CONTENT
Contents
24
MALE INFERTILITY Treatment in Ayurveda : The treatment
includes Shodhan chikitsa i.e. cleansing therapy depending upon dominancy of derranged doshas.
14
POWDERED GLOVES -
ARE WE CLOSE TO A GLOBAL BAN ON POWDERED MEDICAL GLOVES? Powdered medical gloves can cause allergic reactions, severe airway inflammation, wound inflammation, adhesions, and post-surgical scar tissue formation
28
JUVENILE ARTHRITIS Juvenile idiopathic arthritis (JIA), previously known as juvenile rheumatoid arthritis, is the most common type of arthritis in children.
18
MEDITATION Can Meditation reduce your need for sleep? It is a known fact that meditation helps increase awareness, reduce stress and improve your health.
4
September 2017 Pink Medico
PINK MEDICO
EDITORIAL TEAM: Executive Editor: Prakash Subramanian Sub Editor: Suresh Kumar M Correspondent: Pallavi J DESIGN & DEVELOPMENT TEAM Creative Director: S Vidhyaa Prakash Graphics and Artwork: Dhanush Veerasamy SALES AND MARKETING CORRESPONDENCES: Email: contact @pinkmedico.com Tel: 080 4959 0544 Cell: +91 88610 55444
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Disclaimer:
All the details published in this magazine contain opinions, ideas and experiences of various writers, professionals and sources. It is intended to provide informative material on the subjects contained therein. It is sold or presented with the understanding that the members, managers, writers, publisher and Pink Medico are not engaged in providing medical or health or healthcare services, do not dispense, directly or indirectly, medical advice, or do not prescribe the use of any technique or products as a form of treatment for any medical or similar issues of any kind or nature whether physical, mental or otherwise, and do not recommend any of the product or services directly or indirectly. Pink Medico does not have any intention to provide specific medical advice, readers should not use any Content for diagnosing or treating a medical or health condition. If you have or suspect that you have a medical problem, you should contact your professional healthcare provider through appropriate means. You agree that you will not under any circumstances disregard any professional medical advice or delay in seeking such advice in reliance on any Content provided herein, reliance on any such Content is solely at your own risk. You should carefully read all information provided by the manufacturers of any products advertised or promoted before purchasing and/or using such products Views and opinions expressed in this magazine are not necessarily those of Pink Medico or Anarghyaa ETech Solutions Pvt Ltd (AETSPL) or its publishers and or editors. We at Pink Medico do our best to verify the information published but do not take nay responsibility for the absolute accuracy of the information. Pink Medico or AETSPL does not accept any responsibility for any investment or other decision taken by readers on the basis of information provided herein. Pink Medico or AETSPL does not take any responsibility for returning unsolicited material sent without true postal stamps for return postage. No part of this magazine can be reproduced without our prior written permission of the publisher. Pink Medico or AETSPL reserves the right to use the information published herein any manner whatsoever.
Pink Medico September 2017
5
NEWS & UPDATES
NEWS & UPDATES
Health - tech Startup CureFit raises $25 mn Health and fitness startup
CureFit aims to address preventive healthcare
CureFit,
by
through a combination of engagement, coaching
Myntra co-founder Mukesh
and delivery, using both online and offline
Bansal and former Flipkart
channels
founded
executive Ankit Nagori, has raised $25 million (Rs 160
Bangalore-based Cure Fit Healthcare Pvt. Ltd
crore) in a Series B round
is one of the best funded early-stage Indian
of funding, it said in a
startups. Earlier this month, it had announced a Rs
statement.
100-crore endorsement deal with Hrithik Roshan, which saw the Bollywood star pick up an equity
Bansal said the startup will
stake in the company.
use the funds to strenghten its technology platform and
The startup, which has been in the works since
expand
early 2016, formally launched its mobile app cure.
its
footprint.
geographical
The
company
fit in May.
will set up shop in Gurgaon by the end of this year, and
CureFit aims to address preventive healthcare
expand to two other cities
through a combination of engagement, coaching
in 2018, Nagori elaborated.
and delivery, using both online and offline channels
6
September 2017 Pink Medico
NEWS & UPDATES
Dr Nanda Kumar Jairam, CEO, Chairman and Group Medical Director, Columbia Asia has
Hospitals, been
India,
awarded
the
"Healthcare Personality of the Year"
Besides, he is also the Chairman of the National Accreditation Board
for
Hospitals
&
Healthcare Providers (NABH) under the auspices of QCI (Quality Council of India), and was Chairman of the health services committee of FICCI.
Dr
Jairam
was
given
the
Dr.
Nanda
Kumar
Jairam,
award at the ninth Healthcare
CEO, Chairman
Excellence Awards instituted
Medical
by the Federation of Indian
Asia Hospitals, India, has been
Chambers
awarded as the ‘Healthcare
and
of
Industry
Commerce (FICCI).
The
Director,
Personality
of
Columbia
the
Year’
in
Quality Council of India.
Excellence Awards by FICCI, at
ninth
Group
programme is supported by the
held
the
and
The
Le
Healthcare Méridien,
Excellence
New Delhi, on August 17.
Awards by FICCI is an attempt to
The program was supported by
recognise the contributions of
Quality Council of India.
The
Healthcare
those who have set benchmarks of excellence in the healthcare
With 40+ years in the profession,
space.
Dr. Jairam has been associated
He is the founder member of NATHEALTH and GAPIO as well as the founder trustee for Terry Fox
Foundation
Bangalore
until its existence. He founded Krishna charitable trust. “I am honored that FICCI has bestowed this award on me. I cherish and value the award and the decision of the jury and commit to continue my journey towards
quality
healthcare
in India,” said Dr. Jairam on receiving the award.
with Columbia Asia Hospitals for more than twelve years now. Pink Medico September 2017
7
NEWS & UPDATES
Amity University and Medvarsity launch new Online MBA programme in Healthcare Management: Amity University Online has signed an MOU with
Mr. Ajit Chauhan, Vice Chairman, Amity Univer-
Medvarsity- a venture of Apollo Hospitals Group,
sity Online, said, “At Amity University Online,
to launch a new program, Master of Business Ad-
we always aim to deliver innovative programs by
ministration in Hospital & Healthcare Manage-
combining Amity’s core content with Industry
ment. The MOU signing ceremony took place re-
knowledge and insights. Amity – Medvarsity MBA
cently between the management groups of both
in healthcare and hospital is a program that of-
Amity University Online and Medvarsity in Delhi.
fers expertise of healthcare and business management with hands-on internship experience, which
This two-year MBA degree will equip students for
makes our students industry ready in true sense”
healthcare responsibilities as professional managers in any healthcare organizations. The course
The UGC approved two-year programme focuses
aims at laying a strong foundation in hospital
on imparting healthcare management & leader-
quality management, hospital administration,
ship skills to aspiring professionals in the hospital
hospital business development and marketing.
and healthcare domain.
