INDIGESTION AND HEARTBURN DURING PREGNANCY

Heart burn and indigestion are very common in pregnancy, especially in last few months of pregnancy.

Heart burn and indigestion occur in pregnancy due to the hormonal changes that occur in later months of pregnancy, to facilitate baby’s growth. As the growing baby presses on the intestines and stomach,  heart burn and regurgitation of food may occur. Stress may also be considered as one of the causes of heart burn and indigestion in pregnancy or otherwise.

 Normally, a valve that is present between esophagus and stomach prevents the acid released in stomach from entering or going back into esophagus. The raised progesterone hormone levels in pregnancy relax this valve and allows acid to enter into esophagus causing a burning sensation in the center of chest and upper part of the abdomen which is called heart burn. It is not related to heart as the name suggests.

 Symptoms of indigestion may include vomiting sensation (nausea), vomiting, pain or discomfort in chest and stomach, loss of hunger, feeling full, burps, seen any time of the day or after eating food or drinking fluids.

Generally, no investigation may need to be done in the beginning stages unless there is a suspicion for obstruction or an ulcer in digestive system or an underlying serious disease condition. Mild symptoms can be managed by following a few of the tips mentioned below. Severe symptoms may demand prescription of medications along with the home remedies for an effective treatment.

Medications which may be of help are antacids which neutralize the acid released in stomach and give relief, acid-suppressing medicines which decrease release of the acid and anti-emetics for vomiting.

Avoiding a heart burn and indigestion is considered as the best approach. A few tips which may be of help are

  • Eating small, regular and frequent meals rather than 3 large meals in a day.
  • Sitting straight while eating food which eases off the pressure on stomach and helps in better digestion.
  • Having healthy foods like green leafy vegetables, fresh fruits and vegetables.
  • Cutting down spices in food, avoiding oily, fatty and spicy food.
  • Drinking at least 2-3 litres of water daily.
  • Walking for a few minutes after having food, rather than lying down immediately
  • walking for around 5-10 minutes often in a day without sitting or lying down for long hours (avoiding a sedentary lifestyle)
  • Eating an early dinner, at least 1-3 hours before going to bed.
  • Adding one or two pillows while sleeping which keeps the head slightly elevated and propped up….This avoids reflux of stomach contents into food pipe.
  • Avoiding smoking and alcohol consumption.
  • Avoiding foods that triggers ingestion for you
  • Bending over immediately after eating etc.

References:

https://www.nhs.uk/conditions/pregnancy-and-baby/pages/indigestion-heartburn-pregnant.aspx

http://americanpregnancy.org/pregnancy-health/heartburn-during-pregnancy/

https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy/art-20047208

– Dr. Divya Teja Pasupuleti

Pregnancy: Achy Back? Let’s solve it

Pregnancy creates a great deal of strain on a woman’s body. It increases pressure on the spine, feet and the legs. All these can result in severe lower back pain during pregnancy. Back pain during pregnancy is not a trivial matter. If not addressed, back pain in pregnancy can have a negative impact on your daily lifestyle, from possibly causing missed time from work to making your delivery more difficult.

While it is fairly common, back pain during pregnancy should definitely not be accepted as just part of the process. It is estimated that between 50% and 80% of women experience some form of back pain during pregnancy. Such pain can range from mild pain associated with specific activities to acute back pain that can become chronic back pain.

To help make your pregnancy as pleasant as possible and facilitate an easier delivery, back pain should always be addressed as quickly as possible and managed throughout your pregnancy.

Studies show that lower back pain in pregnancy usually occurs between the fifth and seventh month of being pregnant. In some cases, pregnancy pain in the lower back can begin as early as 8 to 12 weeks after becoming pregnant. Women with pre-existing lower back problems are at higher risk for back pain, and their back pain can occur earlier in the pregnancy.

Types of Pregnancy backache: 

  • Lumbar, or lower back pain
  • Posterior pelvic pain 

Lower Back Pain during Pregnancy (Lumbar Pain)

Lumbar pain during pregnancy is generally located at and above the waist in the centre of the back. In general, lumbar pain during pregnancy is similar to lower back pain experienced by non-pregnant women. This type of pain typically increases with prolonged postures (such as sitting, standing, or repetitive lifting), and tenderness may also be present in the muscles along the spine during pregnancy.

Pregnancy Pelvic Pain

Posterior pelvic pain (in the back of the pelvis) is four times more prevalent than lumbar pain in pregnancy. It is a deep pain felt below and to the side at the waistline, and/or below the waistline on either side across the tailbone. Such pregnancy pelvic pain may be experienced on one or both sides.

Posterior pelvic pain during pregnancy can be brought on or exacerbated by the following activities:

  • Rolling in bed
  • Climbing stairs
  • Sitting and rising from a seated position (such as getting in and out of cars, bathtubs, bed)
  • Lifting, twisting, bending forward
  • Running and walking.

A job that involves prolonged postures at extreme ranges (such as sitting at a computer and leaning forward, standing and leaning over a desk or workstation) increases the risk of developing pregnancy pelvic pain.

Unlike many other forms of lower back pain in pregnancy, a previous high level of fitness does not necessarily prevent posterior pelvic pain while pregnant.

