Hypertension Archives - InnoHEALTH magazine

OBESITY – A Global Challenge in Emergency and Tertiary Care

InnoHEALTH magazine digital team — Tue, 23 Aug 2022 07:51:20 +0000

Actual challenge is in diagnosing and managing these patients in emergency set up. Auscultation is one of the most primary physical examination in which findings are going to be altered in a obese patient.

Obesity is one of the leading problems that phcians and technicians face in emergency and tertiary care set up. It not only leads to a number of deadly diseases but also makes the patient management awful for the doctor. This article will enlighten the facts how obesity is a curse to the patient as well as the attending physician in an emergency set up, studies regarding the subject as well as how we can overcome the situation.

Obesity is one of the most common morbid problems in the modern era. It has become a part and parcel of our society. The problem is a lot bigger than it seems to be. It’s about survival and not merely related to fitness only. Obesity is a condition that predisposes an individual to a number of diseases , worsens them and even hinders recovery. It is one of the biggest enemies the emergency department doctors face. It delays diagnosis of a condition, closes a few doors of treatment , carries a number of co-morbidities with it and what not !

In order to counter a problem we must first know what is obesity or overweight? Grossly, accumulation of excessive fat is called obesity but it has a compact quantifiable definition. First we need to have an idea about Body Mass Index i.e Body Weight(KG) / Body Surface Area(m²) A body mass index (BMI) over 25 is considered overweight, and over 30 is obese. The numbers coming up are going to shock you even more. In 2017 , over 4 million people were thrown into the mouth of death just because of this demon called obesity. Such a huge number indicates that the problem has already become an epidemic and not merely a sporadic issue. This monster affects every age group and economical section of the society. From 1975 to 2016, within the span of 40 years the prevalence of overweight or obesity among children and adolescents of age group 5–19 years has increased more than four-fold from 4% to 18% globally. Obesity and Underweight are the two sides of the coin called malnutrition! And the demon of obesity outnumbering the burden of underweight population globally except in some low economic status countries. Slowly but steadily middle income countries, developing ones have taken over the lion’s share of the disease burden. Overweight and obesity are major risk factors for a number of chronic diseases, including cardiovascular diseases such as hypertension, Angina and cerebrovascular diseases such as stroke, which ultimately lead to disastrous outcomes in most of the cases.

Obesity never comes alone. It brings another enemy of the healthcare system called Diabetes Mellitus and its associated conditions, including retinopathy, nephropathy, neuropathy all are clearly on rise having the helping hand in the name of obesity. Rates of diabetes have quadrupled since around the world since 1980.Shockingly the proportion of adults being overweight or obese has increased between 1980 and 2013 from about 29 to 37% in men and from about 30 to 38% in women. Estimated that in 2013, more than 2 billion people in the world were overweight or obese and about 671 million of them were obese. Carrying excess weight can lead to musculoskeletal disorders including osteoarthritis as excessive weight brings about the degenerative changes earlier than normal. Obesity is also associated with some cancers, including endometrial, breast, ovarian, prostate, Non Alcoholic Fatty Liver Disease, Cholelithiasis, kidney and colon. Increasing BMI leads to proportional increase in fatality rates of all these non communicable diseases.

The emergency department is where two broken pieces of healthcare meet: obesity and poor access to care. Two recent studies illustrate the results of a phenomenon that weight bias researchers have documented for some time. Overweight and obese people often receive negligence, mocking from some of the health care professionals. As a result, they avoid seeking medical care and frequently switch providers. Numerous comorbid conditions have been associated with obesity, including type 2 diabetes, hypertension, hypercholesterolemia, hypertriglyceridemia, and nonalcoholic fatty liver disease. As a result of these comorbidities, the medical costs directly related to obesity are difficult to determine, but a conservative estimate would place the healthcare burden for obesity at approximately $150 billion per year in the United States. Such a mammoth amount actually breaks the economic backbone of a developing country.Increase in mortality is not directly due to obesity but due to the associated conditions it brings. Obese patients present challenging and complex issues in medical and surgical intensive care units. In the current debate over healthcare reform in the United States, no proposed solution can reasonably ignore or minimize the role that obesity plays with regard to economic and health consequences.

Actual challenge is in diagnosing and managing these patients in emergency set up. Auscultation is one of the most primary physical examination in which findings are going to be altered in a obese patient. Most of the times in emergency set up doctors miss important auscultatory findings in these patients that causes the diagnostic delay. ABGs play a massive role in management of a patient coming to the emergency department. In this case the radial artery is the one from which blood is drawn. In case of obese patients, it’s a troublesome job to puncture the radial artery correctly . Securing a central venous line or even putting up a peripheral cannula in some patient needs a mammoth effort if he or she is too obese. While diagnosing a condition radiological limitations and adjustments are also of huge concern. Added on to this ETT and Foley catheter placement is quite difficult. Anesthetic dose adjustment is also a major concern in obese patients and may even lead to disasters if not done properly. Transportation of patients as well as equipments are also a big hazard. Basically every step needs to be placed very carefully in obese patients while managing in emergency set up and a tiny mistake may cost the patients life as well as lead to medico-legal issues.

Such a huge set back in the form of obesity in emergency and tertiary care units needs to be controlled. The only way to decrease obesity is building up awareness among the common people. Government , health care centres have to take up the responsibility to make them understand how deadly obesity can be. Regular counselling in health care centres advertisements can reduce the burden of obese patients on society. Society should be made aware of the necessity of physical exercise and healthy food. But these all are long term processes . Obesity is a global problem. And it’s the high time for the physicians to come up with some plan that helps them manage the obese patients in emergency set up. Dopplar Ultrasound can be a very good option while managing a obese patient in a emergency care unit. Using the technique we can get access to veins, arteries very easily.

Obesity is a global problem. And it’s the high time for the physicians to come up with some plan that helps them manage the obese patients in emergency set up.

This aids in quick management and avoids multiple pricks to the patient. In spite of using fixed non-movable beds , if we use beds with wheels , it will be a lot easier to take patients to the CT room or MRI room. Placing them on the machine will remain an issue though. Portable x-ray devices are a good advancements in medical science that helps to decrease the need of carrying the patient always. Still there will be some unavoidable circumstances in spite of all these where transportation of the patient is mandatory i.e operation theatre etc. It is the high time for the national and international health agencies to publish proper guidelines to manage obese patients in emergency set up. Proper infrastructure and trained staff in every hospital will ease the cause. It’s a global issue and every possible effort should be made to improve the quality of the medical support we can provide to obese people in emergency set up. With so much advancement and innovations coming up in health care system we can surely hope that this global problem will be solved soon.

