implants. In other words, virtually all dental implants placed in the 21st century appear similar to an actual tooth root (and thus possess a "rootform") and are placed within the bone (end- being the Greek prefix for "in" and osseous referring to "bone").
Sept – Oct 2010
Prior to the advent of root-form endosseous implants, most implants were either blade endosseous implants, in that the shape of the metal piece placed within the bone resembled a flat blade, or subperiosteal implants, in which a framework was constructed to lie upon and was attached with screws to the exposed bone of the jaws. Dental implants can be used to support a number of dental prostheses, including crowns, implantsupported bridges or dentures.
43
D E N TA L
HYG I E N E What Dental Implants Can Do? • Replace one or more teeth without affecting bordering teeth. • Support a bridge and eliminate the need for a removable partial denture. • Provide support for a denture, making it more secure and comfortable.
Types of Implants in Use Today • Endosteal (in the bone): This is the most commonly used type of implant. The various types include screws, cylinders or blades surgically placed into the jawbone. Each implant holds one or more prosthetic teeth. This type of implant is generally used as an alternative for patients with bridges or removable dentures. • Subperiosteal (on the bone): These are placed on top of the jaw with the metal framework's posts protruding through the gum to hold the prosthesis. These types of implants are used for patients who are unable
to wear conventional dentures and who have minimal bone height.
Advantages of Dental Implants Over Dentures or a Bridge Every way you look at it, dental implants are a better solution to the problem of missing teeth. Esthetic Dental implants look and feel like your own teeth! Since dental implants integrate into the structure of your bone, they prevent the bone loss and gum recession that often accompany bridgework and dentures. No one will ever know that you have a replacement tooth. Tooth-saving Dental implants don't sacrifice the quality of your adjacent teeth like a bridge does because neighboring teeth are not altered to support the
implant. More of your own teeth are left untouched, a significant long-term benefit to your oral health! Confidence Dental implants will allow you to once again speak and eat with comfort and confidence! They are secure and offer freedom from the irksome clicks and wobbles of dentures. They'll allow you to say goodbye to worries about misplaced dentures and messy pastes and glues. Reliable The success rate of dental implants is highly predictable. They are considered an excellent option for tooth replacement.
Are You a Candidate for Dental Implants? The ideal candidate for a dental implant is in good general and oral health. Adequate bone in your jaw is needed to support the implant, and the best candidates have healthy gum tissues that are free of periodontal disease. Dental implants are intimately connected with the gum tissues and underlying bone in the mouth. Since periodontists are the dental experts who specialize in precisely these areas, they are ideal members of your dental implant team. Not only do periodontists have experience working with other dental professionals, they also have the special knowledge, training and facilities that you need to have teeth that look and feel just like your own. Your dentist and periodontist will work together to make your dreams come true.
What Is Treatment Like? This procedure is a team effort between you, your dentist and your periodontist. Your periodontist and dentist will consult with you to determine where and how your implant should be placed. Depending 44
Sept – Oct 2010
MELAG
PREMIUM QUALITY AUTOCLAVES Made in Germany
Premium-Class Vacuklav 40-B Tap-water connection - Chamber depth: 35 cm, 18 litres Vacuklav 44-B Tap-water connection - Chamber depth: 45 cm, 22 litres Vacuklav 41-B No tap-water connection - Chamber depth: 35 cm, 18 litres Vacuklav 43-B No tap-water connection - Chamber depth: 45 cm, 22 litres
Vacuquick® Vacuquick 13-B No tap-water connection - Chamber ø 18 x 23 cm, 5.7 litres Vacuquick 14-B Tap-water connection - Chamber ø 18 x 23 cm, 5.7 litres
Pro-Class Vacuklav 30 B+ Tap-water connection - Chamber depth: 35 cm, 18 litres Vacuklav 24 B+ Tap-water connection - Chamber depth: 45 cm, 22 litres Vacuklav 31 B+ No tap-water connection - Chamber depth: 35 cm, 18 litres Vacuklav 23 B+ No tap-water connection - Chamber depth: 45 cm, 22 litres Vacuklav 24 B/L+ Tap-water connection - Chamber depth: 60 cm, 29 litres
Cliniklav® 25 The Big from MELAG according to European standard EN 285 with a chamber volume for 1Sterilization Unit (30 x 30 x 60 cm)
MELAtronic® EN MELAtronic 15EN - Chamber volume: 7 Liter MELAtronic 17EN - Chamber volume: 11 Liter MELAtronic 23EN - Chamber volume: 19 Liter
S-Class Euroklav 23 VS+ With single pre-vacuum - Chamber depth: 45 cm, 22 litres Euroklav 29 VS+With single pre-vacuum - Chamber depth: 35 cm, 18 litres
M4 BIOMEDICA INDIA PVT LTD People and Technology
E-458, Greater Kailash II, New Delhi - 110048 (INDIA) Mobile: 09810121216, 9999855039, 9971270783 Telefax: +91-11-40548989 Website: www.m4biomedica.com E-mail: sales@m4biomedica.com, info@m4biomedica.com
Dealers Network in India Mumbai, Goa, Hydrabad, Bhilai, Chandigarh, Patna, Ranchi, Kolkotta, Guwahati, Bhibneshwar, Shimla, Ahmadabad, Bengalore, Chennai, Lucknow
D E N TA L
HYG I E N E
A dental implant replaces both the lost natural tooth and its root. Replacing Several Teeth If you are missing several teeth, implant-supported bridges can replace them. Dental implants will replace both your lost natural teeth and some of the roots. Replacing All of Your Teeth If you are missing all of your teeth, an implant-supported full bridge or full denture can replace them. Dental implants will replace both your lost natural teeth and some of the roots. Sinus Augmentation
on your specific condition and the type of implant chosen, your periodontist will create a treatment plan tailored to meet your needs. Click for more information about the treatment options described below.