Natural Causes of Back Pain during Pregnancy

Common changes due to pregnancy that can cause back pain include:

1.Weight gain. Pregnancy can cause you to gain as much as a quarter of your body weight, adding stress to the back and other weight-bearing structures.

2.Hormonal surges (relaxin and estrogen). Pregnancy-related hormones can cause problems by creating joint laxity, especially in the pelvis. These hormones during pregnancy help your uterus grow by loosening the joints and ligaments of the pelvic bones attached to the spine.This might affect your back and it may not be as strong and may not support your body the way it usually does and you may suffer from a severe back pain during early pregnancy.

3.Gravity: As your baby grows you will be forced to pull your body forward and your center of gravity will move forward. This change in your posture will give you a lower back pain during early pregnancy. This is why you might be shaky when standing up, sitting down or bending.

4.Stress: Pregnancy pains can make you stress over little things. And why wouldn’t it! You’re having a baby for crying out loud! It is stressful. Stress piles up in the weaker areas of the body and tightens the muscles. This causes body pain especially in the back because it is carrying most of the weight of your body.

Activities that Can Cause Back Pain during Pregnancy

Some or all of these factors can cause pregnancy pain in the lower back or posterior pelvis, especially with activities that create asymmetrical loading of the spine, pelvis, and hips. Common activities that load the spine in an uneven fashion include:

  • Rolling over in bed
  • Bending forward
  • Twisting
  • Lifting
  • Navigating stairs.

Back Pain Treatments during Pregnancy

Maintaining an optimal level of function throughout your pregnancy and having the least amount of discomfort are the main goals of treatment for back pain during pregnancy. Your doctor may recommend the following

  1. Proper posture while pregnant  
  2. Specific body mechanics for routine activities, such as housework, job, sleeping  
  3. A home exercise program appropriate for your stage of pregnancy
  4. Self-help techniques for pain management and mobilization during pregnancy

What you can do-

Correct your Posture

An appropriate posture is essential to avoid lower back pain during early pregnancy. You tend to lean forward because of the weight of the baby in front, which causes the strain on the back. To avoid this, always remember to lean back and have a straight back as much as you can.

Balance while bending

You must avoid bending down to lift things as much as possible. If you must bend, make sure to do that while squatting and not bend from your hip or back. This will avoid unnecessary pressure on your spine.

Sleep on one side

While sleeping it is recommended that you sleep on either side and not on your back. Bend one or both your knees while lying on one side. This will help reduce severe back pain during early pregnancy.

Wear shoes wisely

Avoid wearing high heels as this can make you lean forward and put pressure on your spine. However, wearing flat shoes is also not advisable, what you need is a comfortable low-heeled shoe which will adequately spread your weight back and forward and help you walk with an erect back.

About pain medication

During pregnancy, keeping it natural is always recommended as chemical based formulations can often cause more harm than good. Topical balms made of natural ingredients that penetrate deep inside, produce warmth to relax the muscles and help you recover fast, Moov is soothing, effective and most of all, it is safe.

Often just one or two visits to a physical therapist experienced in pre/post-partum treatment who will perform an individual evaluation and recommend a treatment program for you, may provide relief.

Remember, while back pain is fairly common during pregnancy, it should definitely not be accepted as just part of the process.To help make your pregnancy as pleasant as possible and facilitate an easier delivery, back pain symptoms should always be addressed as quickly as possible and managed throughout your pregnancy.