Composed by: “Dr. Mahan Shome likes to study about the recent advancements in the field of medicine that might help mankind in future. Writing is his passion. He hails from Howrah, West Bengal.”

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Health and Oral Health Diseases

InnoHEALTH Magazine — Thu, 14 Nov 2019 11:06:01 +0000

Well, many of them must be wondering how that can be possible. But if we look over the past 2-3 decades, the mortality rate has increased to its next level, obesity being one of the rising causes. In 1990, the World Health Organization considered obesity as a global epidemic. And guess who made it go globally that vast? We humans did. Irregular eating habits, irregular sleep patterns, stressful life and not maintaining overall health is leading to an unsatisfactory life.

Talking about obesity, what is more important for the body? Nutritionist are vital to human development and maintaining health. 7 essential nutrients a body needs are water, carbohydrates, proteins, amino acids, fats, vitamins, minerals and omega-3 fatty acids.

Also Read: Super Foods For Your Diet This Winter

What exactly is obesity and why is it an important topic that everyone should be aware of? In simple terms, it means abnormal or excessive fat accumulation that may impair health. And it is an important concept in our day-to-day lives because of health consequences. Thus, in today’s generation an individual’s life is more interconnected to one’s personality, lifestyle, socioeconomic status, and social interactions.

Recently heard of benign obesity? It is a term sometimes used to describe a condition in which an individual is overweight or obese but does not suffer from any co-morbidities, such as diabetes, hypertension etc. Our daily lifestyle choices have a direct connection to whether or not a person is prone to facing obesity.

Also Read: Cover Your Ears on Public Transport

Asking about if obesity is hereditary? Then, genes aren’t the most worrisome risk of obesity. An individual’s upbringing can be, the way the family raises, the daily food intake, importance placed on physical activity and how a person would take their behaviour model, are the bigger influences on likelihood of obesity than genes. Health is not valued till sickness comes, true isn’t? Obesity is not because it runs in the family!! It is because no one runs in the family!!!

Today, more than 95% of all chronic diseases is caused by food choice. Yes,being overweight is linked to a number of health and oral health diseases, including: heart disease, high blood pressure, diabetes, cancer, gallbladder and gallstones, breathing problems, such as sleep apnea (when a person stops breathing for a short time during sleep) and asthma, oral health problems such as caries, halitosis, poor oral hygiene, periodontal disease. Symptoms for obesity include breathlessness, Increased sweating, snoring, inability to cope with sudden physical activity, feeling tired, back and joint pain, low confidence and self-esteem, and feeling isolated.

Also Read: Exclusive interview with Minister Dr Harsh Vardhan

After being aware of the risks, proper health and oral hygiene should be maintained. And why is maintaining diet an important factor? Because a poor diet may result in lack of essential nutrients and vitamins thus potentially making it more difficult for your body to fight off an infection. A diet high in fat and calories, including large quantities of processed foods or sugar, and lack of physicalactivity, leads to obesity. Those same foods can cause oral health problems including gum disease, premature tooth loss and bad breath Our body craves for what is in our bloodstream. Wheat, sugar, alcohol, coffee and de-vitalized foods are designed to be addictive. Sugar being addictive – agreed. But how does sugar affect an individual’s health and oral health? Well, consuming sugar is bad for an individual, but consuming too much has become a norm and that can cause health issues. The only type of sugar the body needs is glucose, which it can make by breaking down carbohydrates, proteins and fats. When ingested, simple sugars are converted into plaque if not removed immediately. As plaque begins to accumulate on our teeth and gums, the risk of varying forms of gum diseases such a gingivitis and periodontitis, as well as tooth decay, may become inevitable.

In 2018, a study revealed that 170 children and young people have rotten teeth removed every day, undergoing general anaesthesia. That’s an unpleasant operation that is completely avoidable; we have got a lot of evidence to show that the main cause is excessive sugar. There are also links with type 2 diabetes, usually chronic disease seen in adults, but we are seeing more and more under the age of 25 these days.

Also Read: A Right Gesture Saves Life

So, what an oral health care professional should be aware of? Dentists must be aware of how nutrition impacts general and oral health, and how dental treatment can impact patient’s nutritional status. Oral health is strongly influenced by the daily intake of food; on the other hand, oral health can also play a significant role in nutritional intake and general health status. The dental caries is also a chronic disease and may be depend on oral hygiene, high intake of sugar added to food, lifestyle factor, and host factors (salivary flow, buffer capacity and buccal microflora). Relationship between obesity and gum disease – we actually don’t know if this is a one-way or a two-way street. For example, conditions like diabetes, the relationship is bilateral. Periodontal disease will affect diabetes and diabetes will worsen periodontal disease, so that could be a possibility here. What are the other reasons of obesity affecting gums and what would be its risk factors? Because of various dietary habits and improper maintenance of oral hygiene, chronic periodontal infection is an inflammatory state that is described by a deviation in microbial environment and composition of subgingival plaque bio films and accelerated destruction of tooth supporting structures. Thus, low glycaemic diet may be beneficial to our oral health. Periodontal diseases are also influenced by various risk factors including aging, smoking, oral hygiene, socio-economic status, psycho social stress, osteopenia, osteoporosis and various systemic diseases, which signifies that periodontitis does not merely occur as a consequence of plaque deposition but is also coupled with various other host factors. Also, on examination, obese adolescents exhibited multiple carious teeth, higher plaque index, gingival inflammation, bleeding on probing and probing depth compared to normal weight subjects of similar age.

