Be in the pink of your health
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CONTENT
Contents
28 IN VITRO FERTILISATION New study results could pave the way for an additional treatment option for the estimated 1.5 million women worldwide who undergo In vitro fertilization (IVF) treatment each year.
14 MEDICAL TOURISM - A COVER STORY Medical tourism is a growing sector in India. India's medical tourism is projected to grow to $7–8 billion by 2020.
32 FOOT CARE IN DIABETES Patients with Diabetic Foot Ulcer (DFU) have a greater all-cause death risk compared to the patients without a history of DFU.
18
RHYTHM OF LIFE An analysis of Cardio Vascular Diseases - A systematic and consistent approach to keep our heart healthy is an obligatory responsibility. A controlled, organised, and healthy lifestyle can help us fight for the cardio vascular disease (CVD).
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April 2017
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PINK MEDICO
EDITORIAL TEAM: Executive Editor: Prakash Subramanian Sub Editor: Suresh Kumar M Correspondent: Pallavi J DESIGN & DEVELOPMENT TEAM Creative Director: Vidhya Prakash Creative and Content Head: Ramani Ranjan Behera Graphics and Artwork: Ponnuswamy S. SALES AND MARKETING CORRESPONDENCES: Anarghyaa ETech Solutions Pvt Ltd No.22, 2nd Floor, 5th A Main International Airport Road, Hebbal Bangalore 560 024 Email: info@pinkmedico.com Tel: 080 2343 5444 Cell: +91 91084 83395
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HEALTH NEWS
NEWS & UPDATES
World Health Day:
T
his year the theme for World Health Day - "Depression - Let's Talk" says WHO, as depression tops list of
causes of ill health.
factor for suicide, which claims
Depression is the leading cause of ill health and disability worldwide. According
Depression is a common mental
to the latest estimates from WHO, more
illness characterized by persistent
than 300 million people are now living
sadness and loss of interest in
with depression, an increase of more than
activities that normally people
18% between 2005 and 2015.
enjoy, they may also have symptoms like
loss
of
energy, sleeping
Many people hesitate to access the
more or no sleep at all; reduced
treatment due to lack of support coupled
concentration, restlessness, guilt,
with fear of social stigma.
hopelessness and thoughts of harming self or suicide.
Dr.Margaret Chan - WHO Director General call for all countries to re-think their approaches to mental health and to treat it with the urgency that it deserves.� Depression also increases the risk of other diseases and disorders such as diabetes
April 2017
Depression is also an important thousands of lives every year.
said “These new figures are a wake-up
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and heart related problems.
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NEWS & UPDATES
Good hospital base for AYUSH Medical treatment National AYUSH Mission (NAM) also extends support for development of AYUSH educational institution,
posed by the States/UTs in their Programme
Quality control of Ayurveda, Siddha, Unani &
Implementation Plans (PIPs). These supports also
Homoeopathy (ASU & H) drugs and Medicinal Plants.
include support for engagement of AYUSH doctors/ paramedics in public health facilities.
A total of 3590 hospitals providing AYUSH medical treatment are functioning in the country. These include 2820 hospitals of Ayurveda, 256 of Unani, 273 Siddha hospitals, 7 of Yoga, 30 of Naturopathy and 203 homoeopathy hospitals. The number of
Medical Council of India
AYUSH dispensaries in the country was 25,732. The number of AYUSH registered practitioners
The Medical Council of India (MCI) is a statutory
in the country as on are 7, 71,468. The Central
body for establishing uniform and high standards
Government, through Centrally Sponsored Scheme
of medical education in India. The Council grants
of National AYUSH Mission (NAM), extends support
recognition
for promotion of AYUSH healthcare to the States/
accreditation to medical schools, grants registration
UTs for co-location of AYUSH facilities at Primary
to medical practitioners, and monitors medical
Health Centres (PHCs), Community Health Centres
practice in India. The current President of MCI is Dr.
(CHCs) and District Hospitals (DHs) for development
Jayshreeben Mehta.
of
medical
qualifications,
gives
of infrastructure, purchase of equipment & furniture and supply of essential AYUSH medicines. NAM
The NITI Aayog has recommended the replacement
also extends support for development of AYUSH
of Medical Council of India (MCI) with National
educational institution, Quality control of Ayurveda,
Medical Commission (NMC). The decision has been
Siddha, Unani & Homoeopathy (ASU & H) drugs and
approved by most states.
Medicinal Plants. Further, under National Health Mission (NHM), support is provided to States/UTs for strengthening their healthcare systems including for mainstreaming of AYUSH based on the requirements Pink Medico April 2017
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NEWS & UPDATES
Cabinet approves
National Health Policy 2017 The primary aim of the National Health Policy, 2017, is to inform, clarify, strengthen and prioritize the role of the Government in shaping health systems in all its dimensions- investment in health, organization and financing of healthcare services, prevention of diseases and promotion of good health through cross sectoral action, access to technologies, developing human resources, encouraging medical pluralism, building the knowledge base required for better health, financial protection strategies and regulation and progressive assurance for health. The Union Cabinet chaired by the Prime Minister Narendra Modi in its recent meeting has approved the National Health Policy, 2017 (NHP, 2017). The Policy seeks to reach everyone in a comprehensive integrated way to move towards wellness. It aims at achieving universal health coverage and delivering quality health care services to all at affordable cost.
