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Department of Radiology Cardiology Gastroenterology
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CONTENTS
Contents NEWS
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Innovations Spark Growth...
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Asicon
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5th International Medical
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Doctor as an Entrepreneur 18
Health Care Architechture
Obesity may leads
Becoming a Doctor 30
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EXPERT
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EYE
CARE
HIP REPLACEMENT
D E N TA L
Latest Cataract Surgery 32
HYGINE
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Orthodontics & Cosmetic Dentistry 34
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H EA LTH &
FITNESS
Deal with HIGH BLOOD PRESSURE 46
TOOTH Sensitivity 36
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VERICOSE VEIN SUPPORT
KNEE SUPPORT
ANKLE SUPPORT
ADVANCE HEALTH CARE
Manufacturer of ortho and Rehabilitation Aids
C-162, Prem Nagar - II, Nangloi, Delhi - 110 041 Phone: 011-25180014 Mobile: +91 9968139239, +91 9310039239 Email: info@advancehealthcare.in Website: www.advancehealthcare.in
Jan – Feb 2011
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INNOVATIONS Spark Growth
in the Endoscopy Laparoscopy Markets
Trends point to a shift from open surgery to minimally invasive surgery (MIS), using endoscopic/laparoscopic tools as they guarantee lower risk, faster recovery, and cost efficiency. MIS is slated to be the default surgical procedure in the future as scalating demand for sophis- opposed to open surgery unless ticated technologies that en- other complications are involved. able early detection of colon, Complications are rare in endosesophageal, and gastrointestinal (GI) copy but may include perforation of cancers has forced companies to the stomach or intestine, which will launch highly versatile technologies require immediate surgical intervento cater to the needs of endoscopists. tion. The proliferation of gastrointes-
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Haryana gives 300 acres land for AIIMS-like institute
tinal diseases and a huge untapped, aging population have helped fuel market momentum. “High uptake of sophisticated diagnostic and surgical procedures has encouraged traditional manufacturers pioneer the development of flexible, rigid, and capsule endoscopy to roll out technological innovations in a short time span,” notes the analyst of this research service. “The market is poised to witness enhancements in therapeutic capabilities in wireless capsule endoscopy, size and scope of flexible endoscopes, high definition (HD) visualization systems, and robotic endoscopic surgical assistance.
Sticking to a vegetarian diet
may be good for kidney disease patients
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he Haryana government Thursday approved the lease of 300 acres of land in the state’s Jhajjar district for the setting up of a premier medical institute on the lines of the All India Institute of Medical Sciences. AIIMS phase-II in Haryana will be an extension of the country’s premier health institute situated in south Delhi. The new project will be located 100 km from the national capital. The health services and research facilities of the AIIMS phase-II would be extended to patients from Uttar Pradesh, Punjab, Himachal Pradesh and Uttrakhand, besides Haryana, the spokesman added.
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new study has suggested that sticking to a vegetarian diet can help kidney disease patients avoid accumulating toxic levels of phosphorous in their bodies.
Kidney disease patients must limit their phosphorous intake, as high levels of the mineral can lead to heart disease and death.
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How Acupuncture May Alter Perception of Pain Study Suggests Acupuncture Affects Areas of Brain Involved With Pain Perception cupuncture many. Theysohn works diand colleagues rectly on the used functional brain to alter MRI scans to the way we capture brain process and activity while perceive pain, participants repreliminary received electrical search suggests. currents from a T h e device attached 18-person study to their ankles. suggests that Functional MRI the ancient Chinese practice allows doctors to look at how relieves pain, says study leader blood flow increases in response Nina Theysohn, MD, of the Uni- to brain activity. versity Hospital in Essen, Ger-
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Osteoporosis Drug Approved for Cancer-Related Bone Pain
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geva Reduced Fractures, Pain in People With Advanced Cancer The FDA has approved Xgeva (denosumab), an osteoporosis drug reformulated to reduce the risk of bone fractures and bone pain in patients with cancer that has spread throughout the body.
Echo Preferred for Pre-Chemotherapy
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chocardiograms in cancer patients prior to cardiotoxic chemotherapy provide more useful clinical information than the more commonly-used gated blood pool scans (GBPS), accordingto Australian research.Researchers from the cardiologyand oncology departments at The main limitation of GPBS is that it could only estimate ejection fraction, and could not detect diastolic dysfunction or other abnormalities which could influencedecisions about chemotherapy. They retrospectively audite more than 200 echocardiograms ordered by medical oncologists during a 36-month period. Almost 90% of patients were female with a mean age of 55 years, and three-quarters had breast cancer.The researchers hypothesised
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that a baseline echo could detect clinically relevant abnormalities other than ejection fraction in at least 5% of cases. In fact, 7.5% had abnormalities that would not have been detected by GPBS.There were over 13% of patients with at least one abnormality on echo. Systolic and moderate diastolic dysfunction was seen in 5% and 2.7% respectively. Patients with an abnormal echo were older and had a mean ejection fraction of 57% compared with64% in patients with a normal echo.An abnormal echo finding led to a change in the chemotherapy plan or a cardiology referral in 31% of cases. Changes to chemotherapy included a one to three-week delay in starting treatment.
The FDA based its approval on three clinical trials involving more than 5,700 patients with various cancers, including breast and prostate cancer.The trials compared Xgeva with a similar drug, Zometa. Researchers looked at groups of cancer patients on one of the two medications and measured the time until occurrence of skeletal-related events such as a bone fracture or spinal cord compression due to their cancer or until surgery or radiation was needed to alleviate severe bone pain. Jan – Feb 2011
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Attracts huge quality visitors and sets a new record s 0- Make , 1 0 2 I I H t ve debu i s s e r p an Im pleased s r o t i b i exh sults e r l l a r e with ov
ospital Infrastructure India 2010- India’s first and premier exhibition on hospital infrastructure, planning, hospital supplies and healthcare development was held successfully from Dec 7-9, 2010 at Bombay exhibition Centre, Mumbai, India.