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An obese patient, whose lungs are often not large enough to lift heavy chest walls, can have trouble during breathing, especially when active. Also, during sleep the person might breathe through his/her mouth instead of nose, thus jaw is forced into an unnatural position for a longer period of time. This can lead to teeth grinding and development of an overbite, over jet or spacing between the anterior teeth.How can we, as dentists, help the obese patients? Dentists should include the evaluation of BMI in routine patient examination and eventually refer obese periodontal adolescents for weight reduction interventions like diet therapy, behavioural therapy, pharmacotherapy, so that they can have better control over periodontal inflammation.What are the practical considerations in dentistry? It can be difficult carrying out dental care for an obese patient: the maximum lifting weight for modern dental chair is approximately 140kg (23 stones). The position of anatomical landmarks may be less obvious if surrounded by fatty tissue, the landmarks for placement of an inferior alveolar nerve block can be impossible to palpate through excess soft tissue. It may be impossible to palpate cervical lymph nodes in a large neck. Also due to constant secretion of saliva, the mouth and teeth are rinsed and kept free off food debris and foreign particles, thus excess of buccal pad of fat hinders with self-cleansing action in the mouth. Because of lack of saliva present in the mouth, it can lead to dry mouth. Sip water frequently throughout the day and use alcohol-free antiseptic mouthwash daily for cure. A normal sized mirror is unsafe for retraction of soft tissues: a ‘lax’ tongue retractor can be useful.What is the alternative to conventional dental chair? Refer the patient to the hospital environment where the patient may be treated on an operating table or trolley. Another possible solution for obese patients is a custom-made chair such as DIACO dental chair. What is the difficulty faced during conscious sedation? When thinking about conscious sedation for obese patients, the potential difficulties in airway management and intravenous cannulation should be considered. The provision of inhalation sedation with nitrous oxide during which oxygen levels are maintained at or above 30% may be more appropriate. If intravenous sedation with midazolam is proposed, the overall benefit to the patient must be carefully weighed up against the increased likelihood of significant respiratory depression and the difficulties in managing a respiratory complication. New research suggests that the health of your mouth mirrors the condition of your body as a whole. A healthy smile can surely transform our visual appearance and the positivity of our mind-set.

‘Eat every two hours, sleep eight hours, have plenty of water and pray to keep calm. Most importantly, carry a smile on your face.’

About the author

Dr. Vishaj S. Maru is a dental surgeon. She studied dentistry at the D.Y. Patil School of Dentistry. She does clinical practice in Mumbai with a keen interest in academia and clinical dentistry.

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Study: Awareness about Hypertension Very Low

InnoHEALTH Magazine — Wed, 24 Jul 2019 10:45:05 +0000

Hypertension, high blood pressure or BP, call it by any name; is a common condition which is caused by the force of blood against the artery walls.

A new study has highlighted the need for an intensive effort to improve upon hypertension awareness, care and control in the country especially for those in the most productive age group of 15–49 years, with emphasis on households with lower-income levels and those living in rural areas.

The study, which was based on the data collected under the National Health and Family Survey 2015–16 has found that efforts to tackle hypertension are lacking in all aspects, from screening for the condition and providing a diagnosis to the level of treatment given to the patients.

The data, for instance, showed that only three out of four people, who were found to have hypertension during the survey, had ever been checked for blood pressure earlier and only 45 percent of the hypertensive patients identified during the survey already knew that they suffered from blood pressure problem. Further, less than one in seven (13 percent) reported that they were under hypertensive medication and less than one in 10 (8 percent) had their blood pressure under control.

Significantly, contrary to general expectations, women had better control over their blood pressure than men. The analysis revealed that while 10.9 percent of hypertensive women were taking their medicine and had normal blood pressure; on the contrary, only 5.3 percent of hypertensive men did so.

The National Health and Family Welfare Survey had covered 731,864 individuals from twenty-nine states and seven union territories.

“Detection of hypertension is straightforward, treatments are simple yet effective, and hence hypertension can be easily controlled. However, India does not perform well in any of the measures of detection, treatment and control,” said Dr. Dorairaj Prabhakaran, Vice President, Research and Policy at PHFI and one of the authors of the study. “The new National Health Mission through the health and wellness clinics has the potential to address the issue.”

Dr. Lindsay Jaacks, another member of the research team, said, “we need demand-side interventions to raise awareness in India that hypertension is relatively easy and cheap to treat, and that keeping it under control can have huge benefits in terms of preventing heart attacks and stroke.”

Credits: India Science Wire

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Welcome 2019! Another Year of Development

InnoHEALTH Magazine — Mon, 21 Jan 2019 10:54:08 +0000

Our best wishes for the Year 2019 to all our readers, advisory group and wellwishers. We have completed three years and this year has been very eventful; we have launched IC Foundation of Healthcare and Excellence (ICFHE), a not-for-profit organization for social interventions and are now connected to the community of 40,000 like-minded people. We have put this issue on the theme of “Innovation in Diabetes-Unmet needs“given India has 73 million population suffering from Diabetes and 50% of people are not even diagnosed properly which means 7% of the Indian population is diabetic. World’s 18% diabetics are in India, second largest in the world. At present, the world has 425 million diabetics which would become 629 million in the year 2045.

We intend to handle this menace by conducting awareness programs, find innovative methods to bring diagnostic tools and treatments at a lower cost with quality & behavior modification programs for preventive and curative measures.

The lifestyle changes are the key to the treatment of lifestyle diseases like hypertension, diabetes, obesity and select cancers. They cause complications for other parts of the body such as eyes, heart, kidney, and foot. People must be told of the importance of diet, exercise, and meditation in order to have a healthy lifestyle. We have taken this initiative and created a website to raise awareness of the latest scientific interventions www.experimentswithsugar.in

We intend to publish articles regularly of common interest and would also encourage the professionals in this field to share their experiences through our magazine. Our team participated in ESICON 2018, to learn latest on the diabetes treatment from the top experts. We have also surveyed the clinicians for their unmet needs and will soon be releasing the findings.

We plan to have the next issue on the theme Cyber4Health: security and privacy issues linked with the health sector and their solutions. Healthcare providers are welcome to share their articles and help us increase awareness in this new arena. Our cybersecurity training programs for senior officers of the Armed Forces and various healthcare organizations were very well received.

What is new in the kitty for 2019-a delegation visit to Sweden during the month of May for B2B meetings and Vitalis conference; regular club meetings, InnoHEALTH magazine issues, and webinars to promote and foster innovations; our annual international InnoHEALTH conference in October in New Delhi.

We request you to join in various initiatives and make your contributions towards a better world.