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This Policy looks at problems and solutions holistically with private sector as strategic partners. It seeks to promote quality of care; focus is on emerging diseases and investment in promotive and preventive healthcare. The policy is patient centric and quality driven. It addresses health security and make in India for drugs and devices. The main objective of the National Health Policy 2017 is to achieve the highest possible level of good health and well-being, through a preventive and promotive health care orientation in all developmental policies, and to achieve universal access to good quality health care services without anyone having to face financial hardship as a consequence. In order to provide access and financial protection at secondary and tertiary care levels, the policy proposes free drugs, free diagnostics and free emergency care services in all public hospitals. The policy envisages strategic purchase of secondary and tertiary care services as a short
NEWS & UPDATES
term measure to supplement and fill critical gaps in the health system. It recommends prioritizing the role of the Government in shaping health systems in all its dimensions. The roadmap of this new policy is predicated on public spending and provisioning of a public healthcare system that is comprehensive, integrated and accessible to all. The NHP, 2017 advocates a positive and proactive engagement with the private sector for critical gap filling towards achieving national goals. It envisages private sector collaboration for strategic purchasing, capacity building, skill development programmes, awareness generation, developing sustainable networks for community to strengthen mental health services, and disaster management. The policy also advocates financial and non-incentives for encouraging the private sector participation. The policy assigns specific quantitative targets aimed at reduction of disease prevalence/ incidence, for health status and programme impact, health system performance and system strengthening. It seeks to strengthen the health, surveillance system and establish registries for diseases of public health importance, by 2020. It also seeks to align other policies for medical devices and equipment with public health goals.. The primary aim of the National Health Policy, 2017, is to inform, clarify, strengthen and prioritize the role of the Government in shaping health systems in all its dimensions- investment in health, organization and financing of healthcare services, prevention of diseases and promotion of good health through cross sectoral action, access to technologies, developing human Pink Medico April 2017
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NEWS & UPDATES
resources, encouraging medical pluralism, building the knowledge base required for better health, financial protection strategies and regulation and progressive assurance for health. The policy emphasizes reorienting and strengthening the Public Health Institutions across the country, so as to provide universal access to free drugs, diagnostics and other essential healthcare. The policy affirms commitment to pre-emptive care (aimed at pre-empting the occurrence of diseases) to achieve optimum levels of child and adolescent health. The policy envisages school health programmes as a major focus area as also health and hygiene being made a part of the school curriculum. In order to leverage the pluralistic health care legacy, the policy recommends mainstreaming the different health systems. Towards mainstreaming the potential of AYUSH the policy envisages better access to AYUSH remedies through co-location in public facilities. Yoga would also be introduced much more widely in school and work places as part of promotion of good health.
Vaccination in India Indian Vaccine Regulatory System was assessed by WHO against Global Benchmarking Tool (GBT) comprising 9 functions for measuring the maturity of Indian Vaccine Regulatory System viz. National Regulatory System; Registration & Marketing Authorization; Vigilance; Market Surveillance & Control; Licensing Premises;
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Regulatory Inspections; Laboratory Access & Testing; Clinical Trial Oversight; and NRA Lot Release. WHO has given highest possible rating of 4 to Registration & Marketing Authorization; Vigilance; Laboratory Access & Testing; Clinical Trial Oversight; and NRA Lot Release. WHO has given a rating of 3 in respect of the remaining four functions. The assessment was carried out by a WHO team comprising experts with decades of experience in different areas of Regulatory Systems in Regulatory Agencies, Laboratories & Institutes from WHO Headquarters, WHO India office, USA, Italy, Germany, Netherland, Indonesia, Thailand and Egypt. Indian National Regulatory Agency has been declared functional by WHO based on the most comprehensive assessment ever carried out by WHO anywhere in the world with 63 indicators and 288 sub-indicators.
NEWS & UPDATES
Hospital Acquired infection – Nosocomial infection
Nosocomial infection refers to and infection occurring in patient in a hospital or other healthcare facility, in whom the infection was not present at the time of admission. This infections are acquired in the hospital but may appear after discharge and also occupational infections among staffs of the hospital or the facility. It is also referred as microbiological contamination that is introduced accidently because of infectious material such as bacteria, yeast, mould, fungi, virus, protozoa or their toxin. Even one bacterium can quickly replace itself into millions. This infections occurs worldwide and affects both developed and undeveloped countries. Infections acquired in health care facilities are among the major causes of death and increased morbidity amount patients. A WHO study shows that the highest prevalence of nosocomial infection occurs in intensive care units and in acute surgical and orthopedic wards.
