Category Archives: News & Events

Diwali & It’s Impact On Health

Dr. Bornali Dutta

The air in our cities has become unimaginably polluted – the air is heavy with particulate matter (PM). The sources of this are many and some of the common ones relevant to our city are – automobile exhaust, crop burning in rural & semi-rural areas and seasonal Diwali fireworks. The PM that we inhale into our lungs is sizes 2.5 & 10 micron. The continuous monitoring of air quality tells us that in New Delhi PM 2.5 levels at present are 175, several fold above the acceptable levels of PM2.5 < 50. And it’s not even Diwali!  One can only make a guess as to how high it goes during and after Diwali. In past years PM2.5 has gone up to 1000. The levels are toxic. The city has been described as a gas chamber, and that is possibly not an exaggeration.

This vile dense air, laden with toxic particulate matter, is inhaled into our lungs and gets deposited into the air tubes and the fine substance of the lungs. People with existing lung disease suffer tremendously from the onslaught by the toxic air, resulting in an exacerbation of their disease be it Asthma / COPD (Chronic Obstructive Airway Disease) / ILD (Interstitial Lung Disease). Chest infections & pneumonias are a common presentation post-Diwali. People with no known lung disease also develop cough, severe breathlessness and wheezing, resulting in the development of Asthma. Respiratory specialists in hospitals see a steep rise in Out Patients and In Patients, immediately after Diwali.

Long after Diwali the particulate matter lingers; it envelopes the city for the entire winter period, causing a continuum of poor health and loss of work days. The smog that forms is worst in the early morning and late night hours.

What can the any of us do? First of all, measures to reduce overall pollution and secondly measures to reduce exposure of one’s body to the pollution. Legislation is very important in stopping completely, all use of fireworks during Diwali; this measure will have a dramatic impact on air quality. We need to STOP using fireworks or be prepared for a long and hard winter, full of respiratory illness and distress. Farmers need to be shown alternative ways to clear their fields of dry crop remains. Vehicular pollution can only be reduced by every individual exercising a great deal of good sense and opting for public transport or car pooling.

Indoor pollution can be controlled by use of air purifiers, which are being used increasingly in households. The N95 mask has been shown to keep out 95% of particulate matter and can be used during this season. Avoid exercise in early morning and late evening hours to reduce inhalation of the particularly poor quality air in these times of the day.

Diwali, the festival of lights needs to be celebrated as just that and not as a festival of smoke, noise and pollution. It should certainly should not become for everyone, a harbinger of severe air pollution and illness. Festivities can continue sans fireworks.

Our overall lifestyle of excess needs to be curbed and everything used wisely and well, to prevent ongoing damage to our environment and thereby our own health.

Most of Indian metro cities are among the world’s most polluted ones when it comes to quality of air. There has been steady rise in acute respiratory Illnesses which is related to worsening ambient air pollution.

Before the city turns into a gas chamber, we need to gear up for this environmental emergency. We should Control pollution as much as we can, including not lighting up fire crackers on Diwali. The farmers who burn crops should be given an alternative so that the burring doesn’t lead to adding up the particulate matter in the atmosphere. Since, winter is about to approach you need to understand that the early morning and evening is the time you should avoid going out. The reason is at that time the air is denser with the particulate matter that settles down as the temperature is cold at that hours.”

We list down few steps one should take to stay safe and healthy in this season.

TIPS –

For everyone

  • Do not light up fire crackers and add up pollution to the environment.
  • Do not go out for walks in early morning / evening hours as the air is denser and the particulate matter is in high quantity.
  • If you have to go for walks, choose a time when the sun has come out and the air is lighter with less particulate matter.
  • Wear N95 masks when you step outside.
  • Use purifiers for indoors.
  • Ban the excess use of automobiles.
  • Provide an alternative to the farmers so that they do not burn the crop.

For Respiratory Patients-

  • Stay indoors as much as possible.
  • Take your medication regularly.
  • Use inhalers regularly.
  • Around this time of the year you should take required medication and vaccination (flu vaccination)
  • Smokers should avoid smoking.
  • General health and lifestyle measures should be taken.
  • Don’t overeat.

Inspite using medication if you are not feeling good, visit the doctor / hospital for a checkup immediately.

Associate Director, Respiratory and Sleep Medicine, Medanta- The Medicity 

Detecting Rheumatoid Arthritis Early Crucial

Message On World Arthritis Day

Dr. Raju Vaishya

Rheumatoid arthritis is a chronic, autoimmune disease in which the body’s immune starts attacking the body itself by attacking healthy joints causing inflammation of the tissue that protects them. That results in swelling, pain as well as discomfort. If there is pain and inflammation in small joints is persisting for a few weeks and if it is associated with morning stiffness lasting over 45 minutes to one hour, there is a high probability that the patient is harbouring rheumatoid arthritis.

If not diagnosed in time, deformities like crooked fingers, weakening of muscles of hands, which causes inability to pick and grasp things, weakening of joints like elbows and shoulders makes lifting difficult for the affected and the person can be bed-bound if the lower extremities are affected. RA is not just an illness of the joints, it can affect lungs and blood vessels also.

Though rheumatoid arthritis is not curable but it can be effectively controlled and managed like we do with any other chronic disease, diabetes for instance. It is advisable to not resort to pain killers for relief. There are specific medicines to manage rheumatoid arthritis. But if this disease is left to worsen for long, treatment gets increasingly difficult, so catching this disease young is the right way to avert this situation.

