Medical Toursim Vol 4 Issue 2 eng by Lalfx

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Medical Tourism Oct - Dec 2019

of the patients close to their point of service. We have been able to reduce the infection rates in our ICU due to this design and the outcomes are comparable to some of the world’s best hospitals.

is accelerated not just because of the fantastic clinical care one receives but also because of the feel-good environment created through its unique infrastructure. In less than two years of its operations, Meitra has made significant headway in the industry. Domestic and international patients who have experienced care in Meitra are able to see the value proposition that the brand provides – the highest quality of infrastructure, the best physicians, and data-driven clinical care – provided at an extremely competitive price. The physical environment has a significant impact on safety and human performance at hospitals. By optimising the design of Meitra Hospital, we have been able to unlock unprecedented benefits for the patients, as well as set a new model in healthcare infrastructure development. Meitra’s design focuses on seven critical factors including patient centricity, safety, and effectiveness. With Meitra Hospital, our vision has been to transform healthcare in India, and we have already set industry benchmarks. Using prefabrication, we built the 450,000 square feet tertiary care facility in a record 18 months – less than half the time typically taken to set up a hospital of this scale anywhere in the world. Prefabricated modular design helped achieve several advantages including standardisation, which reduces reliance on short-term memory and allows those unfamiliar with a specific process or design to use it safely. Standardization of patient rooms,

treatment areas, equipment, and procedures can substantially reduce errors. We were able to monitor and implement safety guidelines in a controlled factory setting and assemble quality-checked building parts on site. To minimize risks of patient transfers and handoffs, the entire hospital was designed keeping in mind the patient flow. Each of the outpatient department areas were designated with labs so the patient didn’t have to travel a distance for tests. Even the physical therapy room and rehab facility was planned inside the medical facility so patients didn’t have to leave the facility for postoperative care. Intensive Care Units are critical in any tertiary care facility. They nurse the most critical cases and have the highest rates of infection reported in any hospital. To minimize this risk, we designed individual Intensive care units. We enhanced the visibility of patients to the nursing staff by creating a unique design and brought in a 1:1 nurse to patient ratio. Nurses were also provided immediate accessibility of real time information

KEF Holdings is transforming the healthcare sector by making global healthcare accessible through Meitra Hospital. With its patient-centric design, prefabricated manufacturing and technology integrated processes, Meitra demonstrates how global healthcare can be made available at world-class quality and service standards. Meitra Hospital has an unwavering focus on quality standards and is one of the few hospitals in India to be accredited by the NABH (Constituent Board of Quality Control in India) within two years of its operations. Today, Meitra receives patients from across India as well as the Middle East, especially the GCC countries.

Oman Branch Office:

MEITRA HEALTH CONSULTANCY P O Box: 177, PC.133, Office No:219, Oasis Al Khoud Building Opp.Seeb Sports Stadium, Al Khoud, Muscat, Sultanate of Oman. Tel: +968 99882296

MEITRA HOSPITAL A Unit of Premium Medical and Healthcare Providers Pvt. Ltd., Karaparamba-Kunduparamba Mini Bypass Road, Edakkad Post, Calicut - 673 005, Kerala, India Emergency: +91 495 7123457 Email: int.desk@meitra.com For International Enquiry: +91 9847811811 www.meitra.com A Complete Magazine on Healthcare in Asia

LET’S TACKLE RESPIRATORY AILMENTS

Vol. 4 | Issue No. 2 |Oct - Dec 2019

At least 2 billion people are exposed to toxic effects of biomass fuel consumption and another one billion each to outdoor air pollution and tobacco smoke. Every year, 4 million people die prematurely from chronic respiratory diseases. RNI No. KERBIL/2016/68979 Editor & Publisher BENNY THOMAS Group Editor C GOURIDASAN NAIR Editorial Co-ordinator BYJU ARYAD

In New Delhi, India’s national capital, the situation became so alarming this year that the Supreme Court ordered closure of all educational institutions and an immediate end to burning of stubble in farms in Punjab, Haryana and Uttar Pradesh. Delhi’s experience shows how change in the weather aggravates respiratory diseases as it triggers an increase the amount of pollen and allergens in the atmosphere. It also increases mould proliferation and boosts the concentration of outdoor ozone and particulate matter at the ground level. A direct outcome of this is aggravated asthma, which is one of the most common chronic airway and non-communicable diseases worldwide.

Marketing & Promotion SHIVAKUMAR VISWANATHAN ((VP - GLOBAL, SALES & MARKETING)) TIJO JOHNY (SENIOR EXECUTIVE) Layout & Design LAL JOSEPH Legal Advisor Adv. BIJU HARIHARAN Arabic Translation Dr. A. ABOOBACKER BUSINESS ASSOCIATES Overseas USA : CHICAGO: Vincent Joseph Mob: 847 299 9954 USA : HOUSTON: Shaju Joseph Mob: 847 899 2232 USA : NEW YORK Vincent Sebastian Mob: 917 992 9629 USA : CALIFORNIA: Wilson Nechikat, Ph: 408 903 8997 Canada : Jose Sebastian, Ph: 416 - 509 – 6265 UK : Dileep Mathew, Ph: 044 787 743 2378 Switzerland : Dr. George Sebastian, Ph: 527204780 Ireland : Thomas Mathew Mob: 00353 87 123 6584 Middle East : Anil Nath, Ph: 506854500 Singapore : Mahesh A, Ph: +65 906 22828 Germany : Gayatri Puranik Ph: 0049 179 127 5002 Austria : Monichan Kalapurackal Ph: 0043 6991 9249829 Korea : Dr. A. Thomas, Ph: 0082 10 5822 5820 Australia : S. Mathew, Ph: 61247026086 Oman

: Joy Vincent, Ph: 968 9503 5953

BUSINESS ASSOCIATES India Mumbai : Mohan Iyer, Mob: +91 22 6450 5111 Eastern India : Sanjay D. Narwani, Mob: +91 983 120 7202 Hyderabad : Ephram Joseph, Mob: +91 939 131 5072 Bangalore : Shivakumar Vishwanathan, Mob: +91 829 618 0856 Tamil Nadu : Gurumurthy, Mob: +91 989 460 4804 Puducherry : K. Ramasubramanian, +91 989 497 7161 Trivandrum : Kuriyan K. Raju, Mob: +91 944 610 6644 *Responsible for selection of news under the PRB Act CORPORATE OFFICE FM Media Technologies PVT Ltd, Penta Square, Opp.Kavitha, MG Road, Cochin -682016, Kerala, India. Tel: +91 484 403 4055 Email: director@asianmeditour.com www. asianmeditour.com

Medical Tourism Oct - Dec 2019

It is estimated that worldwide, 235 million people suffer from asthma, more than 200 million people have chronic obstructive pulmonary disease (COPD), 65 million endure moderate-to-severe COPD, 1 to 6 per cent of the adult population (more than 100 million people) experience sleep-disordered breathing, 9.6 million develop tuberculosis (TB) annually, millions live with pulmonary hypertension and more than 50 million people struggle with occupational lung diseases, totalling more than 1 billion people suffering from chronic respiratory conditions.

The occurrence of allergic disorders is increasing at an alarming rate India as well. More than 25% of the Indian population suffer from various forms of allergy. A hospitalization-based survey carried out in India showed that 20 to 30 percent of the population suffers from allergic rhinitis and 15% of them developed atopic asthma. In addition to asthma, the other forms of allergy, such as atopic rhinitis, anaphylaxis, drug, food and insect allergy, eczema, urticaria, and angioedema are also on a rise both in terms of prevalence and severity in India. About 3.3% of children aged 6 to 7 years and 5.6% of children aged 13 to 14 years have been diagnosed with allergic rhinoconjunctivitis. Our cover story in this issue is about ‘Respiratory Diseases’, touching up causes of the diseases including climate change, pollution and tobacco smoke. Medical tourism is gradually transitioning towards medical value travel. The healthcare-seeking behaviour of patients as well as the wider economic impact on the countries hosting them is a subject of intense study now. The challenges that medical tourism sector faces given the diversity of needs and products is another issue in focus in this issue. After the cancer treatment ends, the patients are left with new health issues, often caused by the treatment itself. These include damage to the heart and other organs, or worsening high blood pressure and diabetes. The challenges faced by the cancer survivors are special and has been given special treatment in this issue. And, we are pleased to inform our valued readers that the magazine that you hold in yours hands now is the Official Magazine of Advantage Healthcare-India 2019, the 5th International Summit on Medical Value Travel, to be held at the India Expo Centre and Mart, Greater Noida, from November 13 to 15, 2019. We wish you a happy reading. C Gouridasan Nair Group Editor

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

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

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

Contents 08 12 16 18 22 26 36 42 44

Events Pollution Takes A Heavy Toll On Millions Climate Change Coupled With Air Pollution

Respiratory Illnesses Breath Well With Kapalbhati And Bhastrika

Breathing Trouble? Blame It On Stress, Anxiety

Poor Erection? May Be A Warning Sign Of Heart Attack? Be Careful With Your Sports Injuries Go High On Fibre, Low On BP, Diabetes

Technology Advancement With Good Pricing, Expert Care Medical Tourism Booms Detect Onset Of Stroke Early

Check Obesity With Bariatric Surgery

Eat Alone, Eat Less

Rare Surgeries

News

Medical Conferences

Equipment World

Cancer Survivors: Challenge To Families, Society

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MEDICAL TOURISM ENTERPRISE CONNECT

Medical Tourism Oct - Dec 2019

A Complete Magazine on Healthcare in Asia

Medical Tourism Oct - Dec 2019

A Complete Magazine on Healthcare in Asia

MEDICAL TOURISM EVENTS

KTM 2020 - TO FOCUS ON WAYS TO FIGHT NEW-AGE CHALLENGES

he 11th edition of the Kerala Travel Mart (KTM) will be held in Kochi in September, 2020. This is India’s largest congregation of the tourism industry that will see stakeholders across the country and abroad to seek new ways to promote business.

KTM 2020 will aim at exploring new markets for Champions Boat League (CBL), adventure tourism and MICE (Meetings, Incentives, Conventions and Exhibitions) along with finding excellent global buyers. It will be a four-day event starting on September 24, with two days packed with sessions involving international buyers, MICE operators and corporate houses. The remaining two days will cater to those involved in domestic tourism. This biennial conclave will be organised by the KTM Society with the support from the Kerala Government’s Department of Tourism. It will witness an increase in the number of quality buyers from countries that have the potential to boost the state’s travel industry. Further, KTM 2020, aims to go a step ahead in buyer selection, stall allocation and buyer-seller appointment. Adventure tourism will be a top priority area of KTM 2020. Kerala aims to boost its new products in activities such as trekking, mountaineering, river rafting, paragliding and off-roading. Unlike in the past, the four-day schedule has been fixed for providing a platform for buyers and sellers to hold effective interactions.

OMAN HEALTH EXHIBITION & CONFERENCE 2019 Oman Health Exhibition & Conference, the annual international trade event that highlights the rapid and continuous advancements of the health and medical sector in Oman, was held at the Oman Convention and Exhibition Centre, from September 23 to 25, 2019. It was a common platform that brought together different segments of the health and medical industry to explore new opportunities, showcase the latest technologies, services and facilities, and leverage potential for trade and investment. The Conference was aligned with the government’s Health Vision 2050 and aimed at addressing the challenges as well as discussing initiatives to improve the sector. The event also provide participants with an excellent opportunity to network with government, regulatory authorities, colleagues, and learn up-to-date information, emerging trends, strategies, innovative approaches, management techniques and technologies that would help them enhance the quality of healthcare services in the country. At the conference the Directorate of Planning at the Ministry of Health presented a full day program on human resources development in addition to workshops covering primary and secondary health care. For the first time the Quality Assurance Centre was part of the Health Expo. 10 Medical Tourism Oct - Dec 2019

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MEDICAL TOURISM COVER STORY

OH, FOR ONE MORE BREATH! POLLUTION TAKES A HEAVY TOLL ON MILLIONS AS RESPIRATORY ILLNESSES STRIKE

12 Medical Tourism Oct - Dec 2019

t’s the dead of night in early November. Little Tania wakes up with a cry. The five-year old is unable to breath. As she labours from one breath to the next, her mom and dad are alarmed by the plight of the child. They have no other option but to rush to the nearest hospital for nebulisation. By the time they are back, it is three in the morning. The next day she is unable to attend classes. Tania is not alone. There are many other children and the elderly like her who pay the price for atmospheric pollution that industries, farms and fossil fuel burning causes. In New Delhi, India’s national capital, the situation became so alarming this year that the Supreme Court ordered closure of all educational institutions and an immediate end to burning of stubble in farms in Punjab, Haryana and Uttar Pradesh. The winter crisis is only an acute manifestation of chronic respiratory diseases (CRDs), which are diseases of the airways and other structures of the lung, such as chronic obstructive pulmonary disease (COPD), asthma, occupational lung diseases and pulmonary hypertension, which place a heavy health burden on millons. It affects people of all ages and from all corners of the world.