A key to implant success is the quantity and quality of the bone where the implant is to be placed. The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants due to insufficient bone quantity and quality and the close proximity to the sinus. Sinus augmentation can help correct this problem by raising the sinus floor and developing bone for the placement of dental implants. Ridge Modification
Replacing a Single Tooth If you are missing a single tooth, one implant and a crown can replace it. 46
Deformities in the upper or lower jaw can leave you with inadequate bone in which to place dental implants.
To correct the problem, the gum is lifted away from the ridge to expose the bony defect. The defect is then filled with bone or bone substitute to build up the ridge. Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come.
What Can I Expect After Treatment? As you know, your own teeth require conscientious at-home oral care and regular dental visits. Dental implants are like your own teeth and will require the same care. In order to keep your implant clean and plaque-free, brushing and flossing still apply! After treatment, your periodontist will work closely with you and your dentist to develop the best care plan for you. Periodic follow-up visits will be scheduled to monitor your implant, teeth and gums to make sure they are healthy. Sept – Oct 2010
COMPLETE GIFTS SOLUTIONS FOR PHARAMACEAUTICALS & HOSPITALS • • • • •
T-shirt Caps Bags Key Rings Pens
• • • • •
Our products areare logo printing on on Ourprime prime products logoprint Pen-drive • Corporate Uniforms Coffee Mugs • Hospital Uniforms Watches • Face Mask Calendar • PVC Products Diaries • Wooden Products
• Leather Products etc • Disposable Skin Blade • All Kind of Novelties Products
Corporate Gift Mart TA 64/4, 1st Floor, Main Okhla Road, Tughlakabad Extn., New Delhi - 110019 Contact us: +91 9971258804, +91 9212328518 E-mail: corporategiftmart@gmail.com www.corporategiftmart.in
E X P E RT
VIEWS
To squat after
Hip Replacement – is it asking too much?
Hip replacement was developed in western countries in the late 60’s and early 70’s. It was designed for patients who tended to be in their seventies and had a reasonably low exercise level. These western patients did not have the same unique demands that many patients from Asia have.
Dr. Alan Norrish UK
T
here are many aspects to lifestyle in Asia that are unique and important when considering joint replacement. One thing that puts fear in the heart of most hip replacement surgeons is the risk of dislocation. For this reason, in the Western World, most patients are forbidden from squatting. The squatting position puts a lot of pressure on the posterior part of the hip joint. For patients in Asia, squatting is a very important function, without which patients are put at a significant disadvantage and find it difficult to leave their homes. An excellent range of movement of the hip is required for sitting on the floor, and for Muslim patients it is very important for praying. Even with severe arthritis of the hip many Asian patients often have better range of motion than most equivalent patients in western countries. Therefore, the ideal hip replacement would be the one that permits a maximal range of movement, but still is very stable to comfortably allow squatting. One last consideration is the longevity of the implant. In my experience
48
patients from the Asian community are often younger when they present for joint replacement and so consideration of the longest lasting bearing surfaces must be taken into account. In this short article I intend to impart some of the experience I have had doing joint replacement amongst people with these unique demands.