Mutated genes may make you more susceptible to the disease. You can be more prone to rheumatoid arthritis if you are a woman. Family history, cold temperatures, humidity, or certain foods such as meat, foods containing saturated fat etc. can all trigger the disease.

However there is no cure for RA but medication can reduce joint inflammation, relieve pain and slow or prevent the joint damage. Occupational and physical therapy can help protect joints from further damage. Certain exercises can keep your joints flexible.

 Is a surgeon of international repute, is best known for his swift surgical skills in the field of Orthopedic & Joint Replacement. He has been working at Indraprastha Apollo Hospitals, New Delhi as a Professor and Senior consultant. He is the founder president of Arthritis Care Foundation.  Apart from his distinguished clinical work in the field of arthroscopic and joint replace¬ment surgery, he is well known for his academic contributions. He has more than 150 published articles in various International and national peer-reviewed medical journals and has been regularly invited to give lectures, chairing sessions,etc. in Orthopaedic conferences around the world. He has been awarded for the best paper publication on nu¬merous occasions by Delhi Orthopedic Association and Apollo Hospitals. His work was recognized in the Limca book of records in 2012, 2013 & 2015 for do¬ing bilateral Total Knee Replacement in 93 years old gentleman, bilateral Total Knee Replacement in the oldest couple in a single sitting, ACL reconstruction on oldest man.

Dengue And Chikungunya Can Lead To Rheumatoid Arthritis

Vinod Kumar

Mosquito-borne infections – Dengue and Chikungunya can lead to Rheumatoid Arthritis (RA) in 20 percent patients.

On World Arthritis Day, senior orthopaedic experts said that 80 percent patients with Dengue and Chikungunya became symptom free at the end of four months of treatment but in 20 percent patients, Rheumatoid Arthritis developed.”

Recently Dr. (Prof.) Raju Vaishya, president of Arthritis Care Foundation (ACF) and Senior Consultant, Department of Orthopedics, Indraprastha Apollo Hospital has done a case study on Dengue & Chikungunya with Dr. Sujeet Kumar Singh, Deputy Director General, Ministry of Health and Family Welfare, Govt. of India & Dr. Amit Kumar Agarwal, Professor and Consultant orthopaedic surgery, Dr. Vipul Vijay consultant, orthopaedics and Dr.  Raman Sardana, senior consultant, microbiology of Indraprastha Apollo Hospital, Sarita Vihar, New Delhi. This case study has been published in prestigious British Medical Journal (BMJ).

According to the Directorate of National Vector Borne Disease Control Programme (NVBDCP), Dengue cases in India up by 11,832 over last year. According to (NVBDCP), till July 30, 2016, the total dengue cases in the country were 16,870 while for the same period in 2017 they numbered 28,702. While till July 30, 2017, India has seen a total of 18,466 cases of chikungunya.

Dr. Raju Vaishya Said that Dengue Virus and Chikungunya virus (CHIKV) irritates our immune system and this results in development of RA in 20 percent patients. He said that patients of Chickengunia should consult orthopedic doctor if symptoms continue to appear after some weeks.

“Patients with Dengue and CHIKV infection should be closely monitored to identify those with chronic arthritis who would benefit from a rheumatologic evaluation and early treatment with disease modifying anti-rheumatic drugs (DMARDs)”, said Dr. Sujeet Kumar Singh, Deputy Director General, Ministry of Health and Family Welfare, Govt. of India.

According to Dr. Amit Kumar Agarwal, “chronic manifestations of CHIKV  infection may resemble those of some autoimmune connective tissue diseases. Furthermore, CHIKV infection can cause cryoglobulinemia and may induce rheumatoid arthritis and seronegative spondyloarthropathies in genetically susceptible individuals.”

Dr. Vaishya said that Rheumatoid Arthritis and Chikungunya virus have similar symptoms, which can cause misdiagnosis. The main symptom of Chikungunya virus is joint pain and swelling, which is also a characteristic of Rheumatoid Arthritis.

According to Dr. Sujeet Kumar Singh Chikungunya name describes the stooped appearance of sufferers with joint pain; meaning “to become contorted”. Disease causes flu-like symptoms that can last for months.  Majority of cases recover fully and death is usually due to severe dehydration, electrolyte imbalance and loss of glycemic control. There is currently no treatment or vaccine for the virus and with its rapid spread time is of the essence.

Asian tiger mosquito (aedes aegypti) transmits the Asian virus strain that causes outbreaks. Nearly 80 cases of chikungunya, the mosquito-borne viral disease, have already been reported this year in the Capital.

According to the National Vector Borne Disease Control Programme, the total number of chikungunya cases in India in 2016 was 58,136, which is double the number in 2015.

According to Dr. (Prof) Amit Kumar Agarwal Chikungunya virus (CHIKV) infection is a common cause of febrile arthritis. The most common manifestations of acute infection are fever, symmetrical polyarthralgias or polyarthritis, myalgias, and maculopapular rash. Up to 80% of patients may develop musculoskeletal manifestations that persist longer than 3 months, causing impairment in their quality of life.

Dr Sujeet Kumar Singh said that the most common chronic manifestations are persistent or relapsing-remitting polyarthralgias, polyarthritis, and myalgias. Fingers, wrists, knees, ankles, and toes are the most frequently involved, but proximal joints and axial involvement can occur in the chronic stage.