Studies have revealed that mortality rate for blood-stream infections to be 10-25% A prevalence survey conducted under the support of WHO showed that an average 8.7% of patients had nosocomial infections. These studies indicates that nosocomial infection are one of the leading cause of death worldwide. This infection also results in increased stay at the hospital and in turn increases the cost of treatment, and increased morbidity. Prevention of contamination of medical devices and infusion solutions is of great importance in hospitals and in turn it can save many lives. Studies have proved that use of Closed Infusion Systems supports in the reduction of hospital acquired infections which thereby reduces days of stay of patients in the hospital reduces the mortality rate and treatment cost as well.
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MEDICAL TOURISM - COVER STORY
INDIA: GLOBAL DESTINATION FOR MEDICAL TOURISM Medical tourism is a growing sector in India. India's medical tourism is projected to grow to $7–8 billion by 2020. According to the Confederation of Indian Industries (CII), the primary reason that attracts medical value travel to India is cost-effectiveness, and treatment from accredited facilities at par with developed countries at much lower cost. Medical tourism refers to people traveling to a country other than their own to obtain medical treatment. In the past this usually referred to those who traveled from less-developed countries to major medical centers in highly developed countries for treatment unavailable at home. However, in recent years it may equally refer to those from developed countries who travel to third-world countries for lower priced medical treatments. The motivation may be for medical services unavailable or illegal in the home country. Medical tourism most often is for surgeries (cosmetic or otherwise) or similar treatments, though people also travel for dental tourism or fertility
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Tourism. People with rare genetic disorders may travel to countries where the treatment is better understood. However, almost all types of health care are available, including psychiatry, alternative medicine, convalescent care, and even burial services. Medical tourism is a growing sector in India. India's medical tourism is projected to grow to $7–8 billion by 2020.
MEDICAL TOURISM - COVER STORY
According to the Confederation of Indian Industries (CII), the primary reason that attracts medical value travel to India is cost-effectiveness, and treatment from accredited facilities at par with developed countries at much lower cost. The Medical Tourism Market Report found that India was "one of the lowest cost and highest quality of all medical tourism destinations, it offers wide variety of procedures at about onetenth the cost of similar procedures in the United States." Medical tourism is a growing sector in India. India is becoming the 2nd medical tourism destination after Thailand.
"Primary reason that attracts medical value travel to India is cost-effectiveness, and treatment from accredited facilities at par with developed countries at much low-
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MEDICAL TOURISM - COVER STORY
Foreign patients travelling to India to seek medical treatment during the past three years numbered 171,021, 236,898, and 184,298 respectively. Traditionally, the United States and the United Kingdom have been the largest source countries for medical tourism to India. However, according to a CII-Grant Thornton report released a few months back, Bangladeshis and Afghans accounted for 34% of foreign patients, the maximum share, primarily due to their close proximity with India and poor healthcare infrastructure. Russia and the Commonwealth of Independent States (CIS) accounted for 30% share of foreign medical tourist arrivals. Other major sources of patients include Africa and the Middle East, particularly the Persian Gulf countries. In 2015, India became the top destination for Russians seeking medical treatment. Chennai, Kolkata, Mumbai, Hyderabad, Bangalore and the National Capital Region received the highest number of foreign patients primarily from South Eastern countries. Advantages of medical treatment in India include reduced costs, the availability of latest medical technologies and a growing compliance on international quality standards, Doctors trained in western countries including US and UK, as well as English speaking personnel, due to which foreigners are less likely to face language barrier in India. The Medical Tourism Market Report found that India was "one of the lowest cost and highest quality of all medical tourism destinations, it offers wide variety of procedures at about one-tenth the cost of similar procedures in the United States."
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Cost: Most estimates found that treatment costs in India start at around one-tenth of the price of comparable treatment in the United States or the United Kingdom. The most popular treatments sought in India by medical tourists are alternative medicine, bone-marrow transplant, cardiac bypass, eye surgery and hip replacement. India is known in particular for heart surgery, hip resurfacing and other areas of advanced medicine. India has 28 JCI accredited hospitals. However, for a patient traveling to India, it is important to find the optimal Doctor-Hospital combination. After the patient has been treated, the patient has the option of either recuperating in the hospital or at a paid accommodation nearby. Many hospitals also give the option of continuing the treatment through telemedicine. The city of Chennai has been termed "India's health capital". Multi- and super-specialty hospitals across the city bring in an estimated 150 international patients every day. Chennai attracts about 45 percent of health tourists from abroad arriving in the country and 30 to 40 percent of domestic health tourists. Factors behind the tourist’s inflow in the city include low costs, little to no waiting period and facilities offered at the specialty hospitals in the city. The city has an estimated 12,500 hospital beds, of which only half is used by the city's population with the rest being shared by patients from other states of the country and foreigners. Dental clinics have attracted dental care tourism to Chennai. Medical tourists may be subject to a number of risks, such as deep vein thrombosis from air travel or poor post- related field operative care.