At least 2 billion people are exposed to the toxic effects of biomass fuel consumption and another one billion each to outdoor air pollution and tobacco smoke. Every year, 4 million people die prematurely from chronic respiratory diseases. It is estimated that worldwide, 235 million people suffer from asthma, more than 200 million people have chronic obstructive pulmonary disease (COPD), 65 million endure moderate-to-severe COPD, 1 to 6 per cent of the adult population (more than 100 million people) experience sleep-disordered breathing, 9.6 million develop tuberculosis (TB) annually, millions live with pulmonary hypertension and more than 50 million people struggle with occupational lung diseases, totalling more than 1 billion people suffering from chronic respiratory conditions. The risk factors include air pollution, occupational chemicals and dusts, tobacco smoke and frequent lower respiratory infections during childhood. CRDs are not curable, but various forms of treatment that help dilate major air passages and address shortness of breath can help control symptoms and increase the quality of life for people with the disease. Change in the weather aggravates respiratory diseases it triggers an increase the amount of pollen and allergens produced by plants. It also increases mould proliferation and

boosts the concentration of outdoor ozone and particulate matter at the ground level. Dr Jacob Baby, Senior Consultant Pulmonologist, Aster Medcity, Kochi, says pollution and climate change leads to several infectious diseases including viral fever, H1N1 and flu. As atmospheric temperature comes down, the possibility of people getting infected with these contagious diseases also increases. “These non-infectious diseases are caused mainly due to dust particles inside the room and house dust mite. House dust mites are found in our sofas, beds and pillows which cause itching and result in respiratory diseases”, Dr Jacob Baby says. During the spring season, pollen allergy is at its peak. Therefore, at this time, those suffering from respiratory diseases should stay in dust-free areas and the buildings and surroundings they stay close to must also be clean and free from pollution. Soon after the recent floods in Kerala, fungal infections were on the rise due to the presence of moisture everywhere. Fungal pneumonia was reported from various parts of the country that suffered from the floods, he said. Asthma and chronic obstructive pulmonary disease (COPD) are the most significant public health burdens. Asthma is a chronic inflammatory disorder of the airways characterised

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various climatic or demographic variables, air pollutants, viral infections, and indoor aeroallergens. In spring, the increased incidence of asthma may be related to fungal spores and pollen grains, while in autumn it may be due to rapid changes in temperature.

by episodes of reversible breathing problems due to airway narrowing and obstruction. COPD is a preventable and treatable disease characterised by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases (typically from exposure to cigarette smoke). Dr Jacob Baby said that respiratory diseases also cause cardiac problems to patients. All the cells in our body need oxygen and if the lungs are weak the blood purification process will be affected resulting in rapid heartbeats. The heart muscles will become weak in this process and it will finally lead to pulmonary hypertension. Asthma is one of the most common chronic airway and non-communicable diseases worldwide and its prevalence has increased in recent years. Average global temperature has increased 0.85 ◦C between 1880 and 2012, notes Dr. Nandini , Senior Consultant Interventional Pulmonologist, Baby Memorial Hospital, Kozhikode, pointing out that air temperature 14 Medical Tourism Oct - Dec 2019

maybe directly or indirectly be related to the recurrence of asthma. Cold air may directly affect airways and cause hyper-responsiveness. It might also indirectly trigger asthma by predisposing people to viral diseases or air pollution. Using air conditioners in warm weather may also trigger the recurrence of asthma. “Cold and hot temperatures affect the respiratory system through different mechanisms. Warm weather may cause micro-organisms, mites and cockroaches to grow in the interior of human dwellings, or warm air can cause increased air pollution such as an increase in ozone and PM10,” she says. Cold and dry air increases the risk of airway inflammation, reduces lung function and lung capacity. Cold weather can decrease moisture in the mucosal membrane of the respiratory tract, predispose it to irritation by allergens, cause sensitivity to viral and bacterial infections and increase the risk of asthma attacks,” Dr Nandini adds. The reason for the difference in recurrence of asthma in different times of the year can be due to the effects of

Keeping pace with the global epidemiology, the occurrence of the allergic disorders in India is also increasing at an alarming rate as more than 25% of the Indian population suffer from various forms of allergy. A hospitalization-based survey carried out in India showed that 20 to 30 percent of the population suffers from allergic rhinitis and 15% of them developed atopic asthma. In addition to asthma, the other forms of allergy, such as atopic rhinitis, anaphylaxis, drug, food and insect allergy, eczema, urticaria, and angioedema were also on a rising trend in terms of prevalence as well as severity in India. 3.3% of children aged 6 to 7 years and 5.6% of children aged 13 to 14 years were diagnosed with allergic rhinoconjunctivitis, Dr Nandini says. Preparedness for an epidemic has to go way ahead in India. Eventhough Kerala could contain the Nipah epidemic in a few days, the situation may not be the same in other States. The government should take adequate steps to prevent panic among the citizens during outbreaks and infrastructural support should be stepped up. Influenza is considered to be the common problem among people who have cold, but the fact is that, there's a wider spectrum of viruses causing diseases. And the self medication adds up to the problem. “Seek medical help when sick. Milder symptoms maybe treated at home with antipyretics. If fever persists for more than a few days or if the patient develops newer symptoms like cough or breathlessness they have to get immediate medical attention. Self

medication will worsen the disease and finally the patient may require intensive care admission. This can result in increased expenses too. It may even cause threat to life due to delayed proper treatment,” says Dr Nandini. Medical care includes treatment of acute asthmatic episodes and control of chronic symptoms, including nocturnal and exercise-induced asthmatic symptoms. Pharmacologic management includes the use of control agents such as inhaling corticosteroids (inhalers) and other medications whichever is the treatment of choice.

Primary mode of therapy  Avoid exposure to sensitizing allergens especially pollen  Avoid going outdoors on days when pollen are present in high concentration in the air.  Close all windows in the evenings, when pollen generally settle down. This can help to minimize their concentration.  Air conditioning decreases indoor pollen counts.  Do not plant lot of trees and shrubs around your house.  Take bath after coming from outdoors and wear fresh cloths.  Eliminate weeds and grasses in the house compound.

In general, patients should be assessed every 1 to 6 months for asthma control. During every visit, adherence, environmental control and comorbid conditions should be checked. If the patient has good control of their asthma for at least 3 months, treatment can be stepped down. Non-pharmacological approaches are an important aspect of asthma management. These approaches are used in combination with medications. Approaches include avoidance of environmental exposures, physical activity and educational intervention. High-level evidence is available for some non-pharmacological approaches. These include avoidance of exposure to tobacco smoke, physical activity, healthy diet and avoidance of medications that can aggravate the disease. Environmental Tobacco Smoke (ETS), or second hand smoke, is increasingly recognized as the direct cause of lung disease in adults and children. ETS is responsible for significant mortality in adults, causing approximately 3000 deaths per year from lung cancer. It also causes significant effects on the lung health of adult non-smokers, including reduced lung function, increased sputum production and cough and chest discomfort. In children, ETS is associated with an increased risk of lower respiratory tract infections such as bronchitis and pneumonia. ETS is causally associated with increased prevalence of fluid in the middle ear, upper respiratory tract irritation, and reduced lung function. It is also associated with increased severity of asthma in children. Finally, ETS is a risk factor for the development of asthma in children

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MEDICAL TOURISM CLIMATE CHANGE

UNDER THREAT! CLIMATE CHANGE COUPLED

WITH AIR POLLUTION POSES A MAJOR THREAT TO HUMAN HEALTH

ir pollution is closely associated with climate change, and an individualâ&#x20AC;&#x2122;s response to air pollution depends on the source and components of air pollutants, as well as climatic agents. Epidemiological studies attribute the most severe respiratory health effects of air pollution to particulate matter and depletion in the ozone layer. Evidence associating particulate matter and short and long-term health effects are seen to be growing. Recent scientific evidence shows that inhalation of particulate matter leads to significant respiratory effects. Based on scientific evidence, the World Health Organization (WHO) suggests that

16 Medical Tourism Oct - Dec 2019

there is no threshold below which no adverse health effects of exposure to particulate matter would be anticipated.

Some air pollution related episodes of rhinitis and asthma exacerbation are due to climatic factors that favour the accumulation of air pollutants.

The main cause of adverse health effects seems to be combustion-derived ultra-fine particles that incorporate organic and transition metal components. Diesel exhaust particles (DEPs), composed of 80% ultra-fine particles and associated polycyclic aromatic hydrocarbons impact on airborne allergens, increasing exposure effects, concentration and allergenic biological activity. Several studies have demonstrated the effects of ozone over respiratory symptoms, including shortness of breath, wheezing and coughing, lower respiratory tract infections, acute and transient decrease in lung function, increased airway responsiveness, airway injury and inflammation, and systemic oxidative stress. Climate change, coupled with air pollutant exposures, may have potentially serious adverse consequences for human health. Rising temperatures will contribute to the elevation of the concentrations of ozone (due to more sunlight and higher temperature) and particulate matter (due to wildfire, droughts, desertification, sandstorms and an increase use of coal-fired power to produce energy for cooling) at the ground level. Some air pollution-related episodes of rhinitis and asthma exacerbation are due to climatic factors that favour the accumulation of air pollutants, such as ozone, at the ground level and some cities are continuously affected by air pollution caused by motor vehicles, including particulate matter and nitrous oxides. Climate change also negatively impacts the indoor air quality. Consistent results support short-term (aggravation) and, although more rarely, long-term (prevalence augmentation) effects on asthma, chronic bronchitis and COPD in indoor settings with poor air quality. Indoor air pollution is responsible for the deaths of an estimated 1.6 million people annually, and more than half of these deaths occur among children aged <5 years in countries where the effects of climate change are relevant. A growing body of evidence shows that components of air pollution interact with airborne allergens and enhance risk of atopic sensitisation and exacerbation of symptoms in sensitised subjects. Experiments show that pollen production increases in higher atmospheric carbon dioxide concentrations. Epidemiological studies have demonstrated that urbanisation, high levels of vehicle emissions and a westernised lifestyle are correlated with an increase in the frequency of pollen-induced respiratory allergy in people who live in urban areas compared with those who live in rural areas. Air pollution can interact with allergen-carrying paucimicronic particles derived from plants. The paucimicronic particles, pollen originated or not, are able to reach peripheral airways with inhaled air, inducing asthma in sensitised subjects. In particular, air pollution particulate matter, DEP, ozone, nitrogen dioxide and sulfur dioxide have been shown to have an inflammatory effect on the airways of susceptible subjects causing increased permeability, easier penetration of allergens into the mucus membranes, and easier interaction with cells of the immune system. Climate changes affect many physical and biological systems, including the immunological and respiratory systems that are critical to human health, and it is foreseeable that environmental risk factors will have a stronger effect in the coming yearsď&#x20AC;ź A Complete Magazine on Healthcare in Asia

MEDICAL TOURISM SEASONAL DISEASES

18 Medical Tourism Oct - Dec 2019

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20 Medical Tourism Oct - Dec 2019

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MEDICAL TOURISM WELLNESS

Panchkarma procedures like Vaman,Virechan, Nasya, Basti are especially effective in treating respiratory disorders. Panchakarma therapies become very effective when combined with a personalized to the personâ&#x20AC;&#x2122;s style regimen that compliments the therapies.

BREATH WELL WITH KAPALBHATI, BHASTRIKA

he body has different channels (srotas) which conduct materials and nutrients throughout the body as well as carries waste materials out of the body. There are a total of 13 srotas in the human body. Of these 3 are Prana Vaha Srota, Udaka Srota, Annavaha Srota, 7 srotas are responsible for the 7 dhatus in the body, 3 dedicated srotas to carry waste materials out of the body. Pranvaha srota, which is responsible for carrying life bearing air inside the body, has a major role among the strotas.

22 Medical Tourism Oct - Dec 2019

tion. Ayurveda considers prana vayu (air we breathe) and ahara (food) as prana (life), hence the channels that are responsible for carrying nutrients and oxygen are known as the pranavaha srota. The pranavaha srtota is the western equivalent of the respiratory system. This helps in the Shvasan (respiration), a process in which shudda vayu is inhaled into the body and ashuddha vayu is exhaled. Disorders of this srota can lead to different problems such as shortness of breath, experiencing pain when breathing, wheezing sounds, irregular breathing patterns or interrupted breathing. The body has different channels (srotas) which conduct materials and nutrients throughout the body as well as carries waste materials out of the body. There are a total of 13 srotas in the human

body. Of these 3 are Prana Vaha Srota, Udaka Srota, Annavaha Srota, 7 srotas are responsible for the 7 dhatus in the body, 3 dedicated srotas to carry waste materials out of the body. Pranvaha srota, which is responsible for carrying life bearing air inside the body, has a major role among the strotas.

COMMON DISORDERS OF THE PRANVAHA SROTA Respiratory disorders occur when the Pranvaha srotas are blocked. These disorders cause discomfort in the sufferer. Some of the most common respiratory disorders that afflict us are: Asthma: Asthma is a chronic disorder in which the bronchial tubes become swollen and filled with mucus. It makes breathing difficult. Other symptoms include coughing, wheezing, tightness in the chest, trouble sleeping, weakness & fatigue, nasal

congestion and pain in chest. Children below 5 years may develop asthma but with proper treatment the conditions can significantly improve. Asthma is not curable but proper treatment can control and manage the symptoms. COPD: Chronic obstructive pulmonary disease (COPD) is a collection of different respiratory disorders that causes breathlessness. Here, patients are unable to exhale or inhale normally and they wheeze when they breathe. Lack of energy and tightness in the chest are some other symptoms of COPD. Under certain circumstances, especially due to infections or environmental factors, symptoms may worsen suddenly and last for several days. This is called an exacerbation of COPD. Prevention is the best defence against COPD since it is also not completely curable.