The Centers for Disease Control and Prevention recommend acetaminophen and non steroidal anti-inflammatory drugs for the acute rheumatic manifestations of CHIKV infection. However, some studies suggest that low-dose corticosteroids for about 1-2 months (depending on clinical course) are beneficial in relieving acute rheumatic symptoms. Conversely, hydroxychloroquine in combination with corticosteroids or other disease modifying anti-rheumatic drugs (DMARDs) has been successful in treating chronic rheumatic manifestations. Methotrexate and sulfasalazine (alone or in combination) have also been effective for chronic CHIKV arthritis.

10 Essential Health Tests For Every Woman

Dr Anita Suryanarayan

The modern woman plays many roles, and her health is of paramount importance in helping her get through the day. Every woman’s health is dependent on and affected by a variety of factors. It is important that every woman after a certain age, goes for regular physical check-ups to be forewarned of any ailment. Diseases like diabetes, blood sugar, calcium deficiency, thyroid malfunction and such can be detected with simple tests, undertaken periodically. Here are 10 important health tests that every woman should make note of

Body Mass Index Check

Body Mass Index (BMI) is a measure of body fat based on the individual’s height and weight. There are multiple apps and online BMI Calculators that can calculate your BMI by dividing your weight in kilograms by your height squared in metres, on entering your height, weight, gender and age. The BMI Calculator then analyses the intensity (high, medium or low) of the individual’s BMI and compares the data with others in the same height and age bracket.

Anaemia Check

A person is considered anemic if they have a low count of RBCs in the body. Low haemoglobin (HGB) level in the red blood cells leads to low absorption of oxygen in the blood, physical weakness or dizziness.

Vitamin Deficiency Check

It is common to find Indian women who have a deficiency in Vitamin D and B12. A deficiency in Vitamin B12 for women who are planning for a pregnancy or are pregnant could result in a problematic pregnancy. Vitamin D is extremely critical to maintain healthy bones and calcium absorption, as calcium depletion sets in with age.

Blood pressure screening

Check your blood pressure every two years starting at the age of 18. Ideal blood pressure for women is less than 120/80 mmHg (millimetres of mercury). In case of persistent high-blood pressure, do a stress test as well.

Blood glucose tests

Women should get a blood glucose test every three years starting at age of 45 to test for diabetes or pre-diabetes. However, if you have a family history of diabetes, then begin early and start getting your blood sugar checked in your 30s itself.

Cholesterol check

Women should have their cholesterol checked, at least periodically, post 25, to decrease the risk of heart diseases. If the results are normal, the AHA recommends testing once in three years.

Pap smears and pelvic exams

Recommended to begin at 21 or even earlier if women are sexually active, this is an important test to reduce risk of cervical cancer, which is the second leading cause of death in women.

 

Mammograms and breast exams

A manual exam where a doctor tests for lumps and abnormalities is recommended from the age of 20 up until 40. It is recommended to do a mammogram every one or two years beginning at age of 40, as recommended by the American Cancer Society.

Bone density screening

Women should start getting screened for osteoporosis with a bone density test at age 65. However, those who have been detected with calcium deficiencies or have a personal or family history of fractures should get a dexa scan earlier.

Colon cancer screening

It is ideal to begin a colon cancer screening at age 50 and is typically performed once in five or ten years depending on the technique used. With normal results, a flexible sigmoidoscopy needs to be repeated every 5 to 10 years and a colonoscopy only every 10 years. The non-invasive virtual colonoscopy is another option. Those with a greater risk of colon cancer may need earlier or more frequent cancer screening tests.

 Is Vice President (South India & Sri Lanka) of Metropolis Healthcare.

 

CONGENITAL HEART DISEASES- THE TENDER HEARTS WITH DEFECTS

Dr. Murtaza Kamal

Every year approximately 1, 80,000 babies in our country are born with congenital heart disease, i.e. a condition in which these babies are born with a defect in the heart. The overall prevalence of these defects is 8-10/1000 live births according to western data. In simple words, 1 in every 100 babies born has a defect in the heart. It is the most common birth defect presently. These defects can present soon after birth or any time later in the life.

Congenital heart diseases can broadly be classified as those in which the baby turns blue i.e. cyanotic congenital heart diseases and acyanotic congenital heart diseases in which the babies do not turn blue. In these defects basically, there is defect in the developmental process in utero and the babies are born with an abnormal structure of the heart. Naturally, as there is structural defect in these tender hearts, there will be abnormalities in blood flow too i.e. haemodynamics which will produce the problems leading to a constellation of symptoms. These defects in the young hearts can be either inherited from their parents, have genetic basis, can have environmental factors influence and can be due to infections to the mother when the foetus is in the womb. Certain drugs taken during pregnancy can lead to these defects. Maternal smoking and alcoholism also have important influence on the development heart.

The babies with congenital heart disease have varied presentations and at different times too. They can present soon after birth and can even be asymptomatic till late adulthood. These babies can present with feeding difficulties, failure to grow well, excessive sweating, repeated chest infections including pneumonia, turning blue as such or during crying etc. Recognition of these early signs and symptoms both by the parents and the primary care giver is very much essential. These babies demand thorough evaluation by the paediatricians and if suspected of having heart diseases should be referred to a “Paediatric Cardiologists,” who are especially trained in the care of these hearts, unlike the adult cardiologists.