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Artificial Intelligence Coming Big Way in Healthcare Sector

InnoHEALTH Magazine — Mon, 19 Nov 2018 10:13:51 +0000

Brig Arvind Lal, CMD of Dr Lal Path Labs, is a pioneer in bringing laboratory services in India at par with the western world. In 1977, he took charge of the medical diagnostics laboratory founded in 1949 by his late father. Under his expert guidance and leadership, the initiative has become one of the most reputed laboratories in Asia, having to its credit quality accreditations from various national and international bodies.

The critical care environment has undergone significant alterations in the past several years. This has happened because our lifestyles in the fast-paced lives of modern India are ensuring that most people, in the age group of 30-50 years are falling prey to life-threatening cardiac diseases and strokes, in addition to diabetes, hypertension, cancers, liver, kidney and lung diseases – these diseases being called Non-Communicable Diseases or NCDs. They are now responsible for killing more than 65% of our population says Dr Arvind Lal, known for his diagnostic labs across the country.

Flagging concerns on such trends, these patients need high-cost intensive care, be it for complications of heart attacks, strokes, diabetes, hypertension, cancer or lung diseases. This is where the importance of Point-of-care testing (POCT) comes in. It helps in almost diagnosing the patient instantly and improves the physician’s ability to take immediate corrective action and decreases hospital stay. One such test is Troponin – that has revolutionized cardiac care by diagnosing heart attacks or myocardial infarction.

This article is based on the keynote address on the occasion of 2nd Annual International InnoHEALTH Conference 2017 – ‘Transforming Healthcare Through Innovation’ in New Delhi, said there are numerous promising diagnostic technologies. The key message is that in a country where 70% of the population lives in rural surroundings, ‘it is our duty to rapidly adopt disruptive innovative affordable technologies including telemedicine. Thus, our underserved population would be able to avail of the best treatment possible and bring in massive visible change’. He said the importance of bringing quality healthcare needs no reminder and the time has come for India to change the direction of healthcare for the masses.

Healthcare is a right – and access to good healthcare should not depend on where one lives and how much he or she earns. But sadly, that is exactly what plagues India’s healthcare today, he lamented. India faces a severe shortage of both hard infrastructure and talent. With about one doctor and one functional bed per 1000 population, healthcare is truly underserved in India. Add to this the regional imbalances and variations in healthcare delivery. The healthcare infrastructure is skewed towards urban over rural India.

Although rural India accounts for about 70% of the population, it has less than one-third of the nation’s hospitals, doctors and beds, resulting in large disparities in health outcomes across urban and rural India. British Medical Journal (BMJ) has observed that there is a remarkable saving of lives in India if good healthcare facilities consisting of operation theatres, surgeons, anaesthetists, blood banks are available within 50 kilometres of the patient providing quality medical services within the ‘golden hour’.

Though there has been a sea change in the last five decades, India now needs to reinvent the field of diagnostics as laboratory tests are responsible for 70% of all clinical or medical decisions.

In today’s life where internet rules the roost, the patients have become very knowledgeable, thanks to the globalisation of healthcare, and are demanding very high-quality healthcare for themselves. They are insisting on a very wholesome and satisfying experience rather than being told that the ‘treatment is over’.

Soon, a time will come when the tests shall be ordered by the patients based on clinical history and clinical findings that shall be answered by an Artificial Intelligence (AI) application. Artificial intelligence has already found several areas in healthcare from the design of treatment plans to assist in repetitive jobs to medication management and drug designing. The most obvious application of artificial intelligence in healthcare is data management. Collecting it, storing it, normalizing it, tracing its lineage – it may well be the first step in revolutionizing the existing healthcare systems.

Recently, the AI research branch of the search giant, Google, launched its Google Deepmind Health project, which is used to mine the data of medical records in order to provide better and faster health services. The project is in its initial phase, and at present, they are working with Moorfields Eye Hospital of NHS Foundation Trust, UK to improve eye treatment.

Just a few years ago the patient after giving the sample used to come back in the evening to the lab to collect a physical copy of the test report. This was replaced by making the report available on the internet that could be downloaded by the patient in the comfort of his home. These days this has been further replaced by making available an App on his mobile phone wherein he can book an appointment for the sample to be collected at home and the report being later available on the same mobile App.

‘IBM Watson, whose headquarters I had the privilege of visiting a few months back in the Silicon Valley, is an AI-based engine that has launched its special program for oncologists to provide clinicians evidence-based treatment options. The program has an advanced ability to analyze the meaning and context of structured and unstructured data in clinical notes and reports in its encyclopedic memory that may be critical to selecting a treatment pathway’. IBM launched another algorithm called Medical Sieve. It is an ambitious long-term exploratory project to build a next-generation ‘cognitive health assistant’ that is able to analyze radiology images to spot and detect abnormalities faster and more reliably. This shall help radiologists in the future to look at the most complicated cases where human supervision is essential.

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‘Wearable Tech is another area which I am personally very excited about. It has the potential to change the world as it helps people understand their own bodies by using mass data collected on a daily basis. From fitness bands to smartwatches to eye based wearables, they are being adopted widely. Take the case of Zephyr’s Anywhere Bio Patch which is an FDA-approved, small device that is attached to a patient’s chest and monitors their vitals minute-by-minute and collects medical-grade data for doctors’ use. These devices will connect our organs digitally, enabling disease detection at very early stages. It has the potential to bring down cardiac and other deaths drastically. This offers immense potential to do remote testing, monitoring and thus assisting the doctor in timely treatment’.

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Point of Care Testing: Technological advancements in laboratory automation, including POCT, and initiatives to increase patient satisfaction are transforming the clinical laboratory market. POCT has come a long way from a handful of simple tests to a multibillion-dollar global market that holds great promise for the future. Not so long ago, laboratory data would often arrive at the bedside too late to be of significant use in the active, continuing care of critically ill patients. Now, most clinicians acknowledge that POCT is a prerequisite for early recognition of life-threatening conditions as they require that laboratory results are made available in real-time and, if possible, at the critically ill patient’s point of care. The College of American Pathologists defines POCT as tests designed to be used at or near the site where the patient is located, that do not require permanent dedicated space, and that are performed outside the physical facilities of the clinical laboratories.