Shvasan Kriya (respiration) is an activity which is defined as the combination of Nishvas (inhalation) and Ucchvas (exhalation) which carries prana vayu through the Pranvaha srota and is the key to maintain vital body functions. Problems in the pranvaha srota leads to respiratory disorders. All 13 srotas in the body are named on the basis of their functions and the pranvaha srota is no excepA Complete Magazine on Healthcare in Asia

24 Medical Tourism Oct - Dec 2019

Bronchitis: Bronchial tubes in people who have bronchitis make more mucus as a natural defence against germs, which leaves less space in the tube to carry air. This results in breathlessness, shortness of breath, fatigue and cough up discoloured (yellowish-grey, grey) sputum. Causes of bronchitis are weak immunity, smoking, gastric reflux and exposure to irritants. Pneumonia: Pneumonia is also an infection of the lungs in which the aveoli (air sacs within the lungs) are filled with puss, which makes breathing difficult. Since this is a contagious disease, children as well as adults can become infected when they are in contact with the infected person.

HOW TO KEEP THE PRANVAHA SROTA HEALTHY? All organs in the human respiratory system are important. Throughout the span of our life, we use these organs every day to breathe. Our respiratory system is under constant attack from disease causing pathogens, environmental pollutants, allergens, smoke and dust. Hence, it is vital to prioritize the respiratory health. Here are some useful tips: 1) Avoid smoking and the company of smokers: Nicotine smoke is the biggest cause of respiratory problems today. Smoking causes chronic bronchitis, emphysema, chronic lung diseases and even lung cancer. Cigarettes and bidis cause extensive damage to the lung structure and reduces the lungâ&#x20AC;&#x2122;s capacity to extract oxygen from the air and supply it to the blood stream. Second-hand smoke is equally dangerous as smoking. For this, the company of smokers should be avoided especially when they are smoking. 2) Yoga and Pranayama: Special breathing techniques such as Kapalbhati and Bhastrika have significant benefits for patients suffering from asthma, bronchitis and lung congestion. Practising these will help to strengthen the lungs, improve immunity and

provide relief from mental and physical stress. Daily practice of these yoga asanas can help you to keep the lungs strong and disease-free. 3) Morning Walks: If you are unable to practise yoga, try to incorporate 20-30 minutes of morning walk in your daily schedule. Morning time is considered the best for mild physical exercises such as walks and stretches. Choose a good location without pollution where you can walk and do simple stretching exercises. 4) Keep your hands clean: Most contagious diseases are spread by touch. Touching infected surfaces or infected objects is the most common reason for contacting disease causing germs. Use a hand sanitizer to wash your hands before consuming food or after being outdoors or in a public place. 5) Anti-oxidant rich foods: Seasonal fruits and vegetables are highly beneficial in enhancing the immunity and supplying the body with the essential nutrients. This can strengthen the bodyâ&#x20AC;&#x2122;s internal defence mechanism and prevent disease causing germs from entering the body.

HOW PANCHAKARMA HELPS? Panchkarma procedures like Vaman, Virechan, Nasya, Basti are especially effective in treating respiratory disorders. Not just that, pre-emptive Panchakarma therapies can help prevent respiratory diseases in the first place. Ayurveda recommends Vasantic Vaman (Vaman in Vasant Ritu) to prepare the body against natural Kapha aggravation in spring. Panchakarma therapies become very effective when combined with a personalized diet plan prepared according to the personâ&#x20AC;&#x2122;s Prakriti and specific lifestyle regimen that compliments the therapies. This is where unique wellness centres such as Jivagram come into the picture Source: jivagram.jiva.com A Complete Magazine on Healthcare in Asia

MEDICAL TOURISM STRESS

BREATHING TROUBLE?

BLAME IT ON STRESS, ANXIETY Anxiety can tighten the muscles that help you breathe, making yourbreath faster than normal. The more anxious you get, the faster your breathing and the faster your muscles get tired.

tress is a chronic condition that has multiple causes. It can also lead to a lot of problems and one of these is shortness of breath. This can in turn lead to several other disorders like nervousness and anxiety. Once you start feeling short of breath, it is common to get nervous or anxious making your situation even worse.

Shortness of breath is thus a common symptom for all kinds of anxiety disorders. Anxiety itself is a troubling issue and when this affects your health, it becomes a huge health burden. It is common for people suffering from anxiety and anxiety attacks to worry about their physical health, and often one of the main contributing symptoms is shortness of breath.

CAUSES Anxiety related breathing issues tend to be a result of hyperventilation. Hyper-ventilation is also known as â&#x20AC;&#x2DC;overbreathingâ&#x20AC;&#x2122;, and it occurs when your body receives too much oxygen and expels too much carbon dioxide. Even though the body needs oxygen, healthy carbon dioxide levels are still important. When you breathe in too much air you are also letting out too much carbon dioxide. This can cause your body to feel like you're not breathing enough. Disrupting the balance of oxygen and carbon dioxide in the body by over-breathing can lead to symptoms such as dizziness, tingling and headache. Anxiety can tighten the muscles that help you breathe, making your breath faster than normal. The more anxious you get, the faster your breathing and the faster your muscles get tired. This can cause an even more shortness of breath and anxiety leading to a panic attack. Hyper-ventilation and anxiety, thus, can lead to other issues like chest pain, dizziness, and light headedness. These are the result of an increase in the carbon dioxide in the blood. These symptoms usually subside as normal 26 Medical Tourism Oct - Dec 2019

breathing resumes. Yet, the harmless but uncomfortable sensations are often misinterpreted as signs of serious illness. This can become a further trigger for anxiety, leading to even worse breathing difficulty. In the short term, you'll need to understand that you may be hyper-ventilating and hence you should consciously try to control the temptation to over-breathe. In case of a panic attack, you may simply need to wait it out. This may generally peak after 10 minutes and subside later. Traditionally, breathing into a paper bag was suggested, but today, there are more successful ways suggested to control your breathing.

SYMPTOMS Anxiety is your body’s natural response to fear. This is known as the ‘fight-or-flight’ response. Your body reacts in physical and mental ways to prepare you to either fight the situation or run away from it. Shortness of breath is one of those responses. You may feel like you can’t catch your breath, tightness in your chest, or like you are suffocating or hungry for air. Studies have shown a strong association between anxiety and respiratory symptoms, including shortness of breath.

THE WAY OUT When you experience shortness of breath due to an anxiety attack, it may seem counter-intuitive that your breathing is what you should focus on. This can help you be in control of your breath so that the right amount of oxygen enters into your lungs. Experts recommend practicing diaphragmatic breathing. This is a type of breathing technique using the diaphragm, which is the most efficient breathing muscle we have. If you start feeling shortness of breath, it is good to remain calm. First thing to do in this situation is to stop whatever you are doing and lie down to relax. If this is not possible, then sit A Complete Magazine on Healthcare in Asia

on a chair and relax your shoulders as much as you can. Place your arms on a table or desk in front of you. Lean forward and start your pursed-lip breathing exercise. Pursed-lip breathing helps you breathe more air out so that your next breath can be deeper. Here, you should first breathe in through your nose and out through your mouth while almost closing your lips. Breathe in for about 4 seconds and breathe out for 6 to 8 seconds. Shortness of breath, when related to anxiety, will go away once your breathing returns to a normal state. If you can control over-compensating by trying to get too much air, you should be able to get your breathing to feel natural again. It’s important to remember that anxiety attacks can’t kill you. You won’t suffocate, won’t stop breathing, and won’t die from an anxiety attack. An anxiety or panic attack won’t turn into a heart attack, either. If you’re worried about your physical health, get it checked. Once you’ve been cleared of any physical reasons for your shortness of breath, hold onto that clean bill of health as a reminder when you’re back in an anxious moment. See a mental health professional for further help and assistance with coping techniques

RELAXATION TIPS • place where you can relax. • Tighten and relax each muscle of your body. • Imagine your muscle groups relaxing and becoming heavy. • Empty your mind of all thoughts. • Let yourself relax more and more deeply. • Become aware of the state of calmness that surrounds you. • When your relaxing time is over, you can bring yourself back to alertness by moving hands and feet, and then stretch and move your entire body. • Lie on your back or prop yourself up on several pillows. With one hand on your belly and the other on your chest, breathe in. Push your belly out as far as possible. You should be able to feel the hand on your belly move out, while the hand on your chest should not move. • When you breathe out, you should be able to feel the hand on your belly move in.

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MEDICAL TOURISM ENTERPRISE CONNECT

30 Medical Tourism Oct - Dec 2019

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32 Medical Tourism Oct - Dec 2019

A BRIEF HISTORY OF THE HOSPITAL HISTORY Caritas Hospital foundation stone laid by H. E Cardinal Tiserang in the presence of Mar Thomas Tharayil on 27th November 1953. Caritas Hospital was established in 1962 by Mar Thomas Tharayil, Bishop of Kottayam, with just 50 beds. Dr. Peter

planning, lack of true commitment and above all, wide spread corruption, have led to the deplorable situation that the health mission of 'Caritas Hospital' has to play a vital role in alleviating pain of the sick and the suffering, especially to those who cannot afford adequate treatment. THE-PRESENT The unconditional support and enlightened vision of Mar Kuriakose Kunnachery, the Bishop of Kottayam, the hospital has grown to a worldclass manifold academic and community based hospital that is from a 50-bedded hospital to a 658-bed strength hospital. Footing on the strong guidance of Mar Mathew Moolakkatt, the Archbishop of Kottayam, the hospital is growing to its renowned heights. The hospital has 33 plus state-of-the-art clinical specialties and cares more than 4,00,000 outpatients and almost 50,000 in-patients each year. In addition there is also. Authentic and well-versed administration, senior doctors and energetic and aspiring junior doctors do work as a team to uphold the health care system the hospital has earned its cherishing and memorable years of service in the sphere of health care. Self immolated and Christianized charity motivated religious sister nurses and service- based staff nurses and student nurses, the nursing service department excels. Committed and skilled paramedical services and other hard working auxiliary services do make the hospital the best in Central Kerala.

Caritas Hospital Thellakom P.O., Kottayam-686630, Kerala, India Phone: 0481-2790025 to 29 Email:mail@caritashospital.org www.caritashospital.org A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM TECHNOLOGY ADVANCEMENT

AI BOOST FOR THYROID CANCER

RISK DIAGNOSIS

36 Medical Tourism Oct - Dec 2019

sing Artificial Intelligence (AI) with thyroid ultrasound offers a quick and non-invasive approach to thyroid cancer screening, says a new study.

The study, published in the journal PLOS Pathogens, suggests that automated machine learning shows promise as an additional diagnostic tool that could improve the efficiency of thyroid cancer diagnosis.

"Machine learning is a low-cost and efficient tool that could help physicians arrive at a quicker decision as to how to approach an indeterminate nodule," said the study's lead author John Eisenbrey, Associate Professor of Radiology, Thomas Jefferson University, US. According to the researchers, at present, ultrasounds can tell if a nodule looks suspicious, and then decide whether to do a needle biopsy, although fine-needle biopsies can only act as a peephole and will not reveal the whole picture. As a result, some biopsies return inconclusive results as to whether the nodule is malignant, or cancerous in other words. In order to improve the predictive power of the first-line diagnosis, the ultrasound, researchers looked into machine learning or AI models developed by Google. They applied a machine learning algorithm to the ultrasound images of the patients' thyroid nodules to see if it could pick out distinguishing patterns. The researchers trained the algorithm on images from 121 patients who underwent ultrasound-guided fine needle-biopsy with subsequent molecular testing. From 134 total lesions, 43 nodules were classified as high risk and 91 were classified as low risk, based on a panel of genes used in the molecular testing. A preliminary set of images with known risk classifications were used to train the model or algorithm. From this bank of labelled images, the algorithm utilised machine learning technology to pick out patterns associated with high and low risk nodules. It used these patterns to form its own set of internal parameters that could be used to sort future sets of images; it essentially ''trained'' itself on this new task. Then the investigators tested the trained model on a different set of unlabelled images to see how closely it could classify high and low genetic risk nodules, compared to molecular test results. The researchers found that their algorithm performed with 97 percent specificity and 90 percent predictive positive value, meaning that 97 percent of patients who truly have benign nodules will have their ultrasound read as ''benign'' by the algorithm, and 90 per cent of malignant or ''positive'' nodules are truly positive as classified by the algorithm. The overall accuracy of the algorithm was 77.4 per cent. Thyroid nodules are small lumps that form within the thyroid gland and are quite common in the general population, with a prevalence as high as 67%. The great majority of thyroid nodules are not cancerous and cause no symptoms. However, there are currently limited guidelines on what to do with a nodule when the risk of cancer is uncertain. "Machine learning is a low-cost and efficient tool that could help physicians arrive at a quicker decision as to how to approach an indeterminate nodule," says Dr. Eisenbrey. "No one has used machine learning in the field of genetic risk stratification of thyroid nodule on ultrasound." Though preliminary, the study suggests that automated machine learning shows promise as an additional diagnostic tool that could improve the efficiency of thyroid cancer diagnoses. Once it becomes more robust, the approach could give doctors and patients more information in order to decide if a thyroid lobe removal is necessary A Complete Magazine on Healthcare in Asia

MEDICAL TOURISM TECHNOLOGY ADVANCEMENT

SLEEVEBALLOON

NEW WAY TO TREAT TYPE 2 DIABETES

hunger, keeping the person fuller for longer and substantially reduces weight,” he added. With type 2 diabetes, the body either resists the effects of insulin — a hormone that regulates the movement of sugar into the cells — or doesn't produce enough insulin to maintain normal glucose levels.

ype 2 diabetes is a chronic condition that affects the way the body processes sugar (glucose) and severly affects the quality of life of a person. Lot of research has gone into the treatment of this condition. Recently, researchers have found that a newly tested medical device, called “Sleeveballoon”, that mimics the effects of traditional bariatric surgery in rodents, produces impressive results on body weight, fatty liver and diabetes control.