The paediatric cardiologist along with proper history and examination gets chest x-ray and ECG of these babies. These babies are then subjected to an Echocardiographic examination, by especially trained cardiologists. When a diagnosis of a congenital heart defect is made the plan of management is decided by a team comprising of Paediatric cardiologist, Paediatric cardiovascular surgeon, Paediatric cardiac intensives and paediatrician. This plan of management is separate for each of the babies and depends on the type of defect they have.

Our country, in which we are still trying our best to make all the deliveries in institution, has a long way to go in this field. Many of these babies have critical defects in the hearts, which needs to be surgically palliated or corrected within the first few days of life. So, the early recognition of these defects by primary care givers and paediatricians is the need of the hour. More and more paediatricians are needed to be given special paediatric cardiac training, to combat this problem. We are lagging almost 5 decades in the field of Paediatric Cardiology from the western countries. There is need to create awareness in the public regarding these defects and also that these defects are curable.

 Is a resident DNB Super Speciality (pediatric cardiology) at Star Hospitals, Hyderabad.

 

What is Cancer & What are its general Signs & Symptoms?

    Dr. Navile Aditya Murli

Cancer is the uncontrolled growth of abnormal cells in the body. Cancer develops when the body’s normal control mechanism stops working. There are over 100 different types of cancer, and each is classified by the type of cell that is initially affected. Old cells do not die and instead grow out of control, forming new, abnormal cells. These extra cells may form a mass of tissue, called a tumor. Some cancers, such as leukemia, do not form tumors.

Tumors can grow and interfere with the digestive, nervous, and circulatory systems, and they can release hormones that alter body function. Tumors that stay in one spot and demonstrate limited growth are generally considered to be benign. When a tumor successfully spreads to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is called metastasis, and the result is a serious condition that is very difficult to treat.

Cancer may occur anywhere in the body. In women, breast cancer is one of the most common. In men, it’s prostate cancer. Lung cancer and colorectal cancer affect both men and women in high numbers.

There are five main categories of cancer:

 Carcinomas begin in the skin or tissues that line the internal organs.

 Sarcomas develop in the bone, cartilage, fat, muscle or other connective tissues.

 Leukemia begins in the blood and bone marrow.

 Lymphomas start in the immune system.

 Central nervous system cancers develop in the brain and spinal cord.

Signs and symptoms of Cancer

 Cancer is a group of diseases that can cause almost any sign or symptom. The signs and symptoms will depend on where the cancer is, how big it is, and how much it affects the organs or tissues. If a cancer has spread (metastasized), signs or symptoms may appear in different parts of the body.

 As a cancer grows, it can begin to push on nearby organs, blood vessels, and nerves. This pressure causes some of the signs and symptoms of cancer. If the cancer is in a critical area, such as certain parts of the brain, even the smallest tumor can cause symptoms.

 But sometimes cancer starts in places where it won’t cause any signs or symptoms until it has grown quite large. Cancers of the pancreas, for example, usually don’t cause symptoms until they grow large enough to press on nearby nerves or organs (this causes back or belly pain). Others may grow around the bile duct and block the flow of bile. This causes the eyes and skin to look yellow (jaundice). By the time a pancreatic cancer causes signs or symptoms like these, it’s usually in an advanced stage. This means it has grown and spread beyond the place it started – the pancreas.

 A cancer may also cause symptoms like fever, extreme tiredness (fatigue), or weight loss. This may be because cancer cells use up much of the body’s energy supply, or they may release substances that change the way the body makes energy from food. Cancer can also cause the immune system to react in ways that produce these signs and symptoms.

 Sometimes, cancer cells release substances into the bloodstream that cause symptoms that are not usually linked to cancer. For example, some cancers of the pancreas can release substances that cause blood clots in veins of the legs. Some lung cancers make hormone-like substances that raise blood calcium levels. This affects nerves and muscles, making the person feel weak and dizzy.

General signs and symptoms of cancer

You should know some of the general signs and symptoms of cancer. But remember, having any of these does not mean that you have cancer – many other things cause these signs and symptoms, too. If you have any of these symptoms and they last for a long time or get worse, please see a doctor to find out what’s going on.

Unexplained weight loss

Most people with cancer will lose weight at some point. When you lose weight for no known reason, it’s called an unexplained weight loss. An unexplained weight loss of 10 pounds or more may be the first sign of cancer. This happens most often with cancers of the pancreas, stomach, esophagus (swallowing tube), or lung.

Fever

Fever is very common with cancer, but it more often happens after cancer has spread from where it started. Almost all people with cancer will have fever at some time, especially if the cancer or its treatment affects the immune system. (This can make it harder for the body to fight infection.) Less often, fever may be an early sign of cancer, such as blood cancers like leukemia or lymphoma.

Fatigue

Fatigue is extreme tiredness that doesn’t get better with rest. It may be an important symptom as cancer grows. But it may happen early in some cancers, like leukemia. Some colon or stomach cancers can cause blood loss that’s not obvious. This is another way cancer can cause fatigue.

Pain

Pain may be an early symptom with some cancers like bone cancers or testicular cancer. A headache that does not go away or get better with treatment may be a symptom of a brain tumor. Back pain can be a symptom of cancer of the colon, rectum, or ovary. Most often, pain due to cancer means it has already spread (metastasized) from where it started.