8
September 2017 Pink Medico
NEWS & UPDATES
HCG to Set Up 12 New Hospitals in 18 Months
Healthcare Global Enterprises (HCG), a Bengaluru-based chain of specialised cancer care centres, plans to set up a dozen new hospitals over the next 18 months, the publicly traded company’s chairman, BS Ajai Kumar, said. HCG plans to expand its network of cancer care centres to
Twelth Five Year Plan:
about 30 from 21 now, and will add a few more IVF clinics to its existing network, Kumar told
The Twelfth Five Year Plan projected
to
increase
total
public fund, plan and nonplan on core health to 1.87 per cent of GDP by the end of Twelfth Plan. The National Health Policy, 2017 envisages increasing public expenditure on health to 2.5% of GDP in a time bound manner by 2025. As per WHO Global Health Expenditure
database
2014,
the expenditure on healthcare for BRICS is China (3%), the Russian Federation (4%), Brazil (4%) and South Africa (4%) of Gross Domestic Product. The
Government
spending
on
healthcare
in
india
ET.
as
percentage of GDP has increased from 1.16% in 2004-05 (Actual) to 1.4% in 2016-17 (BE) as per
HCG has a partnership with Kamini Rao, a leading medical practitioner in the field of as-
Economic Survey.
sisted reproduction, to run IVF clinics under the brand name
The allocation of funds for
‘Milann’.
health sector is based inter-alia, on the availability of resources
The IVF clinics contributed
and
on
about a tenth of HCG’s revenues
these resources. An increase
of Rs 700 crore for the previous
in
financial year.
competing economic
claims
growth
makes
available increased resources for funding the health sector. In addition to this, availability of
overall
resources,
past
utilization, requirements and absorptive capacity inter-alia guide the allocations to the health sector.
Founded 27 years ago by Kumar, a doctor trained at MD Anderson Cancer Center in Houston, Texas, the hospital chain has expanded to include centres in cities such as Cuttack, Ahmedabad and Vijayawada.
Pink Medico September 2017
9
NEWS & UPDATES
Price caps on most medical devices soon?
A draft national medical devic-
This poses a challenge for the
order,” the draft says.
es policy that could bring most
government when regulating
It suggests amending the Es-
medical devices within the am-
prices of even select devices like
sential Commodities Act and
bit of price regulation while also
stents or knee implants as it has
the scope of NPPA’s functions
outlining measures to boost lo-
to base its calculations on land-
and, instead, create a separate
cal manufacturing of devices
ed price of imports.
body – national medical devic-
has been circulated by the Centre.
es authority – to boost growth The draft suggests creation of
of the medical devices sector.
a national medical devices au-
The medical devices market in
The proposal, which comes
thority to promote local manu-
India is estimated at around
soon after a draft national
facturing as well as a separate
$7 billion, growing annually at
pharma policy, marks contin-
pricing policy and a division un-
around 15%. The department
ued government activism to
der the national pharmaceutical
will also meet industry bodies
reduce costs of medical care
pricing authority (NPPA) to reg-
at New Delhi’s FICCI to discuss
and control insurance payouts
ulate the price of such devices.
the draft policy.
hospitalisation expenses in the
“The
an-
However, industry executives
private sector. Currently, only a
nounce
policy
said the department has re-
few critical medical devices are
enunciating the principles for
circulated a 2015 draft policy
under indirect price control and
regulating prices of identified
without changes though the in-
80% of all devices are imported
medical devices and implement
dustry has submitted its several
products.
the same by notifying a separate
recommendations.
in view of steep treatment and government a
may
separate
medical devices prices control
10 September 2017 Pink Medico
NEWS & UPDATES
Tourists on Medical Visa More Than doubled in 2 yrs: Govt
NPPA threatens legal action against 40 hospitals for not displaying knee implant prices The National Pharmaceutical Pricing Authority
The Centre said that the number of tourists arriving in the country on medical visa has more than doubled in the last two years and India’s medical visa policy has been appreciated by foreign governments. In a written reply to the Rajya Sabha, Minister of State for Tourism Minister Mahesh Sharma said there were no restrictions on medical visa to foreign patients, instead the number of such visas being issued has increased over the years. “The government’s policy for medical visa has been appreciated by the applicants for medical visa and foreign governments. The number of medical visas issued to foreign patients has been constantly increasing,” Sharma said. The number of arrivals in the country on medical visa was 66,254 in 2014, which grew to 1,22,121 in 2015 and 1,77,972 in in 2016. In a written reply in the Lok Sabha, Minister of State for External Affairs V K Singh said that restrictions for medical visa only existed on those from Pakistan where a recommendation letter from Advisor to the Prime Minister on Foreign Affairs is required for obtaining a visa.
(NPPA) on its Twitter handle released a list naming 40 hospitals across the country that will face action. “40 hospitals not displaying knee implant prices on their websites to face action”, the regulator said in a tweet. NPPA, however, did not elaborate on the action it has envisaged. Besides some hospitals located in cities like Noida, Patna, Bhopal, Ahmedabad and Kanpur have also been named in the list. The authority in a memorandum on August 18 had asked all manufacturers /importers and marketers and hospitals to comply with the notified ceiling price of orthopaedic knee implant system. The government on August 16 fixed a price range for knee implants from Rs 54,000 to Rs 1.14 lakh, nearly 70 per cent lower than their earlier cost. Hospitals that have been named in the list include Rockland Hospital (Delhi), Moolchand Medcity (Delhi), Apex Multi Speciality Hospital (Varanasi & Mumbai), Vijaya Hospitals (Chennai) and Sahara Hospital (Lucknow). The minister had also warned of stringent action against hospitals, importers, retailers if they charged in excess of the MRP saying that the government would recover excess profit from such knee implants with 18 per cent interest and may also cancel licences of hospitals. Pink Medico September 2017
11
ARE WE CLOSE TO A
GLOBAL BAN ON POWDERED
P
MEDICAL GLOVES?
owdered medical gloves
can cause allergic reactions, severe
airway
inflammation,
wound
inflammation,
adhe-
sions, and post-surgical scar tissue formation. These concerns provide the stimulus for the banning of powered gloves and the transition to the use of powder-free or synthetic gloves as the new standard of care.