This is a device that combines a balloon with a connected sleeve, which covers the initial parts of the small intestine. It is inserted into the stomach and bowel during minimally invasive surgery under general anaesthesia. For the study, published in the journal EBioMedicine, researchers compared the effects of the Sleeveballoon and traditional bariatric surgery on 30 rodents fed with a high-fat diet, achieving very similar results. Results were also compared to rats, with the new device reducing food intake by 60% and resulting in a 57% reduction in fat mass. 38 Medical Tourism Oct - Dec 2019

The effect on diabetes was similarly impressive with blood glucose levels dropping by 65%. “Gastric bypass surgery is a highly effective treatment of obesity and type 2 diabetes. However, very few eligible patients, only around one per cent, are offered surgery and some also prefer less invasive approaches,” said the study’s lead author Geltrude Mingrone, Professor at King’s College, London. During the study, the research team found that the metabolic effects of the Sleeveballoon device are similar to those of the gastric bypass but have distinct advantages over the traditional method. In both, insulin sensitivity and heart functions improved. “However, while gastric bypass causes a rapid rise in post food blood glucose levels, which can cause hypoglycaemia, the Sleeveballoon induces a slowing down of digestion which has a steadying effect on blood sugar levels,” Mingrone said. “This helps control appetite and

Type 2 diabetes used to be known as adult-onset diabetes, but today more children are being diagnosed with the disorder, probably due to the rise in childhood obesity.

SYMPTOMS •

Increased thirst

•

Frequent urination

•

Increased hunger

•

Unintended weight loss

•

Fatigue

•

Blurred vision

•

Slow-healing sores

•

Frequent infections

•

Areas of darkened skin, usually in the armpits and neck

MEDICAL TOURISM TECHNOLOGY ADVANCEMENT

NANOTUBES

TARGETED CANCER DRUG DELIVERY SYSTEM

precise and non-toxic treatment that targets lung cancer cells at the nanoscale is able to effectively kill the cells even at a low dose.

Researchers from Washington State University and the Department of Energy's Pacific Northwest National Laboratory (PNNL) used tiny tubes made from organic molecules called peptoids to deliver cancer-killing drugs in a targeted manner. The research, led by Yuehe Lin, Professor in WSU's School of Mechanical and Materials Engineering, and Chun-Long Chen, a Senior Research Scientist at PNNL and a Joint Faculty Fellow at the University of Washington, was published as the cover story in the journal, Small. The biologically-inspired nanotubes, which are about a hundred thousand times thinner than a human hair, were rolled up from membrane-like nanosheets. The drug molecules, fluorescent dyes and cancer-targeting molecules were precisely placed within the nanotubes, enabling them to track the efficiency of the drug delivery into the cancer cells.

enabled the use of a lower dose of the cancer drugs than using a single drug, leading to effective killing of cancer cells with low toxicity. "By precisely engineering these nanotubes with fluorescent dyes and cancer targeting molecules, scientists can clearly locate tumor cells and track how the drug regimen is performing," said Lin. "We can also track how nanotubes enter and deliver the drugs inside the cancer cell." The team tested the nanotubes on lung cancer cells and found that they delivered the chemotherapy drug doxorubicin directly into the fast-dividing cancer cells, resulting in highly efficient cancer killing while using less chemotherapy drugs. "This is a promising approach for precision targeting with little damage to

healthy surrounding cells," said Lin. While other nanomaterials, such as carbon nanotubes, have been used to deliver and track cancer-killing drugs, researchers have found that they are toxic to the body. Furthermore, they didn't do well at precisely recognizing molecules. "By using these peptoids, we were able to develop highly programmable nanotubes and a biocompatible delivery mechanism," said Chen. "We also harnessed the high stability of peptoid and its well-controlled packing to develop nanotubes that are highly stable." "Due to their unique structure, these nanotubes can be easily assembled for use in cancer therapy and stay in the body longer for treatment," said Lin.

The new technology allows the two drugs -- one for chemotherapy and the other for a less-invasive photodynamic therapy treatment -- to be delivered directly to the cancer cells. Photodynamic therapy uses a chemical that, when exposed to light, releases reactive oxygen species (ROS) that kill the cancer cells. The researchers' dual-drug approach A Complete Magazine on Healthcare in Asia

MEDICAL TOURISM TECHNOLOGY ADVANCEMENT

WHITE NOISE

TO HELP MONITOR BREATHING BY BABIES

esearchers, including one of Indian-origin, from Washington University, have developed a new smart speaker skill that lets a device use white noise to both soothe sleeping babies and monitor their breathing and movement. White noise is a combination of different sound frequencies, which makes a seemingly random soothing sound that can help cover up other noises that might wake up a sleeping baby. "If we could use this white noise feature as a contactless way to monitor infant's hand and leg movements, breathing and crying, then the smart speaker becomes a device that can do it all, which is really exciting," said Indian-origin researcher and study co-author Shyam Gollakota, Associate Professor at Washington University. To use white noise as a breathing monitor, the team needed to develop a method to detect tiny changes between the white noise a smart

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speaker plays and the white noise that gets reflected back from the infant's body into the speaker's array of microphones. The prototype device, called BreathJunior, tracks both small motions -such as the chest movement involved in breathing -- and large motions -- such as babies moving around in their cribs. It can also pick up the sound of a baby crying. The prototype device was first tested on an infant simulator showing the system could accurately detect respiratory rates between 20 and 60 breaths per minute. Breath Junior was then tested on five babies in a neonatal intensive care unit, with the babies connected to wired respiratory monitors for comparison. Again, the system proved accurate, tracking respiratory rates up to 65 breaths per minute, closely matching the rates detected by wired, hospital-grade devices.

"We start out by transmitting a random white noise signal. But we are generating this random signal, so we know exactly what the randomness is," said study author Anran Wang. "That signal goes out and reflects off the baby. Then the smart speaker's microphones get a random signal back. Because we know the original signal, we can cancel out any randomness from that and then we're left with only information about the motion from the baby," Wang said. "BreathJunior holds potential for parents who want to use white noise to help their child sleep and who also want a way to monitor their child's breathing and motion," Wang added. While BreathJunior currently uses white noise to track breathing and motion, the researchers would like to expand its capabilities so that it could also use other soothing sounds like lullabies

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MEDICAL TOURISM HEALTHCARE

WITH GOOD PRICING, EXPERT CARE

MEDICAL TOURISM BOOMS Medical tourism is gradually transitioning towards medical value travel that also includes capturing a patientâ&#x20AC;&#x2122;s healthcare-seeking behaviour as well as the wider economic impact on the countries hosting them.

42 Medical Tourism Oct - Dec 2019

ver the past few decades, India has been advancing in medicine by leaps and bounds and has turned out to be a major revenue earner India.

sector’s growth. Indian government has also released a fresh category of visa - the medical visa or M visa, to encourage medical tourism in the country.

According to the Indian Tourism Statistics 2018, the total number of inward tourists seeking medical care doubled in a span of three years from 2017. Healthcare seekers from all over the world are making a beeline to India thanks to the fast pace at which path-breaking innovations in medical care have been assimilated in the country, presence of highly skilled medical staff and the reasonable pricing of healthcare services.

The Ministry of Tourism has also set up a National Medical and Wellness Tourism Promotion Board to look into various issues such as regulatory affairs, accreditation and marketing. The industry has also taken several initiatives for marketing and promoting Indian healthcare in key overseas markets and India at international platforms such as WTM London, ITB Berlin, FITUR Madrid and ATM, Dubai. Yoga, Ayurveda and Wellness are also finding prominence in print, electronic, online and outdoor media under the ‘Incredible India!’ campaign.

Around 22% of the tourist arrivals from West Asia was for medical purposes, followed by 15.7% from Africa. Government of India has notified medical tourism as ‘deemed export’ and has given it fiscal incentives, including lower import duties, prime land at subsidised rates and tax breaks. Total contribution by travel and tourism sector to India’s GDP is expected to increase from Rs 15,24,000 crore (US$ 234.03 billion) in 2017 to Rs 32,05,000 crore (US$ 492.21 billion) in 2028. According to WTTC, India is ranked 3rd among 185 countries in terms of travel and tourism’s total contribution to GDP in 2018. International tourist arrival is expected to reach 30.5 billion by 2028. Foreign tourist arrivals for medical purpose increased from 427,014 in 2016 to 495,056 in 2017. During 2018, arrivals through e-tourist visa increased 39.60% year-on-year to 2.37 million. During May 2019, arrivals through e-tourist visa route increased by 21.70% year-on-year to 1.23 million.

Despite the diversity of languages, India is one of the largest English-speaking nations. Further, easy availability of language interpreters, English-based documents etc. work as an advantage for the country, especially with inward medical tourists. Be it cardiac bypass, heart surgery and bone-marrow transplant or even cosmetic surgery and dental care, India is a popular destination for these procedures along with advanced and alternative medicine processes. India has also an unmatched heritage represented by its ancient traditional treatment methods such as Ayurveda,

Yoga, Unani, Siddha and Homeopathy (AYUSH), which are now widely accepted as alternative treatment procedures in the entire world. Medical tourism is gradually transitioning towards medical value travel that also includes capturing a patient’s healthcare-seeking behaviour as well as the wider economic impact on the countries hosting them. It is estimated that 11 million people travel out of their country annually to seek medical care, which is around 1% of the global tourist volume. Medical tourism is today a $30 billion industry, having grown at an impressive rate of more than 15% over the last decade. What India provides is a contrast in the price range to the exorbitant medical attention costs in developed European countries and the US. It costs roughly $1800 for a state-ofthe-art heart surgery in India, which is about 2% of the $90,000 that an average heart surgery costs in the United States. A medical procedure comparison shows India to be the cheapest when it comes to medical procedures. A gastric bypass procedure would cost someone roughly $25,000 in the USA, and $12,900 in Costa Rica, $10,900 in South Korea. But the same procedure would only cost $7,000 if done in India

The launch of several branding and marketing initiatives by the Government of India such as ‘Incredible India!’ and ‘Athiti Devo Bhava’ have provided a focused impetus to the A Complete Magazine on Healthcare in Asia

MEDICAL TOURISM HEALTH

DETECT ONSET OF STROKE EARLY Dr Manish Yadav Consultant, Imaging & Interventional Radiology, KIMS Hospital, Thiruvananthapuram

44 Medical Tourism Oct - Dec 2019

troke is a major debilitating disease caused either by bleeding inside the brain or due to interruption of blood supply to a part of brain. It is the first leading cause of permanent physical disability and second leading cause of death. Stroke affects one life every 6 seconds and it will effect one in 6 people in their lifetime. Worldwide there are 80 million people surviving the effects of stroke. It is also a major cause for loss of productivity and financial constraint for the family.

Broadly there are two types of stroke. Hemorrhagic stroke (caused by bleeding inside or around the brain) and Ischemic Stroke. Hemorrhagic Stroke is caused by trauma, uncontrolled blood pressure or abnormality of blood vessels such as abnormal connection between artery or vein (Arteriovenous malformation) or a bulge in the artery of the brain called aneurysms. Ischemic stroke is caused by narrowing or block in the arteries supplying blood to the brain.

PREVENTION Do regular exercise to maintain a healthy body weightwalking daily, indulging in outdoor sport, etc., are good. Avoid smoking, alcohol and other narcotic substances. Go for a healthy diet. Reduce oily and fried foods, and increase intake of green leafy vegetables and fibre content in food. Control cholesterol, blood pressure and diabetes. Take medications regularly.

IDENTIFICATION OF STROKE A stroke can be identified by common people by identifying certain simple changes in a person (BEFAST) B – BALANCE : Is the person experiencing a sudden loss of balance or coordination? E – EYES: Is the person having sudden change in vision or trouble seeing. F – FACE: Ask the person to smile. Does once side of the face droop? A – ARMS: Ask the person to raise both arms. Does one arm drift downward? S – SPEECH: Ask the person to repeat a simple phrase. Is their speech slurred or strange? T- TIME: If you observe any of these signs it is time to call for medical care. Apart from these simple signs there are a number of other symptoms of stroke like having a seizure or fits and loss of consciousness. If one finds any person nearby having any of these symptoms, it important to seek medical care immediately.