Skin changes

Along with skin cancers, some other cancers can cause skin changes that can be seen. These signs and symptoms include:

Darker looking skin (hyperpigmentation)

Yellowish skin and eyes (jaundice)

Reddened skin (erythema)

Itching (pruritis)

Excessive hair growth

 

Signs and symptoms of certain cancers

Along with the general symptoms, you should watch for certain other common signs and symptoms that could suggest cancer. Again, there may be other causes for each of these, but it’s important to see a doctor about them as soon as possible – especially if there’s no other cause you can identify, the problem lasts a long time, or it gets worse over time.

Change in bowel habits or bladder function

Long-term constipation, diarrhea, or a change in the size of the stool may be a sign of colon cancer. Pain when passing urine, blood in the urine, or a change in bladder function (such as needing to pass urine more or less often than usual) could be related to bladder or prostate cancer. Report any changes in bladder or bowel function to a doctor.

Sores that do not heal

Skin cancers may bleed and look like sores that don’t heal. A long-lasting sore in the mouth could be an oral cancer. This should be dealt with right away, especially in people who smoke, chew tobacco, or often drink alcohol. Sores on the penis or vagina may either be signs of infection or an early cancer, and should be seen by a health professional.

White patches inside the mouth or white spots on the tongue

White patches inside the mouth and white spots on the tongue may be leukoplakia. Leukoplakia is a pre-cancerous area that’s caused by frequent irritation. It’s often caused by smoking or other tobacco use. People who smoke pipes or use oral or spit tobacco are at high risk for leukoplakia. If it’s not treated, leukoplakia can become mouth cancer. Any long-lasting mouth changes should be checked by a doctor or dentist right away.

Unusual bleeding or discharge

Unusual bleeding can happen in early or advanced cancer. Coughing up blood may be a sign of lung cancer. Blood in the stool (which can look like very dark or black stool) could be a sign of colon or rectal cancer. Cancer of the cervix or the endometrium (lining of the uterus) can cause abnormal vaginal bleeding. Blood in the urine may be a sign of bladder or kidney cancer. A bloody discharge from the nipple may be a sign of breast cancer.

Thickening or lump in the breast or other parts of the body

Many cancers can be felt through the skin. These cancers occur mostly in the breast, testicle, lymph nodes (glands), and the soft tissues of the body. A lump or thickening may be an early or late sign of cancer and should be reported to a doctor, especially if you’ve just found it or notice it has grown in size. Keep in mind that some breast cancers show up as red or thickened skin rather than a lump.

Indigestion or trouble swallowing

Indigestion or swallowing problems that don’t go away may be signs of cancer of the esophagus (the swallowing tube that goes to the stomach), stomach, or pharynx (throat). But like most symptoms on this list, they are most often caused by something other than cancer.

Recent change in a wart or mole or any new skin change

Any wart, mole, or freckle that changes color, size, or shape, or that loses its sharp border should be seen by a doctor right away. Any other skin changes should be reported, too. A skin change may be a melanoma which, if found early, can be treated successfully. See pictures of skin cancers and other skin conditions in our Skin Cancer Image Gallery.

Nagging cough or hoarseness

A cough that does not go away may be a sign of lung cancer. Hoarseness can be a sign of cancer of the larynx ( voice box) or thyroid gland.

Is a Consulant of Medical Oncology at Oncoplus Cancer Care Centre, New Delhi. Dr. Murli passed his DM oncology in the August 2016 from the prestigious cancer institute (WIA), He did his Senior Resident and fellowship for three years in Cancer Institute Adyar Chennai.

 

One Million Children Saved, Says A New Study Published In The Lancet

India has avoided about 1 million (10 lakh) deaths of children under age five since 2005, owing to the significant reductions in mortality from pneumonia, diarrhoea, neonatal infections and birth asphyxia/trauma, measles and tetanus, according to study published in the latest issue of The Lancet.

The ‘India’s Million Death Study’, implemented by the Registrar General of India, is the first study to directly quantify changes in cause-specific child deaths in India, nationally and sub-nationally, from 2000-15 among randomly selected homes.

The study further illustrates that the conditions prioritized under the National Health Mission had the greatest declines. Pneumonia and diarrhea mortality fell by over 60% (most of the decline due to effective treatment), mortality from birth-related breathing and trauma during delivery fell by 66% (most of the decline due to more births occurring in hospital), and measles and tetanus mortality fell by 90% (mostly due to special immunization campaigns against each). The study states that mortality rate (per 1000 live births) fell in neonates from 45 in 2000 to 27 in 2015 (3.3% annual decline) and 1-59 month mortality rate fell from 45.2 in 2000 to 19.6 in 2015 (5.4% annual decline). Further, amongst 1-59 months, pneumonia fell by 63%, diarrhoea fell by 66% and measles fell by more than 90%. These declines were greater in girls, indicating that India has, remarkably, equal numbers of girls and boys dying, a significant improvement from just a few years ago.Pneumonia and diarrhoea mortality rates for 1-59 months declined substantially between 2010 and 2015 at an average of 8-10 % annual decline nationally and more so in the rural areas and poorer states.
The Million Death Study builds on the SRS by directly monitoring the causes of death in over 1.3 million (13 lakh) homes. Since 2001, about 900 staff interviewed about 100,000 (1 lakh) living members in all homes who had a child die (about 53,000 deaths in the first month of life and 42,000 at 1-59 months)every six months and completed a simple two-page form with a local language half-page narrative describing the deceased’s symptoms and treatments. The records have been digitized and each one uniformly coded for cause of death independently by two of about 400 trained physicians, using World Health Organization approved procedures. This is a direct study based on face-to-face interviews with families, and is not based on modeling or projections from small samples.