MEDICAL TOURISM - COVER STORY
Risks: Medical tourism carries some risks that locally provided medical care does not. Some countries, such as South Africa, or Thailand have very different infectious disease-related epidemiology to Europe and North America. Exposure to diseases without having built up natural immunity can be a hazard for weakened individuals, specifically with respect to gastrointestinal diseases (e.g. Hepatitis A, amoebic dysentery, paratyphoid) which could weaken progress and expose the patient to mosquito-transmitted diseases, influenza, and tuberculosis. However, because in poor tropical nation’s diseases run the gamut, doctors seem to be more open to the possibility of considering any infectious disease, including HIV, TB, and typhoid, while there are cases in the West where patients were consistently misdiagnosed for years because such diseases are perceived to be "rare" in the West. Differences in healthcare provider standards around the world have been recognised by the World Health Organization, and in 2004 it launched the World Alliance for Patient Safety. This body assists hospitals and government around the world in setting patient safety policy and practices that can become particularly relevant when providing medical tourism services. If there are complications, the patient may need to stay in the foreign country for longer than planned or if they have returned home, will not have easy access for follow up care. .......to be contd Pink Medico April 2017
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Rh An analysis
Healthy heart is the cornerstone to hea Image courtesy:www.pixabay.com
body, healthy mind, and hearty feelings
An optimist feeling, a jovial mood, a blissful soul and a con healthy heart and a healthy heart fosters human wellbeing. Hea and body and it is the cornerstone to healthy body, healthy mi making our heart healthy we can inspire a healthy and well func 18 April 2017
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Rhythm of life
hythm of Life
of cardio vascular disease
althy
s
ntented mind: all add fodder to althy heart leads to healthy mind ind, and hearty feelings. Hence, ctioned cardio vascular system.
A
systematic and consistent approach to keep our heart healthy is an obligatory responsibility. A controlled, organised, and healthy lifestyle can help us fight for the cardio vascular disease (CVD). According to a study, in India, 45 million people suffer from coronary artery disease – heart attack. Based on the estimation, heart attack will account for 35.9% casualties by 2020 in India. It has been creating an alarming health risk for Indians; according to a study by Saffola 2013 study conducted by Saffola suggests 70 % of the urban people are at the risk of heart disease. Similarly, according to Global Health Observatory data report, for every 10000 the mortality rate for female and male in India in 2012 was 264.6 and 348.9 respectively. Saffola Life Study 2014 reports 77% of women at the age of 35 at CVD risk have high BMI. And 89% of the women above the age 35 at CVD risk have low HDL.
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Rhythm of life
A careful analysis and understanding of various
below 60 beats per minute (BPM). This is also
CVDs provides us insights into all the aspects of
known as bradyarrhythmia. A normal heart
the fatal disease: types, reasons and remedies
should beat about 100,000 times at a rate of 60
or treatment.
BPM. Nevertheless, a slow heart of 40-50 BPM is normal while sleeping.
Simplifying the technical jargon of the disease, making the people aware of the disease, and
The slow heart beats vary from person to person
educating them about the disease can help a
depending on the age, physical activity, and
lot to control the pervasiveness of the disease.
fitness. The heart beat rate which is not below
Various campaigns, events, awareness programs
60 BPM but slow due any medical condition is
help to realize the seriousness of the diseases
considered as Relative Bradycardia.
and take proper actions.
Causes of Bradycardia: The World Heart Day campaign is successfully observed across the globe to spread awareness
It is difficult to find out the symptoms of
of the fatal diseases.
bradycardia unless the heart rate drops to 50 BPM. Among the other symptoms, weakness,
Bradycardia:
dizziness, fatigue and fainting are most prominent.
Bradycardia is slow heart rate which defined
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Rhythm of life
In Bradycardia, one can feel difficulties in
chambers of the heart or in both. This leads to
walking,
disruption in the electrical impulse that helps
climbing
stairs,
exercising,
and
breathing, and light-headedness.
pumping activity.
According to experts, the heart contains two
Many factors can contribute to problems with
upper chambers (left and right atria) and two
the heart’s electrical impulse.
lower (left
chambers and
ventricles).
In
a
normal condition, sinus
node,
an
area in the right atrium
These factors include
right
originates
“In India 70 % of the urban people are at the risk of heart disease”
which travels first to the atria, so that they can contract and pump blood into the ventricles. The electrical impulse then travels through its circuit to the ventricles signalling them to contract and pump blood out to the lungs and the body. In Bradycardia, electrical impulse may travel to slow through heart which results in pumping less blood out to the body causing dizziness, fatigue, shortness of breath, chest pain. Even it causes cardiac arrest.