pected GDP spend of 8 per cent by 2012 from 5.5 per cent in 2009. India spent 5.2 per cent of the GDP on healthcare, of which 4.3 per cent was spent by the private sector valued at USD22billion. Private sector expenditure in the healthcare segment is expected to reach USD 45 billion by 2012, The Indian Healthcare sector it added. It is estimated that the – Opportunities Galore: hospital segment alone is expected The Indian healthcare sector to reach USD 54.7 billion by 2012, is expected to become a USD 280 billion industry by 2020 with spending on health estimated to grow 14 per cent annually, according to a report by industry chamber, FICCI. Healthcare has emerged as one of the most progressive and largest service sectors in India with an ex12
representing more than 70 per cent of healthcare sector revenues. Quality Visitors, Quality Business: HII event attracted 2800+ trade visitors comprising CEOs, Medical Director, Hospital Administrators, Medical Superidentants, Bio Medical Consultants, Healthcare architects, Project management consultants, Developers, PE firms, and many senior decision makers and healthcare professionals.A detailed visitor analysis, and post show report is being worked upon. Innovations & trends presented: The event offered visitors the possibility to collect information Jan – Feb 2011
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about the hospital infrastructural products, medical equipments, hospital consultancy and planning, and meet their potential suppliers & future partners. Leading companies in hospital planning, hospital floorings, ceilings, OT lights, Clean room partitions, medical equipments & products, healthcare IT, hospital furniture, hospital supplies, engineering & construction, and so on. Efficient business meetings made it possible for exhibitors to gain prospective business contacts and to open new possibilities for their business. The key exhibitor’s objectives were to extend their business & solutions to hospitals, meet & network with hospital consultants and planners, and to deepen their collaboration & partnerships, and to gain information on emerging trends in hospital infrastructure and management. Exhibitors realized the importance of cultivating their business relationship with direct influential contacts hospital partners by continuous participation. One of them state .The hallmark of the show was the quality visitors and the variety of
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products and services on display. It was a one stop shop for any healthcare professional or entrepreneur to see, compare and negotiate the various services on offer.The exhibitors included hospital consultants, healthcare architects, planners, developers, medical equipment suppliers, flooring, roofing, clean room partitions amongst many more. 107 exhibitors from 12 overseas countries showcased the entire gamut of hospital infrastruc-
ture products, medical equipments/ technology, and hospital solutions all under one roof. Countries represented were US, UK, Australia, Hungary,Taiwan, Switzerland, United Arab Emirates, Japan, Singapore, Italy, Germany, The Netherlands & the host India. Some of the leading companies included L & T, Sony India,Armstrong World, HKS, Burt Hill, GMP technical, Everest Industries, Tahpi, Draeger Medical, Smart Network International, Gerflor, Tarkett, Responsive Industries, Medica Synergie, Hosmac, Hospaccx , Forbo, CCIL, and Ediffice besides others. The International conference, which focused on vital issues concerning hospital planning and design, medical technology & equipment, healthcare IT, and hospital accreditation running alongside the exhibition received an outstanding response from delegates at large. Attractive panel discussions, from internationally acclaimed companies and influential healthcare personalities from India served as an excellent catalyst to the entire conference topics. 13
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Dr. Arvind Kumar (Organising Secretary) Asicon 2010
Mr.
Afzal Kamal Mr. Abhishek Khandelwal
(National Head) Medgate today Magazine
(Asst. Marketing Manager) Asitech
The 70th Annual conference of the association of surgeons of India 6 days event concluded successfully at AIIMS New Delhi.
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sitech, the trade exhibition and key platform for expanding the Indian Medical market. The one stop medical technology exhibition with 1st comprehensive symposium & workshop
on “Doctor as an Entrepreneur”. ference and exhibition. Several innovative medical devices The exhibitors did a very good and products were displayed that business and response and they met made the event truly global. entire medical fraternity at one place. Thousands of delegates had registered for participation in con-
The 71th asicon 2011 to be held in Kochi (Kerala) have already begun and booking of booth and registration for asicon 2011 has started.
Conference Secretariat:
Dr. Santhosh John Abraham Organizing Secretary ASICON 2011 Lourdes Hospital, Pachalam P.O, Kochi - 682012, Kerala, India.
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Tel: +91 484 4121137 Mob: +91 98470 53424, 94960 02204 Email: mail@asicon2011.org www.asicon2011.org
Official Media Partner
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5 International Medical & Health care th
Summit Medifest 2010 concluded successfully in Indian capital New Delhi.
Mr. Roohit Madan CEO Medifest offered both foreign and local companies an exclusive support and assistance to explore the Indian healthcare sector which is expected to become a US$ 280 billion industry by 2020 with spending on health estimated to grow 14 per cent annually.
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ith strong decesion making presence of 64% visitors representing management and 74% visitors involved in product selection and technology purchasing decesions, Medifest India 2010 premier
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medical & healthcare summit on 13-14-15 december 2010 at NASC Complex PUSA New Delhi the most comprehensive annual event serving Indian sub continent proved to be perfect platform to explore US$ 40 billion Indian healthcare Industry
which is estimated to grow US$ 78.6 billion by 2012. Medifest India an umbrella event for healthcare industry attracted key decesi on makers from twenty countries including Malaysia, Thailand, Iran, Mongolia, Poland, Ko-
Jan – Feb 2011
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rea, Netherland, Germany, Czech Republic, India, Singapore, Japan, China, Hungary, Sudan, Srilanka, Zimbabwe, USA,Veitnam, Kuwait.A delegation from Ministry of Health and Child Welfare Govt. of Zimbabwe led by Dr. P.K Chivaurah, Dr. Jasper Chime-
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dza, Dr. C.T Basera besides other private buyers across the globe was one of the main highlight of the event. India is seeing a shift in disease patterns from communicable diseases to the high incidence of noncommunicable and lifestyle-related
diseases—hence, the demand for tertiary and quaternary care is huge. The gap in infrastructure, in terms of healthcare facilities and personnel, presents opportunities for foreign companies. As per a study by an industry body and Ernst & Young, India would require another 1.75 million beds by the end of 2025.The public sector however is likely to contribute only around 15-20 per cent of the required US$ 86 billion investment said Mr. Roohit Madan CEO Medifest. Concurrent conference sessions on Injection Safety, Sexuality, Quit Smoking, Percutaneous Therapy of Valvular Lesions in Heart Failure, Approach to a Patient of Fatty Liver were hosted by Safe Point Centre India, Indian Medical Association (Janak Puri Branch), Indian Medical Association ( Central Delhi Branch) motivated medical and paramedical faternity to exchange with renowned speakers like Dr.T K Joshi, Dr. (Col) V.K Wadia, Dr.A.K Kansal, Prof (Dr.) Vijay Trehan, Prof. ( Dr.) Nirmal Kumar & Dr. H.P Singh.
