The most prevalent hormonal disorder among women of reproductive age is polycystic ovarian syndrome (PCOS). This condition involves endocrine gland malfunction, which causes an increase in the production of male hormones (androgen), resulting in hormonal imbalance. PCOS causes cysts to develop in follicles with immature eggs, causing them to grow inside the ovaries and not mature. Failure to generate mature eggs can interfere with ovulation, resulting in infertility. PCOS has been linked to reproductive difficulties, infrequent or extended periods, weight gain, excessive body hair growth, and acne in women.
PCOS IN INDIA
India has experienced an increase in PCOS instances due to lifestyle changes and added pressures brought on by the virus. While this illness is growing more frequent among women, the symptoms may be controlled with correct medical treatment and good lifestyle choices including eating a balanced diet and exercising regularly.
According to the All India Institute of Medical Sciences (AIIMS), one in every four women has PCOS, while one in every ten women between the ages of 35 and 49 has diabetes (the Journal of Diabetes & Metabolic Disorders).
HOW IS PCOS RELATED TO DIABETES?
Women with PCOS are more likely to acquire diabetes because hormonal imbalances caused by PCOS and obesity can lead to insulin resistance and compensatory hyperinsulinemia in the body, which is a known component in type 2 diabetes development. For women with PCOS, a lack of physical exercise, along with a poor diet and a stressful lifestyle, can contribute to obesity and hormonal disruption, which can lead to diabetes. Women with PCOS should maintain a balanced lifestyle that includes adequate food and exercise to keep their hormones in line and diabetes at bay.
PCOS is a condition in which a woman’s reproductive system does not operate correctly. According to some estimates, PCOS is directly or indirectly responsible for around 70% of female reproductive problems. Small fluid-filled sacs develop on the ovaries in PCOS, which can turn into cysts. It can result in poor egg quality and infrequent ovulation, lowering the odds of becoming pregnant.
Diabetes, on either side, can reduce women’s fertility by delaying the beginning of menstruation (or menarche). This can result in excessive sugar levels, which can accelerate ovarian ageing and lead to premature menopause. Diabetes is linked to menstrual irregularities, particularly in women of reproductive age. The likelihood of delayed periods or oligomenorrhea is directly related to blood glucose levels. As a result, diabetes can reduce a woman’s reproductive lifetime while simultaneously altering her biological clock.
HOW IS PCOS ASSOCIATED WITH SECONDARY INFERTILITY?
A much lesser-known impact of PCOS is secondary infertility. The World Health Organisation defines secondary infertility as “when a woman is unable to bear a child, either due to inability to become pregnant or inability to carry a pregnancy to a live birth following either a previous pregnancy or previous ability to carry a pregnancy to a live birth following either a previous pregnancy or previous ability to carry a pregnancy to a live birth.” In layman’s terms, Secondary Infertility is the inability to conceive for the second time.
It’s discouraging to know we don’t always know the reason behind secondary infertility. Lifestyle factors that cause infertility in the first place are likely to induce subsequent infertility, and vice versa. While some of these may manifest as problems early on (and thus be detected during primary infertility), others may not manifest until after one (or a few) successful pregnancies. Here are several possible reasons for infertility, both primary and secondary.
Hormonal imbalance (either too high or too low) due to PCOS is one of the reasons for secondary infertility due to the havoc on the brain-ovary connection. If the brain doesn’t provide the correct signals, the ovary won’t know it’s supposed to deliver an egg every month. Some of these hormonal imbalances may not show up until later in life. Hormonal imbalances can be caused by the thyroid, pituitary gland, or a diagnosis of polycystic ovary syndrome. Besides increasing the risk of infertility, PCOS may also lead to other problems such as metabolic syndrome, sleep apnea, endometrial cancer, and depression.
Making healthy lifestyle changes and choices can go a long way in curbing hormonal imbalances in the body and reducing the risk of diabetes, secondary infertility and other health complications that may be caused by PCOS. It is also advised to consult your doctor for diagnosis and treatment plans, especially if one is planning to conceive a child.
The writer is CEO and Co-Founder of Indira IVF.
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DENGUE FEVER DURING PREGNANCY CAN HAVE SERIOUS EFFECTS TO THE FETUS
Dengue is caused by the bite of an infected Aedes Aegypti mosquito and presents as a high-grade viral fever. Pregnant women need to protect themselves from getting infected with the disease as the occurrence of dengue in pregnant women is on the rise due to a heavy increase in mosquitoes in densely populated areas.