Examples include kits and instruments that are hand-carried or transported to the vicinity of the patient for immediate testing at that site (e.g. capillary blood glucose) or analytical instruments that are temporarily brought to a patient care location (like operating room, intensive care unit). In many cases, the simplicity was not achievable until technologies developed that was simple and affordable. For example, various kinds of urine test strips have been available for decades, but portable ultrasonography did not reach the stage of being advanced, affordable and widespread until recently. Similarly, pulse oximetry can test arterial oxygen saturation in a quick, simple, non-invasive, affordable way today, but in earlier eras, this required an intra-arterial needle puncture and a laboratory test. Thus, over decades, testing continues to move toward the point of care.

The lab-on-a-chip (LOC) is another device that integrates one or several laboratory functions on a single integrated circuit (commonly called a “chip”) of only a few square centimetres to achieve automation and high throughput screening. Imagine that a patient comes to one of our 2,100 collection centres in the remote tier three or tier four towns in India with the high fever. We take a drop of blood from his finger and inform the clinician almost immediately that the patient is suffering from Chikungunya and not from Malaria or Typhoid, or Dengue fever or Japanese Encephalitis – all in a matter of minutes! The driving notion behind POCT is to bring the test conveniently and immediately to the patient. Needless to add, the patient’s data by POCT shall be made available to update the patient’s electronic health records (EHR).

Talking about POCT Instruments: Currently, two broad type of POCT instruments are available: Small benchtop analyzers (for example, blood gas and electrolyte systems) and handheld, single-use devices (such as urine albumin, blood glucose, and coagulation tests). Now let us talk about if POCT is Boon or Bane? The strong point of POCT is speed and the rapidity with which it shall save lives in emergencies. As India marches towards quality healthcare delivery, in course of time regulatory compliances shall have to be adhered to in the interest of the patient’s health.

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Global nutrition needs swift efforts

InnoHEALTH Magazine — Mon, 30 Apr 2018 11:05:15 +0000

Global nutrition crisis threatens human development, demands ‘critical step change’ in response – Report

Women’s health in India has emerged as a major nutritional challenge with the country wrestling largest number of anemic women in the world and the other having to tackle diseases related with obesity –that is on the rise, warns the latest Global Nutrition Report, 2017. It says there is malnutrition among adults globally.A total of 614 million women aged between 15–49 years were affected by anemia. India had the largest number of women impacted, followed by China, Pakistan, Nigeria and Indonesia.In India and Pakistan, more than half of all women of reproductive age have anemia.

It is a global issue that many women in high-income countries also suffer from; prevalence rates may be as high as 18% in countries such as France and Switzerland. Obesity (body mass index (BMI) ≥30) is most common among North American men (33%) and women (34%), and lowest among Asian and African men (6%) and Asian women (9%).

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Overweight and obesity are increasing in almost every country and are a real concern for many low and middle income countries, not just high-income ones.The problem affects more women than men in all the world’s regions, reflecting a wider global gender disparity.

Hypertension is most common (28%) among African women and European men, and lowest (11%) among North American women. A quarter of Asian and Latin American men suffered from raised blood pressure in 2015. While more women worldwide are affected by obesity, the case for diabetes and hypertension is mixed. There is more diabetes among men than women in Asia, Europe, Northern America and Oceania, and more hypertension among men than women in all regions except Africa.

The world now faces a serious nutrition- related challenge, whether stemming from under nutrition or obesity, states Global Nutrition Report 2017.

The report found the vast majority (88%) of countries studied face a serious burden of two or three of these forms of malnutrition. It highlights the damaging impact this burden is having on broader global development efforts.

“The world can’t afford not to act on nutrition or we risk putting the brakes on human development as a whole,” said Corinna Hawkes, Co-Chair of the Global Nutrition Report’s Independent Expert Group and Director of the Centre for Food Policy at City, University London. “We will not achieve any of the Global Goals for Sustainable Development (SDGs) by the 2030 deadline unless there is a critical step change in our response to malnutrition in all its forms. Equally, we need action throughout the goals to tackle the many causes of malnutrition.”

The Report calls for nutrition to be placed at the heart of efforts to end poverty, fight disease, raise educational standards and tackle climate change.

“We know that a well-nourished child is one-third more likely to escape poverty,” said Jessica Fanzo, Bloomberg Distinguished Professor of Global Food and Agriculture Policy Ethics at Johns Hopkins University and Global Nutrition Report CoChair.

At least 41 million children under five are overweight, with the problem affecting high and lower income countries alike
At least 10 million children in Africa are now classified as overweight
One-third of North American men (33%) and women (34%) are obese
155 million under-fives are stunted; Africa is the only region where absolute numbers are rising, due to population growth
52 million children worldwide are defined as wasted, meaning they do not weigh enough for their height

In all 140 countries studied, the report found ‘significant burdens’ of three important forms of malnutrition used as an indicator of broader trends:
1) childhood stunting-children too short for their age due to lack of nutrients, suffering irreversible damage to brain capacity,
2) anemia in women of reproductive age-a serious condition that can have long term health impacts for mother and child, and
3) overweight adult women-a rising concern as women are disproportionately affected by the global obesity epidemic.

“They will learn better in school, be healthier and grow into productive contributors to their economies. Good nutrition provides the brainpower, the ‘grey matter infrastructure’ to build the economies of the future.”

Rates of undernutrition in children are decreasing, the report said, with recent gains in some countries. But global progress is not fast enough to meet internationally agreed nutrition goals, including the Sustainable Development Goals (SDG) target 2.2 to end all forms of malnutrition by 2030.

EmornUdomkesmalee, Co-Chair of the Global Nutrition Report’s Independent Expert Group and Senior Advisor, Institute of Nutrition, Mahidol University, Thailand, said, “It’s not just about more money – although that is important – it’s also about breaking down silos and addressing malnutrition in a more joined-up way alongside all the other drivers of development. There’s a powerful multiplier effect here that we have to harness.”

The report found that overweight and obesity are on the rise in almost every country.With 2 billion of the world’s 7 billion people are now overweight or obese and a less than 1 per cent chance of meeting the global target of halting the rise in obesity and diabetes by 2025.