https://www.webmd.com/baby/guide/pregnancy-discomforts-causes#7-20

https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy/art-20046080

-Dr.Bhavani Sagar. P​

Know-Hows of Diabetes; this World Diabetes Day

India is often called the “Diabetes capital of the world”, ever since India became the country with highest number of people suffering with Diabetes.
Diabetes is a chronic medical condition. It affects the way body metabolizes sugar, body’s important source of fuel. Insulin is a hormone that is needed to allow sugar (glucose) to enter in to cells to produce energy. Insulin is secreted by a gland called pancreas located in our abdomen, behind the stomach.
In Type 1 Diabetes, body produces little or no Insulin. Type 1 Diabetes usually appears in young children and adolescents, but can appear in adults. Type 1 Diabetes treatment involves insulin injections from the time of diagnosis.
In Type 2 Diabetes the body resists the effects of insulin or doesn’t produce the required amount of Insulin to maintain normal glucose level. Type 2 Diabetes usually presents in adulthood, but with increasing childhood obesity, it can appear in young children and adolescents. Type 2 Diabetes can be managed by medications for some time but eventually may need insulin injections.
In the last 3 decades, number of people suffering with Diabetes is steadily increasing in India. This increase can be attributed to urbanization and change in lifestyles of people.These changes include increased caloric intake in diet and decreased physical exercise. Smoking and alcohol intake along with Diabetes are also contributing to development of complications. Diabetes along with Hypertension, abnormal lipid profiles is contributing to coronary artery disease, which is the leading cause of death for people of India.
Urban rural divide is decreasing gradually as prevalence of Diabetes is increasing in rural India. Many people are unaware of their elevated blood sugars; take no measures towards control of blood sugars which leads to long term complications that are known to occur due to Diabetes.
The impact of Diabetes is more on people of low socioeconomic status as they have poor access to medical care and lack of affordability for testing and medications.
Not all type 2 Diabetics in India are overweight. Indians have increased risk of having Diabetes at a lower BMI compared to their western counterparts. Indians also are affected with Diabetes at a younger age
November 14 th is the world diabetes day dedicated for raising awareness about diabetes all over the world. The day is marked on the birthday of  Frederick Banting one of the scientists who discovered insulin for the treatment of Diabetes, along with other scientists Charles Best and Macleod.
While type 1 Diabetes which is the less common and accounts up to less than 10% of total Diabetes, cannot be prevented with the current knowledge, we can prevent Type 2 Diabetes by taking some measures.
What can you do to decrease your risk of type 2 Diabetes?
  • Maintain a healthy weight
  • If you are overweight, take measures to lose few kilos in a steady manner.
  • Include fruits and vegetables in your diet
  • Cut down diet high in calories, like processed foods and fast foods.
  • Include physical exercise in your daily routine. To begin with any activity is better than no activity.
  • As you are increasing your physical activity gradually, aim for at least 30 minutes of moderate physical activity daily and 45 minutes of vigorous activity per week. Check with your doctor before starting any high intensity physical activity.
  • If you have a family history of type 2 diabetes, your chance of getting type 2 diabetes is more. Get your blood sugars checked at regular intervals.
  • As you age, your chance of getting type 2 diabetes goes up.
  • Women having Polycystic ovarian syndrome are at increased risk for type 2 diabetes.
  • Women who had gestational diabetes (diabetes diagnosed during pregnancy, which usually resolves after childbirth) are at increased risk for getting type 2 diabetes.
  • If you have hypertension, get your high blood pressure under control.
  • If you have lipid abnormalities, discuss with your doctor about measures to take to bring them to desired levels.
Watch for these symptoms of Diabetes and seek immediate medical care
  • Frequent urination
  • Dryness of mouth and increased thirst
  • Frequent skin infections; frequent urinary and vaginal infections in women
  • Weight loss
  • Weakness and fatigue
  • Blurry vision
  • Some people with type 2 diabetes have patches of velvety dark skin at the back of the neck and skin folds. This condition is a sign of possible insulin resistance and is called acanthosis nigricans.
Long term complications from uncontrolled blood sugars are
  • Heart problems, causing angina, heart attack
  • Brain stroke
  • Kidney problems leading to end stage kidney disease
  • Eye problems sometimes leading to vision loss
  • Damage to nerves causing causing nonhealing  ulcers of the limb leading to lower extremity amputations.
  • People with Diabetes are more prone to depression.
If you are diagnosed with Diabetes, what can you do to avoid long term complications from Diabetes
  • If you are diagnosed with Diabetes, talk to your doctor if there are concerns. This helps in accepting the diagnosis, as denial and lack of follow up can worsen blood sugars and lead to long term damage to organ systems.
  • Discuss the management plan with your doctor. Remember that you are part of the team and need to share your concerns and limitations with your doctor for him to be able to help you with all possible choices.
  • If you are started on medications by your doctor, take them regularly as suggested by the doctor.
  • Have a plan for sick days and travel days by talking to your doctor.
  • Maintain regular follow ups as advised by your doctor.
  • Schedule eye check up yearly once and more frequently if the ophthalmologist suggests so.
  • Stick to the diet plan advised by the doctor. If you have concerns about the choices and the quantity of the food items, consider asking your doctor to refer to a nutrition expert who can give you some more choices and tips.
  • Always carry a high glucose snack or a juice carton with you for those instances when you experience symptoms of low blood sugar. It is common for every diabetic to have low blood sugars at sometime or the other.
References
  1. http://diabetes.diabetesjournals.org/content/63/1/53
  2. http://www.sciencedirect.com/science/article/pii/S0168822711001161
  3. http://www.heart.org/HEARTORG/Conditions/More/Diabetes/UnderstandYourRiskforDiabetes/Understand-Your-Risk-for-Diabetes_UCM_002034_Article.jsp
  4. http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf

    – Dr. Lavanya Aribandi, Chief Medical Officer, eKincare

How can we delay the progression of Pre diabetes to Diabetes?

Diabetes is the fifth-leading cause of death by disease. India is called “The world capital of diabetes” due to the magnitude of the problem.

We need to focus more on people who have “Prediabetes” to reduce the mortality and complication caused by diabetes. Diabetes is a metabolic disorder that is mainly caused by obesity, unhealthy and inactive lifestyle. In Diabetes the body is unable to store and use energy from food which we consume. Being physically inactive and eating unhealthy food are primary causes of diabetes. It is a long-term condition which causes high or unstable blood sugar levels in the body.

The disease lasts a lifetime and is usually progressive in nature, but can be managed by taking regular medication, choosing an active lifestyle and maintaining proper body weight.

How is Prediabetes different from Diabetes?

Pre-diabetes is a condition of elevated blood glucose level that has not yet reached a diabetic level. Along with insulin resistance, pre-diabetes causes no symptoms. An individual may be pre-diabetic for years without knowing it. Pre-diabetes increases your risk of developing Type 2 diabetes and heart disease.