Worldwide there are 190 million cases of dengue, while our country is seeing a 25% increase each year mainly due to ineffective preventive steps to control mosquito breeding. As we look at the statistics, it becomes extremely important to keep your surroundings clean to stay away from dengue. Here are some important things about dengue that pregnant women need to keep in mind.
BEING CAREFUL WHILE YOU ARE PREGNANT
While you are pregnant, it is important to be careful of the places you travel to as dengue is fairly common in more than 100 countries, including tropical countries. Before you set out on your journey, ensure to find out if dengue is prevalent in that country. Also, do not forget to talk to your gynaecologist before travelling. Prevention is better than cure as far as dengue is concerned as an expecting mother infected with dengue has the possibility to pass the infection to her fetus during pregnancy or at the time of birth. Dengue can have serious effects on the fetus including low birth weight, premature birth and even death.
However, if you happen to reside or need to travel in an area with risk of dengue, do remember to protect yourself from mosquito bites by wearing long-sleeved clothes, using a safe mosquito repellent, staying at a place with screens on windows and doors and most important is to take adequate steps to keep your surroundings clean to control mosquitos in and around your locality.
EFFECTS OF DENGUE ON MOTHER
For expectant mothers who happen to contract the infection—adequate fluid intake is the first thing to be prescribed as hydration is crucial to maintain embryonic fluid level. In addition to antipyretics, careful monitoring is important by medical experts.
Besides high-grade fever, persistent vomiting, fluid accumulation, intense headache, retro-orbital pain, abdominal pain, mucosal bleeding, lethargy, liver enlargement, and increasing haematocrit with decreasing platelets are some other symptoms. haemorrhage, severe plasma leakage, or organ failure are some of the presentations of severe dengue. Also, pregnant women infected with dengue have a possibility of pre-term delivery, low birth weight babies and pre-eclampsia.
Effects of dengue on the fetus or newborn vary with possibly less fetal harm occurring earlier in pregnancy. Early detection of dengue in pregnancy and appropriate medical care reduces fatality to below 1%. In view of the risk of vertical transmission, newborns with mothers who had dengue just before or at the time of delivery need to be closely monitored.
In summation, dengue fever also known as a break-bone disease results in severe weakness in patients which can be very dangerous for pregnant women. Timely treatment is the key to controlling the infection in its early stages. Any delay in treatment could result in multi-organ infection, acute respiratory distress syndrome and internal bleeding which can lead to spontaneous abortions and other complications in expectant mothers.
The writer is Gynaecologist, Obstetrician, and IVF Expert, Nurture IVF Clinic.
Pregnant women need to protect themselves from getting infected with the disease as the occurrence of dengue in pregnant women is on the rise due to a heavy increase in mosquitoes in densely populated areas.
Worldwide there are 190 million cases of dengue, while our country is seeing a 25% increase each year mainly due to ineffective preventive steps to control mosquito breeding.
DEPRESSION AND ITS PHYSICAL MANIFESTATIONS
“Our mind controls our body” is true to a great extent as a lot of people having mental illnesses have physical expressions of the same. Of all the mental illnesses it’s primarily depression and anxiety which have physical manifestations to a greater extent. Depression is a mental illness that affects the mood of people, leads to a feeling of hopelessness, reduced attention and concentration. Beyond that, it also leads to a variety of physical symptoms. Some of the physical manifestations which point towards depression are as follows:
Weight Changes: Appetite changes are most seen in depression and people can have either weight gain or weight loss. Some patients feel excessive craving for food and hence they end up gaining a significant amount of weight due to their binge eating. This increase in weight further like a ripple effect leads to various health conditions like heart disease and diabetes. On the other hand, a few people give up food completely owing to their depression and thus experience fatigue, exhaustion and other health issues.
Sleep deprivation: Insomnia is one of the most reported symptoms of depression. The patients who experience sleep deprivation for a long time start seeing effects on their cognition, experience weight gain, have cardiac manifestations and it is also reported to lead to various serious health issues like cancer.
Chronic Pain and Inflammation: Another frequently reported symptom especially in the Asian Population is chronic joint and muscle pains when people are depressed. Breast tenderness in females and headaches which can be debilitating at times are also reported by patients. In these patients, pain affects more due to decreased pain tolerance. Depressive patients also report repeated inflammations or worsening of inflammatory conditions like arthritis, inflammatory bowel disease, and type 2 diabetes. There is some relationship between worsening of these conditions and research is still on to figure out what causes what?
