Friday, May 27, 2016

Hypertension is common among first-time mothers

If not treated, it leads to pre-eclampsia and then eclampsia


The study’s authors screened 416 pregnant women attending antenatal outpatient department of two private teaching hospitals in Telangana between January and July 2015. To determine the occurrence of hypertension attributable to pregnancy, the authors only selected those women without past history of hypertension. The screened women were aged between 20 and 35 years. Women with other conditions that may suggest past history of hypertension were also excluded.

Among the 416 women screened, 34 – or eight per cent – were found to be hypertensive, with blood pressure readings consistently over 140/90 mm Hg. Alarmingly, 80 per cent of these women were primigravidae or pregnant for the first time, according to a discussion of the findings in the Journal of Evidence Based Medicine and Healthcare.

Common cause of death
“It is important for women to get their blood pressure checked during antenatal checkups. For uncontrolled hypertension can have fatal consequences for the mother and the baby,” said Dr. Srirang Abkari, a practitioner of internal medicine at Global Hospitals who was not associated with the study.
Hypertension is one of the most common causes of deaths during pregnancies.

Uncontrolled hypertension, whether induced by pregnancy (during or after the 20{+t}{+h}week) or existing, may lead to conditions like pre-eclampsia, a condition characterised by unusual amounts of protein in urine and uncontrolled-hypertension that affects the foetus.

If the risk of complications due to hypertension is high, delivering is suggested depending on how far the pregnancy has progressed. If not treated, hypertension leads to pre-eclampsia and then eclampsia, marked by seizures.

The condition warrants abortion to treat the mother. In the Telangana study, the authors noted pre-eclampsia in about 15 per cent of primigravidae women with hypertension, as against 7 per cent in women with hypertension who have been pregnant before.

Regular monitoring
Dr. Abkari notes that women with hypertension can give birth with regular blood pressure monitoring. Those with readings suggesting borderline PIH can benefit from exercises and diet modifications, including regulation of salt intake, without medication. However, uncontrolled high BP warrants medication certified for use during pregnancy, he added.
The authors suggested that pregnancy-induced hypertension may be common among Indian women, while stating the need for population studies to establish its prevalence.

Source:  The Hindu

Friday, May 20, 2016

NPPA decision to cut post-surgical drug prices,big relief for transplant patients

Arnity Homji (57) has a reason to smile. With the National Pharmaceuticals Pricing Authority (NPPA) deciding to slash the prices of immunosuppresive drugs by 50%, she would be saving Rs 10,000 a month.
Immunosuppresive drugs are post-surgical medicines that needed to be taken lifelong by transplant patients to avoid rejection by the organ transplanted. Homji's daughter underwent a heart transplant in 2014 in Chennai and has been on immunosuppresive drugs.

The NPPA, which controls drug prices, has slashed prices of immunosuppresive drugs like Tacrolimus, Mycophenolate and Ciclsosporine last month.
Daara Patel, secretary general of Indian Drug Manufacturers' Association (IDMA), said that the NPPA notification came recently.

"As per the notification, manufacturers have to bring down prices. According to my knowledge, this is for the first time the prices of these drugs have been brought down," said Patel.

Transplant patients spend lakhs of rupees on surgery and end up spending more on post-surgical drugs, he said. "After surgery, it is compulsory that patients take immunosuppresive drugs lifelong. It is good that NPPA has decided to bring the prices of these drugs to a reasonable level," said Patel. On an average, patients spend almost Rs 10,000-15,000 per month on anti-rejection drugs. "Apart from medicines, we have to undergo blood test every month. So, the monthly cost comes to Rs 30,000. Charitable organisations do help with funds during surgery but not after that," said Homji, who lives in Bandra.

Parents of Dhruv Ranalkar (8), who underwent a kidney transplant at PD Hinduja hospital recently, said that they spend Rs 12,000 on anti-rejection drugs. "The decision will help save money. I am the only breadwinner in the family," said Dhananjay, who works in a private firm in Nashik.

Renowned cardiologist from Mumbai said "This move by the NPPA will go a long way as organ transplant patients have no choice but to take medicines. A successful organ transplant depends on the patient complying to immunosuppressive drugs."