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COVER
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How to Get
Doctor as an Entrepreneur
Employees to Generate Great Ideas Seek team members’ honest feedback and watch your business thrive
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here used to be considerable interest in what employees thought. But as the economy tightened up, downsizing and rightsizing occurred. Employers became less focused on individual needs and wants, and more focused on producing products and services. Above all, they were concerned with making money and increasing the return on their investments just to survive. Indeed, the increasingly competitive nature of the business environment and the reduction in 20
product demand meant cutting expenses, salaries, and even jobs. One obvious outcome of staff reductions is that employees concerned about keeping their jobs fear speaking up, alienating their boss or questioning the status quo, especially if the latter includes someone’s pet project or policy. This puts entrepreneurs in a bind:You want to take appropriate risks but may be reluctant to do so because of economic realities.You want input from your employees, but you don’t want them to fear
being reprimanded or dismissed if their ideas come across as negative or critical.You are aware that some innovative ideas and thoughts about positive change may be stifled due to this fear.
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sthe entrepreneur and head of your organization, you need to create an atmosphere that allows and even encourages innovative thoughts about processes, policies, people and procedures.
1. Make sure senior management gets it. Meet with your senior managers and emphasize the need for opening channels of communication up and down the hierarchy.The need for gathering input from the people who are performing the tasks is crucial.
2. Encourage employees to question the status quo. Don’t just pay lip service. Demonstrate that you want employee feedback. Be the first one to examine a process, policy, human capital allotment or procedure and raise a question as to its functionality and effectiveness. In front of your employees, state that you are open to constructive suggestions that will improve the system, its efficiency, and its cost, even with fewer available resources. 3. Plan meetings specifically for challenging the status quo. With praise, e-mail, voice mail and even simple gifts, reward employees who come up with creative ideas.
4. Recognize employees when their ideas are implemented. Make it a big deal and make sure everyone knows which individual or team was responsible for the innovation.
5. Create diverse groups to discuss ideas. Include employees with differing perspectives, educational backgrounds, and experiences to share ideas and question the status quo.
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Some entrepreneurs incorrectly assume that they are the only ones who can generate a new idea or approach. Many times that is true. But empowering others in the company to do the same will not only increase employee interest and motivation to perform at their peak, but it will also lead to a more successful organization. 21
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HealthCareArchitechture
Health Care Architechture
Better Interior of Hospital
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ery soon, every single establishment will parade as a hotel industry unit. It’s bad enough that regular spaces such as salons and banks imitate hotel-spa concepts, but now hospitals too seem to be following suit. But when it comes to medical institutions catching up with this trend, you cannot take it at face value – for good reason, really.The little touches of the Leonardo da Vinci painting on the wall, the natural window views and maybe Beethoven’s Ninth Symphony or Pavarotti in the background in your average hospital room, could potentially reduce recovery time. In other words, these décor changes (well, maybe not as grand as a da Vinci painting) go beyond the adage of old content in new packaging.
The nub of healthcare design is to make a patient feel better– faster. A quick sweep through scientific data to establishthe link bet ween design and patient benefits reveals that research is nascent. Still, it is hard to ignore what is increasingly becoming the norm of a hospital’s functioning – ambient facilities and hospitality. The former feature has hospitals goingthe extra mile to create a comfortable and pleasant atmosphere. Some do this by positioning pieces of art and sculpture, others by designing the room around views of nature, and yet others by doing something as simple as carpeting an area to minimise noise..
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Can a painting on a wall or classical music in the background reduce recovery time for a hospitalised patient?
INNOVATIVE AMBIENT CONCEPTS: Healthcare architects, designers and space planners – as they are called – have introduced innovative design concepts ranging from the expected to the unheard of. They not only consider the R&D aspect of these design technologies, they study the healing impact of factors such as room size and scale, privacy, lighting, ventilation, the colour of walls and furnishings, fabrics, art, music and views. In fact, hospitals themselves evaluate the healing impacts, says Amer Salha, the head of Medical Equipment Planning at the American Hospital in Dubai. “The evaluation plays a major role in reviewing current services and planning modifications, and considers the future expansion [of the hospital]. In general, hospitals are aware of the benefits of improved surroundings and pay more attention to patient experience,” he says.
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A few findings validate how changes in décor reduce recovery time for a hospitalised patient. Notably, findings from the Johns Hopkins University that conducted a comprehensive review of 84 studies on the impact of health to demonstrate that the mind, brain and nervous system can be directly influenced positively or negatively by elements in the environment. Further validation comes from a study conducted by Marina de Tommaso and a team from the University of Bari in Italy; they highlighted the aesthetic value of paintings on pain thresholds. Music also forms a part of ambient facilities and the right kind is known to have a positive effect on patients. Studies from Pavia University in Italy showed that listening to certaingenres can slow the heartbeat and lower blood pressure. But regardless of what a
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hospital may choose to aesthetically improve its surroundings, the result is positive: the patient feels better and the hospitalstands to benefit in terms of a shorter length of stay, and hence, lower cost per case. “A hospital’s rating is directly tied with its sur- gical outcomes and the length of stay; the shorter the stay, the higher the rating,” Administration manager Garreth Estment from The City Hospital in Dubai, which won the Best InteriorDesign Award at the Hospital Build AwardsMiddle East last year, agrees. He says, If you thinkabout it, a nice and comfortable place makes you relax. It also creates a positive frame of mind and thereby assists with the healing process.” In the UAE, an example of this trend is the mbient cardiac catheterisation laboratory at the Sheikh Khalifa Medical City (SKMC)
in Abu habi. It has been designed with scene projectors, special lighting and sound effects – all targeted at optimising patient care. And more importantly, it has been clinically proven to reduce anxiety.
However, aesthetic features by themselves aren’t enough. Functionality is just as important. There should be a balance, says Estment. “No amount of pleasant aesthetic surroundings can dispel the anxiety of a clinical area if it isn’t functional.” In the same vein, ambient facilities need to be customised because they do not provide a onesize solution.