TREATMENT Our brain is a very sensitive organ which survives on uninterrupted supply of blood. After onset of stroke,

when the blood supply is blocked, the brain tries to survive by shutting down the function of its different parts. However, this lasts for a very short time which is called ‘window period’. If blood supply is restored during this critical period, the brain will regain its function to a large extent. Otherwise, the part of the brain that gets shut down would become permanently dysfunctional. Once a stroke patient is received at hospital, he or she immediately undergoes a scan to identify the type of stroke, the part of brain involved and to see if there is any occlusion or any abnormality of blood vessel. If it is identified as Ischemic Stroke, the patient may be given a clot-dissolving medicine. This medicine can be administered generally up to 4.5 hours after onset of stroke and may be thereafter in only a few patients. This drug dissolves the clot and opens the blood vessel, thereby restoring the blood supply to that part of brain. In case the scans show that a large blood vessel to the brain is blocked,

in addition to clot-dissolving medicine, a new therapy like mechanical thrombectomy has been found to be very effective. This procedure is performed using a special machine known as cathlab, where a tube is taken through the groin artery into the clot in the brain vessel and, using a special device, the clot from the brain is removed. This treatment has revolutionised the stroke treatment in the last few years and proved to be highly effective, especially in larger strokes, provided it is performed as early as possible after onset of stroke before the brain undergoes permanent damage. After the initial treatment to restore the blood supply, the patient may need other supportive care like physiotherapy and medications to prevent further strokes. Stroke is a major debilitating disease and its early identification and treatment can reverse its effects to a large extent. Awareness regarding stroke and early treatment can help to prevent major disability to our near and dear ones A Complete Magazine on Healthcare in Asia

MEDICAL TOURISM OBESITY

CHECK OBESITY WITH

BARIATRIC SURGERY

ariatric surgery is a surgery that is done to help you lose weight. It is not recommended for all who are overweight or obese. However, it may be a choice if you are obese and have not been able to lose weight using other methods. This is also an option in case you are obese and have other medical conditions like high blood pressure, high cholesterol, arthritic joint diseases, and diabetes. A person is categorized as underweight, healthy weight, overweight, or obese based on his or her body mass index (BMI). Body mass index is a way to measure the body fat of a person based on the height and weight of the person. A BMI of 25 to 29.9 is considered overweight A BMI of â&#x2030;Ľ30 is considered obese

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Weight loss surgery is recommended only for people with one of the following:Severe obesity (body mass index [BMI] above 40) BMI above 35 with a serious medical problem related to obesity (including diabetes, severe joint pain, sleep apnea, and many others) that would improve with weight loss. Certain races, such as Southeastern Asians and Indians, have more truncal obesity and will experience the effects of obesity at lower BMIs; consequently, these patients may be eligible for consideration of surgery at a BMI lower than 27.5 kg/m2. It is good to understand the potential risks and benefits before opting for a

weight loss surgery. You must be motivated and willing to make lifelong changes about how you eat to reach and maintain a healthier weight after surgery. You must also be realistic about the amount of weight you can lose after surgery.

TYPES OF SURGERIES You and your surgeon will work together to decide which surgery, if any, is right for you.

GASTRIC BYPASS Roux-en-Y gastric bypass (RYGB), also called gastric bypass. It helps you to lose weight by reducing the amount of food you eat and reducing the number of calories and nutrients you absorb from the food you eat. To perform gastric bypass, a surgeon creates a small stomach pouch by dividing the stomach and attaching it to the small intestine. This helps you to lose weight in two ways: The smaller stomach can hold less food than before surgery. The body absorbs fewer calories, since food bypasses most of the stomach as well as the upper small intestine. Gastric bypass can be performed as an open surgery (through an incision on the abdomen), but the majority of cases are done laparoscopically, which uses smaller incisions and longer instruments. Gastric bypass has a high success rate, and people lose an average of 70 to 75 percent of their excess body weight in the first year.

GASTRIC SLEEVE Gastric sleeve, also known as sleeve gastrectomy, is a surgery that reduces the size of the stomach and makes it into a narrow tube. The new stomach is much smaller, does not stretch while eating, and produces less of the hormone (ghrelin) that causes hunger, helping you feel satisfied with less food. Sleeve gastrectomy is considered less aggressive than gastric bypass because the intestines are not re-ar-

ranged, and there is less chance of malnutrition. It also does not require any permanently implanted device. The gastric sleeve has a good success rate, and people lose an average of 60 to 65 percent of their excess body weight in two years after their procedure.

GASTRIC BALLOON The gastric balloon is a procedure whereby an inflatable balloon is placed inside your stomach via your mouth using an endoscope. It also works by restricting the amount of food you can eat at one time. Balloon placement requires anaesthesia, but it does not require an incision. The balloon is meant to be placed for up to six months, and removal requires a second procedure. This is an increasingly popular choice because it is relatively safe, easy to perform, and does not require any anatomical changes. After the balloon is removed, some, but not all, patients are able to maintain the weight loss.

you can eat at one time; the band can be adjusted to be tighter (further restricting the amount of food the stomach can hold) or looser (allowing you to eat more).

EFFECTIVENESS The goal of weight loss surgery is to reduce the risk of illness or death associated with obesity. Weight loss surgery can also help you to feel and look better, reduce the amount of money you spend on medicines, and cut down on sick days from work. As an example, weight loss surgery can improve health problems related to obesity (diabetes, high blood pressure, high cholesterol, sleep apnea) to the point that you need less or no medicine. Finally, weight loss surgery might reduce your risk of developing heart disease, cancer, and certain infections

OTHER PROCEDURES Other procedures that are gaining popularity include the Duodenal Switch (DS), Mini-Gastric Bypass (MGB), and Single-Snastomosis Duodenal Ileal Bypass (SADI). These less common procedures work similarly to the gastric bypass.

ADJUSTABLE GASTRIC BANDING (AGB) This is also known as â&#x20AC;&#x2DC;lap bandingâ&#x20AC;&#x2122;, which involves placing a band around the opening of the stomach. This reduces the amount of food that

Dr Sylesh Aikot MBBS, MS, DNB, FMAS, MCh (gastro) Specialist in bariatrics and advanced laparoscopic surgery, chief, gastrointestinal surgery, Baby Memorial Hospital, Kozhikode, Kerala, India. A Complete Magazine on Healthcare in Asia

MEDICAL TOURISM ONCOLOGY

CANCER SURVIVORS

CHALLENGE TO FAMILIES, SOCIETY

Cancer survivors often feel alone and drift as they face these challenges. A few feel well-prepared for the transition to post-treatment, nor are they informed about how to manage their health, going forward.

s more advanced cancer treatments become available, more patients are being successfully treated for cancer. However, a daunting new challenge awaits: navigating the physical and emotional challenges of being a survivor. After the cancer treatment ends, the patientsâ&#x20AC;&#x2122; next journey begins. They are now left with new health issues often caused by the treatment itself. These include damage to the heart and other organs, or worsening high blood pressure and diabetes. Studies show that many struggle with depression, fatigue and a nagging fear that the cancer will come back. Also, after cancer treatments, sexual functions

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and personal relationships are seen to suffer. Some patients with cancer have physical and emotional symptoms that may not necessarily be related to advanced cancer or end-of-life care. There will be issues such as maintaining quality of life after cancer treatment, returning to a normal routine while facing fatigue, and following the recommended schedule for post-treatment screenings and tests. Cancer survivors are also at a greater risk for developing second cancers and other health conditions. Added to these emotional struggles, there are strains on personal relationships, and the profound fear of cancer recurrence.

lead to new cancers and other complications, doctors have reduced or in some cases eliminated radiation as studies suggest chemotherapy alone improves the rate of overall survival for certain patients. There are a variety of cancers, and that means a variety of necessary treatments for patients—and then a variety of follow-up needs for survivors. So, it is crucial for survivors to be monitored by specialists who can assess their individual risk of recurrence and know the after-effects of specific chemotherapy and radiation regimens. Things have got a lot better for survivors of childhood cancer—but also much more complex. More than 83% of children treated for cancer can expect to survive five years or longer, compared with 58% in the mid-1970s, according to the National Cancer Institute.

According to the National Cancer Survivors Day Foundation, more resources, research and survivor-friendly legislation are needed to improve the quality of life of cancer survivors – during and after treatment. They are urged not only to recognize those who are living with a history of cancer but also to raise awareness of the hardships cancer survivors face beyond treatment.

There are growing numbers of cancer survivors. Nearly 40% of men and women develop an invasive cancer in their lifetimes, with men at a slightly higher risk. But thanks to medical advances in detection and treatment, there are close to 17 million cancer survivors in the US—and, with an ageing population, that number is expected to rise to about 22 million by 2030.

Survivors often feel alone and drift as they face these challenges. According to a new survey of cancer survivors by the non-profit National Coalition for Cancer Survivorship, few feel well-prepared for the transition to post-treatment, nor are they informed about how to manage their health, going forward.

Doctors are learning how to make cancer treatments less toxic in the first place, to reduce after effects and recurrence risks. For example, chemotherapy plus radiation was long the standard treatment for a type of Hodgkin lymphoma. But, as evidence emerged that radiation can

As cancer treatment can damage organs, it impedes growth and learning ability, and lead to later cancers, patients need life-long support and follow-up. Treatment for cancer can be physically arduous, it generally disrupts patients’ social and work life, and it may even limit their ability to care for themselves or live independently for some period of time. In addition to these physical and functional burdens, cancer patients often face fears of death or disability and could become prone to feelings of isolation or depression. Many patients show signs of depressed mood or acute stress reactions at some point during their diagnosis and treatment. Given the physical, economic, and psychological burdens experienced by cancer patients during treatment, it is perhaps a testament to human resilience and the quality of care and social support that the patients receive, most adapt to these challenges and have a positive psychological outcome A Complete Magazine on Healthcare in Asia

MEDICAL TOURISM SEX LIFE

POOR ERECTION?

MAY BE A WARNING SIGN OF HEART ATTACK? You can enjoy healthy sex only if you are physically and mentally healthy. Physical as well as mental health issues can impair your sexual functioning.

re you sexually healthy? You may be taken aback when I ask you this direct question. But it is very important. Erectile dysfunction, the inability to achieve or maintain erectile rigidity can be an early warning sign of current or future cardiac problems in those who are in their 40s or above. At Dr. Promodu’s Institute of Sexual & Marital Health Pvt Ltd, among the ED patients screened for cardiac risk we found 8 to 10% of our cases are positive for coronary artery disease. Last week Alexander a handsome, apparently healthy gentleman came to me in tears. “Doc…These days I can’t perform as in the past.….Something happened to me.. Past one 50 Medical Tourism Oct - Dec 2019

year, I had noticed a little weakness when performing with my wife, but it was really exciting to have with my girlfriend. Now I failed miserably with her too…. What happened to me?... I am very upset” I tried to console him, asked a few questions. He is only 49, doesn’t have any known health problems. But gradual reduction in erectile hardness noticed one to two years ago and worsened in the past one year. We suggested investigations. Penile doppler showed narrowing of penile arteries causing reduced blood flow to the penis which in turn lead to loss of erection. Since there was narrowing of penile arteries, for his safety we advised cardiac evaluation

before starting erectogenic drugs. He could not perform for more than four minutes on the treadmill, developed chest pain. Started on medicines and send for further evaluation. Coronary angiogram showed two major blocks and an angioplasty was performed. Most men feel that erectile dysfunction (ED) is a simple sexual issue and ignore. ED is an inability to achieve or maintain an erection sufficient for a satisfactory sexual intercourse. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO). Sexual health is also an indicator of health. WHO considers sexual health as one of the components of health. Both are interrelated. You can

millimetre get blocked you may have a heart attack. So erectile dysfunction can be considered as a predictor of heart disease. Studies conducted among men aged 45 years without any heart disease suffering from erectile dysfunction found to have 50% more risk to be hospitalized for a heart disease.

enjoy healthy sex only if you are physically and mentally healthy. Physical as well as mental health issues can impair your sexual functioning.

serious problems as these are related to your life style. If you experience an erectile failure consult your doctor. Instead of directly taking an ED tablet get yourself investigated Keep your body and mind healthy

A long term follow-up study was conducted in 8063 men without any history of cardiac illness in Texas university. After 7 years 65% of them developed erectile dysfunction and subsequently many of these ED patients experienced heart attack and strokes. Another study conducted in 2126 adult men in John Hopkins University found 90% men with ED had at least one major cardio vascular risk factor such as high blood pressure, high cholesterol, diabetes mellitus or smoking. Men experience even mild erectile dysfunction get 25% greater risk for heart disease. Studies conducted in cardiac patients found that 66% of them had reported ED on an average 5 years prior to the cardiac event.

After the age of 30 years practice regular physical exercise

RISK FACTORS FOR ED AND HEART DISEASE.

Manage excess anxiety or stress

Some of the common factors are found to be associated with ED and cardiovascular diseases. Most of these conditions leads to similar type of pathology

Maintain your body weight Avoid accumulating overweight Adopt healthy food habits If you are a smoker stop it Reduce or limit your alcohol consumption If you have excess cholesterol, hypertension or diabetes mellitus take appropriate treatment and bring it under control Have regular medical check up and follow up.

Learn to relax Donâ&#x20AC;&#x2122;t forget that difficulty to achieve an erection or a reduced erectile rigidity may be the first sign of an impending cardiovascular problem.

Increasing Age You may wonder what is the relationship between an erectile failure and a heart disease. Yes! there is a relationship. Sometimes erectile dysfunction can be a premonitory sign of impending cardiac disease. Cholesterol or fat deposits in the arteries build up plaques - atherosclerosis which leads to reduced blood flow. Narrowing of penile arteries having an internal diameter of one or less than one millimetre leads to reduced blood flow to the penis causing an erectile dysfunction. When the coronary artery having an internal diameter of 3 to 4

High blood pressure High cholesterol Diabetes Mellitus Smoking Excessive alcohol use Obesity Anxiety & stress Depression Low testosterone levels

HOW CAN YOU PREVENT ED & HEART DISEASE If you are a little cautious about health you can prevent many of these

Dr Promodu MPhil M& SP, PhD (Clin. Psy) Sex Therapist, Dr. Promodus Institute of Sexual & Marital Health Pvt Ltd, Kochi. Email: info@drpromodusinstitute.in Website: www.drpromodusinstitute.in A Complete Magazine on Healthcare in Asia

MEDICAL TOURISM SPORTS INJURIES

BE CAREFUL WITH YOUR

SPORTS INJURIES Treatment of sports injury starts from the prevention of injuries to treatment of specific injury. Prehabilitation is a relatively new idea in sports medicine and therapy. It is a personalized exercise program that is individually designed for athletes to help them to prevent injury in their given sport, says Dr. Praveen Kumar KS Senior Consultant – Orthopedics & sports Medicine Kinder Multispecialty Hospital Kochi, Kerala.