What Is The Liver Transplant Procedure And When Is It Done ?

Dr. Subhash Gupta

Liver transplantation has now become a well-accepted modality for the management of end stage liver disease. Liver transplantation involves removing the diseased liver from the patient and replacing it with healthy liver either from a brain dead person or more commonly with partial liver from a healthy donor. Retrieval of organs from brain dead people involves removal of organs from individuals whose brain has stopped functioning (typically resulting after head injuries and brain hemorrhage), but their heart and breathing functions are being supported with artificial support. These organs would be of great service to humanity, however owing to the social structure of our society these organ donations are far below what is needed.  It is said that “Don’t take your organs to heaven for only God knows that that there is a great need for them on earth”.  Owing to the scarcity of brain dead or “cadaveric” organs, the available resource is that for a healthy individual to donate a part of his liver for the patient. Owing to the huge functional reserve of a healthy that we initially talked about, the part of the liver remaining with the donor is sufficient to maintain normal functioning and the remaining liver grows back to it’s normal size soon after donation.

When does one require a liver transplant?

Liver disease severe enough to require a liver transplant can come from many causes. In adults, the most common reason for liver transplantation is cirrhosis. Cirrhosis is a condition in which the liver slowly deteriorates and malfunctions due to chronic injury. Scar tissue replaces healthy liver tissue, partially blocking the flow of blood through the liver. Cirrhosis can be caused by viruses such as hepatitis B and C, alcohol, autoimmune liver diseases, buildup of fat in the liver, and hereditary liver diseases. Many people who develop cirrhosis of the liver due to excessive use of alcohol also need a liver transplant. Abstinence from alcohol and treatment of complications for 6 months will usually allow some of them to improve significantly and these patients may survive for prolonged periods without a transplant. For patients with advanced liver disease, where prolonged abstinence and medical treatment fails to restore health, liver transplantation is the treatment.

In children, the most common reason for liver transplantation is biliary atresia. Biliary atresia is a rare condition in newborn infants in which the common bile duct between the liver and the small intestine is blocked or absent. Bile ducts, which are tubes that carry bile out of the liver, are missing or damaged in this disease, and obstructed bile causes cirrhosis. Bile helps digest food. If unrecognised, the condition leads to liver failure. The cause of the condition is unknown. The only effective treatments are certain surgeries, or liver transplantation.

Other reasons for transplantation are liver cancer, benign liver tumors, and hereditary diseases. Primary liver cancers develop at a significantly higher rate in cirrhotic livers as compared to normal livers, particularly in patients having liver disease secondary to Hepatitis B. Liver Transplantation at an early stage of liver cancer may result in long-term survival for select patients. However, cancers of the liver that begin somewhere else in the body and spread to the liver are not curable with a liver transplant.

Is Chairman of Max Centre for Liver & Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi

Breast Cancer – Giving Up Is Not An Option

Dr. Kanchan Kaur

Being diagnosed with breast cancer is a life-changing experience. It can be hard to handle the news at first, and even harder to know how to proceed.

Breast cancer is a type of cancer that appears in the cells of the breast. The cells present in the breast increases uncontrollably with time and may take the shape of a tumor. The disease has recorded 1.5 lakh new cases in the year 2016. In India, most of the breast cancer cases are reported at a later stage, like stage IV because of the lack of awareness about the symptoms. Here are some of the symptoms

  1. Painless lump in the breast

This is one of the commonest symptoms that the patients see in their body.  A painless hard lump develops in the breast or sometimes under the arm. There can be more than one lump at times too.

  1. Inverted nipple

Nipple pulled inside is another threatening signal of breast cancer. Here, the nipple changes its direction and moves deep inwards into the breast. It is normal for the nipple to be in the outward direction. Also, beware if the nipple looks and feels sore.

  1. Discharge from the nipple

Did you find blood on the tip of the nipple even without any activity? This can be a sign of breast cancer looming just under your skin. While not all discharge is cancerous is nature, you should immediately see your doctor when you notice blood.

  1. Dimpling of the breast

If you have breast cancer, the skin over your breast will change notably. Dimpling or puckering of the breast should not be avoided.

  1. Redness

A red tint around or all over your breast is an indication of inflammatory breast cancer that is rare in nature and termed as an advanced stage of breast cancer. This also includes thickening and flaking where the breast skin looks similar to that of the skin of an orange. Redness in mostly seen in the younger patients whereas the older patients witness scabbing of the nipple.

6. Changes in a breast

The breasts might go through a lot of changes in case you have cancer in your breast cells. There can be a transformation in the breast size, shape, skin texture as well as color. You should be careful if you notice swelling which might take place on just one side.

So, have you off late noticed any of the symptoms? If yes, then you should hurry up and meet your doctor. But not all these symptoms primarily mean that you are suffering from breast cancer. Though this should not stop you from visiting a doctor because it can be some other issue altogether. Many a time mammograms catch breast cancers even before any sign of the symptoms, so a routine check-up can help you invade cancer early.