Gloves are the most common type of Personal Protective Equipment (PPE). Gloves are considered a barrier protecting both healthcare worker and patient from the transfer of harmful microorganisms. Powder has been used as a lubricant in the manufacture of medical gloves in order to facilitate donning and to avoid blocking of the glove. Nowadays, the more widely used dusting powders
12 September 2017 Pink Medico
are cornstarch that coats the glove inside, and Calcium Carbonate (CaCO3) that coats the outer surface.
Complications Associated with Glove Powder Years of clinical studies, research and industry input have provided ample data about the adverse reactions to both workers and patients that may arise from the use of gloving powders. For healthcare workers, the reactions caused by powdered gloves vary from well-known allergy symptoms and upper respiratory-tract disorders to pleuritis, myocarditis and irritation of the central nervous system. For the patients, the reactions caused by powdered gloves includes the development of adhesions and granulomas, delayed healing and increased risk of surgical
site infections.
The adverse effects of powdered gloves use are caused by the powder itself as it enters the patient’s body during surgery and contaminates the wound, despite glove washing or wiping prior to undertaking the surgical procedure. The wound retains a substantial amount of residual powder granules at the conclusion of the operation with the amount of residual granules found to be proportional to the number of powdered gloves used in the operating room, rather than directly related to whether the surgeon is using powdered or powder-free gloves. This is a critical issue as glove powder can act as a vehicle for opportunistic and pathogenic micro-organisms to spread and potentially act as a food source for bacteria including MRSA and VRE,
Powdered Gloves - Global Ban?
which increase the risk for post-operative wound infections. The presence of powder in the wound may trigger a range of responses such as a delay in the healing process, alteration of the normal reparative process and an increase of the wound’s inflammatory response. In addition, researchers have shown that the presence of glove powder significantly decreases the inoculum of bacteria required to produce abscesses. This increases the surgical site infections occurrence risk, which poses a significant burden on the hospital budget. Another common problem that can arise from the use of powdered gloves is the development of adhesions
triggered by the increased inflammatory response, and granulomas. Adhesions are the major cause of postoperative intestinal obstruction. Uterine and fallopian tube adhesions, resulting from glove powder, are a significant risk of female infertility, which is the reason why powder-free gloves should be used even for routine vaginal examination. These effects have been well documented not only in the peritoneal cavity and uterus, but reported in almost every anatomical site such as the eyes, cranial cavity, middle ear, and thorax among others. One of the best documented consequences of the use of powdered gloves in the
healthcare setting is the sensitisation and development of diverse allergic reactions to Natural Rubber Latex (NRL) such as upper respiratory tract symptoms or eye irritation. These reactions are not caused by the powder itself, but rather by its capacity to bind with NRL protein antigens. These allergen/ protein coated powder particles can be aerosolised when the gloves are donned or removed, thus contaminating the hospital environment. Powdered latex gloves aerosolise more latex proteins into the air than any other medical product in a hospital and those hospital areas where powdered gloves are used have 300 times more aerosolised latex proteins that areas of powder-free usPink Medico September 2017
13
Powdered Gloves - Global Ban?
age.
tive complications.
The inhalation or ingestion of these powder particles can remain in the air, on instruments and equipment for many hours, and can lead over time to the development of sensitisation and allergies. A decrease in the number of healthcare workers with suspected NRL allergy including occupational asthma and contact urticaria.when powdered gloves are substituted by powder-free gloves has been reported. This is not surprising if we take into account that it is estimated that the use of powdered gloves will deposit in excess of 2kg of glove powder per year per theatre. The presence of glove powder can result in many other undesirable effects, such as the contamination of catheters, perfused donor kidneys and cosmetic dentistry materials (crowns, prostheses) among others.
Also, it must be stated that the cost of washing surgical powdered gloves prior to use, has been reported as being at least seven times higher than the cost of using powder-free gloves while at the same time being inefficient in totally removing the glove powder.
All the issues outlined in this article can be easily reduced by switching from a powdered to a powder-free environment. This may have additional cost-savings in reduced healthcare personnel sickness and post-opera-
14 September 2017 Pink Medico
Restrictions and Bans on Powdered Gloves The documented adverse effects caused by the use of
powdered gloves are the reason for a global decrease in powdered gloves usage, and a shift towards powder-free gloves. Realising the dangers of cornstarch on examination and surgical gloves, hospitals around the world starting moving to powderfree gloving alternatives. Germany's regulations of personal protective equipment banned the use of powdered medical gloves in 1997. In 2000, the Purchasing and Supply agency for the United Kingdom ceased to purchase any gloves lubricated with cornstarch.
Powdered Gloves - Global Ban?