Dr. Praveen Kumar KS MS, Fellow(ISAKOS), Fellow( IAS) Senior Consultant – Orthopedics and sports Medicine. Kinder Multispecialty Hospital , Kochi, Kerala.

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igh profile sports events like the Olympics, World championships bring the hope that witnessing and celebrating dedicated sports persons will inspire young people to take up sport and physical activities that help them to develop confidence, lead more satisfying lives, and not the least, secure long -term health by reducing their risk of developing chronic illness like diabetes, obesity and cardiovascular diseases. But, unfortunately, if they

don’t take appropriate measures, a young sports person can instead end up in pain, on a different path to poor health - due to avoidable sports injuries. Most common sports injuries are due to accidents, poor training practices or using wrong gear or equipment. Sports injuries can affect skin, tendons, ligaments, muscles, joints, bones and cartilage.

Articular cartilage injuries can be mild inflammation to severe cartilage damage of defects. These cartilage injuries are often associated with joint subluxation and dislocations. Common sports injuries affect joints and muscles of upper limb, lower limb and spine. In the lower limb, ankle and knee injuries are common. Ankle and foot injuries can be a sprain, stress fractures, and avulsion fractures, tendinitis of heel cord and ankle tendons and rupture of heel cord. Knee injuries can be tendinitis of patellar and quadriceps tendon, stretching of rupture of ligaments of the knee â&#x20AC;&#x201C; Anterior cruciate ligament (ACL), Medial collateral ligament (MCL), Lateral collateral ligament (LCL), Posterior cruciate ligament (PCL). Menisci are structures inside the knee joint which has shock absorbing function. These structures get frequently damaged in injuries of knee. Hip injuries can vary from minor sprain of the ligaments, muscle pull to major dislocation and muscle ruptures, commonly the hamstring muscles and calf muscles get injured. Shoulder injuries can vary from minor sprain to major dislocation involving the shoulder bones.

Sprains, strains and muscle pull are the commonest form of sports injuries. Skin injuries can vary from minor abrasions, contusion to serious cut wounds. Strains are injuries involving muscles and tendons. These injuries can be mild stretching to major rupture of tendons and muscles. Bone injuries are minor inflammation to major fractures. Joint injuries can be subluxation or dislocations.

Spine injuries can involve the ligaments, muscle and the bones of the vertebral column. Low back and neck injuries are common. Intervertebral disc injuries are common in sporting activities. Treatment of sports injury starts from the prevention of injuries to treatment of specific injury. It is said that prehabilitation can avoid rehabilitation. Prehabilitation is a relatively new idea in sports medicine and therapy. It is a personalized exercise program that is individually designed for athletes to help them to prevent injury in their given sport. Injury specific treatment can be

divided into first aid treatment or emergency treatment and the definitive treatment. Emergency treatment should be given in the field and this consists of immobilizing the injured muscle, joint or bone, elevating the affected part or limb, ice pack application. Manipulation and massage of the injured part do more harm than good. Definitive treatment depend on the structure involved in the injury and will require detailed evaluation with different investigations like X rays, CT and MRI scans. Skin injuries require wound care like dressings, suturing of wounds and medications to reduce pain and inflammation. Ligament injuries treatment depends on the grade of ligament injury and can be a short period of rest to the involved joint to surgical treatment. Majority of the ligament surgeries of the knee, shoulder and hip can be done by key hole technique using arthroscope. Muscle injuries require treatment in the form of rest of surgical repair. Fracture treatment depends on the bone involved and the type of fracture. Treatment may be splinting to surgical fixation with paltes, screws and nails. Cartilage injury treatment depends on the extent of damage to cartilage. Recent development in medical technology has revolutionized treatment of cartilage injuries. It is now possible to grow an individualâ&#x20AC;&#x2122;s cartilage and replant to the damaged area of cartilage. Sports person should be judged on effort, sportsmanship and hard work. They should be rewarded for trying hard and for improving skills rather than punished or criticized for losing a game or competition. The main goal should be to have fun and learn lifelong physical activity skills. A Complete Magazine on Healthcare in Asia

MEDICAL TOURISM FOOD

WE ARE WHAT WE EAT! GO HIGH ON FIBRE, LOW ON BP, DIABETES

ndian researchers have found that patients with hypertension and Type 2 Diabetes, who consumed a high fibre diet, witnessed an improvement in their blood pressure, cholesterol and fasting glucose.

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For the study, the research team from Care Well Heart and Super Specialty Hospital in Amritsar, investigated the relationship between a high fibre diet and its impact on cardiovascular disease risk factors.

"Comprehensive evaluation of etiological effects of dietary factors on cardio-metabolic outcomes, their quantitative effects and corresponding optimal intakes are well-established," said the studyâ&#x20AC;&#x2122;s lead author Rohit Kapoor.

According to guidelines from the National Institute of Nutrition and the Indian Council of Medical Research, the recommended dietary allowance (RDA) for dietary fibre is 40gm/2000kcal. Patients in this study had Type 2 Diabetes and a calorie intake of 1,200-1,500kcal, causing their RDA for fibre to be 24-30gm. The fibre intake of these patients was increased to 20 to 25 per cent from the recommended allowances for them to be consuming a high fibre diet. The study tracked 200 participants’ fibre intake for six months and included check-ups at the start of the study, three months and six months.

DIETARY FIBRE — found mainly in fruits, vegetables, whole grains and legumes is probably best known for its ability to prevent or relieve constipation. But foods containing fibre can provide other health benefits as well, such as helping to maintain a healthy weight and lowering your risk of diabetes, heart disease and some types of cancer. A high-fibre diet may lower your risk of developing haemorrhoids and small pouches in your colon (diverticular disease). Studies have also found that a high-fibre diet is also likely to lower the risk of colorectal cancer.

SOLUBLE FIBRE —found in beans, oats, flaxseed and oat bran may help lower total blood cholesterol levels by lowering low-density lipoprotein, or ‘bad’ cholesterol levels. Studies also have shown that high-fibre foods may have other heart-health benefits, such as reducing blood pressure and inflammation. In people with diabetes, fibre—particularly soluble fibre—can slow the absorption of sugar and help improve blood sugar levels. A healthy diet that includes insoluble fibre reduce the risk of developing Type 2 Diabetes. Increasing the amount of fibre in your diet can help you manage your

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diabetes. It also helps keep your gut healthy and can reduce your blood cholesterol, which lowers your risk of cardiovascular disease. If you are trying to maintain a healthy weight, it can also be beneficial. Fibre does not raise blood glucose levels. Since it is not broken down by the body, the fibre in an apple or a slice of whole grain bread has no effect on blood glucose levels because it isn't digested. Nutritional and lifestyle factors are now recognized as major determinants of blood pressure. Obesity, high sodium intake and alcohol consumption are established as contributors to elevations in blood pressure. The roles of other dietary and lifestyle factors in raising blood pressure, including physical inactivity and mental stress, and low intakes of dietary protein and fibre, potassium, calcium and magnesium, omega-3 fatty acids,

and dietary antioxidants, have also been investigated.

TIPS FOR INCLUDING MORE FIBRE IN THE DIET

Studies identified populations, such as vegetarians, with a high fibre intake and low blood pressure. Studies in vegetarian populations showed lower blood pressures compared to omnivores. There is some indication that soluble fibre may be most important for low-

For breakfast choose a highfibre breakfast cereal — 5 or more grams of fibre a serving. Opt for cereals with ‘whole grain’, ‘bran’ or ‘fibre’ in the name. Add kidney beans to canned soup or a green salad.

ering blood pressure. Dietary fibres have been categorized on the basis of dispersion (solubility) in water as

Add salad or vegetables to your lunch or main meal.

either insoluble or soluble.

Have plain oat cakes

Soluble fibres can contribute to blood cholesterol reductions, reduced postprandial blood glucose and insulin responses, and perhaps improved insulin resistance. Effects on glucose and insulin metabolism may contribute to blood pressure lowering and weight loss

Yogurt with berries and pumpkin seeds are good Try to eat fruits and vegetables which are rich in fibre. A handful of nuts or dried fruits are healthy and a highfibre snack. Drink plenty of water as fibre works best when it absorbs water, making your stool soft and bulky.

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MEDICAL TOURISM DIET

EAT ALONE, EAT LESS Researchers found that people eat more with friends and family because having food with others is more enjoyable and social eating could increase consumption.

f you are planning to cut down on your daily food intake to get into shape, better dine alone as a new research has found that people tend to eat more with friends and family. Eating ‘socially’ has a powerful effect on increasing food intake relative to dining alone, said the study published in the American Journal of Clinical Nutrition. "We found strong evidence that people eat more when dining with friends and family than when alone," said research leader Helen Ruddock from the University of Birmingham in Britain.

Previous studies had found that those eating with others ate up to 48% more food than solo diners and women with obesity eating socially consumed up to 29% more than when eating alone. For the study, the researchers evaluated 42 existing studies of research into social dining. The researchers found that people eat more with friends and family because having food with others is more enjoyable and social eating could increase consumption. Social norms might ‘permit’ overeating in company, but do not sanction it when eating alone and providing food becomes associated with praise and recognition from friends and family, strengthening social bonds. The researchers called the phenomenon of eating more with friends and family ‘social facilitation’.They found that this social facilitation effect on eating was not observed across studies which had looked at food intake amongst people who were not well acquainted. 58 Medical Tourism Oct - Dec 2019

"People want to convey positive impressions to strangers. Selecting small portions may provide a means of doing so and this may be why the social facilitation of eating is less pronounced amongst groups of strangers," Ruddock said. The researchers explained that ancient hunter gatherers shared food because it ensured equitable food distribution. In the case of social facilitation, we have inherited a mechanism that now exerts a powerful influence on unhealthy dietary intakes, the researchers said. Researchers note that, in the case of social facilitation, we have inherited a mechanism that once ensured equitable food distribution, but now exerts a powerful influence on unhealthy dietary intakes.The same process has been observed in chicken, rats, gerbils and other species, suggesting it serves an ultimate purpose. Individuals compete for resource and research suggests that eating more than others is likely to lead to ostracism, which, in turn, reduces food security. Judging by the number of studies published on social influence on eating, it is thriving research area. A picture is emerging on how norms of appropriate intake influence our own eating and the factors that moderate these processes. Evidence is accumulating that social influences on eating are powerful and pervasive and that the social context of eating may be an important factor underlying the development and maintenance of obesity. Emphasising the healthy eating intentions and behaviours of others may be beneficial in bringing about dietary change.

Social meals appear to make us hungrier, and it appears that we decide that we will indulge even before we order. Such observations led C Peter Herman, a food scientist, to propose his â&#x20AC;&#x2DC;feast hypothesisâ&#x20AC;&#x2122;: indulgence is part and parcel of social meals, and that we socialise partially so that we can all eat more without the guilt of overindulgence. Our dietary choices also tend to converge with those of our close social connections. One reason for this is that conforming to the behaviour of others is adaptive and we find it rewarding

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MEDICAL TOURISM RARE SURGERIES

NEWBORN UNDERGOES RIRS TO REMOVE KIDNEY STONES Doctors at a Hyderabad hospital have performed a complex procedure to remove kidney stones from a fourmonth-old baby boy, who is stated to be the world's youngest patient to undergo the procedure. During the surgery, three stones of size 8 to 9 mm from each kidney were removed by the doctors at Preeti Urology & Kidney Hospital. While kidney stone disease is common in India due to dehydration, malnutrition, usage of excessive salt, excessive intake of non-vegetarian food, the ailment is common among children. However, finding it in new-born babies is very rare, said the doctors. The baby was brought to Niloufer Hospital since he was not urinating and, on examination, he was found to have kidney stones. Doctors at Niloufer referred the case to Preeti Urology & Kidney Hospital, a healthcare institution that specializes in kidney care and has the expertise in performing Retrograde Intra Renal Surgery (RIRS).

According to Dr. V Chandra Mohan, Managing Director, Preeti Urology & Kidney Hospital, who led the team of doctors to perform the procedure, such a surgery is rare and only a few centres in China and the US have done the procedure on children. "It is for the first time that we performed RIRS on both the kidneys simultaneously for a four-month-old baby," he said. RIRS is an endoscopic surgery which allows surgeons to reach the kidney from the ureter. A flexible ureteroscope is used for such procedures. Through this device, a laser fiber (Holmium laser) is used to treat the stones, following which the small fragments are removed using a basket. The same RIRS surgery was done on this baby boy on both the sides of the kidney in a span of just one hour, removing all six stones, three stones from each side, he said. During the procedure, no cuts or sutures were

made and hence there was no bleeding and the baby was discharged a few days after the procedure. Dr. Chandra Mohan was supported by Radiologist Dr. P Roopa, Urologist Dr Ramakrishna, Anesthetist Dr Pavan and Pediatrician Dr Ajay to perform the procedure successfully. He said Preeti Urology & Kidney Hospital is committed to monitor the baby through the lifetime to ensure there is no recurrence of the condition.