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DIFFERENT PROBLEMS, DIFFERENTSOLUTIONS: Ambient facilities need to be ta lored according to whether it’s psychiatric, geriatric or posto erative care. Patients have different needs – whether it is lighting or furniture. Salha says, “In the psychiatric ward for example, we need to choose furniture to ensure that the patient doesn’t injure himself. Whereas in the geriatric ward, we have to choose beds with special pressure ma tress to avoid bed ulcers.” Healthcare design has to look at patients’ needs and how they react to differ26
ent stimuli. “Each unit needs to be suited to a specific medical speciality and the patient’s individual needs,” says Estment. Take lighting for example. A study from the USbased Lighting R search Center (LRC) shows how innovative lighting designs and advanced technologies, including LEDs, photosensors and occ pancy sensors, can help seniors in long-term care environments maintain independence and be more comfortable. There are se eral other areas where the right lighting can reduce the recovery period. According to Estment, these areas include oph-
thalmo ogy, maternity wards, delivery rooms, paediatric wards and dialysis units. Salha adds:“Lighting is an important consideration in the psychiatric and geriatric wards too. It [lighting selection] is crucial to create the effect of day and night for patients who are required to get rest or vice-versa.” In addition to aesthetic features, hospitals are also wor ing towards providing upto- date entertainment systems, internet connectivity and a host of other amenities in the hope that patients will enjoy their stay and leave as soon as they feel well enough to do so. Jan – Feb 2011
EXPERT
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Obesity
may leads to Diabetes & Heart disease?
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any other diseases are also associated with obesity and the patient may manifest any of the symptoms of these - heart disease, hypertension, stroke, cancer, gallbladder disease, type 2 diabetes, etc.
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besity means your body has accumulated excessive amount fat and this is posing a risk to your health.When you consume more calories than you burn off, the body stores these excess calories as fat and you start gaining weight. Obese people are at a higher risk of developing heart disease,Type 2 Diabetes, hypertension, joint pains, etc. Obesity has attained epidemic proportions today due to faulty food habits combined with lack of physical activity. Global statistics clearly show that the disease is on rise not only in developed nations but also in developing countries. Nearly one third of all Americans today are obese. According to the WHO, in 2005, obesity globally affected at least 400 28
Dr. Ajay Kumar Medical Director Muzaffarpur Heart Hospital & Research Center
million adults. The projection was that by the year 2015 more than 700 million will be obese. Billions of dollars are spent every year to tackle with obesity and this includes costs of diet foods, diet books, diet pills, treatment of diseases associated with diabetes, etc. In order to detect obesity, a simple measurement called BMI
(Body Mass Index) is used. BMI is calculated using your weight and height. The weight in kilograms divided by the square of the height Jan – Feb 2011
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in meters (kg/m2) gives the value • Pain in weight bearing joints of your BMI. You can check which like knees, hips and also in the back range your BMI falls into: • Snoring • Rashes in the folds of skin such as in the groins, between thighs, Below 18.5: Underweight axillae, below breasts, etc. 18.5 - 24.9: Normal 25.0 - 29.9: Overweight 30.0 and higher: Obese People who have a BMI of more than 40 are termed to be suffering with ‘Morbid Obesity’ which can pose a serious risk to health and must be effectively tackled without any delay. In addition to the extra weight that you carry, it is also important to determine where you carry this extra fat. Having more fat around the middle portion of the body (called Apple-shaped obesity) is more threatening to health than having more fat around the hips (called Pear-shaped obesity). It is very vital for the patient to realize that he must lose the extra weight even if he does not feel any problem with it. This is because obesity leads to many complications in the long run which the patient may not realize initially.
Obesity? Excessive weight gain and extra fatty tissue are obviously the major symptoms of obesity. However, the weight gain causes a lot more symptoms to be manifest in the patient gradually over a period of time. As the disease advances, these become more and more prominent: • Running out of breath - even with minor exertion sometimes • Difficulty in sleeping • Excessive perspiration Jan – Feb 2011
• Depression Many other diseases are also associated with obesity and the patient may manifest any of the symptoms of these - heart disease, hypertension, stroke, cancer, gallbladder disease, type 2 diabetes, etc.
Causes: When you take consume more calories than you are able to burn off, you start gaining weight. The body stores these excess calories as fat. Over a period of time, this fat increases if there is no corrective change in the lifestyle and this contributes to obesity. Additionally, Obesity is also influenced by other factors such as:
• Poor eating habits and food choices: Diets and drinks high in calories, oversized food portions, fast foods, skipping breakfast, etc. are habits detrimental to weight management • Lack of physical activities / exercise: Sedentary life that is without adequate physical activities is another major contributor to obesity • Genetic - The amount of fat stored in the body as well its distribution is largely determined by the genetic make up of an individual • Family history - 0n account of having similar lifestyle and food habits, people from the same family may suffer from obesity of a similar pattern. If one or both of the parents are obese, a child’s risk of being obese is significantly increased • Pregnancy:Weight gain during pregnancy is a normal and essential phenomenon - however some women may find it difficult to lose this excess weight after childbirth • Certain hormonal problems such as Cushing’s syndrome, Hypothyroidism, Polycystic Ovary Syndrome (PCOD/PCOS), arthritis, etc. can lead to excess weight gain • Chronic arthritis or any other chronic pain may indirectly contribute to obesity since physical activities are reduced due to pain and the patient may tend to overeat to psychologically combat the pain • Certain medications like steroids, antidepressants, seizure medications, certain high blood pressure medicines, etc. may also cause weight gain • Psychological causes include Bulimia, emotional stress, anxiety, depression, etc. that can lead to overeating thus contributing to obesity
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Self care may reduce the obesity
the day. It might be a challenge to fit it into your busy lifestyle but a healthy breakfast goes a long way Obesity is not a difficult task in controlling your weight in the but it is important for the physi- long term. cian to determine what has caused • Eat protein with complex the obesity in the given patient and carbohydrates: Combining these what the corrective measures are food groups in every meal of the for the same.The health history of day, including snacks, will ensure that the patient and the BMI measure- you get a steady flow of energy as the ment make the diagnosis clear. BMI body converts food relatively slowly additionally gives a measure of the to glucose. You can hence prevent stage of your obesity. triggering insulin production and, in Measuring the waist circumfer- turn, minimizing the po- tential of ence (fat stored around the waist) your body to store food as is another way to determine your fat. Proteinrich risk of developing complications foods such as diabetes and heart disease. Women with a waist measurement of more than 35 inches and men with a waist measurement of more than 40 inches have more health risks as are compared to people with smaller l e n tils, lewaist measurements. gumes, milk (soya and regular), egg, meat, fish In addition, the physician makes use of the following for determin- and tofu.Complex carbohydrates are un-milled brown rice, oats, whole ing the probable causes of obewheat, jowar, ragi and bajra. sity: • Stay hydrated: It is important • Complete blood count to drink plenty of water, at least (CBC) 2.5 litres a day and even more in • Cholesterol and triglyceride hot weather or if you are exercislevels - complete lipid profile ing. Remember, your body is 80 per • Thyroid function tests cent water and by the time your • Liver function tests body tells you that you are thirsty, • Fasting and post prandial you are already dehydrated. Limiting glucose - to rule out diabetes alcohol (also high in calories), tea • ECG - Electrocardiogram and coffee is important, as these to assess the cardiac functions and are dehydrating. rule out coronary artery disease • Enjoy a varied diet: It is very easy to get into the habit of eating Food & life style to reduce the same foods every day. Be experimental and make sure your foods obesity: are as colorful as your wardrobe. • Do not skip breakfast: Fuel Try and introduce two new nutrient the brain and the body.A good break- dense foods into your diet every fast kick-starts metabolism, allowing week.This will ensure that you get you to burn more calories during a variety of nutrients each day. 30