Gastric Problems: As mentioned above, eating patterns start changing in any person who is emotionally deprived or distressed. Eating problems can lead to nausea, vomiting, diarrhoea and constipation. Some patients experience IBS symptoms and treatment of depression will not lead to improvement in these symptoms and treatment requires a lifestyle change. The gut is considered as the second brain so gastric problems are very commonly seen in depression, as the change in the bacteria in the gastric tract precipitate both anxiety and depression. Eating a balanced diet with probiotics can solve this issue.
Heart Disease: Change in sleeping, eating predisposes a patient to cardiac conditions as depression leads to major lifestyle changes and a sedentary lifestyle.
Sexual health problems: The major treatment of infertility as explained by most of the experts is destressing the couple. Depression is seen to affect the libido of people, having a less pleasurable sexual life and hence the effect on fertility is seen.
Worsening of underlying chronic health issues: Diabetes, hypertension, and a lot of other chronic conditions worsen in depression. Hence, it’s mandatory to manage both things simultaneously as depressed patients are not able to follow the advised treatment plans and compliance becomes an issue due to forgetfulness.
Overexpression of physical symptoms is one of the reasons for an increase in the number of patients being reported to the psychiatrist by general physicians and there is a strong connection between physical complaints and depression.
The writer is a Consultant Psychiatrist, Masina Hospital, Mumbai.
TECHNOLOGY IS REVOLUTIONISING INDIA’S PRIMARY HEALTHCARE SYSTEM
Health-tech innovators are building IoT-centric connected solutions enabling patients to manage their health more affordably.
Improving the accessibility, affordability, and quality of care should be the heart of the primary healthcare system. While the Covid-19 pandemic crippled India’s primary healthcare system, it also accelerated digital health transformation across the industry. Digital health tools like point-of-care diagnostic devices, teleconsultation applications, EMR/EHR systems etc., facilitated a rapid response and in turn saw a huge uptake—which has laid a foundation for changes in the delivery of care to improve accessibility, affordability, and quality of care.
Accessibility: About 75% of all healthcare resources such as doctors, hospitals, and diagnostic facilities are concentrated in the urban areas which house less than 30% of the population. This has resulted in a tremendous lack of primary healthcare access for the rural population. People need to travel to address minor concerns which costs them both, time and money, over and above actual medical expenses. It’s easier, in this scenario, to ignore health concerns until serious intervention is warranted. Easily curable conditions like Malaria or Breast cancer lead to mortality due to delay in seeking intervention. Thus, there is a prevalent tendency to ignore health conditions until one becomes sick enough to warrant urgent medical care. This challenge of providing ‘care near home’ is now being effectively overcome by integrated digital healthcare support where point-of-care diagnostic devices, telemedicine consultations, and preventive management of diseases. For example, eSanjeevani OPD, a doctor to patient telemedicine system developed by the Centre for Development of Advanced Computing (C-DAC) in Mohali under the Ayushman Bharat Scheme of the Government of India has improved healthcare access in rural communities. Daily over 40,000 patients use eSanjeevaniOPD to seek health services remotely.
Affordability: India has one of the lowest per capita healthcare expenditures in the world. In fact, it is less than even 10% of the global average. While government healthcare facilities offer free treatment, the cost of medicines and diagnostics is still required to be managed out-of-pocket by the public. Due to the lack of doctors and facilities at government-run hospitals, people prefer private hospitals. Further, the government sector accounts for only about 1/3rd of the overall healthcare ecosystem, and the majority of the services especially in the diagnostics arena are managed by the private sector.
In such a scenario, there is an urgent need to develop and deploy affordable cutting-edge technologies. Health-tech innovators are building IoT-centric connected solutions enabling patients to manage their health more affordably by encouraging preventive lifestyle changes, facilitating disease self-management, and lowering the direct and indirect costs of clinic visits, travel or unpaid time off work.
Quality of care: The application of artificial intelligence (AI) and data analytics in healthcare has significantly improved the outcomes and quality of care. AI’s biggest benefit comes in the form of the ability to repeatedly process data and conduct tasks such as analysis of lab tests, evaluation of scans, offering data-driven medical consultations and customisations as per a patient’s medical history. Computerised patient records can reduce medical errors, improve patient safety, and promote quality improvement in diverse patient settings. AI and Big Data are streamlining the operational process of clinical trials resulting in the development of medicines at a faster pace.