AMU DOCTORS REMOVE RARE TUMOUR FROM WOMAN'S HEART breathing difficulty during exertion. She consulted several doctors before reaching the Jawaharlal Nehru Medical College (JNMC) where she was advised immediate surgery after the diagnosis showed a rare tumour pressing her heart in the left chambers.

Specialists at the Jawaharlal Nehru Medical College under the Aligarh Muslim University successfully removed a rare tumour from the heart of a 60-year-old woman. In the past two years, the JNMC has successfully conducted 200 cardiac surgeries.

Harpyari underwent the surgery with a 30-minute stoppage of heartbeats during which a cardiopulmonary bypass machine kept her alive, said Dr Mohd Azam Haseen, Chairman, Department of Cardiothoracic Surgery, who performed the surgery along with Dr Sumit Pratap Singh and Dr M Ghazanfar.

Harpyari, a resident of Mendu, Hathras, experienced chest pain and

"The tumour was removed successfully and the patient's heart

60 Medical Tourism Oct - Dec 2019

was reconstructed," said Dr Sumit Singh adding that Harpyari has been discharged and asked to meet the doctors for follow up. "We knew from the planning and diagnosis stage that the life-threatening tumour could significantly reduce blood flow to the heart," said Haseen and his team members. The surgical intervention was planned by former AMU Pro Vice Chancellor and Cardiothoracic Surgeon Prof M H Beg. Dr Nadeem Raza provided anaesthesia to the patient before the surgery; while Dr Sabir Ali Khan, Dr Shekhar, Dr Shabbah, Dr Noha and Dr Ahmad Ammar were the clinical perfusionists.

MEDICAL TOURISM RARE SURGERIES

ABDOMINAL TUMOUR IN 7-MONTH-OLD REMOVED abdominal wall and extending anteriorly.” “I could see that there was a mix of both liquid and solid elements inside the abdomen. These masses are referred to as teratomas, which means that they are composed of tissues not normally present at that site.”

Doctors have successfully removed a rare abdominal tumour weighing 750 grams from the stomach of a sevenmonth-old baby from West Bengal. The baby suffered from a congenital anomaly — Foetus in Foetu (FIF)-- in which a mass of tissue resembling a foetus forms inside the body. According to the medical literature, FIF is an extremely rare occurrence in India. The patient Abhir Mondal, a premature baby, had a very large abdominal swelling, which his father noticed when he was only two-months old. After initial treatment in Kolkata, the family went to Bengaluru for further treatment. After over a month long treatment there, the family returned to Kolkata. Married for six years, the baby’s parents Tanmoy and Bijiya Mondal are wall design artists, settled at Shantiniketan in West Bengal’s Birbhum district.

“When Bijiya was pregnant, she underwent regular tests and scans, which did not detect any abnormalities with the baby. However, the baby was born pre-mature in the seventh month of pregnancy and when Abhir was two months old, his father suspected an abnormal swelling in the abdomen. A doctor from Kolkata then detected an abnormal tumour and congenital anomaly,” C.N. Radhakrishnan, Head of the Department and Consultant, Paediatric Surgeon & Urologist, Manipal Hospitalsaid. The parents travelled to Bengaluru with the baby last month and, on examination, Dr. Radhakrishnan discovered a tumour that was made of liquid and solid elements including bones. “The parents came to me in a very anxious state as they were unable to understand the strange condition of the baby, who had a very large tumour arising from the posterior

“These are thought to develop from germ cells, which are cells that can change into and divide to form any organ in the body. This resembled a very rare condition known as Foetus in Foetu,” he said. The stomach, pancreas and the major blood vessels supplying the intestine were also displaced and had close proximity to the tumour. “It took careful and meticulous dissection to finally separate the tumour from the rest of the organs. Careful examination revealed some peculiar facts as the specimen had a sac filled with fluid in which solid components were present, including brain, hair, intestinal tissue and bones, almost giving the appearance of an incompletely formed foetus,” Radhakrishnan said. Abhir started recovering within seven-ten days of the operation. “He is now fine, and like any other normal child of his age. He is also gaining normal weight,” the doctor said.

UTERINE WALL PROLAPSE CORRECTED AT LBS MCH, MANDI Doctors of Lal Bahadur Shastri Government Medical College at Nerchowk in Mandi conducted an abdominal colposacropexy surgery successfully on a female patient. It was for the first time in the state that the surgery was conducted successfully in any government hospital. Due to the lack of such modern facility in government hospital or medical

colleges of state, patients usually relied on private hospitals, where this facility is available, but at a high price. According to Dr. Devender Sharma, Medical Superintendent, 10 years ago the uterus of this patient was removed due to some medical complication. The patient was suffering with vault prolapse for one month and

they decided to conduct the surgery. “The surgery was conducted under the leadership of Dr Poojan Dogra Mahvah. Along with Dr Poojan; Dr BR Sharma, Dr Rina Sharma, Dr Sunil and Dr Shalini also assisted in the surgery. It was a 3 hours long operation that was successful. Now,the patient is recuperating well,” said Dr Devender. A Complete Magazine on Healthcare in Asia

MEDICAL TOURISM NEWS

BLOOD TEST THAT HELPS DETECT CANCER EARLY

GRAIL COMES UP WITH BLOOD TEST THAT GIVES 99% ACCURATE FINDINGS ON 12 DIFFERENT TYPES OF CANCER.

arlier this year GRAIL inc., a biotechnology firm from California announced that their researchers have developed a blood test to detect 12 different types of cancers in their early stages. The company also claimed that the test is 99% accurate — with just 1% chance of false positive — and a 94% chance of finding out the tissue of origin of cancer. Now, the Dana-Farber Cancer Institute, a teaching affiliate of the Harvard Medical School, has corroborated these findings, saying that the blood test devised by GRAIL may actually give a correct diagnosis for cancer in 99.4% cases. Globally, one in six deaths occur due to cancer. Scientists all over the world have been looking for an easier and quicker detection technique that can stop the disease progression at the early stage itself. The GRAIL research maybe a significant stepping stone on this path.

them grow uncontrollably or turn cancerous. ctDNA carries these methylations on their surface and is hence different from normal DNA cells. While the findings are new, the research goes back a few years. The method seems to be based on the liquid biopsy procedure, something that GRAIL inc focuses on. Liquid biopsy, which involves sampling body fluids, mainly blood, to look for disease conditions, is now being used in cancer research. It is not a new concept as it is already being used in amniotic fluid samples to check for developmental abnormalities in foetuses. Currently, liquid biopsies are being used for the early detection of cancer — months before — though they look for cancer-related changes in DNA or genetic mutations that can lead to cancer. This is a tedious task since cancer DNA is present in small quantities in the blood and sequencing the DNA samples takes time. Also, the existing methods could detect only one cancer at a time.

The four-part research was published in the Journal of Clinical Oncology, a peer-reviewed medical journal by the American Society of Clinical Oncology. The types of cancers studied for the purpose included anorectal, colorectal, oesophagal, gastric, head and neck, hormone receptor-negative, breast, liver, lung, ovarian, and pancreatic cancers and other multiple myeloma and lymphoid neoplasms.

On the other hand, focusing on detecting methylation pattern has helped scientists to look for more than one type of cancer with a single test. The dual benefit of this test comes in the form of tissue detection—detecting the tissue where cancer has started. Specific methylated regions are present in different body tissues.

The research scientists at GRAIL inc. focused on something known as circulating tumour DNA (ctDNA) and methylation markers. The ctDNA is a specific type of DNA that tumour cells release into the bloodstream after they die. Cancer cells function a lot like normal cells and just like healthy cells, cancer cells die and new cells are constantly formed to replace the dead cells.

GRAIL’s Chief Executive Officer Jeniffer Cook said: “Our improved methylation-based technology has the potential to address gaps that exist with today’s screening options, which are limited to a few cancer types and only screen for one cancer type at a time. Based on these positive data, we plan to advance the development of our test toward commercialization.”

Methylation is a process that attaches specific methyl groups to DNA. It determines the fragment of DNA that is going to be active - the region which gets methylated is suppressed. Specific methylations in healthy cells make

Oncologist Geoffrey Oxnard from Dana-Farber said, “Such assays are a feasible way of screening people for cancer. If the test were in wide use, it could help patients receive more effective treatments.”

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MEDICAL TOURISM NEWS

KERALA IN THE TOP LIST OF AIRBNB’S PLACES TO VISIT IN 2020

erala has made it to the list of top places to visit in 2020 by Airbnb. Based on booking data, the company has released a list of countries, cities and states to visit across the world.

If you are looking to choose vacation spots for the coming year, this will especially interest you. Airbnb has specifically chosen places that are rich in culture, lesser known and eco-conscious. They also aim to highlight places that benefit from an increase in sustainable tourism. They describe this year’s list as ‘full of surprises and hidden gems’. Some of the places include Guadalajara in Mexico, Courtenay in Canada, Malindi in Kenya, Maastricht in Netherlands and Buriram in Thailand.

WHY IS KERALA A GREAT DESTINATION TO VISIT IN 2020? Kerala is known for its palm-lined coast, rolling coffee plantations and stunning Arabian Sea views. It has an array of beaches, lakes, mountains and waterfalls. It is also home to some of the best eco-friendly destinations on the subcontinent. The state runs a Responsible Tourism program encouraging residents and visitors alike to enjoy the culture of the place while also conserving it. Keralatourism.org lists a number of places and activities to look out for when you visit the state. This includes Neyyar Wildlife Sanctuary which is around 32 km from Thiruvananthapuram, the capital of Kerala. This sanctuary holds 12,000 hectares of natural vegetation. The Bathery Jain Temple, which dates back to the 13th century, is said to have been built in the prevalent architectural style of the then reigning Vijayanagar Dynasty and is one of the holiest sites for Jainism across India. It lies in the beautiful hills of Sulthan Bathery town. Chithari is a secluded backwater destination which is lesser known to the outside world but is highly recommended by all locals. And if you are a wildlife photographer, Kadalundi Bird Sanctuary might be the place for you. It features a cluster of scenic islands, beautiful hills and rare avian species of birds.

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MEDICAL TOURISM NEWS

INDIAN-ORIGIN DOCTOR NAMED CHAIR OF ONCOLOGY DEPARTMENT AT US-BASED CLEVELAND CLINIC

n Indian-origin doctor has been newly appointed as the chair of the Hematology/ Medical Oncology Department at the US-based Cleveland Clinic, a non-profit multispecialty academic medical centre founded in Ohio in 1921.

Dr. Jame Abraham, in his new role, will recruit and develop staff and guide the department's focus on patient access which is a multidisciplinary approach to patient care. Abraham, who earned his medical degree from the Calicut Medical College, Kerala, currently serves as the director of the Breast Oncology Programme at Taussig Cancer Institute. He is also the co-director at the Cleveland Clinic Comprehensive Breast Cancer Program. Apart from the above roles, he is also a Professor of Medicine at the Cleveland Clinic Lerner College of Medicine, a member of the National Comprehensive Cancer Network (NCCN) Breast Cancer Committee, vice-chair of the Research Strategy Committee

of NRG Oncology, a member of the Breast Cancer Working Committee for NRG Oncology and vice-chair of the Research Review Committee for the National Surgical Adjuvant Breast and Bowel Project (NSABP). As the national principal investigator of multiple breast cancer clinical trials, Abraham has published and presented more than 200 papers. Brian Bolwell, Chairman of Taussig Cancer Institute said Abraham has "exhibited a passion for the department and caregiver development, elevating our national reputation.” Abraham said that he looks forward to further build Cleveland Clinic Taussig Cancer Institute’s position in Hematology and Medical Oncology. "I am honoured to serve patients who choose Cleveland Clinic for advanced cancer treatment and to support the department's committed and passionate caregivers," he said. He completed his residency at the University Of Connecticut School Of

Medicine, followed by a Medical Oncology Fellowship from the National Cancer Institute (NCI) and Hematology Fellowship from the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. Cleveland Clinic is known for many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the US. The US News & World Report consistently names Cleveland Clinic as one of the nation's best hospitals in its annual “America’s Best Hospitals” survey.

KIMS INTRODUCES A PRODUCT TO PROMOTE MEDICAL TOURISM

itrine Hospitality and KIMS Health care group (KIMS Hospital) has pioneered in launching India's first medical value travel product to promote medical tourism into Kerala.

This Medical tourism product will encourage International travellers visiting Kerala to go to KIMS Hospital for a comprehensive health check up at less than one tenth of the price that is offered In British hospitals in the United kingdom and in Europe. Thus promoting medical tourism into India, specifically to Kerala. Citrine and KIMS have initiated a number of marketing activities in United Kingdom, Europe, GCC countries and many African countries to promote Medical value travel to Kerala, India. This initiative is expected to create a phenomenal increase in medical tourism to Kerala.

64 Medical Tourism Oct - Dec 2019

MEDICAL TOURISM NEWS

BIG THUMBS UP FOR KERALA AYURVEDA FROM GLOBAL AYURVEDA AMBASSADORS

A 12-day tour to promote Ayurved

To promote Ayurveda world-wide, the Ayurveda Promotion Society (APS) has come up with a plan to c 12-day International Ayurveda Ambassador’s Tour & B2B Meet that will start from Bekal (North of K October 24; 2109 and end in Kovalam on November 04; 2019. This is the ﬁrst mega event conducted b promoting Ayurveda globally. Selected and renowned Ayurveda tour operators / agents / Yoga teach with internationally acclaimed media personnel will participate in the event The tour will include destination visits, property visits and interactive B2B meet in different locations in

This unique program will give Kerala an exposure to its unseen destinations especially North Kerala. A many international participants from different countries have already agreed to be part of the meet.