Tachycardia When Bradycardia leads to slow heart beat, Tachycardia is a condition when the heart rate is over 100 BPM. heart
rate
increases
dramatically in the upper chambers or lower
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from
heart
Pink Medico
disease,
abnormal
electrical
pathways
in
the
heart present at birth (Congenital),
electrical impulse
In Tachycardia, the
damage to heart tissues
disease
Rhythm of life
or congenital abnormality of the heart, and
disrupt normal heart function, increase the
anaemia. This is also caused by exercise, sudden
risk of stroke or cause sudden cardiac arrest or
stress, smoking, consuming excess alcohol,
death.
high blood pressure, fever, drinking too much caffeinated beverages.
Cardiac Arrhythmia
Cause that leads to Tachycardia
Arrhythmia, also known as irregular heartbeat, is a state where there is a disturbance of the
Tachycardia occurs when an abnormality in the
normal electrical impulse of the heart. This
heart produces rapid electrical signal. In some
leads to irregular heart beat of too fast or too
cases, the condition may cause no symptoms
slow compare to normal heart rate. When the
or complications. But the abnormal speed can
heart beat is irregular, it doesn’t pump blood effectively that affects blood circulation to the
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lungs, brain, and all other organs. As result, they
This is called AV block. There are three different
can't work properly and may shut down or get
levels of AV block.:
damaged. 1. First Degree: When the electrical signals pass Study shows that there are various types of
through the AV node, it slows down which rarely
arrhythmia for which it is difficult to identify
shows any symptoms.
the symptoms. But the common symptoms may include feeling a pause between heart beats and
2. Second Degree: In a normal heart, all electrical
in worst cases; there may be chest pain, light-
signals have to reach the ventricles. But here
headedness, and shortness of breath. Some of
some signals are delayed to the point that one
the serious arrhythmia can cause stroke or heart
is blocked altogether or may block every other
failure or even cause cardiac arrest.
signal. This can cause dizziness and fainting. Apart from this the patient won’t necessarily
Mainly there are four types of arrhythmia such
have any other symptoms.
as ventricular arrhythmias, extra beats, brad arrhythmias and supraventricular tachycardia.
3. Third Degree: This is complete block and is
Causes of arrhythmia
considered to be fatal. No electrical signals reach the ventricles from the atria. At this
Normally, sinus node consists of heart’s most
juncture, the ventricles eventually produce their
rapidly firing cells that make the area a natural
own electrical signals called the Escape Rhythm.
pacemaker. In unusual conditions, almost all
This will lead to slow heart beat (Bradycardia)
heart tissue can start a type of impulse that
and it leads to blackouts.
can generate heart beats. Cells in the heart's conduction system start electrical activity. This
Diagnoising Block:
can create interruption of the heart's pumping activity.
The patient who suffers from symptoms of heart failure will have to take Electrocardiogram
Heart Block 387160:
(ECG). The ECG measures the electrical activity of the heart to analyse how it is working. At
If a person experiences a heart block, the
times, the doctor will instruct the patient to
problems occurs on how the electrical signals
wear a portable heart monitor over a day or two
are transmitted through the heart. When the
to measure the heart beat over a period of time.
problem occurs at the AV node (Atrioventricular
In between there will be blood tests.
node), it prevents the signals being conducted from the atria (the heart’s upper chambers) to the ventricles (the lower chambers).
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Rhythm of life
The cardiologist after examining these tests
Having diabetes will put into a high risk of heart
will instruct the patient to follow other tests
disease and stroke. Diabetics should lower the
like Chest X-ray, Tilt table test, Echocardiogram,
risk of heart attack and stroke by controlling
Coronary angiography etc.
their blood sugar level, blood pressure and blood cholesterol to the recommended target
Diabetes & Heart Attack
numbers suggested by the diabetes experts. This will prevent narrowing or blockage of the
Insulin, a hormone produced by pancreases,
blood vessels in legs, where the condition is
helps carrying the sugar or glucose from the
called peripheral arterial disease.
bloodstream into cells that provides energy. But in diabetes, due to lack insulin, cells in the
Food habits become a major factor at this point.
muscles, liver, and fat do not use insulin properly.
The patient has to choose the food wisely which
As a result, the glucose amount increases in the
means it should not contain high sugar, high fat.
blood while the cells are starved of energy.
The person should be physically active which can keep both the diabetes and cholesterol
Consequently,
high
blood
glucose
levels
damage nerves and blood vessels that lead to complications such as heart disease and stroke.
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level at good control. The last but the major part is to take medications at the proper time.
Rhythm of life
Cholesterol and Heart Attack:
In case there is a clog in a coronary artery, it narrows down the arteries, shows down blood
Cholesterol is a waxy, fat-like substance which is
flow to the heart muscle. As a result, heart
found in all body cells. Two kinds of lipoproteins
receives too little blood and oxygen. With
carry cholesterol throughout the body: low-
absence of enough oxygen, your heart becomes
density lipoproteins (LDL) and high-density
weak and gets damaged. Additionally, if the
lipoproteins (HDL). To maintain a good health
plaque breaks open, a blood clot may form
level both lipoproteins are important. LDL
on top of the build-up, further blocking blood
which is called ‘bad’ cholesterol when in high
flow. Or, a blood clot can break off and flow to
levels leads to block in arteries. HDL or ‘good’
an artery in another part of the body. If a clot
cholesterol is considered to be very important
completely blocks an artery feeding your heart,
for a healthy body.
you have a heart attack.