• Enjoy your food: Eating has become a chore these days, mostly crammed in between “important” events, and we barely find time to really savor our food.Taking time out to eat is beneficial to our digestive health (that is, we digest better and in turn absorb more nutrients) and far more satisfying. • Avoid sugar: Excessive consumption of foods high in simple sugars (table sugar, fruit juice, fizzy drink, cakes, confectionery) disrupts the body’s blood sugar balance, leading to fat production and weight gain. These foods are high in calories too, forcing you to burn more to weigh less. • Eat the good fats: Not all fats are bad. The body needs the good fats (also known as essential fats) such as Omega 3 (oily fish sardines, raavas, Bangda) and Omega 6 (linseeds, sunflower and pumpkin seeds) to function properly.The key is to limit intake of saturated fats (red meat, dairy, confectionery, butter). • Eat little and often: Graze and not gorge! Eating a balanced meal (complex carbohydrates 50 per cent, good fats 25 per cent, protein 25 per cent) with healthy snacking (nuts, seeds, fruits) gives you a constant supply of energy throughout the day, making hunger, tiredness and food craving a thing of the past. • Last but not least - Exercise: Losing and maintaining weight does not involve just changing your attitude towards food. Exercise and eating healthy go hand in hand.Your daily energy output must balance your calorie intake. Therefore, no matter how busy you are plan 30 minutes of exercise (brisk walking, swimming, jogging, cycling, aerobics) everyday! Jan – Feb 2011
Contact : Mr. Ahamed Khan HP : 9840054355
Jan – Feb 2011
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Becoming A
Doctor? Dr. Pradeep Bhardwaj
CEO, Six Sigma Star Healthcare Limited, Delhi
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here are about 350 odd Across India, while fees in been approving hikes proposed by universities and 18,000 private unaided medical colleges the managements of these colleges colleges providing higher are still way below Rs 3 lakh, the every year. The question that we education in the country, to about Nagpur-based NKP Salve institute need to ask is, when students from 10% of the relevant age group.This charges Rs 4.75 lakh, the highest in these colleges finally reach society is extremely inadequate in a country the country. Karnataka may have what will prevent them from exwhere the demographic dividend by the largest pool of medical seats in tracting their pound of flesh from way of a young population of about India but Maharashtra by far charges their patients.Whither the spirit of 550 million youth, is a much talked the highest fees. service in their minds when they about asset. If we are to achieve a The annual cost of an MBBS have themselves been victim of these Gross Enrolment Ramoney-minting tio (GER) of 15% and schemes. India has above by 2015, we It takes Rs 1.7 crore to produce a single MBBS doctor a dismal patientneed to substantially doctor ratio. For increase the number at AIIMS. (Calculated by Using Time Driven Based Costing every 10,000 Indiof higher education Method, TD-ABC), What’s worse, an earlier study by the ans, there is one institutions (HEIs) in doctor. In conour country. Media Study Group found that over 53% of students who trast, Australia It is no wonder, has 249 doctors pass out as doctors from AIIMS leave India to work abroad. then, that for every for every 10,000 10,000 people in India people, Canada there are only six doctors, compared course in a private college in Ma- has 209, UK has 166 and US has 548. with nearly 55 in the United States harashtra ranges from Rs 4.75 lakh and nearly 21 in Canada. Regulatory — most of them run by politicians CURRENT SCENARIO: hurdles to the establishment of pri- — charging in the range of Rs 2.5According to the Medical vate medical schools have limited the 3 lakh. The annual fees of the only Council of India (MCI), the total opportunities to train for careers private college within Mumbai, K.J. number of registered allopathic in medicine, prompting would-be Somaiya,went up from Rs 1.89 lakh doctors in the country is 6,83,582 doctors to go abroad, despite a to a whopping Rs 3.72 lakh between with the population ratio working boom in private health care. 2003 and 2006. The main reason out to 1:1634. In addition, there Over the last three years, the for this state of affairs is that the are more than 6 lakh practitioners tuition fees paid by an aspiring doc- government committee responsible of Indian Systems of Medicine and tor in India have almost tripled. for regulating fees in the state has Homoeopathy in the country. 32
Jan – Feb 2011
DOC TOR
SPEAK
Postgraduate courses and seats available in different subjects: SUBJECT
APPROXIMATE NUMTOTAL NO. OF BER IN LIKELY TO BE NO. OF COLLEGES SEATS AVAILABLE AVAILABLE PER YEAR OFFERING COURSE THE SUBJECT AFTER GRADUATION
MD Anatomy MS Anatomy MD Physiology MD Biochemestry MD Pathology MD Microbiology MD Pharmacology MD Forensic Medicine MD Community Medicine MD Social and Preventive Medicine MD General Medicine MD TBRD (Tuberculosis and Respiratory Diseases) MD Dermatology MD Dermatology,Venerealogy and Leprology MD Psychiatry MD Paediatrics MS General Surgery MS Orthopaedics MS Otorhinolaryngology (ENT) MS Ophthalmology MD Obstetrics and Gynaecology MS Obstetrics and Gynaecology MD Radiodiagnosis MD Radiology MD Anaesthesiology MS Anaesthesia
23 79 85 66 124 88 87 42 37 80 141 46
221 172 133 448 214 182 67 163 1200 74
170 130 100 340 160 140 50 125 900 55
32 43
145 125
110 95
499 1049 370 248 356 617 162 609
380 790 280 190 270 460 120 460
58 117 131 109 102 109 112 18 63 16 12 57
See text for Details of Calculation There are 271 medical colleges in the country, out of which 138 are in the government sector and the remaining 133 in the private sector. The MBBS students’ intake capacity of these colleges is about 31,172 and the number of seats available in various post-graduate medical courses is approximately 11,005 annually. In 1965, there were 86 medical colleges in India. This number increased to 112 by 1980 (a rate of growth of 30%), to 143 in Jan – Feb 2011
the next decade (a rate of growth of 28%), and since 1990 over the past 17 years to 260, an increase of 82% compared with the figure in 1990. The intense competition for the few postgraduate (MD/MS) seats in medicine makes it very difficult for students to qualify as medical specialists after they complete MBBS. A good alternative is the Diplomate of National Board (DNB) degree (included in the Indian Medical Council
Act, 1956) awarded by NBA which is equivalent to the postgraduate (MD/MS) degrees. However though this examination has global recognition. Calculation, For subjects such as Forensic Medicine, Psychiatry, Tuberculosis and Respiratory Diseases, etc. less than 100 fresh qualified teachers will be available per year even assuming that all who qualify would desire to be teachers at a medical college. 33
EYE
CARE
Latest CataractSurgery Dr.Sharad Lakhotia M.S. (ophth) C.A.M.S (Vienna)
T
here has a great advancement in treatment of cataract in last two decade. Now the patient can have remarkable improvement in vision after Cataract Surgery. What is Cataract- There is natural crystalline lens present in every one’s eye behind the pupil. It is transparent.When it becomes opaque it is called Cataract.