Rising rates of anemiaamong women of reproductive age are also cited as a concern with almost one in three women affected worldwide and no country on track to meet global targets. “Historically, maternal anemia and child undernutrition have been separate problems to obesity and noncommunicable diseases,” said MsFanzo. “The reality is they are intimately connected and driven by inequalities everywhere in the world. That’s why governments and their partners need to tackle them holistically, not as distinct problems.” Donor funding for nutrition rose by just two per cent in 2015, to US$867 million, representing a slight fall in the overall percentage of global aid. The report says funding needs to be ‘turbo charged’ and calls for a tripling of global investments in nutrition, to $70bn for over next 10 years to tackle childhood stunting, wasting and anemia and to increase breastfeeding rates. Crucially, donors are only spending 0.01 per cent of official development assistance on diet related Non-Communicable Diseases, a ‘disturbingly low’ level.

Pledges to invest in nutrition must be ‘concrete’ and ‘acted upon’, not ‘empty rhetoric’, the report said. Of the 203 commitments made at the Nutrition for Growth Summit in 2013 those most likely to be classified as ‘on course’ are the UN agencies’ at 86 per cent, followed by ‘other organisations’ at 75 per cent and NGO policy commitments at 73 per cent.

The report found there is a critical need for better data on nutrition – many countries don’t have enough data to track the nutrition targets they signed up to and to identify who is being left behind.

Report says the world consumes too much salt. Intake varies by region, but no region had intakes within the WHO-recommended limits of 2 g/day of sodium. Asia has the highest intake (4.3 g/day of sodium), followed by Europe (4.0 g/day of sodium). At national level, only seven countries (Burundi, Comoros, Gabon, Jamaica, Kenya, Malawi and Rwanda) have sodium intakes within desirable limit).

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Read all the issues of InnoHEALTH magazine:
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InnoHEALTH Volume 1 Issue 2 (October to December 2016) – https://goo.gl/4GGMJz
InnoHEALTH Volume 2 Issue 1 (January to March 2017) – https://goo.gl/DEyKnw
InnoHEALTH Volume 2 Issue 2 (April to June 2017) – https://goo.gl/Nv3eev
InnoHEALTH Volume 2 Issue 3 (July to September 2017) – https://goo.gl/MCVjd6
InnoHEALTH Volume 2 Issue 4 (October to December 2017) – http://amzn.to/2B2UMLw
InnoHEALTH Volume 3 Issue 1 (January to March 2018) – https://goo.gl/fksdQx
InnoHEALTH Volume 3 Issue 2 (April to June 2018) – https://goo.gl/grbtRo

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Stressful events can increase women's obesity

InnoHEALTH Magazine — Tue, 03 Apr 2018 08:33:59 +0000

Women who experienced one or more traumatic lifetime events or several negative events in recent years had higher odds of being obese than women who didn’t report such stress, according to preliminary research presented at the American Heart Association’s Scientific Sessions 2017, a premier global exchange of the latest advances in cardiovascular science for researchers and clinicians.

“Little is known about how negative and traumatic life events affect obesity in women. We know that stress affects behaviour, including whether people under- or overeat, as well as neuro-hormonal activity by in part increasing cortisol production, which is related to weight gain,” said study senior author Michelle A. Albert, M.D., M.P.H., professor of medicine, cardiology, and founding director of the Center for the Study of Adversity and Cardiovascular Disease, at University of California, San Francisco.

Obesity, a preventable risk factor for cardiovascular and other diseases, impacts more than one-third of U.S. adults. According to the American Heart Association, nearly 70 percent of American adults are either overweight or obese. Women tend to live longer than men, putting especially obese, aging women at greater risk for disease, said study author Eva M. Durazo, Ph.D., a post-doctoral scholar at the NURTURE Center, Division of Cardiology, and UCSF said.

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The researchers studied the relationship between major life events and obesity in a group of 21,904 middle-aged and older women, focusing on women with the highest obesity prevalence. They defined obesity as having a body mass index (BMI) of 30 kg/m2 or higher. And, they measured the impacts of two types of stress: traumatic events, which could occur anytime in a woman’s life and includes events as death of a child or being a victim of a serious physical attack, as well as negative life events that had occurred in the previous five years of a woman’s life. Negative events included wanting employment but being unemployed for longer than three months or being burglarized.

Sleep deprivation may increase risk of cardiovascular disease in older women Older women who don’t get enough sleep were more likely to have poor cardiovascular health, according to preliminary research presented at the American Heart Association’s Scientific Sessions 2017. In the new study researchers considered sleeping at least two hours more during the weekend than on the weekday as a sign of being in state debt. Among the roughly 21,500 female health professionals between ages of 60 and 84 the research team followed, women who were in sleep debt were more likely to be obese and have hypertension. When taking into account socioeconomic status and sources of stress, such as negative life events and work-related stress that could also influence cardiovascular health, quality of sleep was still an important factor for good overall cardiovascular health. The results suggest that not getting enough sleep during the week might throw the body off and may increase risk of cardiovascular disease in older women.

NEARLY A QUARTER (23 PERCENT) OF THE WOMEN STUDIED WERE OBESE

Women who reported greater than one traumatic life event versus no traumatic life events had 11 percent increased odds of obesity;

The higher the number of negative life events reported by women in the last five years, the higher the tendency for increased odds of obesity. Specifically, women who reported four or more negative life events had a 36 percent higher risk of obesity, compared to women who reported no such events;

Among women who had higher levels of physical activity, there was a stronger association between increasing cumulative/chronic stress and obesity, though the reason for this finding remains uncertain.

“Our findings suggest that psychological stress in the form of negative and traumatic life events might represent an important risk factor for weight changes and, therefore, we should consider including assessment and treatment of psychosocial stress in approaches to weight management,” Albert said.

Because the study looks at the association between stressful events and obesity in a snapshot of time, future studies should look at the relationship longitudinally, following people for weight gain over time after life events have occurred, according to Albert.

“This is important work because women are living longer and are more at risk for chronic illnesses, such as cardiovascular disease. The potential public health impact is large, as obesity is related to increased risks of heart attack, stroke, diabetes and cancer, and contributes to spiraling healthcare costs,” Albert said.

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Menace of Non-Communicable diseases: A far reaching impact

InnoHEALTH Magazine — Wed, 28 Mar 2018 08:49:26 +0000

Non-communicable diseases (NCDs) represent a major peril to the economic growth and development and human health of any nation. The economic loss to India is pegged at $4.58 trillion before 2030 due to NCDs and mental health. The vicious cycle of high out-of-pocket expenditure on health, poor economic growth, workforce productivity loss and rising disease burden are intricately linked to the rising menace of NCDs.