Digital health is vital to strengthen any country’s primary healthcare system. As per World Health Organisation, to make digital health a reality in primary health care, countries must address its key components. These include: building the physical infrastructure, deploying appropriate services and applications, developing a capable health workforce, ensuring a sound legal and regulatory environment, and improving governance, policy, standardisation and interoperability.
Undoubtedly, India has embarked on a path to build a digital healthcare ecosystem There will be greater emphasis on out-of-hospital healthcare for disease treatment and prevention. Handheld and personalised IoT devices will lead the diagnostic and disease management efforts and with the unveiling of the NDHM, integration with health insurance and other components is the next step in this direction.
It remains to be seen if the pipe dream of equal and affordable universal healthcare for all will become a reality courtesy of the digital healthcare innovations taking place in India!
The writer is the CEO of HealthCube.
ALL YOU NEED TO KNOW ABOUT EPILEPSY AND MANAGING SEIZURE ATTACKS
Epilepsy is a long-term illness that produces recurrent, uncontrollable seizures. Epilepsy is diagnosed after a person has experienced two or more unprovoked seizures. Seizures occur when a burst of electrical impulses in the brain exceeds their usual boundaries. They spread to other places, causing an uncontrollable storm of electrical activity. Electrical impulses can be conveyed to muscles, resulting in twitches or convulsions. 17 November is observed every year as National Epilepsy Day to create awareness about epilepsy.
Seizures can be divided into two categories. Seizures that affect the entire brain are known as generalised seizures. Focal seizures, also known as partial seizures, impact one portion of the brain. A mild seizure may just last a few seconds and can be difficult to detect. Seizures that are more severe can produce muscular spasms and involuntary twitches, and they can last anywhere from a few seconds to several minutes. Some individuals get disoriented or lose consciousness after a more severe seizure.
Seizures can be triggered by a lack of sleep, sickness or fever, stress, bright lights, flashing lights, or patterns, coffee, alcohol, medications, or narcotics, skipping meals, overeating, or certain dietary ingredients. A seizure is generally caused by a combination of factors. Keeping a seizure notebook is an excellent approach to figuring out what triggers your seizures. After each seizure, write down the date and time, what you were doing, what was going on around you, any strange sights, smells, or noises, any unusual stresses, what you were eating or how long it had been since you’d eaten, your degree of exhaustion, and how well you slept the night before.
The following are some factors that may increase the risk of epilepsy: Epilepsy is most commonly diagnosed in children and older people, although it can strike anybody at any age. If your family has a history of epilepsy, then you may be more susceptible to having a seizure problem, instances of head injury, strokes, and other vascular illnesses that can cause brain damage, which can lead to epilepsy. Infections that cause inflammation in the brain or spinal cord, such as meningitis, may further raise the risk. Seizures are also occasionally linked to high fevers in children. Steps to be taken to assist someone who is having a seizure: Allow the patient to lie on the ground and gently roll the individual to one side. Remove any ties or other objects from around the neck that may make it difficult to breathe. Take off the spectacles and clear the area surrounding the individual of anything hard or pointy. Place something soft and flat beneath his or her head, such as a folded jacket. Seizures should be timed and look for a medical bracelet or other emergency information. It is also critical to never perform any of the following: Do not restrain the individual or restrict his or her actions. Never put anything in the person’s mouth as this might result in tooth or jaw damage. Do not perform mouth-to-mouth breaths (like CPR) as post the seizure, most people resume breathing on their own. Wait till the person is entirely awake before giving him or her a drink or food. Contact an ambulance or take the individual to the hospital right away if they face the following:
· Has never previously experienced a seizure or after the seizure.
· The patient has trouble breathing or awakening after the seizure.
· More than 5 minutes have passed since the seizure started.
· Soon after the first seizure, the individual experiences another.
· During the seizure, the patient gets injured.
· The seizure occurs when the individual is in water.
· The person has diabetes, heart problems, or is expecting a child.
The writer is a Consultant Neurologist and Epileptologist, Aster RV Hospital.
BRIDGING THE GAP BETWEEN ROBOTIC-ASSISTED SURGERY AND MASSES
Modernisation in the field of medical science is a sign of the development of any society or country. With the increased research in the usage of robotics for surgeries, the entire landscape of the healthcare system is changing. After the first patient was operated on in 1998 using a surgical robot, over a million robotic surgeries have been completed successfully in the last 20 + years with a continuous evolution in technology.