The people who are greatest risk for developing Prediabetes?

  • Age 45 or over
  • overweight
  • Physically inactive
  • Have previously been identified as having IFG (impaired fasting glucose) or IGT (impaired glucose tolerance)
  • Have a family history of diabetes
  • Are members of certain ethnic groups (including Asian American, African American, Hispanic American, and Native American)
  • Have had gestational diabetes or have given birth to a child weighing more than 9 pounds
  • Have elevated blood pressure
  • Have an HDL cholesterol level (the good cholesterol) below 35 mg/dl and/or a triglyceride level above 250 mg/dl
  • Have polycystic ovary syndrome
  • Have a history of vascular disease

If your doctor told you that you have pre-diabetes, watch for these symptoms.

  • Frequent urination
  • Extreme hunger or thirst
  • Weight loss
  • Problems with vision
  • Tingling or numbness of the extremities.
  • Unexplained fatigue
  • Cuts or sores that heal slowly
  • Frequent infections

What can you do to prevent Prediabetes and Diabetes

1.Reduce simple sugars and excessive oil in food.

  1. Exercise daily for at least 30 minutes
  2. Take measures to reduce your stress
  3. Visit a physician for medical advice
  4. If you are overweight or obese,weight loss and exercise may delay the progression of diabetes from pre-diabetes by returning blood glucose levels to a normal range.

If you are having any of the symptoms mentioned above, meet your physician.

Dr. Bhavani Sagar

Air Pollution: Tackle the right way

“We do not inherit the earth from our ancestors; we borrow it from our children” – Ancient proverb

Air pollution is contamination of indoor or outdoor environment by any physical, chemical or biologic agent that modifies the natural characteristics of the atmosphere.

The usual culprits for air pollution are Industries emitting toxic waste, forest fires and motor vehicle emissions. In India burning fuel and biomass for the purpose of cooking contributes to major part of indoor air pollution.

The common pollutants in air are carbon monoxide, ozone, nitrogen oxides, Sulphur dioxide and particulate matter.

“Particulate matter” is a term used for the mixture of solid particles and liquid droplets in the air. Particle pollution includes PM 10 (inhalable particles of diameter 10 micrometers or smaller), PM 2.5 (inhalable particles with diameter 2.5 or smaller). PM 2.5 particles can lodge deep in the lungs and lead to short term and long term respiratory problems.

SMOG refers to mixture of emissions under particular climatic conditions. Ozone a colorless, odorless gas forms a protective layer in earth’s upper atmosphere. But when present near the ground, it forms smog and causes health hazards.

“Air Quality Index” is a way of describing outdoor air pollution levels in a clear and simple way.

Harmful effects of air pollution on health

Air pollution causes increase in respiratory problems and contributes to exacerbations of conditions like Asthma, COPD. Environmental pollution increases the risk of cardiovascular problems and stroke It also increases the risk of Lung Cancer. These affects are more pronounced in infants, Children, elderly, people suffering with chronic health conditions and urban poor and homeless people.

What can we learn from the experience of Delhi’s scenario?

It doesn’t take much for health emergencies to happen due to catastrophic levels of pollutants in the air, if we, the people, the government don’t take environmental pollution seriously. Bad practice of burning of agricultural waste in the neighboring states of Delhi is attributed to the worsening of the problem along with other usual sources like Road dust, vehicle emissions and Industrial wastes.

Today as people of Delhi are breathing air polluted with alarming levels pollutants, let’s look at the measures citizens can take to protect themselves from the polluted air and bad health consequences of pollutants.

Supreme Court rightly placed a ban on fire crackers this Diwali, to reduce the pollutant burden on citizens of Delhi.

When we talk about health hazards, we should also take into account the stress and anguish faced by citizens, more so if they or their loved ones are already dealing with health ailments.

What can you do to protect your health if you are living in a city with significant environmental pollution?

  • If you have Asthma or COPD, talk to your doctor and Have an action plan for Asthma and COPD exacerbations.
  • If you are an Asthmatic, Carry your rescue inhaler with you. Do not miss your maintenance medications.
  • Regular deep breathing exercises in fresh air can increase the lung capacity.
  • Plant more trees, have the plants recommended by NASA that are known to decrease indoor air pollution at home.
  • Avoid strenuous physical activity on the days that pollution is high.

Some measures you can take to prevent worsening of environmental pollution

  • For short distances avoid vehicle usage and walk
  • Choose public transport over private vehicles
  • Encourage and engage in car pooling
  • Get pollution certificate for your vehicle.
  • You can save fuel by keeping the automobile fuel filters clean
  • Keep up with the maintenance of your vehicle because well maintained vehicle uses 9% less fuel and emits less toxic gases.
  • If you are stopping beyond one minute, it is more fuel efficient to restart the car.
  • Avoid smoking to protect yourself and people around you from the double burden
  • When outdoor air pollution is more than indoor air pollution, keep the windows closed and limit outside air entering inside

Role of masks

The role of masks is debatable at this time, with no clear proven benefit from wearing a mask. The most sophisticated masks can filter some pollutants but they may not be able to protect small particulate matter that is most damaging to health. Given how severe the air pollution is at present in Delhi, the mask may help to some extent.