There are few risk factors that take you closer to breast cancer. Some of them are incurred while others are natural.  Like Alcohol, Drinking too much alcohol has been directly linked with the increased risks of breast cancer. It is found that as compared to non-drinkers, those who have 1-5 glasses of alcoholic drink a day are more at risk. Not just breast cancer, it escalates the chances of other cancers too. Other factors may include Obesity  the period after menopause is vital. If you gain weight post-menopause, you are at higher risk. The ovaries and fat tissue makes estrogen in women’s body. Once you reach menopause, the ovaries stop doing this activity but the fat tissue continues. This raises the estrogen level after menopause, hence taking you closer to breast cancer. Fat accumulation around the waist area and as well as weight gain during adulthood in women are the other factors. Some other factors include Birth control pills, Gender, Menstrual history, Aging, etc.

Like other types of cancer, breast cancer has its stages too which defines the severity of a patient’s condition. It has 5 stages in total which start with 0 to IV. These are decided based on the size of the tumor (T), its spread to the surrounding lymph nodes (N) or to other parts in the body (M). In these stages there stand few subcategories as well. Traditionally, the size of the tumor helps to stage the breast cancer patients. While Stage 0 indicates an early stage, the seriousness increases with the growing stages. Knowing the stages clearly might help you understand your breast cancer better.

With breast cancer being on the rise in India, doctors at the breast cancer department at Medanta say they are witnessing higher number of cases of women with breast cancer.

Once a woman has been diagnosed with breast cancer, the doctor will suggest appropriate treatment options according the stage of the disease. These options include

Surgery

Surgery is the standard treatment for breast cancer. This depends upon factors like the size of the cancer in your breast and also the affected area. The surgery is done in two procedures.

Breast-conservation surgery: Best suited for initial breast cancer Stages like I and II, this surgery tries saving the as many as healthy breast tissue. This procedure includes Lumpectomy, Partial mastectomy and breast reconstruction.

Other side effects are possibilities of infection, pain and bleeding which are considered part of any operation.

Radiation Therapy

Radiation therapy is the usage of a large machine which targets the patient’s body with external energy beams. The X-rays and protons present in the powerful energy beams kills the cancer cells. The other way through which radiation can be delivered to the patient is by putting radioactive material internally.

Radiation therapy leaves the skin red and rashes appear on the targeted area. Swollen breast tissues and nausea are the other side effects.

Chemotherapy

This is the process of using powerful drugs to kill the fast growing and dividing cancer cells in the body. Chemotherapy lessens the chances of cancer recurrence. The drugs either taken orally or infused through the veins, is advised by the doctor when there is a high risk of the cancer spreading to the other parts of the body. The level of the after-effects of chemotherapy depends on the kind of drugs that you are put on. Generally, nausea (very low currently), hair loss, infection, fatigue, fever, anemia, loss of appetite, lower sex drive, pain and constipation are some of the demerits of chemotherapy.

Hormone Therapy

Hormone therapy blocks or reduces the growth of the hormones in the body which encourages the advancement of some breast cancers. This therapy also narrows and controls the cancer that in this case uses hormones in the blood to grow. Fatigue, nausea, hot flashes, pain in the joint and muscle, vaginal discharge and vaginal dryness or irritation are some of the common risks involved.

Targeted Therapy

Targeted therapy uses drugs and other substances to locate and target cancer cells more accurately in the cancer treatment. This a new type of therapy which only targets the cancer cells in the body unlike chemotherapy which damages the cancer cells as well as the healthy cells. This therapy usually affects the skin. Dry skin, itching, photosensitivity, redness and hand-foot syndrome (pain, swelling, and redness on the palms and soles of the feet) are those included. High blood pressure, blood clotting, heart damage are other risks that the patient might experience.

Can Any of These Treatments Single-Handedly Cure Breast Cancer?

The answer is no. None of the treatments have that powerful impact when used alone for treating breast cancer. These treatments are always done in combination to cure the cancer in a better way. Your doctor is going to customize your treatment according to the intensity of your condition. It is often-

  1. Surgery+ Radiation+ Chemotherapy
  2. Surgery+ Chemotherapy
  • Surgery+ Hormone Therapy
  1. Surgery+ Chemotherapy+ Hormone Therapy+ Targeted Therapy
  2. Surgery+ Chemotherapy+ Targeted Therapy
  3. There are certain patients who need all five of the treatments. That makes it- Surgery+ Chemotherapy+ Hormone Therapy+ Targeted Therapy+ Radiation

When treatments are combined, you can always expect better results. Your oncologist and surgeon at Medanta Hospital are the best persons to combine the mentioned treatments according to your condition.

 

Caring For Yourself After A Heart Surgery

Heart surgery recovery takes a lot of care.The first phase of heart surgery recovery can last from 6 to 8 weeks. When you’re released from the hospital, you will have to follow a set of instructions for post-surgery care. These will help you heal physically and feel better.

Care of the incision after heart surgery

Depending on your surgery, your chest incision may extend through layers of skin, muscle and bone. Your skin should be healed by the time of discharge, your breastbone should take six to eight weeks, and your scar should fade in approximately six months to one year. Tingling, itching, and numbness are normal sensations associated with surgical wounds and will eventually disappear. During the first six months after surgery, protect your incisions from the sun by wearing a shirt or sun block. For women, wearing a soft bra to support your breasts will minimize incisional discomfort.