In a heart transplant, patients spend around Rs 20,000-25,000 a month on these drugs for the initial 12 months and Rs 10,000-12,000 a month after that. "For a poor family, spending Rs 20,000-25,000 a month on medicines is a huge thing," said Agarwal.

Dr Ravi Mohanka, chief surgeon and head of the department, liver transplant and hepato-biliary surgery at Global hospitals, said it is a respite to all organ transplant patients.
Heart transplant: Rs 22-30 lakh
A heart recipient has to spend Rs 20,000-25,000 on post-operative care for six months. Lifelong medication costs Rs 10,000-15,000 every month
Kidney transplantation: Rs 4-6 lakh
A kidney recipient has to spend Rs 12,000-15,000 on post-operative care for six months. Lifelong medication costs Rs 10,000 every month.
Liver transplant: Rs 25-30 lakh
A recipient has to spend Rs 10,000-15,000 a month on medications.

Immunosuppressant drugs or anti-rejection medicines suppress or reduce the strength of the body's immune system , thereby lowering the body's ability to reject a transplanted organ such as a liver, heart or kidney.
A transplant patient has to compulsorily take immunosuppressant drugs as the body recognises a transplanted organ as a foreign mass. This triggers a response by the body's immune system to attack it.

source: DNA

Thursday, May 19, 2016

High Blood Pressure or Hypertension

Hypertension is defined as blood pressure is higher than 140/ 90 mm Hg. This threshold of blood pressure has been set to define Hypertension for clinical conveniences as patients benefit once they bring their blood pressure below this level. 
Normal level of blood pressure is 120/80mm Hg.
Pre hypertension range is 120-139 or 80-89 mm hg.
Stage 1 Hypertension is 140 to 159 mm Hg systolic or 90 to 99 mm Hg diastolic .
Stage 2 Hypertension is 160 or higher systolic Or 100 or higher diastolic.
Hypertensive crisis is when blood pressure above 180mm Hg systolic or above 110mm Hg diastolic.

Causes of Hypertension are:1.Age :- everyone is at greater risk of  Hypertension as get older.
2. Size:- Being overweight or obese is key risk factor for Hypertension.
3. Sex:- Males are more prone in younger age and women at older age
4. Lifestyle:- Greater intake of dietary salt, Excessive alcohol, Low dietary  potassium, Physical inactivity, Hereditary causes and family history,  Chronic poorly managed stress
5.Other causes :- Diabetes Mellitus, Kidney diseases, Pheochromocytoma, Cushing syndrome, Congential abdominal hyperplasia , Hyperthyroidism, Hyperparathyroidism, Pregnancy, sleep apnea.

Symptoms: Hypertension per say does not causes symptoms but Hypertension can cause by quietly damaging Cardiovascular system.
·         It  causes Arteriosclerosis which means hardening of arterial walls , this will cause complications like Enlarged or weakened heart.
·         It can results in Aneurysm which is abnormal bulging  of wall of artery),
·         Blood vessel narrowing can cause Kidney failure, Heart failure,
·         It can  diminishes blood supply to brain and legs,
·         Stroke
·         Chronic Heart Diseases

High Blood Pressure is diagnosed by measuring Blood Pressure by using instrument named sphygmomanometer.

Treatment of hypertension: Lifestyle changes not only for treatment but also for prevention of diseases which includes Salt restriction, moderation of alcohol consumption, High consumption of vegetables and fruits and low fats. Reducing weight and maintaining it. Regular physical exercise. Stress reduction .Drug treatment for hypertension are diuretics, beta and alpha blockers, calcium channel blockers, central agonists, peripheral adrenergic inhibitors, vasodialtors, ACE inhibitors, Angiotensin receptive blockers,
Choice of the drugs depends upon individuals and any other condition they may have, while single drug is used in monotherapy but we can use combination for two drugs as and when they  are required.

Hypertension and Stroke:
Stroke:- is a disease that affects the blood vessels supplying the brain. Stroke occurs when blood vessel is blocked by clot is called ischemic stroke , or blood vessels bursts and bleeds into brain parenchyma hemorrhagic stroke. High blood pressure can damage arteries throughout the body. About 87% of strokes are ischemic and 13 % of stroke are hemorrhagic stroke.