Which mask?

Surgical masks are a definite No, and if you prefer to wear a mask, it is better to go for N-95 or N-99 mask. Mask with adjustable ear strings and nose clip offer better fit.

Role of air filters for home

While air cleaning devices may help to control the levels of airborne allergens, particles or in some cases, gaseous pollutants in a home, they may not decrease adverse health effects from indoor air pollutants.

Driving tips

To avoid accidents, maintain a safe distance between vehicles when visibility is less due to smog. Drive at a lower speed than the usual in smog; think that the Speed limits are lowered by 10 km/hr.

These actions by the Government can be helpful

“Odd Even scheme” for the vehicles may be implemented for other cities too.  Analysis of the benefits with measurable components will be beneficial. No unauthorized construction work should be allowed. Taking steps to avoid burning of agricultural wastes will cut down hazardous particles in the air. Long term control of air pollution is beyond the control of individuals and requires major actions from both state governments and central government.

Long term measures

Plant more trees : Political parties should come together instead of blaming each other for the current situation, formulate policies to control air pollution, come up with stringent rules for industrial setups, enforce disposal of agricultural waste in a nature friendly manner. 

Devise health policies and action plans to protect children, pregnant women, elderly and people with chronic health conditions.
References

 

– Dr. Lavanya AribandiChief Medical Officer, eKincare

Role of Health care Technology Companies in Enhancing Health care in India

Health care in India faces unique challenges.

Though Government promises health care to every citizen free of cost, majority of the health care expenses in India are paid out of pocket by most families. India has a diverse population with vast differences in their ability to access affordable health care, depending on their social strata and where they live.

There is a discrepancy in treatment standards and availability of health care services in India depending on where the person is getting treatment from. Quality control is lacking with many players like RMPs, Homeopaths, Ayurvedic doctors and sometimes chemists at the pharmacies dispensing medications and providing medical consults. There are inadequate regulations on the billings of corporate hospitals. Often, the common man, who cannot afford corporate medical care, finds himself in a situation where he does not want to go to government hospitals which lack infrastructure and do not maintain minimum standards of hygiene.

The central government contributes with budget allocation and the Ministry of Health and Family Welfare (MOHFW) plays a crucial and important role in guiding India’s public health system, health care is a state subject in India. Some special health plans by state governments provide free inpatient and surgical services but outpatient care and preventive services are often not covered and diseases are neglected until it is too late, requiring hospital admissions and invasive procedures. Though primary health centers in rural areas are set to provide necessary primary care free of cost, they are often not equipped with essential medicines, infrastructure and lack adequate supervision and quality control. Situation is changing to some extent now with expansion of health plans to outpatient services, establishment of generic medical shops and betterment of Primary health centers with some states like Kerala and Tamil nadu setting good examples.

Huge portion of health care expenditure goes into private pockets, the office visits are short, discharge planning is poor, proactive reach out is lacking and private health centers’ contribution to disease prevention and efforts to cut down healthcare costs with best disease management programs is sub-optimal for obvious reasons.

People seek medical care at different stages of life, however; the personal health data is missing, paper records are disjointed and continuity of care is missing even in the best of health care systems. This often results in repetition of tests, medication errors and poly-pharmacy. This is made worse when people directly consult specialists bypassing a primary physician who is the anchor for all the specialists. Additionally, disease registries are not maintained and statistics of incidence and prevalence of a particular disease are not accurate.

While Indians are always ready to adapt to technological developments and are first to use fancy devices, when it comes to disease education with mass media campaigns and implementing strategies for disease prevention through authenticated sources in health sector, we are lagging behind in using technological advances and in reaching out to masses.

Whereas we were battling with communicable diseases until 1960s and 70s, with the discovery of antibiotics, vaccines coupled with the vigorous implementation of Vaccination programs, now our struggle has shifted towards tackling Lifestyle diseases, due to enormous change in lifestyles of Indians in the last 30 years. These non-communicable diseases (NCDs) now contribute to 60% of total deaths. A person in India has 26% probability of dying between ages 30 and 70 years from four major NCDs, i.e. cardiovascular diseases, cancer, chronic respiratory diseases and diabetes.

As India is marching towards fulfilling the Sustainable Development Goals, there is a lot that is still to be done to achieve the targets. Bringing all stakeholders together and using all available resources is the key to success.  Central and State governments as well as private health systems working hand in hand by utilizing services of paramedical workers and ancillary health workers such as ANMs, ASHAs and Anganwadi workers, developing public-private partnerships, encouraging NGOs, running effective mass media campaigns, maintaining disease registries and performing situation analysis when needed will go a long way in reaching the targets.

Another valuable tool in this struggle for a healthy 21st century India is the nascent telemedicine service which is far from realizing its full potential. With young enthusiastic entrepreneurs entering into this space and technology companies dreaming about changing the face of Indian health care, it is time for both governments and general public to be open to change.