High cholesterol causes heart attack:
Like diabetes, cholesterol also should be controlled by strict food diet. Fatty foods and
When we have more fatty foods, that caused
outside should be totally excluded and the
piling up of cholesterol level which can cause
supplements should be homely food and fruits
plague build up in your arteries.
as per the instruction of experts.
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IVF - Treatment
In Vitro Fertilization New Study Results May Lead to a New Standard of Care
N
ew study results could pave the way for an additional treatment option for the estimated 1.5 million women worldwide who undergo In vitro fertilization (IVF) treatment each year. In the Lotus I study, which involved more than 1,000 women across 38 international sites, oral dydrogesterone had similar efficacy and tolerability to micronized vaginal progesterone (MVP), which is the current standard of care globally to prepare the uterus lining for pregnancy.
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IVF - Treatment
IVF is one of several methods of assisted reproduction technology whereby a fertilized embryo is transferred to the woman’s uterus. Progesterone or a related hormone, such as dydrogesterone, is used in IVF to prepare the lining of the uterus (luteal phase support) to allow a fertilized egg to implant. According to a 2015 analysis by Ernst & Young (EY), infertility has a high prevalence affecting nearly 10 – 15 percent of married couples in India. Nearly 27.5 million couples who are actively seeking children suffer from infertility. Despite the increasing demand for infertility treatment in India, only 1 percent of couples in India seek assisted reproductive treatment such as IVF. MVP is the most commonly used method of administering progesterone in IVF centers globally, but is associated with side effects, such as irritation and discharge, as well as poor patient acceptance. Lotus I, a Phase III randomized controlled clinical study, evaluated the effects of oral dydrogesterone in luteal support in IVF. The findings of the Lotus I study provide clinical evidence for an oral treatment option. Besides its ease of administration, the Lotus I study concluded that oral dydrogesterone is similarly
In the Lotus I study, oral dydrogesterone achieved similar results to MVP in terms of the presence of fetal heart beats at 12 weeks gestation, representing an ongoing pregnancy. The two treatment groups also had similar pregnancy and live birth rates.
The results from the Lotus I study add to the body of evidence from smaller IVF studies of the benefits of using oral dydrogesterone for luteal support as part of IVF. Lotus I Study Findings: The Lotus I study achieved its primary efficacy endpoint, demonstrating non-inferiority of oral dydrogesterone versus MVP with the presence of fetal heartbeats at 12 weeks of gestation. Results were similar between the full analysis sample (FAS) and per protocol sample (PPS) for all measures of efficacy. In the PPS, the pregnancy rates at 12 weeks gestation were 37.6 percent and 33.1 percent in the oral dydrogesterone and MVP treatment groups, respectively, demonstrating non-inferiority of oral dydrogesterone to MVP. For the secondary objective, the Lotus I study demonstrated that pregnancy rate two weeks after embryo transfer and at eight weeks of gestation as well as live birth rates were similar for both treatments.
well-tolerated and efficacious compared to MVP.
"The findings from this study have the potential to have important implications for women undergoing IVF," said Herman Tournaye, M.D., Ph.D., Director of the Center for Reproductive Medicine at Universitair Ziekenhuis Brussel, and lead clinical researcher for the Lotus I study. "We found oral dydrogesterone to be effective, well tolerated and easy to administer – all of which point to it becoming the new preferred treatment option."
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IVF - Treatment
“Oral dydrogesterone has the potential to become new treatment of choice for an estimated 1.5 million women worldwide who undergo IVF treatment each year�
About the Study: Lotus I was a double-blind, doubledummy, two arm multicenter, multinational Phase III randomized controlled study conducted across 38 sites in Austria, Belgium, Germany, Finland, Israel, Russia and Spain. The study took place from August 2013 to March 2016 and was performed in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. The study enrolled pre-menopausal women undergoing IVF treatment (>18 to <42 years of age with a documented history of infertility who were planning to undergo IVF).
Lotus I participants were randomized to receive either oral dydrogesterone 10 mg or MVP 200 mg three times daily. This treatment to prepare the lining of the uterus (luteal support) was started on the day of oocyte retrieval (egg collection) and continued for up to 12 weeks of gestation.
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About Dydrogesterone: Dydrogesterone has been marketed for more than 50 years for conditions related to progesterone insufficiency. The safety and tolerability profile of the drug has been well-established through the experience of an estimated 94 million patients globally. The use of dydrogesterone is specific to each country regulatory approval and includes the treatment of threatened or recurrent miscarriage, as well as luteal phase support in infertility and menstrual disorders, endometriosis and hormone replacement therapy post menopause. Currently, dydrogesterone is not approved in any country for the treatment of luteal phase support in IVF or artificial reproductive technology.