Also, Kerala Tourism, CII and BRDC have agreed to partner with the event. Co-partners include Soma Research Institute & Ayurveda and Ayurbethania. Our publication, Ayurveda & Health Tourism will be the ofﬁcial magazine of the event.

The Ayurveda Promotion Society was formed in May 2018 with major all Ayurveda stakeholders as its m The objective of the society is to promote Ayurveda worldwide and bring all its stakeholders under one with active participation from both the government and private players.

H.3105, 2nd Floor, Jawaharlal Nehru International St Kaloor, Kochi – 682017 +91 98469 77000 info@ayurvedapromotionsociet www.ayurvedapromotionsociet

Official Magazine

he first International Ayurveda Ambassador’s tour and B2B meet, a 12 day journey with 42 participants from 30 different countries, showing and experiencing the strength of Kerala Ayurveda, its uniqueness and its authenticity was held in Kerala. The programme was organised by Ayurveda Promotion Society (APS), in association with Kerala Tourism and India Tourism comprising International Ayurveda operators, agents, bloggers and media personnel. They stayed in Kerala for 12 days and discovered the possibilities for Ayurveda tourism and discussed the unique health culture and Ayurvedic treatment in Kerala.

As part of the tour, there were six B2B meetings that was held at different parts of Kerala so that the visitors could interact directly with the service providers. The tour participants visited key Ayurveda properties and service providers during their trip across the state. They Ambassadors’ found it as the perfect platform to exchange ideas on Ayurveda and meet and network with experts. The Ambassadors touring Kerala were from Russia, Ukarain, Denmark, Hungary, Poland, Spain,

Israel, Thailand, South Korea, Taiwan, Malaysia, France, Switzerland, Solovakia, USA, South Africa, Japan, Germany, Bangladesh, Indonesia, Lebanon, Netherlands, Romania, Sweden, Bulgaria, Italy, Australia, China, Saudi Arabia and United Arab Emirates. The tour that started from Bekal, will concluded at Kovalam.

It was an eye opener for them by seeing and experiencing the uniqueness of Kerala Ayurveda both Wellness and Therapeutic and assured to promote the Kerala Ayurveda In their respective countries. All these delegates paid their own air tickets to reach Kerala, showing their interest to know Kerala Ayurveda closer. A Complete Magazine on Healthcare in Asia

MEDICAL TOURISM NEWS

FB LAUNCHES HEALTHCARE TOOL FOR CHECK-UP REMINDERS

aking a foray into the personal digital healthcare domain, Facebook has unveiled a â&#x20AC;&#x2DC;Preventive Healthâ&#x20AC;&#x2122; tool that connects people to health resources and sends check-up reminders. Launched first in the US, the tool is designed to help users of the social networking giant to find affordable places to receive care, set reminders to schedule tests and mark when tests are completed. "Our initial focus is on the top two leading causes of death in the US: heart disease and cancer, (according to CDC) as well as the flu, a seasonal illness that affects millions each year," Freddy Abnousi, Facebook's Head of Healthcare Research, said in a blog post. The resources available in the tool are provided by the American Cancer Society, the American College of Cardiology, the American Heart Association and the Centers for Disease Control and Prevention. The recommendations to the users will be provided on the basis on their age and sex. "In the US, people can search for Preventive Health in the Facebook mobile app and find out which check-ups, such

as cholesterol tests or mammograms, are recommended by these health organisations based on the age and sex they provide," Abnousi said. "Reminders for flu shots will also appear at the appropriate time of year," Abnousi said. Facebook said it would now show ads based on the information users provide in Preventive Health. "Personal information about your activity in Preventive Health is not shared with third parties, such as health organisations or insurance companies, so it can't be used for purposes like insurance eligibility," Abnousi said. Facebook earlier launched a feature in India, Brazil, Bangladesh, Pakistan, and the US that makes it easy to sign up as a blood donor on Facebook and get notified when nearby blood banks are in need. "So far, more than 50 million people have signed up to donate," Abnousi said. "According to our blood bank partners in India and Brazil, 20 per cent of voluntary, walkin blood donors are coming from Facebook," Abnousi added

MAR SLEEVA MEDICITY OPENED ITS OP SERVICES

ar Sleeva Medicity Pala, a super speciality hospital and tertiary care hospital founded by the Diocese of Pala, started its OP services.

The specialities include General Medicine, General Surgery, Paediatrics, Dermatology, Psychiatry, Neurology, Clinical , Medical Gastro, Medical Oncology, Urology, Nephrology & Dialysis, Pulmonology and Dental. The Outpatient rooms, laboratory and pharmPsychologyacy Services was blessed by Cardinal Clemis, Major Archbishop of Syro Malankara Catholic Church in the presence of Joseph Kallaranagatt, Bishop of Pala and Joseph Pallikaparambil,Bishop Emeritus of Pala. The hospital has 22 specialities and 17 super specialities. Mar Sleeva Medicity Pala also offers Homoeopathy and 66 Medical Tourism Oct - Dec 2019

Ayurveda with thesupport of modern medicines under one roof. The blessing of thesedepartments was done by Joseph Kallaranagatt, Bishop of Pala.

MEDICAL TOURISM MEDICAL CONFERENCES

NATIONAL ENDODONTIC CONFERENCE & ZONE ONE 2ND PG CONVENTION

71ST ANNUAL CONFERENCE OF CARDIOLOGICAL SOCIETY OF INDIA (CSICON 2019)

(Nov ember 28 to December 01, 2019), Mumbai

(December 05 to 08, 2019) New Delhi

The 34th IACDE 2019 National Endodontic Conference & Zone One 2nd PG convention is organized by Indian Association of Conservative Dentistry and Endodontics (IACDE) and will be held from November 28 to December 01, 2019 at CIDCO Exhibition Centre, Mumbai, Maharashtra, India. The conference will be an extravaganza of the most recent technological advances in the field of micro restorative dentistry, micro surgical endodontics and digital smile designing with emphasis on workshops and live lectures by an array of international and national speakers.

THE ANNUAL INDIAN GERIATRIC CONFERENCE (GERICON 2019) (December 6 and 7, 2019), Vellore, Tamil Nadu

GERICON 2019 - The Annual Indian Geriatric Conference is organized by Department of Geriatrics Christian Medical College and will be held from December 06 - 07, 2019 at Department of Geriatrics, Christian Medical College, Vellore, Tamil Nadu, India. GERICON 2019 will provide a platform for researchers, practitioners and educators to share recent innovations, studies, the practical challenges faced and solutions thereof in the field of Geriatrics. Apart from appraising the beginners and veterans alike in the field of Geriatrics, it will enlighten the medical graduates and post graduates in General Medicine, Community medicine, Family medicine, Physiatrists, Palliative Care specialists, General medicine, Community medicine, Family medicine, and specialists from any medical field interested in Geriatric care.

53RD ANNUAL CONFERENCE UROLOGICAL SOCIETY OF INDIA (USICON 2020) (January 23 to 26, 2020) Kochi, Kerala

USICON 2020 - 53rd Annual Conference Urological Society of India is organised by The Urological Society of India (USI) and will be held from Jan 23 - 26, 2020 at Lulu Bolgatty International Convention Center (LBICC), Kochi, Kerala, India. Kerala has been home to legendary Urologists who reigned supreme, nurturing the specialty and pioneering the efforts to assimilate latest trends and technology in the practice of Urology.

The 71st Annual Conference of Cardiological Society of India (CSICON 2019) is organised by Cardiological Society of India (CSI) and will be held from Dec 05 - 08, 2019 at The Ashok Hotel, New Delhi, India. The Conference is aimed at encouraging active participation particularly from young & budding Cardiologists. In addition, this Conference will put forth a coordinated, combined and collaborative effort from Cardiologists, spread across the Globe, to disseminate knowledge as well as know-how of new treatments besides leveraging technology for the benefit of the participants.

POSICON 2020: 26TH ANNUAL CONFERENCE OF THE PAEDIATRIC ORTHOPAEDIC SOCIETY OF INDIA (POSICON 2020) (January 09 to 12, 2020) Coimbatore, Tamil Nadu India

26th Annual Conference of the Paediatric Orthopaedic Society of India is organised by Paediatric Orthopaedic Society of India (POSI) and will be held from January 09 - 12, 2020 at Ganga Hospital, Coimbatore, Tamil Nadu, India. The conference theme is "Challenges in 2020". The conference will share the challenges and look at the possibilities to navigate through the future. At the conference, international and national faculties will discuss the various challenges faced in the day-to-day practice of paediatric orthopaedics, based on their huge wealth of experience. For the first time in the history of POSICON, It is for the first time that POSICON has planned a two day workshop that will showcase Live Surgery. This will be done in six different sub-specialities of Paediatric Orthopaedics.

63RD ALL INDIA CONGRESS OF OBSTETRICS AND GYNAECOLOGY (AICOG) (January 29 to February 02, 2020) Lucknow, Uttar Pradesh

The 63rd All India Congress of Obstetrics and Gynaecology (AICOG) is organized by Concept Conferences Pvt. Ltd and will be held from Jan 29 - Feb 02, 2020 at Manyawar Shri Kanshiram Ji Smarak Sthal, Lucknow, Uttar Pradesh, India. The slogan of the congress is "We pledge for women's health, "which envisages all global aspects of feminine health including basic fundamental issues and practical applications to comprehensive multidisciplinary programs. All well-known national and international stalwarts will share a single academic platform to share and exchange breakthrough ideas and research work to ensure appropriate women's health and wellbeing. This conclave will show an insight into the recent research and cutting-edge technologies and will create immense interest amongst the colossal exuberant presence of adepts, brilliant researchers, delegates and talented faculty members.

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MEDICAL TOURISM EQUIPMENT WORLD

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CLINICAL CHEMISTRY ANALYZER

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MAC 5500 HD

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68 Medical Tourism Oct - Dec 2019

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MEDICAL TOURISM EQUIPMENT WORLD

MYNX® VASCULAR CLOSURE DEVICES

PRISMAFLEX SYSTEM FOR CRITICAL CARE

https://www.cardinalhealth.com/en/product-solutions/medical/cardiovascular/mynx-vascular-closure-devices.html

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BIS™ COMPLETE 4-CHANNEL MONITOR

EVIS EXERA III VIDEO PROCESSOR -

https://www.medtronic.com/covidien/en-us/products/brain-monitoring/ bis-complete-4-channel-monitor.html

http://olympusmedical.co.in/products/all-products/imaging-systems/ processors/cv-190/index.html

ISECURE™ SYRINGE SYSTEM

HD ARTHROSCOPE

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For more information call: + 91 98461 21715 A Complete Magazine on Healthcare in Asia

MEDICAL TOURISM HOSPITALS

ADK HOSPITAL

RAK HOSPITAL Sosun Magu Male', 20040 Maldives Phone: (+960) 331 3553 Email: info@adkhospital.com

www.adkhospital.mv

Al Qusaidat Ras Al Kaimah UAE Phone: +971 72074444 Email: mail@rakhospital.com www.rakhospital.com

HOSPITALS IN INDIA

MVR CANCER CENTRE & RESEARCH INSTITUTE

CIMAR COCHIN

Calicut, India Email: info@mvrccri.co

Ernakulam, Kerala India Phone : +91 484 4134444 Email : cimarcochin@gmail. com

www.mvrcancerhospital.com

cimarindia.org

BABY MEMORIAL HOSPITAL

NARAYANA HEALTHCARE Bangalore , Karnataka Ph: +91 99860 13353 Email: international@narayanahealth.org

Kozhikode, Kerala Phone: +91 - 495 â&#x20AC;&#x201C; 2723272 Email: info@babymhospital.org

www.babymhospital.org

www.nhinternational.org

SRI RAMACHANDRA MEDICAL COLLEGE

ASTER MEDCITY Kochi Phone: +91 484 66-99999 Email: astermedcity@asterhospital.com www.astermedcity.com

www.sriramachandra.edu.in/medical/

RAJAGIRI HOSPITAL

MANIPAL HOSPITALS Bangalore Ph: +91 80 2222 1111 Email: info@manipalhospitals.com

www.manipalhospitals.com 70 Medical Tourism Oct - Dec 2019

Chennai India Ph: +91 984 096 9698 Email: ipcs@sriramachandra.edu.in

Cochin, India Ph: +91 484 290 5037 Email: international@rajagirihospital.com

http://www.rajagirihospital.com/

MEDICAL TOURISM WELLNESS CENTERS

AYUR BETHANIYA

AYURVAIDYA Athani, Thrissur, Kerala Phone: +91 703 40 99 999 Email: info@ayurbethaniya.org

www.ayurbethaniya.org

SHINSHIVA AYURVEDIC RESORT

Edappally North Kochi, Kerala Phone: +91 4842802383 Email: mail@ayurvaidyahospital. com www.ayurvaidyahospital.com

NIKKIâ&#x20AC;&#x2122;S NEST

Balaramapuram, Thiruvananthapuram Phone: +91- 471-2266331, Email: ayurveda@shinshivaresort.com www.shinshivaresort.com

Chowara, Thiruvananthapuram, Kerala Phone: 91-471-2267822 Email: info@nikkisnest.in

www.nikkisnest.com

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