The US Food and Drug Administration (FDA) enacted a rule banning the use of powdered surgical gloves, powdered exam gloves, and absorbable powder for lubricating surgical gloves. The ban, first proposed in March 2016, was announced by the FDA on December 19, 2016 and became effective on January 18, 2017. FDA’s rationale for the ban is based on the risk of illness or injury to patients and healthcare providers exposed to the powdered gloves, when internal body tissue is exposed to the powder, which may include severe airway inflammation and hypersensitivity reactions. Powder particles may also trigger the body's immune response, which can lead to an array of conditions from allergic reactions to surgical complications. Alternatively, there are other medical gloves available that are powder-free and provide the same degree of protection, hand dexterity, and performance without posing the same risks to individuals. In addition, on January 8, 2017, the Saudi Food and Drug Authority (SFDA) banned the manufacture, import, sale and distribution
of powdered surgical and patient examination gloves as well as the absorbable powder used to facilitate wearing of medical gloves. In a statement on its website www. sfda.gov.sa, the Authority explained that the reason for the ban is the probable link of using such gloves with many health risks, including acute respiratory infections; anaphylaxis; allergic asthma; inflammation and damage of lungs' airways (bronchial tubes); skin rash and adhesions of abdominal membranes. The ban is to go into effect March 27, 2017. On December 27, 2016 Japan
announced their intention to enact a similar ban with a two-year transition through to December 2018. The Ministry of Food and Drug Safety Korea in a January 24th 2017 meeting announced they too are considering a powdered glove ban transition through to December 2018. Hospital Authority (HA) of Hong Kong implemented a ban to local hospitals effective 19th January 2017, following the ruling of US FDA. This applies to government hospitals which is under the responsibilities of HA. Private hospitals which are not under control of HA Pink Medico September 2017
15
Powdered Gloves - Global Ban?
have also adopted the same stance.
Improved Glove Technology Improved technologies and manufacturing techniques can eliminate the need for powder entirely. The application of a polymer coating to the inside film of latex or synthetic gloves enhances the donning attributes of the glove in both wet and dry conditions. A wide array of synthetic glove choices are available today such as polyisoprene, neoprene or nitrile which are latex free (safe for those with a latex / Type I allergy), some are chemical free (safe for those with a chemical / Type IV allergy) and all provide excellent barrier protection. The bottom line is: there are other, better clinically relevant solutions available that have all the same fit, feel and comfort of powdered gloves. And while many healthcare providers have already moved away from powdered gloves, many are still actively exploring the new offerings to determine which option is right for them. That’s
16 September 2017 Pink Medico
where education is critically important to help workers select the best option that ensures performance, protection and safety. When it comes to clinical education in this area, Ansell leads the way globally with a comprehensive program available for healthcare professionals around the world.
Financial Savings The prices for these new technologies can besomewhat higher. But the return on investment for powderfree gloves well outweighs the initial higher cost: protection afforded to both the worker and patient and reduced adverse events associated with gloves powder. The FDA estimates that total annual benefits of the powdered ban in the United
States are expected to range between $26.6 million and $29.3 million. As powdered bans continue, the global impact in terms of savings will be measured potentially in the hundreds of millions of dollars. Undeniably, we need gloves which provide excellent barrier protection, which do no harm to patient or worker, and provide a financial benefit. The literature indicates that these gloves should be powder-free. The use of powder-free gloves has been demonstrated to reduce the spread of infection, improve the safety and health of patients and healthcare professionals, as well as provide a financial benefit to the healthcare facility.
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MEDITATION
Can Meditation Re 18 September 2017 Pink Medico
N
educe Your Need for Sleep
meditation
A single mother, Sue would be dead tired by the end of the day. From making breakfast, to dropping her son to school, from a full day at office to making dinner and helping her child with his homework, Sue would find herself falling asleep on her feet by the end of the day. The toughest part was getting up in the mornings and her disturbed sleep had started taking its toll. Normally, a calm and happy person, Sue started getting irritated by the smallest of things. When she lost her cool one evening and nearly slapped her son, Sue realized that she needed to pull herself together. She picked up the phone and spilled her heart out to her mother. Her mom came over the next day and informed Sue that she would be staying with her for a week. That evening, her mom asked Sue if she had ever tried meditation.
Sue told
her that she hardly got time to breathe during the day, where could she find time for meditation? Her mom insisted that Sue take out half an hour daily for meditation, saying that it would really help her to relax. Although skeptical, Sue decided to give it a shot. By the time her mom left, Sue found that not only was she less tired everyday; she was also managing to do with less sleep without getting affected in any way.
Pink Medico September 2017
19
meditation
It is a known fact that meditation
on meditation and sleep
compared to non-meditators.
helps
awareness,
A study by the University of
The researchers found that
reduce stress and improve your
Kentucky, in 2010, concluded
while the meditators slept 5.2
health. Like Sue, however, most
that meditation increases short
hours per night on average, the
of us find it difficult to take out
term mental performance and
non-meditators
time for meditation.
Luckily
reduces the need to sleep.
hours.
for us, there is an alternative
The study found that with 40
the meditators tested better
to this problem. Rather than
minutes of meditation, novice
on their mental performance
trying to take out time from
meditators performed better
and exhibited no signs of sleep
your daily schedule, you can
on
performance
deprivation, despite the lower
try meditating by reducing
test, as compared to their
number of hours spent sleeping.
some time from your daily
normal performance without
So, how exactly does meditation
sleep. Research is showing that
meditating.
findings
help in reducing our sleep?
meditation helps reduce the
suggest
meditation
Here are a few facts that prove
number of hours that you sleep,
caused the participants to be
the effect of meditation on your
without any adverse effects.
mentally well rested post their
sleep patterns.
Meditation is perfect for people
meditation.
who have difficulty in falling
The study also looked at the
asleep, staying asleep or waking
amount of sleep required by
up in the mornings. Research
experienced
increase
20 September 2017 Pink Medico
a
mental
The that
meditators
as
required
7.8
They also found that
Reduces Stress and anxiety: Meditation helps in reducing
meditation
stress and anxiety, which in
allows you to fall asleep quickly.
sleeping better with less sleep
turn helps you fall asleep
A calm mind is also important
disturbance. This in turn allows
faster. Since you do not have
to be able to sleep fitfully.
the body to heal faster. As the
a disturbed sleep pattern, this
Eventually your body gets into
body starts moving towards
allows your body to refresh
a healthy cycle of rest and
a state of natural balance, it
itself at a faster rate and hence
wakefulness.
requires less sleep. The longer
reduces the amount of time that
we meditate; the less sleep our
you need to sleep.
Restores Balance
Calms your mind
Our bodies repair themselves as we sleep – and the more
body requires.
Increases Melatonin
One of the prime reasons for
our bodies are out of sync,
not managing to sleep is the
the more sleep is required to
Research shows that meditation
constant flow of thoughts in
maintain our balance of long
increases the production of
the mind.
Meditation helps
term health, well being and
melatonin, a hormone which is
in calming the mind and this
sanity. Meditation helps us in
responsible for inducing restful sleep. In fact, people suffering from
insomnia,
have
been
found lacking in the production of this hormone.