Warning sign are FAST:
F Face dropping to one side, Ask the person to smile , Is person’s smile uneven ?
A Arm weakness, one arm will be weak or numb, Ask person to raise both the arms, does one arm drift downwards?
S Speech Difficulty, Is speech slurred? Is person unable to speak or hard to understand?
T Time to call , its emergency.

Saturday, May 7, 2016

Successful Heart Transplantation on 3 people from Chennai, Andhra Pradesh and Chhattisgarh

Longevity is the benchmark for a heart transplant’s success

Awareness among the public, financial constraints and number of centers performing transplants are the major challenges in India 

Chennai, 04th May: Longevity after a heart transplant is the yard stick for measuring the success of a heart transplant globally. In U.S almost 3.5 lakh patients suffer from end stage heart diseases.  Heart Transplantations carried out amounts to 3500 per year. The requirement in India is almost 10 folds higher but the number of transplant surgeries performed is not more than 200 a year. Heart transplantation, has evolved into a treatment of choice for many people with severe heart failure who have severe symptoms despite maximum medical therapy. Survival among heart transplant recipients has improved as a result of improvements in treatments that suppress the immune system and prevent infection.    

The lives and hope of three men from Andhra Pradesh, Chennai and Chhattisgarh, who were suffering from end-stage diseases of Heart, were kept alive at Global Health City in spite of financial constraints and other challenges, with the successful complex heart transplantations. 

Mr. Narayana, a 56 year old gentleman from Ongole, Andhra Pradesh had been suffering from Dilated Cardio Myopathi. A 30 year old donor organ received fortunately to save the life of Mr. Narayana, now he is on his fifth year after transplant hale and healthy.  

Mr. Ramesh, a 43 year old gentleman from Chennai had been suffering from severe heart failure. The heart failure had progressed to a level, where it had caused liver decompensation (Liver Cirrhosis).  Luckily he had a suitable donor. 

Mr. Rakesh, a 37 year old gentleman hailing from Chhattisgarh, had been suffering from severe heart failure. The heart failure had progressed to an end stage, where it had lead to Dilated Cardiomayopathy. 

Dr. Rahul Chandola – Senior Consultant Heart & Lung Transplant Surgeon said “Heart transplant is an excellent treatment modality for patients with heart failure that gives great survival out comes and good quality of life out to many many years. There is a sheer need for awareness about this life changing modality amongst the patients and physicians alike. A great example is Mr. Rakesh who hails from Chhattisgarh and was suffering from heart failure. He got referred to a reputed hospital in Vellore, where he was told that he’s got only few months to live and suggested terminal care for him. Later he approached us for a second opinion where he was offered heart transplantation that was carried out successfully and now his quality of life has changed completely. We are stepping up to create corpus funds from the affordable public / organizations to realize the dream of offering non affordable patients like Mr. Rakesh, Mr. Ramesh, Mr. Narayana and many more in the near future.”  

Dr. Govini Balasubramani – Senior Consultant Heart & Lung Transplant Surgeon said, “In India Chennai is considered as Mecca of organ transplantations. There are three major factors influencing heart transplants in India, awareness among the public, financial constraints and the number of centers performing transplants.  

All the three patients here had affordability issues for their transplantation. I strongly believe that India can surpass United States in terms of heart transplantations in the year 2022. Duly addressing the mentioned issues will make us global leader in heart transplantation.”  

Highlighting the uniqueness of the transplants, Dr. K. Ravindranath – Chairman, Global Hospitals Group added “Over the years, Global Health City had become the most preferred organ transplant centre and is one of the largest multi-organ transplant centers in India adding to many first-of-its-kind transplant surgeries. Today with a series of high risk heart transplants, Global Heart and Lung Institute had once again demonstrated its constant endeavor to offer the best possible treatment to patients by combining contemporary technology and processes. Challenges faced by.”
Global Heart & Lung Institute

As one of Global Hospital’s cornerstone Centers of Excellence, Heart & Lung Institute is a premium, comprehensive center providing innovative, quality care close to home. Utilizing advanced medical and surgical equipment, the expert team of physicians and nurses practice evidence-based medicine blended with patient-centered care. From intervention to cardiothoracic surgery and rehabilitation, the institute’s approach hinges on personalized care, recognizing that every patient is unique.