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Image courtesy:www.pixabay.com
FOOT CARE IN DIABETES I
t was just yet another small wound for Manjunatha before he ignored it while encountering a flooded Chennai street. Little had known that the small wound in his right foot caused by a small submerged rock would result in amputation of his leg. The 50year old businessman became busy in his day to day affairs ignoring the small wound. To his surprise, instead of healing, the wound got infected and
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became severe in some days. It did not take much time for his foot to become black with weeping pus. It became too late to reach the doctor who suggested surgery urgently. In the process they had to amputate Manajunathaâ&#x20AC;&#x2122;s leg. But the infection and damage was so severe that Manajunatha was not responding to the treatment. Gradually the other leg was also infected and had to be amputated
foot care in diabetes
Manjunathaâ&#x20AC;&#x2122;s story is a reality check for those who are not ready to realize how unrestrained diabetes can be proved with number of health complications such as heart problems, kidney injury, loss of sight, and cancers that ultimately lead to amputation. Diabetes condition must be treated carefully otherwise it would result in a horrifying damage to human being like death Alarmingly, Manjunathaâ&#x20AC;&#x2122;s situation is not unique. There are millions of people who have been suffering from the fatal epidemic. According to a leading newspaper in India, 44 lakh Indians aged 20 to 70 are unaware of their diabetes which can lead them to heart attack, stroke, amputations, nerve damage, blindness and kidney disease. According to a study, the diabetes epidemic had killed 10 lakh people in India in 2011 and surprisingly it affected 34 million rural people and 28 million affluent urban. This clearly suggests that lack of awareness, self care and medication is the reason behind this. According to a study published in Diabetologia, a journal on diabetes, patients with Diabetic Foot Ulcer (DFU) have a greater all-cause death risk compared to the patients without a history of DFU. Based on an assessment of 619 events of allcause mortality, an additional 58 deaths per 1,000 each year with diabetic foot ulcer are reported.
Diabetic wounds: causes and effects: A small wound on body, especially, in the extremities (hands and legs) during diabetes can be proved dangerous and fatal. It is hardly curable and takes longer time for healing. Having high level of blood sugar for longer period makes the bodily functioning improper such a reduced blood flow and damaged nerves especially in the extremities. The patients with diabetes would likely to develop infection to a small external wound which is ignored, unnoticed, or delayed in treatment. Gradually the wounds get infected and increase in size with chronic pain or completely painless; signs of inflammation, heat, pain and loss of function; signs of infection such as pus drainage, bad odour and dead tissue. The affected areas also develop numbness and dullness, chills of limb-threatening or life-threatening infection. Hence, in diabetes, special care must be given to legs since legs are prone to external wounds and wound of negligible size must not be ignored.
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foot care
Foot care in Diabetes According to Dr. Srujal Shah, vascular surgeon, foot ulcers are sores or wounds on the foot and are often a strong indicator of advanced diabetes. Most frequently, these wounds occur on the bottom of the foot under pressure points (such as the ball of the foot) and on the toes. If the there are wound in these areas, then it worsen the situation. "Up to 25% of patients with diabetes develop a foot ulcer. More than half of all foot ulcers become infected, requiring hospitalization and 20% of infections result in amputation. Diabetes contributes approximately 80% of all non-traumatic amputations performed every year. After a major amputation, 50% of people will have another other limb amputated in two years. People with a history of a diabetic foot ulcer have a 40% greater 10-year death rate than people with diabetes alone. Diabetic foot ulcers double death rate and heart attack risk while increasing risk for stroke by 40%," said cardiologist Dr Hemang Baxi. It is a moral obligation of diabetics to take care of their feet. Walking regularly with a pair of comfortable shoes solves half of the problems. The physical activity while walking controls diabetes and takes care of the feet due to the loose and comfortable shoes. They must strictly avoid using extreme tight and pointed shoes, slippers, and walking bare foot. They must use cosy and cleaned shocks. They must avoid extremes of temperatures and direct heat or cold to the feet. They must get regular checkups with the doctor, who will examine the legs for a proper pulse and blood supply. In case of doubts, a Color Doppler test is suggested. Diabetics must inspect their feet every day, and in case get a foot injury, they must seek care early. They must strictly and judiciously follow the instructions provided by the doctor and obey do's and don'ts of foot care.
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With adequate carefulness, diabetic people can prevent serious foot problem by taking care of their feet every day.