MALE INFERTILITY
M INFE
TREATME
A
yurveda explains following
causes for male infertility : Ativyavayat – Over indulgence in sexual activity. Vyayamat – Over exertion, it may include any kind of physical exertion or strenuous mental efforts. Avyayamat – Over relaxation, laziness or spending very leisure life. Asatmyanam cha sevanat – Eating over spicy, salted, sour, frozen foods, foods with low nutrition and lack of hygiene; Also behavioural habits like sleeping very late at night,
22 September 2017 Pink Medico
MALE INFERTILITY
MALE ERTILITY
ENT IN AYURVEDA hectic lifestyle leads to dispar-
Masturbation, oral or anal sex
ity of Rakta and Pitta Dosha,
etc.
ultimately causing Shukra kshaya i.e. deficit in Shukra Dhatu
Maithunam Na Cha Gachataha
qualitatively and quantitative-
– Suppression of sexual urge.
ly.
Narinam Arasaudnyata – Having intercourse with undesir-
Akale – It means at inappro-
able partner.
priate time; i.e. before desirable age specifically before
The other essential causes are
age of 16 in females and 18 in
fear, stress, sorrow, tight cloth-
that of males, or beyond the
ing, working in hot environ-
age of 65-70 where the body
ment for long duration. Smok-
faces generalised debility. An-
ing and alcohol consumption
other aspect explains having
significantly affect virility in
intercourse very frequently
males.
and many times (5-6 times) in a day also leads to debility of
Trauma to the genital organs,
Shukra dhatu.
generalised debility, muscle weakness and stress can result
Ayonau – Indulging into sex in other than natural ways, i.e.
in erectile dysfunction.
Suppression of sexual urge, infection in reproductive tract, or any kind of stricture can cause an obstructive pathology.
Treating Male Infertility : Overcoming male infertility requires some basic modulation in lifestyle and food habits. The treatment includes Shodhan chikitsa i.e. cleansing therapy depending upon dominancy of derranged doshas. Vaman in Kapha dushti, Virechan in Pitta dushti and Basti in case of Vata dushti. Panchakarma therapies like Abhyanga (whole body massage), Shirodhara, Nasya endows great deal of physical and mental relaxation. Regular exercise and yoga promotes added assistance. One should practice pelvic floor exercises, padmasan, mool bandha to strengthen and optimize the functionality of the desired organs. Treating obstructions or infec-
Pink Medico September 2017
23
Medicines which serve both the above purpose. Medicines like Shatavari, Nagbala, Bala, Musali, Ashwagandha, Milk, Ghee, Haritaki, Amla, Yastimadhu, Pippali, Shatavari kalpa plays an essential role in improving count of efficient sperms. Kapikacchu, Vidari, Gokshur, Shatavari, Ashwagandha, Bruhati phala, medicinal preparations like Vrushya vati, Shilajatu, Vanari kalpa cures problems related to Semen ejaculation. tions if any, with medicines
Musali paak, Rasayan vati,
Gokshur, Ashwagandha, Mu-
like Gokshur, Guduchi, Triphala,
Kandarpa paak, Kushmand av-
sali, Kapikacchu, Pippali, Milk,
etc. Also Uttar Basti treatment
leha, etc serves the purpose.
Ghee, Fruits and fruit juices;
serves beneficial in cases of
A combination of milk + ghee
and the most important as-
obstructive pathologies, it as
+ honey + cold water in spe-
pect – pleasant relaxed state
well strengthens the muscles
cific
depending
of mind is the key ingredi-
of urinary tract and reproduc-
upon one’s body constitution
ent to treat infertility. Vrushya
tive system.
along with other medicines like
vati not only increases sperm
yastimadhu, shatavari, amla,
count qualitatively and quan-
etc. serves as a good rasayan.
titatively, but also improves
Rejuvenation and Aphrodisiac
proportion
treatment plays an important role;
Rejuvenation
therapy
vigor, it also takes care of probAphrodisiac Therapies are of 3
lems like impotency, loss of li-
types :
bido.
ternally thus enhances body
Sperm generating or enhanc-
All the above mentioned med-
endurance and also assists
ing sperm count.
icines can be used in powder
revitalizes the body and reinforces it internally and ex-
in creating healthier sperms. Medicines like Chyawanprash,
form, or for superior results Those which helps in ejaculation of seminal fluid.
24 September 2017 Pink Medico
they should be used in the
2nd Annual
MENA PHYSICAL MEDICINE & REHABILITATION CONGRESS 2-4 November 2017 Dubai, UAE
Improving Lives through Interdisciplinary Rehabilitation Approach 19 CME
Pre-Congress Workshops: 2 November, 2017 International Conference: 3-4 November, 2017
Chairman Yousif Alnuaimi, MRCSEd, FRCP, Chair, Department of Physical Medicine & Rehabilitation, Zayed Military Hospital, UAE
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Ali Albarrati, PT, MSc, PhD, Assistant Professor, President, Saudi Physical Therapy Association, Cardiorespiratory Rehabilitation Consultant, King Saud University, KSA
Mariam Hadi Syeda, M.B.B.S, M.S., CCC-SLP, Speech Language Pathologist, American Hospital Dubai, UAE Fahim Anwar, P.T, MBBS, MRCS, FRCP, FEBPRM, Consultant Rehabilitation Medicine, Neurologist, Cambridge University Hospital NHS Foundation Trust, UK
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• Hear top regional and international experts discussing the most pressing rehabilitation conditions, and the current trend in physical medicine 'Robotics' • Join interactive hands-on workshops that will enhance your learning experience featuring the latest techniques from expert faculty in the industry such as hands on musculoskeletal ultrasounds, new technology on PRP for knee osteoarthritis, occupational therapists and disabled patients. • Gain continuing medical education 19 CME credit hours that will enhance your professional development • Review and discuss up-to-date treatments for Musculoskeletal conditions, Stroke Rehabilitation and covering the common conditions in physical medicine across the Middle East • Enjoy interactive presentations, panel discussions covering the latest approaches and practical knowledge in the field of physical medicine and rehabilitation
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form of medicated milk or ghee, Because oleation and revitalization of cells is an integral part of the treatment.