Monday, May 2, 2016

Spending long hours in AC rooms can trigger asthma attack

Spending long hours in air conditioned rooms to beat the summer heat can trigger asthma attacks, warn physicians.

On the eve of World Asthma Day, pulmonologists and allergy experts say asthmatics should avoid spending long hours in air conditioned rooms as reduced humidity and cold can trigger an attack. “An attack triggered by reduced humidity and cooling by an air conditioner has been aptly named the ‘Freon Effect’,” noted Dr. Sudhir Prasad, a consultant pulmonologist at Global Hospitals.

“Consuming cold foods and beverages also ups the risk of irritating the airway and an attack,” he added. Attacks are common in winter and spring when pollen becomes an allergen.In summer, extremely high or low humidity levels are known to trigger attacks, warranting maintenance of ambient indoors.

The American Centre for Disease Control and Prevention advises maintaining indoor humidity between 35 per cent and 40 per cent. Dr. Prasad added that air-conditioned room temperature should not dip below 24 degree Celsius if asthmatics are the room’s occupants.

The impact of air-conditioning on allergic and asthmatic children can be markedly severe.

According to the president of Allergy and Asthma Network India, children attending classes in air-conditioned classrooms are more likely to report symptoms of rhinitis, sneezing and blocked nose. “This will happen often if air-conditioning filters are cleaned regularly. The upper and lower respiratory tract can get aggravated in sensitive allergic children. Additionally, given that class rooms harbour many students in closed premises for long hours, infections will also tend spread very swiftly,” he said.

In summer, extremely high or low humidity levels are known to trigger attacks

source: The Hindu

Saturday, April 30, 2016

Does Science Lead or Mislead Human Lives!

‘Science’ word truly means knowledge (scientia). Science just means knowledge existing then. It is neither total truth nor eternal fact. There are many who are worshippers consider Science as demigod. Science of today is more segmental if not fragmental. I seek the attention of genuine scientists to ponder over this fact. Karl Popper rightly says ‘the problem of demarcation was not the problem demarcating science from metaphysics but rather problem of demarcating science from pseudoscience’. But any belief not founded on knowledge remains superstition that deserves to be condemned. Modern world is the product of science and its fruits. 

Current scenario of science especially in the arena of Health is far from being scientific. On one side the professionals of health and medical sector are under constant influence of the data called Statistics of success or failure in various clinical trials and animal experiments. Mr. Koestler is right when he said ‘Scientific evidence is a rather elastic term and verification is always a relative affair’. The certainty of objective knowledge lies in our subjective faith and conviction. 

The myth of a 1.5 trillion dollar business over 40yrs is now blown out that Cholesterol is not a nasty chemical. The US government has finally accepted that cholesterol is not a 'nutrient of concern', doing a U-turn on their warnings. This fear probably caused death of a million sensitive citizens who believe the US drug industry. Eggs, butter, full-fat dairy products, nuts, coconut oil and meat have now been classified as "safe" and have been officially removed from the "nutrients of concern" list.

What is more intriguing is ‘The US Department of Agriculture, which is responsible for updating the guidelines every five years, stated in its findings for 2015: "Previously, the Dietary Guidelines for Americans recommended that cholesterol intake be limited to no more than 300 mg/day."The 2015 DGAC will not bring forward this recommendation because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum (blood) cholesterol, consistent with the AHA/ACC (American Heart Association / American College of Cardiology) report."Cholesterol is not a nutrient of concern for overconsumption.” We do not know that all this is a fact of relief or recovery from shock of having been cheated so long by both professionals and the drug industry.