India being a country of the young (half the population of India is in the 20 to 59 age group), we need to think ahead and protect the health of this young population by adopting innovative strategies. It is alarming that lifestyle diseases like Diabetes, Hypertension, Heart disease, Stroke and some cancers like Breast cancer are affecting people at a younger age compared to before. – Dr. Lavanya Aribandi, Chief Medical Officer, eKincare

If attention is not paid to curb this situation urgently, the disease burden on the country is going to be huge. As technologically savvy youth is more adept at using electronic devices and internet communication, healthcare technology companies have a lot to offer and a huge role to play in health sector. With increasing prevalence of mental disorders in India, availability of evidence-based (electronic) clinical decision support systems for adopting standard levels of care by doctors, and creating systems for longitudinal follow-up of affected persons to ensure continued care through electronic databases and registers can greatly help.

With the emergence of health technology companies with ability to effectively collect healthcare data, it is now possible to identify people at high risk, to diagnose diseases at early stages, and properly initiate and guide treatments. Patients can be educated about their diseases and appropriately referred to a specialist when needed. Chronic conditions can now be managed better with regular reminders being sent with the help of better communication technology. Health technology can now truly make a difference in improving the quality of health while reducing the health care costs across the country, mitigating the geographic limitations.

All of this is made possible with the ability of health care technology to store patient data with the help of electronic health records and leveraging their computing power for data mining and running back-end analytics. They can now offer personalized care and implement individualized risk reduction strategies. Similar plans can be drawn for larger populations by devising prevention strategies, assisting physicians by enabling them in using clinical decision support systems with evidence based guidelines incorporated into the system. Technology can be used for promoting continuing medical education and knowledge transfer for medical and paramedical personnel. With the availability of sensor devices, using cloud based transferring and storing of data we can improve monitoring of chronic diseases and prevent long term complications.

All of this will result in reduction in incidence of diseases due to better implementation of prevention strategies, early diagnosis of diseases, and reduction in complications from chronic diseases due to better management of the conditions as well as decreased hospitalizations due to identification of acute problems and early deployment of treatments.

For Corporates, health care technology companies can provide information about problem areas in employees’ health, suggestions for improvements in institutional policies, work infrastructure and approach to employee health with positive changes in work environment which in turn would reduce employee burnout, absenteeism and attrition.

For insurance companies, this will result in reduced claims; their money is well spent, early but appropriately.

For the common man, Telemedicine cuts down health care costs, reduces commutes whenever possible, facilitates proper health record maintenance, provides continuity of care leading to availability of better health care even in remote areas.

The current challenges to health technology companies in India are: lack of proper telemedicine law, no clarity regarding the dos and don’ts and lack of proper guidelines for maintaining confidentiality of health care data. The common man’s lack of skills in using technology is also a challenge, but with some innovative strategies, it is possible to overcome this.

For India, telemedicine and other services of health care technology companies could be invaluable addition if used judiciously.

Dr. Lavanya Aribandi, Chief Medical Officer, eKincare

References:

  1. Role of government in public health: Current scenario in India and future scope https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114612/
  2. Burden of NCDs and their risk factors in India (Excerpted from Global Status Report on NCDs – 2014) http://www.searo.who.int/india/topics/noncommunicable_diseases/ncd_situation_global_report_ncds_2014.pdf?ua=1       
  3. National Mental Health Survey of India, 2015-2016 http://www.nimhans.ac.in/sites/default/files/u197/National%20Mental%20Health%20Survey%20-2015-16%20Summary_0.pdf

NEED FOR JUDICIOUS USE OF ANTIBIOTICS IN PRESENT DAY

With the advent of technology like internet, now a days it is very easy to get access to information. To read about illnesses and medicines is possible which may be considered good in some ways and bad in other ways.

With regards to preventive medicine, internet forms a great tool. However with regards to diagnosis and treatment, internet is sometimes being misused. There are many cases of self-diagnosis and treatment which is not safe. Many medicines are being misused or abused and one such group of medicines are the Antibiotics.

To be able to understand the importance of use of antibiotics, we must know what they are. Antibiotics, also known as antimicrobial drugs, are drugs that fight infections caused by bacteria in both humans and animals. Antibiotics fight these infections either by killing the bacteria or making it difficult for the bacteria to grow and multiply. Antibiotics do not have any effect on viruses.

Antibiotic / Antimicrobial resistance is the ability of microbes to resist the effects of drugs that is, the germs are not killed, and their growth is not stopped. Antibiotic resistance has been called one of the world’s most pressing public health problems. Almost every type of bacteria has become stronger and less responsive to antibiotic treatment when it is really needed. It is very important to know how antibiotic resistance develops and how we, as a community can avoid it-

  1. Simply using antibiotics or over use of antibiotics creates resistance.  These drugs should only be used to manage infections under the guidance of a medical doctor. Self-prescription should be avoided.
  2. Avoid using antibiotic prescription of previous doctor’s visit repetitively.
  3. Not finishing the entire antibiotic course- A course of antibiotic is carefully planned by a doctor based on the suspected organism and the effects that it is showing. Not completing the antibiotic course as advised by doctor and no follow up give the organism optimum opportunity to develop resistance.
  4. Never demand antibiotics if your health worker says you don’t need them.
  5. Never share or use leftover antibiotics.
  6. Prevent infections by regularly washing hands, preparing food hygienically, avoiding close contact with sick people, practicing safer sex, and keeping vaccinations up to date

 

The already discovered antibiotics are not less than a huge treasure. We have reached a point where in we need to preserve them by using them carefully only under the prescription of medical professionals and remember that if used inappropriately, we may run out of them and then be left vulnerable to highly dangerous organisms.