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Necessary Diet Modifications : Fresh, organic fruits, fruit juices and vegetables. Almonds, walnuts, pumpkin seeds, black currants, dates, figs, apricots, and raisins. Milk , milk-date shake, milk-mango shake can also be cherished. Dairy products like cream, lassi, butter; especially intake of Milk and Ghee should be increased. They can be taken plainly, or in medicated form. Non-vegetarians can include preparations of eggs, meat (Goat meat), rooster. Soups increases appetite and also provides desired nutrition.
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Rice pudding or vermicelle pudding, sweet prep-
Address 2 : ______________________________________
aration of suji in ghee is also beneficial.
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Spices such as ajwain powder, cumin, turmeric cleanses the genitourinary tract. Include coconut and coconut milk in your diet. A big “NO” to Smoking and Alcohol consumption is must. You should always attend the natural urges.
• Use Bold & Capital letters only • Write your name and address behind the cheque • The subscription once ordered cannot be cancelled or terminated Send the form along with cheque / DD to: Pink Medico Anarghyaa ETech Solutions Pvt Ltd J6,003, Provident Welworth City Marasandra, Doddaballapur Road Bangalore 561203
26 September 2017 Pink Medico
There are still many medicines depending upon an individual body constitution, all the above recommended medicines should be taken under Conditions Apply
consultation of Ayurvedic physician.
Juvenile Arthritis
Juvenile Idiopathic Arthritis
28 September 2017 Pink Medico
dangerous invaders.
J
•
Redness in the affected
area
uvenile idiopathic arthri-
In children with JIA, the im-
• Swollen lymph nodes
tis (JIA), previously known as
mune system releases sub-
• Recurrent fevers
juvenile rheumatoid arthri-
stances, mainly cytokines,
tis, is the most common type
that damage healthy tissues
of arthritis in children.
in the body. This causes in-
JIA may affect one joint or
flammation and pain in the
multiple joints. In some
joints.
cases, the condition can af-
Arthritis is a long-term con-
fect the entire body, caus-
dition characterized by stiffness, swelling, and pain in
Most cases of JIA are mild,
ing a rash, fever, and swollen
the joints.
but severe cases may result
lymph nodes. This subtype
in complications, such as
is called systemic JIA (SJIA),
An estimated 300,000 chil-
joint damage and chronic
and occurs in about 10 to 20
dren in the United States
pain. Knowing the symp-
percent of children with JIA.
have a form of arthritis.
toms of JIA is important for
Researchers think SJIA is an
Some children have arthritis
getting treatment before the
autoinflammatory
for just a few months, while
condition progresses.
which is different from an
disease,
autoimmune disease.
others have arthritis for several years. In rare cases, the
Treatment usually consists
condition can last a lifetime.
of decreasing inflammation, controlling
There are six types of JIA:
pain, improv-
• Systemic JIA, which affects
The exact cause of JIA isn’t
ing function, and preventing
the internal organs and one
known. However, researchers
joint damage. This can help
or more joints
believe it’s primarily an au-
ensure your child maintains
toimmune disease. In people
an active, productive life-
• Oligoarticular JIA, which
with autoimmune diseases,
style.
affects four or fewer joints
Symptoms:
• Polyarticular JIA, which af-
healthy cells in the body and
The most common symp-
fects five or more joints (The
harmful substances, such as
toms of JIA include:
protein known as rheuma-
viruses and bacteria. This
• Joint pain
toid factor may or may not
causes the immune system
• Stiffness
be present.)
to mistakenly attack harm-
• Reduced range of motion
less cells as though they are
• Warm and swollen joints
the immune system can’t differentiate
between
the
• Juvenile psoriatic arthritis,
• Limping Pink Medico September 2017
29
Juvenile Arthritis
which affects the joints and occurs with psoriasis •
Enthesitis-related JIA,
which affects where bone meets the tendons and ligaments (The genetic marker HLA-B27 is often present.) • Undifferentiated arthritis, where symptoms may span two or more subtypes or not fit any of the other subtypes The more joints that are affected, usually the more se-
and strength.
Other prescription medica-
vere the disease.
Medical treatment:
tions known as biological
Diagnosis
agents might also be used to Nonsteroidal
anti-inflam-
matory drugs (NSAIDs), such
help decrease inflammation and joint damage.
Your child’s doctor may be
as ibuprofen (Advil) and
able to diagnose JIA by per-
naproxen (Aleve), are often
Such medications can ease
forming a thorough physical
used to reduce inflammation
symptoms by suppressing
exam and taking a detailed
and swelling.
the immune system. How-
medical history. They may
ever, they may take several
also order various diagnostic
Stronger medications may
months to reach maximal
tests, such as:
also be prescribed if over-
benefit.
the-counter (OTC) medica-
Treatment
tions aren’t effective. Aspi-
In some cases, a drug called
rin might be recommended,
methotrexate is used to sup-
Various treatments can ef-
but this is rare because the
press joint inflammation in
fectively manage and mini-
medication may cause ad-
children with JIA.
mize the effects of JIA. Doc-
verse side effects in children.
tors usually recommend a
Never give your child aspirin
In severe cases of JIA, sur-
combination of treatments
without a doctor’s consent.
gery may be used to replace
to relieve pain and swelling
Learn more about OTC anti-
the joints altogether.
and to maintain movement
inflammatories.
30 September 2017 Pink Medico
Juvenile Arthritis
Fluids might also be extract-
Eating well
en muscles and improve joint
ed from the tissues to reduce
flexibility, making it easier to
inflammation, and a steroid
Weight changes are common
cope with JIA in the long run.
medication may be injected
in children with JIA.
Low-impact exercises, such
into the joint.
Medications may increase
as swimming and walking,
or decrease their appetite,
are usually best. However,
causing rapid weight gain or
it’s a good idea to speak with
weight loss. In such cases, a
a doctor before your child
Exercising and maintaining
healthful diet containing the
begins a new workout rou-
a healthful diet are impor-
right amount of calories can
tine.
tant for everyone, but they’re
help your child maintain an
especially beneficial for chil-
appropriate body weight.
dren who have JIA.