The South Asian region─with a population of more than 1.7 billion─is experiencing a marked demographic transition─characterised by declining birth and death rates and an increasingly aging population. This increase in longevity has also been accompanied by a rise in the prevalence of NCDslike diabetes (78 million cases in 2015). India has the second highest number of diabetic patients in the world, at about 69 million, after China, and this figure is likely to reach 140 million by 2040 and almost half of them remain un-diagnosed. A recent study showed that seven out of ten diabetics in India – especially those in the 20-24 age group – do not take enough steps to control their blood sugar level – even after diagnosis.

The Economic Impact of Diabetes, As per a study conducted by the Indian Institute of Public Health, the number of diabetes patients in the country is likely to go up to 120 million in next 20 years as against the current 70 million. On an average a diabetic patient spends about INR 25,000 annually to manage the disease and its associated complications. Beyond placing a financial strain on the patient due to treatment expenditures, poor management of diabetes significantly impacts the patients’ quality of life: it may lead to loss of productivity due to multiple hospital visits, elevating rates of absenteeism, diminishing the energy and focus of a productive workforce, and depleting critical workplace skills ultimately leading to reduced mobility and span of life. Diabetes related complications like kidney failure, nerve damage along with obesity, dyslipidemia and hypertension make diabetes management quite complex for clinicians.

In this context, it becomes important that healthcare professionals have access to more educational resources to remain updated about how to tackle the diabetes epidemic. But due to scarcity of time and high patient load in South Asian healthcare facilities, medical practitioners find it very difficult to update their knowledge. Remaining updated can help clinicians offer better diabetes management options to their patients.

A Possible Solution: E-Learning Courses e-Learning programs can help clinicians in acquiring skills required to address the growing complex management of diseases. E-learning courses can be tailored to fit the clinicians schedule, delivering content right at the moment when it is demanded by the doctor. Interactive e-learning programs also offer peer to peer learning, thus enabling clinicians to discuss learning from key cases. Those e-learning programs which also offer the opportunity of contact classes, offer a richer and immersive learning experience.

An effective e-learning program will incorporate guidelines for determining the correct and appropriate blend of instructional strategies, including on-line learning, face-to-face instruction, and skill demonstrations, thus facilitating the learning of a clinician far beyond than traditional learning materials. Unlike traditional CMEs, e-learning can be designed to be self-paced, and research has indicated that e-learning reduces the learning time by at least 25-60% when compared to traditional learning, which can be an added advantage for time-constrained clinicians.

Intelligent e-learning management systems also adapt and learn from the learners’ aptitude and change and deliver a personalized learning experience. The right mix of video, audio, and text content formats help to ensure that delivery of content is mapped to the medium most appropriate & relevant to concept development.

Keeping in mind these perspectives, a Six Months Certification Course in Diabetes in partnership with Fortis C-DOC Hospital was launched by BMJ in South Asia. This course is endorsed by the Royal College of Physicians. This is a six months online learning course offered in two formats: with hands-on training and online-only – to cater to the learning needs of clinicians in South Asia.

Courses such as these will go a long way in knowledge & skill upgradation for clinicians in areas which the country faces a high disease burden. Such courses are clinician-centric and learner-led, and have been developed keeping in mind the real and on-ground challenges faced by doctors in South Asia.

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AYURVEDA: MOTHER OF ALL HEALINGS

InnoHEALTH Magazine — Mon, 27 Nov 2017 09:27:56 +0000

The fundamentals on which the Ayurvedic system is based are essentially true for all ages and so can be easily adopted time after time, century after century – By Indu S Arya

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Ayurveda is generally understood as ‘Science of life’ translating ‘Ayuh (r)’as life and ‘Veda’ as science. Ayurveda is an ancient system of life and also the oldest surviving medical system in the world. Dating back almost 5000 years, it is also considered to be an ancient science of healing that enhances longevity. It has evolved from the quest to have a happy life, through a deep understanding of creation and its maintenance, perceived and conceived by the rishis or seers of ancient India. Ayurveda emphasizes upon life in general with bit more emphasis on human life.

Its influence can be found in many ancient traditional methods of healing including Tibetan, Greek, and Chinese medicines thus making it the ‘mother of healing’.

The fundamentals on which the Ayurvedic system is based are essentially true for all ages and so can be easily adopted time after time, century after century. The philosophy of Ayurveda teaches a series of conceptual systems characterized by balance and disorder, health and disease. It teaches that am person’s mental, emotional and spiritual being are all interconnected and any kind of imbalance between them results in health disorder and diseases. Therefore, to be healthy, harmony must exist between the purpose for healing, thoughts, feelings and physical action.

Health and disease are defined in a very special way in Ayurveda. Ayurveda’s central tenant is that life is a manifestation of mind, body, soul and spirit. Body and mind are prone to suffering while the spirit is free of any such trappings of life. Thus to remain healthy and happy, efforts are required to be made in the direction of maintaining harmony among all these elements and only then can one get closer to the goal of longevity and disease free life.

Science of Ayurveda

Ayurvedic science is not merely a traditional Indian form of medicine but a perennial naturopathic system of healthcare that has survived the test of time as well as onslaught of modern science and methods of treatments. Based on wisdom acquired through the centuries, the main aim of Ayurvedic science is to achieve perfect health by creating an equilibrium of perfect harmony between human body and the environment it habitats.

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Ayurveda is also known as the science of living a healthy and disease free life. It is built on the premise that in olden days, man used to live close to nature and whenever he got exposed to some disease, he used to cure himself using resources and material provided by the Mother Nature. It therefore would not be wrong to say that Ayurveda charts out a health patter based on nature and its natural resources.

The Vedic philosophy believes that human beings are all a part of nature. Just as animals and plants are interdependent on each other to create balance within their beings, there is a concurrent and inherent connection between the universe and human beings. The complex world that the human beings reside in, is perpetually exposed to environmental changes. Any amount of change in weather, lifestyle, diet, work, emotions and relationships can easily tip the balance and negatively influence an individual’s state of mind, body and soul.

Ayurveda calls for a complete harmony of human body with the elements of nature and the surrounding environment for a stress free and healthy life. The Ayurvedic science does not merely deal with medical science but its scope goes much beyond the universe of the conventional science. It also includes factors like herbal medicine, body works, and surgery apart from social, psychological, ethical, spiritual and intellectual life of human beings.