-Dr.Afroze Fatima

References

https://infectioncontrol.tips/2015/11/18/6-factors-that-have-caused-antibiotic-resistance/

http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/

TOP FEEDS FOR NEONATES

-A neonate is a new born baby till 28 days of life according to WHO.

-Top feeds are the feeds anything apart from breast milk of the mother for new born babies.

-It is very important for the baby to feed only on mother’s milk since birth till 6 months of age.

-Common top feeds that are given include water, honey, sugar water, formula milk, cow milk, buffalo milk etc. which are not good for the baby.

EXCLUSIVE BREASTFEEDING:

-Exclusive breastfeeding is defined as breastfeeding but nothing else including water till 6 months of age of the baby. The baby can receive ORS, drops and syrups of vitamins, minerals, medicines as per doctor’s prescription. Breast feeding is the healthiest and the most ideal way of feeding the baby to achieve optimal growth, development and health.

-Babies don’t have enough immunity to fight against infections they can get outside mother’s womb after birth due to absence of IgA antibodies which act against a number of micro-organisms harmful to the baby.

-Breast milk has high levels of IgA antibodies which protect intestinal lining of the baby. Breastfeeding helps in improving the baby’s immunity by passing these IgA antibodies through mother’s milk.

-Breastfeeding hence decreases the risk of infections after birth until the baby develops its own immunity gradually and naturally and also from Vaccinations, given after birth.

-The goal is to encourage the mother to feed as many times as the baby demands, educate her about recognizing the cues from the baby when the baby is hungry, encourage her to take nutritious diet, drink plenty of fluids and proper rest.

-It is known that the baby is hungry when the baby puts hand in mouth or when the baby directs tongue to the side when that side of cheek is stroked gently with finger.

-Baby can be breastfed as many times as the baby is hungry and demands for, rather than keeping a certain time gap between two sessions of breastfeeding.

-Latching in such a way that baby’s mouth covers entire areola is equally important while breastfeeding for good amount of milk intake by the baby. Good latching also prevents mother from getting sore nipples.

-Emptying both breasts by starting feeding alternatively with each feeding is also very important for good breast milk production.

-Exclusive breastfeeding is ideal unless the baby has any complications or disease conditions that require formula milk along with mother’s milk (mixed feeding) for additional nutritional support or if the mother is not able to produce enough milk for exclusive breast feeding.
TOP FEEDS : Giving top feeds to the baby is unnecessary and inevitably exposes the baby to micro-organisms of external environment, increasing the risk of infection.

-Enterocolitis is the most common condition seen in newborns who are given top feeds. The baby develops diarrhea, vomiting leading to dehydration, improper nutrition which disturbs the normal growth and development of the baby.

-If top feeding is inevitable due to a medical condition of a baby, it is important for the caregiver to maintain proper hand hygiene while preparing formula feed and use boiled and cooled water for the preparation of the formula.It is also important for proper sterilization of the feeding bottles and nipples.

– Dr.Divya Teja Pasupuleti

https://www.ncbi.nlm.nih.gov/pubmed/6798576

http://www.who.int/nutrition/topics/infantfeeding_recommendation/en/

Work stress and its management

Stress at the workplace has become a common phenomenon due to external factors such as technological advancement, changes in the economy of a country which might lead to better productivity and stressful working conditions. Stress can be considered as an inevitable condition at least at one point in time or another; however it can also be minimized to the extent that the productivity and health of the employee is maintained which could lead to a productive organization. Work stress is a common occurrence in multinational companies where operation is global and employees have different cultural background.

Stress isn’t always bad. A little bit of stress can help you stay focused, energetic, and able to meet new challenges in the workplace. It’s what keeps you on your toes during a presentation or alert to prevent accidents or costly mistakes. But in today’s hectic world, the workplace too often seems like an emotional roller coaster. Long hours, tight deadlines, and ever-increasing demands can leave you feeling worried, drained, and overwhelmed. And when stress exceeds your ability to cope, it stops being helpful and starts causing damage to your mind and body—as well as to your job satisfaction.

Stress is defined as an organism’s total response to an environmental condition or stimulus, also known as stressor. Stress typically described as a negative condition that can have an impact on an human being’s mental and physical wellbeing.

-Stressors can be Positive or Negative.

Work stress is also known as occupational stress.This is the adverse reaction people have to excessive pressures or other types of demands placed on them at work. Stress is not an illness but a state. However if stress becomes too excessive and prolonged, mental and physical illness may develop.