be extended up to 5.25 mm and a non foldable lens can also be put without suturing. This is because the incision is made in such a way it forms a valvular self healing wound. The bigger is the incision; more is the
astigmatism i.e. cylindrical power.The goal of surgery is to have minimum induced astigmatism. New micro incision surgery is also available where by cataract can be performed by a sub 2mm incision. This is a great stride as induced astigmatism is nil or minimal. Patient comfort is excellent and quality of vision is also great.There are micro incision lenses also available, which can be inserted through such incision. Multifocal IOL:There is a wide range of intraocular lens available for the procedures. Primarily there are foldable and non foldable lens.
Suture less surgery by phaco:The biggest advancement in cataract surgery is that it can be performed without sutures by phaco emulsification. In this technique through a small hole of about 2.8mm, a round circular opening is made in the capsular bag and Cataract can be removed by emulsifying the lens. In the capsular bag, a foldable lens can be put through the same incision. However the incision can 34
Jan – Feb 2011
EYE
CARE
with all these lenses a small amount of distant glass number and a reading glass number is required. Now there are multifocal IOL available which can correct both distance and reading glasses. Some of them are good for reading and some of them are good for distant vision. There are diffractive and refractive kind of multifocal IOLs are available. Because of two focuses there are adjustment problem for some patients who may not be satisfied. So there should be correct selection of patient after the counseling. Accommodative lenses hold a great promise by which lens can alter there power and can give both distance and to some extent near vision. All these lenses can be mixed and matched in both eyes of the patients. There is no universal consensuses to
The foldable lens requires a little bigger incision but is cheaper. Now also 360 square edge lenses are available which prevents posterior capsular thickening. Their edge is so deigned that when they are put in the capsular bag, they prevent migration of cells from anterior capsule to posterior capsule and this prevents posterior capsule thickening which can be impair vision after surgery.YAG Laser capsulotomy is required by which a hole can be made in post capsule and patient can start seeing well again... There are also aberration free lenses available which can give good contrast sensitivity and hence good quality of vision. There are foldable lenses made which is the best combination and of acrylic material and silicon ma- depends upon surgeon’s individual terial. Acrylic material lenses are preference. preferred lens especially in diabetes; Jan – Feb 2011
Higher End phaco Machine:Phaco emulsification can be performed fairly alright with any type of machine by a competent eye surgeon. However there are higher end machines available which can be simplify the job and make the procedure safer and faster.They utilize the principal of cold phaco there by wound burn is avoided. They have high vacuum capabilities without changing the fluid balance
inside the eye. Thus a high level of sophistication can be achieved Complication :Phacoemulsification with a state of art machine is a very safe procedure with a success rate over 99% . However complications do occur and an experienced surgeon can manage these complications fairly well. Thus phaco with all new advancements has made cataract surgery simple and gives very high quality of vision to the patients.
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D E N TA L
HYGIENE
Orthodontics &
D
Cosmetic Dentistry
ental braces are used to straighten crooked teeth, align upper and lower jaws, improve the aesthetics of smiles and faces, and relieve pressure on temporomandibular joints. Orthodontics refers to the use of devices to move teeth or underlying bone. Teeth can be moved at any age.“Ideal� results can be achieved in most children but only in a small percentage of adults.This is because in children both the bone around the teeth (alveolar process) and the jaw bones can be molded by braces as the child is growing. In adults the jaw bones can be altered only by surgery.Therefore, it is recommended that orthodontic intervention be considered as soon as a problem in teeth alignment is noticed by the child, parent, or dentist. The ideal age for starting orthodontic treatment ranges from 3 to 12. In children, the goal of orthodontic treatment is not only to create straight well-aligned teeth, but also to improve the facial profile that will remain stable throughout adolescence and adulthood. Orthodontic treatment in adults is more difficult.Those who undergo treatment should be aware that they will probably need to wear a retainer at night the rest of their lives if they 36
want to maintain the results of the treatment. Sometimes braces are used as the end treatment of temporomandibular joint (TMJ) therapy. Problems of TMJ are usually aggravated by the lower jaw being positioned too far back so that the blood vessels and nerves of the TMJ are compressed. TMJ splint therapy is used initially to relieve this pressure and to reduce pain.The splint actually moves the lower jaw to a new position. If the patient does not want to wear a splint for the rest of his/ her life, then the teeth must
Jan – Feb 2011
D E N TA L
HYGIENE
be moved to stabilize the jaws in this new position.This movement of teeth can be done by dental braces. Orthodontic appliances can also be used to help a child overcome the infantile habits of sucking a thumb, finger, or pacifier. Sucking habits are usually not a major concern unless they are perpetuated after age 6 or 7, when the permanent incisors and molars start to erupt into the mouth. If these habits persist in the presence of permanent teeth, then permanent changes in the
constrict, which aggravates breathing and allergy problems. A variety of devices is used for different age groups. Some devices are only for infants to treat congenital defects such as cleft palates. Others are utilized only on baby teeth or in children who have both baby and permanent teeth (mixed dentition). Still others are employed when all the permanent teeth have erupted. Some orthodontic appliances used in children are actually orthopedic devices that redirect
teeth and jaw bones are produced. Sucking habits can create open bites where the upper and lower front teeth do not meet. They can lead to protrusive teeth and upper lips and protrusivelooking faces in general. Excessive sucking causes the muscles of the cheeks to constrict the upper dental arch. This contributes to a loss of space for the tongue to rest, and subsequent abnormal tongue posture or tongue thrusting habits. Sucking also causes the maxillary sinuses to
jaw bone growth. How are patients treated with dental braces? Teeth can be moved by a number of various removable appliances or by fixed braces, depending on the kind of problem that was originally present. Every patient is different and should be individually evaluated by the family dentist or by a specialist in straightening teeth, called an orthodontist. The decision to use removable and/or fixed appliances will depend on the clinician’s training and expe-
Jan – Feb 2011
rience and on the person’s specific dental problems. Patients fitted with removable appliances must wear these devices the number of hours prescribed by the clinician in order to achieve the desired results. The patient will need to maintain accurate records of daily wear and care for the appliance so as not to lose it or break it. Some removable appliances are also called “functional appliances” because their primary benefits are achieved when they are worn during eating.