Speak with a doctor about
Lifestyle remedies
Physiotherapy
a meal plan if your child is
A physiotherapist can teach
Having your child make the
gaining or losing too much
your child the importance
following lifestyle adjust-
weight as a result of JIA.
of sticking with an exercise
ments can help them cope with their symptoms more
routine and can even rec-
Exercising regularly
ommend exercises suited to
easily and reduce the risk of
their specific condition. Exercising at least three
complications:
times per week can strength-
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31
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IN VITRO FERTILIZATION (IVF) D
uring in vitro fertilization (IVF), eggs and sperm are brought together in a laboratory glass dish to allow the sperm to fertilize an egg. With IVF, you can use any combination of your own eggs and sperm and donor eggs and sperm.
32 September 2017 Pink Medico
After IVF, one or more fertilized eggs are placed in the uterus . Ovulation and egg retrieval. To prepare for an assisted reproductive procedure using your own eggs, you will require hormone treatment to control your egg production (ovulation). This is
done to prevent unpredictable ovulation, which would make it necessary to cancel that in vitro attempt. This is typically done using one of two similar types of gonadotropin-releasing hormone analogue (GnRH agonist or GnRH antagonist). The following are two examples of
IVF
how ovulation can be controlled:
Sperm collection:
What To Expect After Treatment:
You first receive about 10 days of nasal or injected GnRH agonist that "shuts down" your pituitary.
Sperm are collected by means of masturbation or by taking sperm from a testicle through a small incision. This procedure is done when a blockage prevents sperm from being ejaculated or when there is a problem with sperm development. Sperm may have been collected and frozen at an earlier time. Then the sperm are thawed on the day the eggs are collected.
Overall, in vitro fertilization (IVF)related injections, monitoring, and procedures are emotionally and physically demanding of the female partner. Superovulation with hormones requires regular blood tests, daily injections (some of which are quite painful), frequent monitoring by your doctor, and harvesting of eggs.
Next, you get daily ovarystimulating hormone injections and are closely monitored for 2 weeks before egg retrieval. At home, you or your partner injects you with gonadotropin or folliclestimulating hormone (FSH) to make your ovaries produce multiple eggs (superovulation). You start treatment with FSH injections and then add the GnRH antagonist injection after about 5 days, which stops the production of luteinizing hormone (LH) within an hour or two. After the first week, your doctor checks your blood estrogen levels and uses ultrasound to see whether eggs are maturing in the follicles. During the second week, your dosage may change based on test results. And you are monitored frequently with transvaginal ultrasound and blood tests. If follicles fully develop, you are given a human chorionic gonadotropin (hCG) injection to stimulate the follicles to mature. The mature eggs are collected 34 to 36 hours later by needle aspiration guided by ultrasound. You will usually have pain medicine and sedation for this procedure.
Fertilization and embryo transfer: The eggs and sperm are placed in a glass dish and incubated with careful temperature, atmospheric, and infection control for 48 to 120 hours. About 2 to 5 days after fertilization, the best fertilized eggs are selected. One to three are placed in the uterus using a thin flexible tube (catheter) that is inserted through the cervix. Those remaining may be frozen (cryopreserved) for future attempts. Pregnancy and birth: Any embryos that implant in the uterus may then result in pregnancy and birth of one or more infants.
These procedures are done on an outpatient basis and require only a short recovery time. You may have cramping during the procedure. You may be advised to avoid strenuous activities for the remainder of the day or to be on bed rest for a few days, depending on your condition and your doctor's recommendation. Why It Is Done: In vitro fertilization may be a treatment option if: • • • •
•
A woman's fallopian tubes are missing or blocked. A woman has severe endometriosis. A man has low sperm counts. Artificial or intrauterine insemination has not been successful. Unexplained infertility has continued for a long time.
Pink Medico September 2017
33
How long a couple chooses to wait is influenced by the female partner's age and other personal factors. A couple wants to test for inherited disorders before embryos are transferred. IVF can be done even if a: Woman has had a tubal ligation reversal surgery that was not successful. Woman does not have fallopian tubes. Woman's fallopian tubes are blocked and can't be repaired. IVF can be done using donor eggs for women who cannot produce their own eggs due to advanced age or other causes. How Well It Works: The number of women who have babies after in vitro fertilization varies, depending on many different things. Almost all assisted reproductive technology (ART) procedures are done using IVF. Age: Birth rates resulting from a single cycle of IVF using women's own eggs are about 30% to 40% for women age 34 and younger, then rates decrease steadily after age 35.1 The aging
34 September 2017 Pink Medico
of the egg supply has a powerful effect on the chances that an assisted reproductive technology (ART) procedure will result in pregnancy and a healthy baby. Cause of infertility: Infertility can be caused by problems with the woman's or the man's reproductive system. Some of these causes can include problems with the fallopian tubes, with ovulation, or with the sperm. Pregnancy history: A woman who has already had a live birth is more likely to have a successful ART procedure than a woman who hasn't given
birth before. This "previous birth advantage" gradually narrows as women age from their early 30s to their 40s. Own eggs versus donor eggs: Birth rates are affected by whether ART procedures use a woman's own eggs or donor eggs. Many women over age 40 choose to use donor eggs, which greatly improves their chances of giving birth to healthy babies. For each cycle of in vitro fertilization: Using her own eggs, a woman's chances of having a live birth decline from over 40% in her late 20s, to 30% at about age 38, and to 10% by about age 43.
Live birth rates are about the same among younger and older women using donor eggs. Women in their late 20s through mid-40s average about a 55% birth rate using fresh (not frozen) embryos.