Dealing with Discomfort

Itching, tightness or numbness along your incisions is normal when you go home after surgery.

It is also normal to have muscle or incision discomfort in your chest if you are doing an activity. But you should not have the same pain that you had before surgery; if you do, let your doctor know. Also, if your sternum (breastbone) feels like it moves, pops or cracks when you move around, call your doctor.

If you had bypass surgery and saphenous vein grafts were taken, you also may have pain or discomfort in your legs from the incisions. To help ease this discomfort, try walking or doing activities that will move and stretch your legs.

In order to take proper care of the incision after heart surgery, it is important to keep the incision clean and dry. Use Use only soap and water to cleanse the area. You should be able to take a bath or shower within a few days.

Seek medical advice if signs of infection appear. These include: Increased drainage or oozing from the incision, Opening of the incision line, Redness or warmth around the incision and Increased body temperature (greater than 100°F)

You should also seek advice if it seems the sternum (breastbone) has moved, or if it pops or cracks with movement.

Swelling in Your Legs and Feet

Removing a vein from your leg sometimes impairs the ability to return blood to the heart efficiently. The result is swelling in your feet and lower legs. If you have leg incisions, you should continue to wear your white support stockings given to you at the hospital. These should be worn as long as swelling persists during the day and removed in the evening before going to bed.To help alleviate the swelling:

  • Prop your feet up when you are sitting or lying down, so that your feet are higher than your heart level. If you are sitting on the couch, put your feet up on a higher chair or ottoman. If you are lying down, put pillows under your legs and feet.
  • Do not cross your legs.
  • Even if your legs are swollen, walk daily to help circulation.
  • Try using hospital support hose to cut down on the swelling.

If swelling persists or worsens, notify your doctor.

Diet after heart surgery

A healthy diet will help the healing process. It is common after surgery to have a poor appetite at first. If this is the case, try to eat smaller, more frequent meals. Appetite should return within the first few weeks. If it does not, seek medical advice

Activity after heart surgery

For the first six to eight weeks, the following guidelines are recommended:

  • Gradually increase activity. Household chores can be done, but standing in one place longer than 15 minutes is not recommended
  • No lifting objects that weigh more than 2.5lbs
  • No pushing or pulling heavy objects
  • Climbing up and down stairs several times a day, especially when the patient first arrives home, is not recommended. Try to arrange activities so the patient goes downstairs in the morning and upstairs when it is time for bed
  • Walk daily. Guidelines for walking will be given by the doctor upon the patient’s return home

Taking a Shower or Bath

You may shower as usual using warm, rather than hot water. It is OK to let warm water run down over your incisions; however do not take a tub bath, soak in a Jacuzzi or go in a pool for approximately four weeks. Have someone help you get in and out of the shower until you regain your strength.

Consider using a shower stool if you feel weak or unsteady. Wash your incision gently every day with warm water and mild soap then pat dry with a soft towel. Do not apply lotion, powder, or ointments until the scab has fallen off (approximately 3-4 weeks). If you have paper strips on your incisions, they should peel off as you shower daily. If they don’t, you may gently peel them off five days following discharge.

If the sutures are in your chest, shower with your back facing the water spray. If you cannot take a shower, a quick 10 minute bath is okay, but do not soak in the bathtub. Use only normal soap, not perfumed soap or body wash. Do not put the soap directly onto the incision and do not rub the incisions. Put soapy water on your hand or washcloth and gently wash your incisions. Only use a washcloth to rub when the scabs are gone and the skin is completely healed. After the shower or bath, dry yourself thoroughly. Pat your incisions dry, making sure not to rub them.

Taking Care of Your Incisions While Traveling

Doctors usually recommend no driving for about six weeks. This may be shorter for patients who have had minimally invasive surgery. Check with your doctor what is appropriate for you.

Going Home by Plane

When you are making flight reservations, let the airline know that you are recovering from surgery. If you had heart surgery, the sternal wires placed during surgery may set off the airport alarms. Because the distance may be too far to walk, ask for a wheelchair to take you to and from the plane. Once in the plane, stand up in the aisle and stretch your legs for a few minutes every hour to get your circula¬tion going. If possible, also walk up and down the aisle.

Going Home by Car

When riding in a car, remember to stop every hour and walk 5 to 10 minutes to get your circulation going. You should wear your seatbelt, placing a small towel in between the seatbelt and your incision. If your car trip is longer than two hours, we recommend that you stay overnight in a hotel, get a good night’s rest, then resume the next morning.

Emotions after heart surgery

It is common for patients to feel sad. These feelings should go away after the first few weeks. If they do not, seek medical advice. It may help to:

  • Get dressed every day
  • Walk daily
  • Resume hobbies and social activities
  • Talk. Limit visits to 15 minutes at first, then increase them depending on how the patient feels.
  • Get a good night’s sleep

Pain relief after heart surgery

Some muscle or incision discomfort, itching, tightness or numbness along the incision are to be expected. However, the pain will be different from that experienced before surgery and pain medications will be prescribed.

For heart bypass surgery, there may be more pain in the legs than around the chest incision if leg veins were grafted. Walking, daily activities and time will help to lessen leg discomfort and stiffness.