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D E N TA L
HYGIENE
TOOTHSensitivity Dentin Hypersensitivity
T
ooth sensitivity is the most common complaint dentists hear, apparently one in five adults suffer from tooth sensitivity. Tooth sensitivity is a short sharp pain felt when the tooth is exposed to hot/cold and sweet/sour food or drink. In extreme cases just
exposure to cold air can cause pain for people with sensitive teeth.The sensitivity occurs because the enamel of the tooth has been worn down and the dentin is left exposed.There are many causes of tooth sensitivity, the most common are • Loose or missing fillings/crowns
• Bruxism-teeth grinding
•Gum Disease/gin
givitis
g •Teeth Whitenin
•Gum R
• Cracked Tooth
ecessio
• Vigor ous ab rasive brushi ng • Plaqu e
n
•Acidic Foods
Preventing and treating tooth sensitivity is easy with the many products available e zing toothpast •Use a desensiti
mouthwash •Use a flouride
f
•Use a too thb with soft b rush ristles.
t intakes o •Avoid frequen acidic foods.
•Brush your teeth gently, an electric toothbrush will help. You should visit your dentist if you experience tooth sensitivity so that they can recommend the best treatment whether over the 38
fpeci s , h ed eet ur t ity caus o y te tiv ydra r sensi h e r l fo l wil ned eth. • Ge densig your te y icall eaching l by b
• Wear a night gu your se nsitvity ard if is cause grindin d by g your teeth.
counter or surgical. If none of the above methods relieve your tooth sensitivity then it is likely the dentist will carry out a procedure
called iontophoresis whereby the sensitivity is treated with a positive electric current while flouride is applied. Jan – Feb 2011
DOC TOR
SPEAK
Jan – Feb 2011
39
EXPERT
VIEWs
HIP REPLACEMENT Current Trends
A
healthy hip joint is vital for almost all major activities of human body like walking sitting, stooping , bending ,twisting ,stair climbing ,squatting and running. The added significance of hip joint lies in the fact that 1. It is a ball and socket joint hence range of movements expected from it are very wide 2. It is a weight bearing joint 3. It lies in the centre of the body hence movements of upper body or lower limbs, all are dependant on a pain free healthy hip joint.
Diseased Hip Hip joint becomes painful in various conditions like osteoarthritis, rheumatoid arthritis, vascular necrosis of femoral head, ankylosing spondylitis, post traumatic arthritis,
post sepsis arthritis and non union of fractures around hip joint. A painful hip joint leads to decreased mobility of our body as a whole. To carry out our activities
Dr. Ashwani Maichand
M.S. (Ortho) M.Ch (Ortho) Senior consultant Joint Replacement Fortis Hospitals, Shalimar Bagh, New Delhi Sri Balaji Action Medical Institute, New Delhi
40
of daily life we have to compensate for that by putting extra strain on adjoining joints.This leads to backache, knee pain, bad posture, limping etc.Hence hip problem becomes a source for so many other orthopaedic problems.
Evolution of Hip Replacement
Hip replacement has come as a boon for these crippled patients. Over last few decades this procedure has changed the lives of millions across the world. Like every procedure hip replacement has undergone so many changes since its inception that “HIP REPLACEMENT” for a patient becomes a very vague term. Today the implants & techniques
Jan – Feb 2011
EXPERT
VIEWs
available are very different from what existed earlier. It is the duty of the surgeon & right of the patient to know about the details of hip replacement.
What is Hip Replacement
Hip is a ball & socket joint. Ball is head of femur and socket is acetabulum.If only head is damaged and acetabulum is intact then we replace only head of the femur, this is known as partial hip replacement or hemiarthroplasty.If both acetabu-
lum and head are damaged as is seen in arthritis then we replace both components.This is known as total hip replacement.We remove the damaged part & replace it with artificial implants as shown.
Types of Implants
advantages in a very simplified way implants we have to cut a part of patient’s bone to fit in the implant. Cemented hip replacement: In resurfacing we preserve almost In this we use bone cement to all the original bone of the patient. fix the implants. Patient can start Patient can squat and sit cross legged walking within 48 hrs after surgery. It which is a major requirement of is very good for elderly patients with younger patients and most of other osteoporotic bones.Only drawback patients belonging to Asian countries. is that revision surgery is difficult and cumbersome. Ceramic on Ceramic/ Metal on metal hip replacement: Non cemented hip replacement : In most of the implants there In this implants are press-fitted is metal on one side and plastic on into the bone.Weight bearing has to other side.This leads to collection of be delayed for few weeks.It is good plastic particles in hip joints causing for younger patients(less than 60 yrs loosening of implants.To increase of age).Revision surgery is simpler the life of the implant now metal & gives equally good results on metal and ceramic on ceramic bearing surfaces of joints have been Hip resurfacin: introduced.Only drawback is they In above mentioned types of are expensive.