Hip replacement When considering how to achieve a stable hip that can allow the patient to fulfil their two aims: maximal range of movement and a squatting position, two things must be taken into account:
1. Surgical technique 2. Implant choice
Surgical technique Approach: there are several surgical approaches to the hip for the purpose of hip replacement. When I worked in the western world I used the posterior approached to the hip. I favoured this approach because the incision was small (less than 10cm) and the exposure of the hip was excellent. Also, it had the major advantage of not violating the hip abductors. This meant the patient could Sept – Oct 2010
E X P E RT
VIEWS
walk immediately after the operation with a barely noticeable limp. However, since operating on people who need to squat postoperatively, I have changed my surgical approach. The reason for this is that the posterior approach inevitably weakens the posterior structures of the hip joint, and this despite a careful repair. I have changed to the modified Hardinge anterolateral approach through a 12cm incision. The approach goes over the front of the hip and completely avoids damage to the posterior structures of the hip. I have found that the same excellent exposure can be obtained with practice. I am careful to leave the third superior part of the gluteus medius tendon intact and this has minimized the initial postoperative limp. The other important aspect of allowing the hip to safely squat is the positioning of the components for maximal stability. There are different ways to measure the amount of anteversion in which to place the acetabular cup. I find the most reliable indicator is the orientation of the transverse acetabular ligament. This is normally 15 degrees anteverted compared to the long axis of the body. I like to antevert the acetablar cup 10 degrees more than the transverse acetabular ligament, giving around 25 degrees of anteversion. The other important factor is the vertical inclination of the acetabular cup. This is a balance between stability and range of movement. If the angle is less – say 35-40 degrees, the hip becomes very stable but the range of movement is very limited. Conversely if the angle is 50-60 degrees it will have an excellent range of movement but will be more likely to dislocate. I have found the optimal balance between the two in the patient who wants to squat, but also needs the range of movement – say to sit on the floor is exactly 45 degrees. If the anteversion of the cup is 25 degrees and the acetabular index is 45 degrees, the optimal cup position for the squatting patient has been achieved. In addition to the cup anteversion, I also put 10 degrees of anteversion into the femoral stem. The combination of Sept – Oct 2010
Lateral x-ray of the hip in a patient who can squat after surgery, showing the anteversion of the cup, neck and the vertical inclination in the optimal position femoral and acetabular anteversion makes for a very stable hip in deep flexion. As for all hip replacements it is very important that the length and offset be restored exactly. The second important consideration is the implant components. In this area, mechanical principles come into play. The bigger the head and the smaller the neck, the greater the range of movement will be. Whilst hip resurfacing has the advantage of a large head, it has the disadvantage of a large neck. Increasingly options are available to allow a large head and a small neck. If the head can be 36mm, and this is the size I favour, this means that the cup would be very large to accommodate it if an adequate thickness of polyethelene was used for the bearing surface. However, most surgeons would only want to remove the minimal amount of acetabular bone stock as necessary. In order to reduce the amount of acetabular bone that is removed, we have to use different bearing surfaces. Our choice is either metal on metal or ceramic on ceramic. Both have advantages and disadvantages, but I favour ceramic on ceramic implants because of the recent concerns with metal ion sensitivity with metal-onmetal implants. My ideal bearing
AP x-ray of the pelvis after a hip replacement in a patient who can squat, showing the large 36mm ceramic on ceramic head surface is a 36mm ceramic head on a ceramic liner. In some very small patients, I use a 32mm head, as the 36mm cup will not fit into acetabulum. Should we use cemented or uncemented? This is up to surgeon preference. I favour a cemented stem and uncemented cup. This allows immediate full weight bearing and the advantages of antibiotic in the cement. When these modifications are made, both in the surgical technique and the implants used, I have routinely found the patients able to safely squat after total hip replacement. However, cost and availability of certain implants is often an important issue in some Asian communities. Of the two, technique is more important than the implant and it costs nothing to introduce.
Conclusion More than 1/3 of the population of world are Asian, and this is a major group of patients that may benefit from hip replacement. It is time we stop and think afresh about what differences these patients have in terms of expectations of the outcomes of surgery and in their activities of daily living. Can we optimize joint replacement for the Asian community? I believe we can. 49
H E A LT H &
FITNESS
Drinking Cold Water after a meal = Cancer! Can you believe this? It is nice to have a cup of cold drink after a meal. However, the cold water will solidify the oily stuff that you have just consumed. It will slow down the digestion. Once this 'sludge' reacts with the acid, it will break down
50
and be absorbed by the intestine faster than the solid food. It will line the intestine. Very soon, this will turn into fats and lead to cancer. It is best to drink hot soup or warm water after a meal.
Sept – Oct 2010
H E A LT H &
FITNESS
Heart Attacks and Drinking Warm Water
T
his is a very good article.. Not only about the warm water after your meal, but about Heart Attacks. The Chinese and Japanese drink hot tea with their meals, not cold water, maybe it is time we adopt their drinking habit while eating. • For those who like to drink cold water, this article is applicable to you. • It is nice to have a cup of cold drink after after a meal. • However, the cold water will solidify the oily stuff that you have just consumed. • It will slow down the digestion. • Once this 'sludge' reacts with the acid, it will break down and be absorbed by the intestine faster than the solid food. • It will line the intestine. int nttestine. n • Very soon, this w will wi ill turn into fats and lead to cancer & arthritis. • It is best to drin drink warm iin nk hot ho ot soup or wa w rm water after afterr a meal. meall.