Symptoms of work stress –

  • Feeling anxious, irritable, or depressed
  • Apathy, loss of interest in work
  • Problems sleeping
  • Fatigue
  • Trouble concentrating
  • Muscle tension or headaches
  • Stomach problems
  • Social withdrawal
  • Loss of sex drive
  • Using alcohol or drugs to cope

There are many factors which cause work stress. These factors are

  • High professional demands
  • Friction in working relationships
  • Frequent changes in the working environment
  • Unclear design of task
  • Poor management style
  • poor working conditions and erratic work hours

Stress is associated with various kinds of illness like, 

  • Heart disease
  • Asthma
  • Obesity
  • Diabetes
  • Headaches
  • Gastrointestinal problems
  • Alzheimer’s disease
  • Accelerated ageing, Hair fall, wrinkled skin
  • Premature death

Stress reduction methods

  • Time management
  • Meditation
  • Proper nutrition
  • Group/social support
  • Creative imagery
  • Self hypnosis
  • Regular exercise
  • Relaxation response-quiet environment, passive attitude, comfortable position

Tips to reduce and manage job and workplace stress

  • Recognize warning signs of excessive stress at work
  • Figure out where the stress is coming from.
  • Consider what you can control and work on that
  • Reduce job stress by prioritizing and organizing
  • Manage your time well. Time management-A key to reduce work stress.
  • reduce job stress by taking care of yourself
  • reduce job stress by improving emotional intelligence
  • reduce job stress by breaking bad habits
  • Do what you love
  • Learn  to say no
  • Put a ‘Do not disturb’ sign
  • Avoid distractions

Modern life is full of hassles, deadlines, frustrations and demands. Stress isn’t always bad. In small doses,  it can help you perform under pressure and motivate you to do your best. But when you’re constantly running in emergency mode, your mind and body pay the price.

You can protect yourself by recognizing the signs and symptoms of stress and taking steps to reduce its harmful effects

– Dr. Prerna Gaur

Useful links

http://www.webmd.com/balance/stress-management/features/10-fixable-stress-related-health-problems

http://news.health.com/category/stress-management/

http://psychcentral.com/blog/archives/2011/07/11/10-practical-ways-to-handle-stress/

http://www.mindtools.com/cgi-bin/sgx2/shop.cgi?page=smmc.html

An approach for diagnosis and management of “vaginal discharge”

“Vaginal discharge” is the term used to describe the fluid that comes out of vagina. There are two types of vaginal discharge which are normal and abnormal.

Normal vaginal discharge: This is usually clear, white discharge which is not associated with any bad smell. Women can have vaginal discharge at different times like these.

-During periods women can have little vaginal discharge

-During their ovulation which is 2 weeks before she gets her period

-During pregnancy due to hormonal changes

-If they are on oral contraceptive medication

-Women will have comparatively less vaginal discharge after menopause.

Abnormal vaginal discharge: It is usually associated with the following symptoms and it requires treatment based upon the cause.

-Itching and pain around vagina, fever, bad smelly discharge, pain while passing urine, pain while having intercourse, change of colour which looks like curd/cheese, greenish, grey etc., bleeding after intercourse can also be noticed. There are several conditions which can cause abnormal vaginal discharge and some of them are

-Infections like candidiasis, Trichomoniasis, Bacterial vaginosis, Chlamydia trachomatis, Gonorrhea.

– A retained foreign body such as a tampon, condom, or vaginal sponge.

-If they use scented soaps, fragrances or wipes to clean that area.

Vaginal discharge during pregnancy:

Increased amount of vaginal secretions are thought to be normal due to the increased blood flow to the vagina and surrounding glands during pregnancy. It is normal if it is not associated with pain, itching, redness, fever, burning sensation while passing urine, foul smelling discharge etc. If a pregnant woman experiences any of these, visiting their treating doctor/Gynecologist is must for a physical examination to rule out possible causes.

Investigations needed:

In most of the cases empirical treatment is started without doing any investigations. Women with persistent or recurrent vaginal/vulvar symptoms should be examined and investigated.

Urine analysis, Random blood sugar, Vaginal or endocervical swab,Ultrasound abdomen and pelvis

How we can treat abnormal vaginal discharge:

Treatment completely depends upon the cause. For example if infection is the cause then we need to treat that infection, we must know for every infection the treatment is different and using medication for long time without doctor’s advice is not recommended.

For some specific infections like sexually transmitted diseases the partner will also need treatment. Treating partners is necessary and it will reduce relapses.

Recurrent infections even after treatment must be examined and evaluated for the possible cause.

 

How to prevent abnormal vaginal discharge:

-Avoid using wipes, scented soaps or fragrances. Instead of them use V wash which is safe but only for external use.

-Avoid intercourse till the time you receive treatment.

-Avoid satin or polyester undergarments instead of that use loose cotton undergarments. Change undergarments 2-3 times in a day.

-Keep the area clean and dry.

– You can use panty liners instead of sanitary pads during your last days of period when you have only spotting.

-Douching (forceful insertion of liquid inside vagina to rise it out) must be avoided.

-Don’t use hair removal creams for removal of hair in the perineal the area.

Drink plenty of water at least 2 to 3 liters, eat a well-balanced meal, plenty of fresh fruits and vegetables, skimmed milk and curd as it is also a rich source of probiotics  which are needed for normal bacteria growth in the vaginal secretions

 

– Dr.​​Alekhya Yelamanchili