There are so many types of implants available to suit the patient’s age, disease, bone quality, lifestyle demands etc.The surgeon and the patient should reach a concensus on the type of implant to be used so as to give the best results.Here we are presenting different types of implants and their indications and Jan – Feb 2011
41
EXPERT
VIEWs
The Patient Deserves The Best Types of Techniques Over the years hip replacements have been done by conventional techniques.This means large incision ,bleeding ,post operative pain ,delayed rehabilitation and longer hospital stay.I n last few years surgeons have deviced a new technique called MIS technique.In this patient can start walking with in 24 hrs after surgery, no blood transfusion is required and patient can start activities of daily life within a week.The only drawback of this technique is that it is done by very
42
few surgeons.We have been using this technique for last several years with excellent results.
Message
Hip replacement is a very good & pain relieving procedure.The result of surgery depends on patient’s disease, surgeon’s experience , type of implant type of technique used. The last three factors are in our control so the patient and the family should discuss with the surgeon about the details of the procedure before going ahead.
Jan – Feb 2011
Jan – Feb 2011
43
PRODUCT LINE
44
Jan – Feb 2011
PRODUCT LINE
Negative Pressure Wound Therapy Systems WOUNDEX - Common goals of negative pressure wound therapy
• Promote rapid reduction in wound volume • Promote growth of granulation tissue and contraction of wound edges • Manage exudate • Prepare the wound bed for transition to another treatment modality such as MWH, surgical closure, or a flap or graft • Reduce bioburden* • Decrease hospital stay length • Decrease morbidity and mortality • Decrease frequency of dressing change • Prevent deterioration of the wound • Minimize contamination and wound odor by providing a temporary barrier • Improve quality of life
Before
After
WOUNDEX - The main roles of NPWT in traumatic and surgical wounds are; • to provide a bridge to definitive surgical closure • to achieve delayed primary closure using fasciocutaneous flap, muscle flap, or skin graft • to achieve secondary closure with an MWH dressing
Recommendations for the use of negative pressure wound therapy in patients with traumatic or surgical wounds
• Wounds with a large amount of soft tissue loss • Necrotizing fasciitis • Degloving injury • Subcutaneous in filtration injuries with extravasation • Abscess • Open amputation • Post-tumorablation • Dehisced surgical incisions that do not require re-xploration • Abdominal compartment syndrome • Open-extremity fractures that are complex and have significant soft tissue loss
Jan – Feb 2011
Dealer Enquiries Solicited Across India & Abroad Mob: +91-9971722111/ 9990985050 +91-9999405050 E-mail: vacwound@gmail.com Visit Us: www.vacwound.com
45
PRODUCT LINE
Bremed BioSun Light Therapy System Bremed BioSun BD 7000 is an additional
therapic method for many disorders. Main application on wound heeling, pain treatment and relaxation and it has effect other organ for example lungs, liver, glands, kidneys etc. It has special light radiation wave length of 480-3400 nm.
Bremed BioSun BD 7000 has polarized light without ultra violet (UV) radiation. Basically, this type of light increases the blood supply for the effected organs and provides more oxygen and food materials to promote the heeling. Mostly I have applied Bremed BioSun BD 7000 for athletes 39 handball players were treated with Bremed BioSun BD 7000, they play in professional league. They had pain in ankle, wrist, knee and shoulder.We have used
Bremed BioSun BD 7000 as an additional therapy for 2 x 6 minutes per day for a week. All of them have had pain relief in 2 days, there has been no defect in range of motion. After 1 weak treatment they have been able to return to train.
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Bremed BioSun BD 7000 also useful for athletes by overusing harm.The pain of the overused muscles, ligaments and joints are getting better, because of the better blood and oxygen supply. Bremed BioSun BD 7000 is helpful for recovery after operation. Clinical examination has been taken place after forefoot surgery on 33 patients. They have been operated on bunion and hammer toe. After the surgery we have used the light therapy on the affected area of forefoot 2 x 6 minutes for 3 weeks. They have had less pain, swallow and complement after the operation. They have been able to weight baring the foot without pain faster and have caused faster recovery. Skin heels in 7-12 days, but after the operation in the deeper area tissues have to heel toward.
Bremed BioSun BD 7000 can help by heeling in the connective tissue layer or bone layer.
Jan – Feb 2011
D E N TA L HYGIENE
Jan – Feb 2011
47
H E A LT H & FITNESS
Deal with
HIGH BLOOD PRESSURE
Dr. Deepika Malik Wellness
A
s an Ayurvedic physician and a diet expert I am very much concerned about conservation of health.Ayurved presumes that improper dietary habits give rise to various disorders.With practice of dietary measures recommended in Ayurveda while elaborating ‘Medoroga Chikitsa’(weight loss) will definitely beneficial in weight reduction. It will be helpful to minimize the risk of fatty cholesterol deposits and will prevent complication of high blood pressure.
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Jan – Feb 2011
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H E A LT H & FITNESS
significantly raise your blood pressure Chronic anger produces elevation in blood pressure and it can be a serious risk factor for coronary - heart - disease. So be cool, speak softly and gently You can improve your lifestyle and remove unnecessary stress by following some simple rules Take high fiber low fat diet. Coffee may increase your blood pressure. Coffee, which contains caffeine, enhances the action of adrenaline and nor adrenaline and both are important in increasing blood pressure levels. Cigarette smokers tend to have high blood pressure. Nicotine increases the resting heart rate and increases the release of the adrenaline substances that tends to increase blood pressure. Cigarette smoking alone significantly increases risk of having heart attack. Regular Exercise helps to eliminate body fat, lower total cholesterol and raise HDL cholesterol that prevents fatty - cholesterol deposits. According to Ayurveda exercise improves the body, depletes excess fats, brings lightness of the 50
body. Be cool don’t get annoyed, speaking loudly and rapidly can
Laughter is the best medicine: - Laughter is as good as relaxation therapy, exercise or other methods used to overcome stress. Study shows that laughter decreases adrenaline and cortisol production. Laughter can help you if you are having high blood pressure. If you are frustrated, unhappy, angry, just laugh and find yourself away from rage. It is of the effective medicine you always have with you, without spending a penny for it. Meditation: - Try to ease yourself with meditation and by performing yogic asana like Shavasana. Amla is considered an effective remedy for high blood pressure. It tones up the function of all the organs of the body and buildup health by destroying anti-oxidants. Jan – Feb 2011
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WINDOW SECTION
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