Ayurvedic Body Types

According to Ayurveda, each one of us has a unique mix of three body principals that constitutes our mental, physical and spiritual well-being. These three principals are known as doshas, which are further classified as Vatta (air ether), Kapha (water-earth) and Pitta (water). But each individual has its own unique constitution that is usually governed by one or two of the doshas predominantly. It means that that our Ayurvedic constitution is mainly be either of these doshas or a mixed constitution of two doshas like Vatta & Kapa, Kapa & Pitta or Vatta & Pitta.

Kapha:

Kapha governs all structure and lubrication in the mind and body. It is the principle that holds the cells together and forms the muscle, fat, bone, and sinew. It controls weight, growth, lubrication for the joints and lungs, and formation of all the seven tissues — nutritive fluids, blood, fat, muscles, bones, marrow and reproductive tissues. It helps build excellent stamina but when it goes out of balance it can also cause a person to become overweight, sleep excessively, and suffer from the problem of diabetes, asthma and depression.

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Pitta:

Pitta dosha controls digestion, metabolism, and energy production. The primary function of Pitta is transformation. Those with a predominance of the Pitta principle have a fiery nature that manifests in both body and mind. Pittas have a lustrous complexion, perfect digestion, abundant energy, and a strong appetite. When out of balance, Pittas may suffer from skin rashes, burning sensations, peptic ulcers, excessive body heat, heartburn, and indigestion.

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Vatta:

Vatta dosha is known to govern all the movements of mind and body. From controlling the blood flow to elimination of the waste and harmful toxins to breathing and the flow of thoughts in the mind; the vatta dosha is like a predominant force that minimizes stress and feeds the creativity within you. If the vatta dosha is in balance, you will feel energetic, enthusiastic and lively, but the moment it becomes imbalanced, it manifests in the body problems like constipation, hypertension, fatigue, digestive challenges and restlessness among others.

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Ayurvedic Herbs

Ayurveda understands health as a reflection of a man living in harmony with nature and disease arises when this harmony gets disturbed. In the ancient times, rishis and sages believed in Ayurvedic herbs as the solution to cure a number of health problems and diseases. The conducted thorough studies and experimented with these herbs before arriving at any conclusion regarding the accuracy of the medicinal values of these herbs and their effectiveness in treating various ailments and diseases. Due to their natural Ayurvedic herbs are considered to be free of any side effects and thus enjoy a global appeal.

Ayurvedic medicines are mostly formulated using a mix of herbs and other plants, including oils and common spices. By combining several kinds of plants and herbs to get benefit of the drug or therapeutic value, Ayurveda has proven itself capable of overcoming various health problems that occurs in the human body. Today, Ayurveda is being widely used in modern medicine systems. This was triggered by a number of research-conducted by scientific research and has proved how effective and positive the role of plants or herbs can be on human health.,/p>

Herbs play a vital role in the Ayurvedic system and a small herb is known to dissolve stones in the kidney, bladder and gall-bladder easily and effectively. Apart from timely cure, Ayurvedic herbs are also know to provide permanent relief from a disease by removing the metabolic toxins from the body. Know more about the various Medicinal Plants and Their Uses.

Ayurvedic Home Remedies

Ayurvedic home remedies are considered safe as they are natural and herbal in nature, therefore, free from any side effects. They have an advantage over other methods of treatment as Ayurvedic remedies are known to cure the disease form the root, effectively. Treating an ailment or a disease using Ayurvedic remedies will not only help you get rid from it permanently but also aid you in leading am healthy life in the long run.

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Some of the major benefits of using homemade Ayurvedic remedies include:

• Ayurvedic remedies are preventive as well as protective and curative in nature.

• As the emphasis is on using herbal and natural ingredients or things that can be easily found in the kitchen, it does not pose any danger of being toxic.

• These remedies are free of any side-effect and provide long term or permanent cure from the disease.

• The remedies also emphasize on the need for a lifestyle change with modification required in one’s diet, sleep pattern and other basic everyday activity. Therefore, the holistic approach towards the overall well-being of a person is much effective as compared to other conventional forms of modern day science.

Ayurvedic Medicines

Ayurvedic Medicines are fast gaining popularity across the world. One of the major reasons for it being that Ayurveda seeks to normalize body functions with varied techniques including advice on food and activity, internal herbal preparations, purification treatments (panchakarma), and surgical methods (shalya chikitsa).

Ayurveda is based on the belief that the delicate balance of mind, body and spirit determines health and wellness of the body. The goal of Ayurveda is prevention as well as promotion of the body’s own capacity for maintenance and balance. Ayurvedic medicines are non-invasive and non-toxic in nature and therefore are free from any side effects.

Using Ayurvedic medicines in your daily life enables you to re-establish balance and harmony in body’s system, aids in detoxification and cleansing of the body by removing accumulated toxins and normalize body’s functions. Products made using Ayurvedic plants have a stronger action on the body as they help in stabilizing the doshas.

Tulsi, Guduchi, Ajwain, Brahmi, Shilajit and Ashwagandha etc., are some of the most commonly used herbs in Ayurvedic preparations. Each of these herbs or spices hold a multitude of benefits — for the mind, body, and spirit and can be easily used internally or externally, depending on the need.

Ayurveda to the rescue

The daily activities of life in the modern world systematically wear us down and speed up the aging process. Ayurveda maintains it is crucial to practice daily rejuvenative regimens to counteract the stressful wear and tear of everyday life. According to Ayurveda the most important rejuvenative routines for your life are:

Going to bed by 10:00 PM. This simple habit is one of the most powerful techniques for health and longevity, according to Going to bed by 10:00 PM. This simple habit is one of the most powerful techniques for health and longevity, according to Maharishi Ayurveda.

Meditate daily any meditation that does not involve concentration (which has been shown to increase anxiety) can be very helpful. I highly recommend the twice-daily deep rest and enlivenment of the Transcendental Meditation (TM) technique, whose benefits have been verified by over 700 published research studies.

Eat organic, whole fresh food that is freshly prepared. There is an Ayurvedic saying: “Without proper diet. Medicine is of no use. With proper diet, medicine is of no need.” Be sure to avoid those leftovers, processed and microwaved foods for better nutrition and vitality.

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