Sept – Oct 2010
Common Symptoms of Heart Attack... A serious note about heart attacks - You should know that not every heart attack symptom is going to be the left arm hurting. Be aware of intense pain in the jaw line. You may never have the first chest pain during the course of a heart attack. Nausea and intense sweating are also common symptoms. 60% of people who have a heart attack while they are asleep do not wake up. Pain in the jaw can wake you from a sound sleep. Let's be careful and be aware. The more we know, the better chance we could survive. A cardiologist says if everyone who reads this message sends it to 10 people, you can be sure that we'll save at least one life. Read this & Send to a friend. It could save a life. So, please be a true friend frriend and send this article to all your friends you care about...
51
H E A LT H &
FITNESS
ITCHING can be taken care with
HOME REMEDIES
I
tching is common problem face by almost all of us due to various reasons like bug bites, sunburn, poison ivy, allergies, reactions to chemicals, soaps, medication, dry weather, infections and many more. To scratch or not to scratch is the question. Though at times, itching in front of people become very embarrassing, most of us tend to throw self-discipline out the door and scratch to our skin's content. Though this gives a momentary satisfaction, scratching excessively can injure your skin. There are many home remedies for solving the problem of Itching which we are discussing below:
Baking Soda
For hard-to-reach itches, soak in a baking soda bath. Add 1 cup baking soda to a tub of warm water. Soak for 30 to 60 minutes in the tub and air dry. If but tub is not available, you can add 2 Tbsp. in 1 bucket of warm water and take a bath with the water. Localized itches can be treated with a baking soda paste, by mixing 3 parts baking soda and 1 part water. Apply to the itch. Baking soda is a well known home remedy for itching.
Oatmeal
Instead of baking soda, add 1 to 2 cups finely ground oatmeal to a warm bath to ease your itches.
Lemon
Lemon is also another effective remedy. Lemon contains anesthetic and antiinflammatory properties, which may help reduce itching. Squeeze undiluted lemon juice on itchy skin and allow to dry and see the difference.
Aloe Vera
Aloe vera is a must for itches. The same constituents that reduce inflammation and blistering in burns also is helpful to reduce itching. Just rub the the gel of an aloe vera leaf only on the itch. 52
Sept – Oct 2010
Nomination Form Best Doctor Award for his services & excellence.
First Name ............................... Last Name ............................................................... QualiÙcations ............................................................................................................... Specialization .............................................................................................................. Experience (No. Of Year) ............................................................................................. Name of Hospital or Clinic .......................................................................................... Designation ................................................................................................................. Average No. of Patient/Day ......................................................................................... Address ...................................................................................................................... City .......................................... State ........................................................................ Postal code ............................. Country .................................................................... Phone ...................................... Mobile ..................................................................... E-mail ......................................................................................................................... Website ........................................................................................................................ Success Story ............................................................................................................. ..................................................................................................................................... ..................................................................................................................................... .....................................................................................................................................
Signature Note: Please make photo copy for more than one use. Please Ùll the application form and send us by courier/post on below address:
Medgate Today
92/17, Zakir Nagar, Opp. New Friends Colony, Okhla, New Delhi - 110025 Mobile: +91 9289336800 E-mail: info@medgatetoday.com, medgatetoday@gmail.com Website: www.medgatetoday.com
I would like to subscribe for (tick as applicable) 1 year 6 Bi-monthly issues for ` 450 (Our price ` 350/-) & US$30 2 years 12 Bi-monthly issues for ` 900 (Our price ` 700/-) & US$60 First Name ......................................... Last Name .................................... Designation ....................................... Organization ................................. Address ..................................................................................................... City .................................................... State ............................................. Postal code ....................................... Country ......................................... Phone ................................................ Fax ............................................... Email ..........................................................................................................
I enclose cheque no ........................... drawn on ....................................... dated ......................... towards subscription for Medgate Today magazine in favour of Medgate Today.
Sign ......................................................Date ............................
Don’t Miss Out on the Medgate Action!!! “Subscribe Now”
Mail this form with payment to: Medgate Today 92/17, Zakir Nagar, Opp. New Friends Colony, Okhla, New Delhi - 110025 Mobile: +91 9289336800 E-mail: info@medgatetoday.com, medgatetoday@gmail.com Website: www.medgatetoday.com
India’s Top Health & Medical Magazine
Orthopaedic Solutions Medical Shoes Custom made insole Diabetics Shoes Artificial Limbs Spinal Support Rehabilitation Aids
Edrees Medical Equipment P.O Box 123876, Dubai, U.A.E, Behind Day to day, Karama Tel. +971 43979594 Fax: +971 43979584 Mobile. +971 502108378 Email: info@edreesmedical.com Website: www.edreesmedical.com
HO: Jeddah, Kingdom of Saudi Arbia