 Earlier decades, 1970s, 80s and 90s were the 'non fat' years, with the health officials warning people to limit the amount of high-cholesterol foods in their diets to avoid heart disease and strokes. Dr. George V. Mann M.D. associate director of the Framingham study for the incidence and prevalence of cardiovascular disease (CVD) and its risk factors states: "Saturated fats and cholesterol in the diet are not the cause of coronary heart disease. That myth is the greatest deception of the century, perhaps of any century". Any individual consuming cholesterol lowering agents for over a decade possibly may now become victim of both cancer and drug induced diabetes, God forbid. Cholesterol is the biggest medical scam of all time by any stretch of imagination. 

‘There is no such thing as bad Cholesterol!’ say experts.  Men of science have abandoned truth for money. Are we true followers of science? Attempting to control cholesterol is a very, very dangerous practice that occurs in every hospital and medical clinic daily, says Ron Rosedale, MD "Statin Drugs Actually Increase Heart Disease", an alarming statement. Further he adds, the majority of people that have heart attacks have normal cholesterol levels.

From basic human metabolic point of view ‘our body needs 950 mg of cholesterol for daily metabolism and the liver is the main producer, only 15% of cholesterol is being  provided by the food we eat.  If the fat content is less in our food we eat, our liver got to work more to maintain the level at 950 mg.  If the cholesterol level is high in our body, it shows the liver is working perfect.  Experts say that there is nothing like LDL or HDL.

Cholesterol is not found to create block any where in human body, let alone our heart vessels, say scientists.
When our ‘Fat phobia’ took a U turn, who knows, we may face another U turn, in what direction God only knows.

Take knowledge but do not believe blindly.
( The author is former Dean of Nizams Institute of Medical Sciences and currently Director of Global Medical Education and Research Foundation)

Wednesday, April 27, 2016

Global Hospital sets up Mumbai’s first Adult Vaccination Clinic to mark World Immunization Week

Statistics show higher morbidity and mortality in adults from vaccine-preventable diseases as compared to children

Mumbai, 25th April, 2016: This World Immunization Week’s (24-30 April) theme is ‘Closing the immunization gap: Immunization all throughout life’. It stresses on the need for immunization in adolescents and adults, an overlooked but critical health issue. Very alarming is the fact that adults suffer from higher morbidity and mortality from some serious vaccine-preventable diseases when compared to children. For e.g. vaccine preventable influenza and pneumococcal disease kill far more adults than children each year. Most countries including India have public health policies which strongly focus on childhood vaccination. There is a need to push for adult vaccination to bring down adult deaths from preventable illnesses.   

Recognizing the importance of adult vaccination, Global Hospital has started an adult vaccination clinic to make available adult vaccines for serious diseases such as influenza, hepatitis A, B, chicken pox and rubella etc. Diseases such as influenza, pneumococcal, hepatitis A and chicken pox are more aggressive when acquired in adulthood. Certain vaccine preventable diseases like pertussis, influenza and chickenpox not only affect the infected individual but pose a heightened risk of infecting children and older adults in the family, both vulnerable groups of society. Such vaccine-preventable diseases put an increased economic burden on the country.  

Speaking on the occasion of World Immunization Week, Dr. Vasant Nagvekar, Infectious Diseases Consultant, Global Hospital Mumbai said, “The high rates of morbidity and mortality in adults from vaccine-preventable diseases is a grave concern as they far exceed those seen in children. Just the yearly influenza vaccine, especially when taken by the elderly and those having co-morbid conditions, reduces hospitalization risks by 40%. There has been a reduction of 25% adult deaths through the use of the pneumococcal vaccine and a 50% reduction from the use of the influenza vaccine. I would like more and more people to be aware of this fact and choose adult vaccination for themselves and their families.”

Dr. Nagvekar stressed upon the fact that all women planning pregnancy must know whether they are protected against chicken pox and rubella either by having acquired infection in the past or through vaccination against the disease. If not protected, it is important to get vaccinated. He also stressed on the fact that all adult vaccines should be taken as per a doctor’s advice and under his supervision.
Adult immunization coverage is low in India and must be pushed aggressively to bring down the overall disease burden. A lack of provider recommendations for adult vaccines combined with lack of knowledge on adult vulnerability to life threatening diseases plus the perception that these vaccines are costly could be the reasons for people not opting for adult vaccination. This initial cost however must be offset by the benefits that accrue over the long term for individuals and their families and must be considered a necessary investment in good health.