Frozen embryos versus fresh embryos. Donor-frozen IVF embryos from a previous IVF cycle that are thawed and transferred to the uterus are less likely to result in a live birth than are donor-fresh (newly fertilized) IVF embryos.1 But frozen embryos are less expensive and less invasive for a woman, because superovulation and egg retrieval aren't needed. Risks: In vitro fertilization (IVF) increases the risks of ovarian hyperstimulation syndrome and multiple pregnancy. Superovulation with hormone treatment can cause severe ovarian hyperstimulation syndrome. Your doctor can minimize the risk of ovarian hyperstimulation syndrome by closely monitoring your ovaries and hormone levels during treatment. The risk of conceiving a multiple pregnancy is directly related to the number of embryos transferred to a woman's uterus. Multiple pregnancies are high-risk for both the mother and the fetuses. There may be a higher risk of birth defects for babies
conceived by certain assisted reproductive techniques, such as IVF. Talk with your doctor about these possible risks. Embryo transfer success versus the risk of multiple pregnancy: For a woman over age 35 to maximize her chances of conceiving with her own eggs and carrying a healthy pregnancy, she may choose to have more embryos transferred than a younger woman would. But this increases her risk of multiple pregnancy. Because of the risks to the babies of multiple pregnancy, experts recommend limiting the number of embryos transferred. Your doctor will recommend a certain number of embryos to be transferred based on your age and specific situation.
experts recommend using the donor's age to help figure out how many embryos to transfer.2 Smoking has a damaging effect on fertility and pregnancy. Smoking reduces the chance that IVF will work. Smoking can also affect the health of the fetus. In vitro fertilization provides diagnostic information about fertilization and embryo development (which is not the case with a GIFT or ZIFT procedure). Using ultrasound to help collect eggs from the woman's ovaries is less expensive, less risky, and less invasive than egg collection by laparoscopy.
Women over 40 have a high rate of embryo loss when using their own eggs. As an alternative, older women can choose to use more viable donor eggs. When a woman uses donor eggs, Pink Medico September 2017
35
Medical & Heatlhcare Events
Events & conferences
Date: 6-8 Oct 2017 Date: 14-16 sep 2017 The Northeast Healthcare Summit is the biggest healthcare event to be held in Guwahati - Northeast Region. This is the only Northeast based event of its kind to assess investment, developments and technology in Northeast Health sector. The summit will be examining the latest healthcare developments across Northeast; assessing current reforms; and examining the impact of the huge investment boom that is currently forecast in the healthcare sector. The Summit is attended by hundreds of senior level delegates from Ministries of Health, NGO's, hospitals, healthcare providers, distributors and solution providers.
36 September 2017 Pink Medico
Hospital Planning & Infrastructure (H.P.I.) is India’s only international exhibition and summit focused on the challenges of building sustainable and profitable hospital infrastructure across the region. Hospital Planning & Infrastructure (H.P.I.) is a perfect platform for companies showcasing high end capital goods and trying to win tenders, drive sales and increase their market share in the healthcare build space. Venue: Bombay Exhibition Centre, Mumbai
Events & conferences
Date: 6-8 Oct 2017 MEDICALL Hospital Needs Expo: Medical Equipment & Hospital Needs companies from around the world exhibit and showcase their products and services at Medicall. Medicall attracts the who-is-who of the Healthcare industry who find Medicall a convenient one stop shop for choosing and selecting their equipment. Eminent physicians, surgeons, paramedical staff, hospital management professionals .
Date: 12-14 Oct 2017 The 3rd Edition of Advantage Healthcare India 2017 is an International Summit on Medical Value Travel which is being jointly organized by the Ministry of Commerce & Industry, Government of India, Federation of Indian Chamber of Commerce & Industry (FICCI) and Services Export promotion Council (SEPC) from Oct. 12 – 14, 2017 at Bengaluru International Exhibition Centre, Bengaluru India, with the aim of Promoting Services Exports from India.
Pink Medico September 2017
37
P
atients with diabetes are often prescribed multiple medical therapies that help manage their blood sugars and help them to lead normal lives. Firstly is the treatment with medicines, normally the diabetic patients are prescribed with the following generic medicine: Metformin: This is most commonly prescribed medicine for type 2 diabetes mellitus. In patients with type 2 diabetes, the cells in the body do not respond to the insulin that is being secreted by pancreas. Metformin works by increasing the sensitivity of the cells to insulin, allowing them to respond normally, which means the cells can start to use glucose in the
blood stream for energy (which in turn reduces blood glucose levels to normal). It also helps patients lose weight, which is why it is given to overweight patients with diabetes. Glimepiride This drug reduces blood sugar level by increasing the secretion of insulin by the pancreas. It is often added on to metformin and is available as a combination medication. Gliptins This includes the drugs sitagliptin and vildagliptin, which fall under a class of drugs called ‘DPP-4’ inhibitors. They work by blocking an enzyme called ‘di-peptidyl
38 September 2017 Pink Medico
peptidase – 4’ which is responsible for the breakdown of hormones called incretins. Incretins are responsible for the release of insulin from the pancreas, and DPP-4 can stop this, which is not good for diabetes. Blocking DPP-4 with gliptins can help improve the action of insulin. Gliptins can also help with weight loss.
Under the Patronage of H.H. Sheikh Ahmed bin Saeed Al Maktoum, President of Dubai Civil Aviation Authority, Chairman of Dubai Airports, Chairman and Chief Executive of Emirates Airline Group
www.accessabilitiesexpo.com
ENABLING COMMUNITIES INTEGRATING LIVES Held from 9-7 November 2017 at the Dubai International Convention & Exhibition Centre, AccessAbilities Expo aims to bring the world’s latest robotic and assistive technology products under one roof with the goal of enhancing lives of more than 700 million people with disabilities worldwide of whom over 50 million reside in the Middle East. AAE is committed to supporting Government and Private Sector initiatives toward accessibility in education, transportation, public services and equal opportunities to persons with disabilities.
EVENT HIGHLIGHTS: INNOVATION LAB
An open platform to showcase the latest assistive technologies and innovative products in the disability sector created with people in mind to assist them with their daily tasks
RECREATIONAL ACTIVITY AREA
Managed by Tender Hearts Center for Kids with Special Abilities on various activities like Yoga, Dance, Martial Arts, etc.
SPORTS AREA
Sports Zone organised in partnership with Dubai Club for Disabled where regular kids work together with kids with disabilities to play different games, explore physical challenges and compete with other team across different sports activities
KNOWLEDGE CENTER
‘Free-to-attend’ series of seminars and workshops by presenting what is new and relevant to the industry professionals and other event attendees
‘INCLUSION AT THE WORKPLACE’ CONFERENCE Senior Dignitaries, Global Experts, Specialists of Eminence and many prominent international personalities to speak at the event BUSINESS CONNECT PROGRAMME
Connect with professionals from a wide range of industry sectors from across the world
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