Prevention Since people with diabetes are prone to foot problems, a foot care specialist must be hired in their health care team. They must perform an annual complete foot exam by the healthcare provider and even more frequently if the problem is more intense. They must call or see doctors to check whether have cuts or breaks in the skin, or have an ingrown nail. They must very vigilant to observe any change in colour, shape, or sensitivity in legs. The corns or calluses must be trimmed for them by the health care provider. They must trim toenails safely. By following some simple tips, diabetic can take care of their feet. Consultation with diabetic specialist One must give importance to minimise the risk of diabetes by finding specialist for comprehensive diabetes and cardio metabolic care. Strictly one must learn how to keep blood sugar levels under control. Specialists can provide instruction, activities, food, and additional instructions to control diabetes. Attention to feet is as important as face Utmost care and attention must be given to diabetic feet every day. It must be lifetime care process that should be followed regularly. The patients and their family members must check the feet regularly for cuts, red spots, blisters and swelling. The patient may use a mirror to check the feet if the patient has problem in bending.
foot care
Relaxation for feet in warm water: The diabetic feet must be relaxed and given more comfort. One must wash the diabetic feet in warm water every day without fail. The entire feet and especially the gaps between the two toes must be cleaned properly with warm water. Hot water must be strictly avoided as the diabetic feet are sensitive and prone to damages. They must be dried very well especially gaps between two toes with a clean and dry cloth. Moisturize the diabetic feet: The diabetic feet must be moisturized properly to avoid dryness and dullness of the feet and toes. After a thorough discussion with the foot care specialist and according to the advice of the doctors, a specialised skin care lotion must be applied on the top and bottom of the feet. The gaps between the toes must be avoided strictly. Smoothness for Diabetic feet: The diabetic feet must be smooth to avoid dryness, and external injuries and rashes. The diabetics must pay more attention to smoothen the feet. With a proper consultation with the doctor they try to make use specialised objects to smoothen the skin. If required, they can use pumice stone to smoothen calluses and corns in the feet. But the use sharp objects must be strictly avoided. Taking care of toenails: Trimming of the toe nails on regular basis is required Grown up and long nails are prone to accident and foot injuries. As a diabetic, one must strictly avoid long nails. Most of the cases long nails accumulate dirt which can cause swelling and infection in the nails. The patients must trim
their nails regularly before they grow longer. A thorough and regular trimming will keep the nails clean and free from dirt.
Comfortable walk: The diabetic feet must not be pressurised rather must be comfortable every time whether walking or resting. Utmost care must be given while walking to avoid any painful walking experience. While walking, use comfortable and pair of shoes those give smoothness and comfort to feet. Use of cleaned and comfortable shocks makes walking experience more conformable. Diabetics must use cleaned and dirt free shoes. They must check the shoes very carefully about any objects and small stones inside it before wearing. Good blood circulation keeps feet happy: Diabetic limbs especially the extremities experience less blood flow and damaged nerves. These areas must be given more smoothness for better blood circulation. While sitting for long periods of time, they must not be crossed rather must be relaxed. The diabetics must put their feet up while sitting. A little exercise for the toes and ankles can help a lot. Movement of ankles up and down, wiggling of toes about 5 minutes in a day for 2-3 times helps a lot. Diabetes has been considered as a fatal epidemic which needs to be taken seriously. Proper self care, attention can help minimise the severity. Special care must be given to feet as a small wound in the feet can create catastrophic concerns and even can be fatal.
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Manipal College of Pharmaceutical Sciences (MCOPS) ranked No. 1 in India by National Institutional Ranking Framework (NIRF) of the Union Human Resource Ministry in 2016, finds a place in QS World University Rankings of 2017. "It is a remarkable achievement. We've always been proud of our pharmacy college," said Dr. H. Vinod Bhat, Vice Chancellor, Manipal University. "We are extremely happy that the pharmacy and pharmacology stream of Manipal University has featured in the QS World University Ranking by Subject 2017. This is the first time that Manipal University's subject stream is getting into world rankings, and it is a very high entry at 251-300 range. I am sure we'll see more subjects offered by this University like dentistry, medicine and engineering, and will also feature in the world rankings in months to come," the Vice Chancellor, Dr. Bhat said. The rankings are based on academic reputation, employer reputation and research impact. "Coming after the No. 1 rank in India by NIRF, the QS Ranking is a shot in the arm for MCOPS to do better. As a premier institution under Manipal University, MCOPS has been in the forefront of education and research," said Dr. Mallikarjuna Rao, Principal of the Pharmacy College.
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The University support for infrastructural development and the several grants for research from government and non-government funding agencies have helped in the growth of MCOPS. The students and staff of the college are excited about the new status of the college. Dr. Rao added, "We will work assiduously to move up the ranking."
Manipal University: Manipal University is synonymous with excellence in higher education. Over 28,000 students from 57 different nations live learn and play in the sprawling University town, nestled on a plateau in Karnataka's Udupi district. It also has nearly 2500 faculty members and almost 10000 other support and service staff, who cater to the various professional institutions in health sciences, engineering, management, communication and humanities which dot the Wi-Fienabled campus --- Pink Medico News Network
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RNI Ref No: MAG(1)/NPT/258/2016-2017