India was not much behind at acknowledging the change and the first robotic system was installed at Fortis Escorts in 2002, I was the first to do the procedure in December 2002. But the growth in the number of robotic surgeries was not on the surge. Currently, there are close to 79 robotic surgical system installations present in India that are not being used to their full potential as these systems are far too expensive and take years to master, due to which very few surgeons get trained to operate these robotic systems and, much of the world is still waiting to benefit from this technology.
The current robotic system da Vinci available in India at the highest level sells at 16 to 18 crore. Robotic surgery through this system is expensive than conventional surgery and so still not sought after. With a population of 1.4 billion people, robotic surgery will be a blessing in India as it causes fewer traumas and helps the fast recovery of a patient with fewer complications. Just like India, many parts of the world do not have access to less invasive operations. People should get a chance to get to choose robotic surgery as it’s less invasive and more precise. It’s a move towards stronger healthcare infrastructure.
To bring robotic surgery to the masses is a challenge in the present scenario as it’s not cost-effective. Almost 93% of world robotic systems exist between the US, Europe, and Japan. The rest of the world is still waiting for easy access to robotic surgery, mainly due to the cost and partly due to the deficit of knowledge and learning.
The next-generation surgical robots should be economical to bridge the gap, which can be made available for more people and benefit the world in the long run. Around 140 companies and research institutions are working on various robotic systems. The focus is on how to keep it cost-effective. If the procedures are economical and the maintenance contracts are affordable, more patients will get the benefit. Keeping this vision in mind, we are all set to launch the first Made in India robotic surgical system SSI Mantra by the end of this year. The introduction of the SSI Mantra to the Indian healthcare system will revolutionise it. It is going to be our first step towards making robotic surgery part of our healthcare system. Young doctors will also get a scope to learn how to perform surgeries through the robotic surgical system during their Post Graduate training.
Everything said and done is still a huge responsibility to bridge the gap depending on creating awareness about the benefits of robotic surgery. Acceptance of robotic surgery needs to increase significantly, along with the cost-effectiveness. The transition from conventional surgery to robotic surgery will be complete once accessibility and affordability are chalked out and planned accordingly.
The writer is MD and founder of SS Innovations Pvt. Ltd.
HEALTHY HABITS TO STRENGTHEN YOUR IMMUNITY AGAINST PNEUMONIA
Pneumonia can be prevented with simple interventions, low-cost treatment and medication, and care.
Pneumonia is an acute lung infection that can affect one or both lungs. When the alveoli (the part where the lungs and the blood exchange oxygen and carbon dioxide during breathing) get filled with pus, it becomes difficult for the person to breathe. The condition inflames the lungs causing fever, cough, chills, and breathing problems. Pneumonia is caused by bacteria or viruses, which can provoke serious health conditions, especially in children and elders, by attacking their immune system.
Foods that will help prevent pneumonia and strengthen immunity.
According to the World Health Organisation (WHO), pneumonia is the most common infectious disease in the world that can be prevented with simple interventions, low-cost treatment and medication, and care.
Since pneumonia can occur at any age, it is important to identify the common signs:
• Cough (with yellow, green, or bloody mucus)
• Sweating, rapid breathing, and pulse
• Loss of hunger
• Fatigue and weakness
• Chest pain while coughing or breathing
• Muscle pain
• Shortness of breath
• Chronic cough (in severe cases)
The symptoms can also depend on the type of pneumonia infection.
TYPES OF PNEUMONIA
Some of the different types of pneumonia are:
1. Lobar pneumonia: Also known as Non-segmental pneumonia, this is caused by a bacterial infection that affects one or more lobes of the lungs.
2. Bronchial pneumonia: This fungal or viral pneumonia causes infection in the bronchi of the lungs.
Doctors also describe pneumonia based on the place you get the infection and can be categorised as:
• Hospital-acquired pneumonia (can be acquired during long hospital stay)
• Community-acquired pneumonia (caused by bacteria, viruses, fungi, or by breathing food, fluid, or vomit into the lungs)
• Bacterial pneumonia (illness, poor nutrition, old age, or impaired immunity where the bacteria infect the lungs)
• Viral infection pneumonia (caused by flu or influenza)
• Fungal infection pneumonia (caused by breathing fungal spores)
• Atypical pneumonia (mild symptoms which can be treated easily)
PREVENTION AND TREATMENT
Treating and preventing pneumonia is possible with the help of medications and following healthy habits that can strengthen your immune system. Some of the treatment options available are:
• Flu is the most common cause of pneumonia and can be treated with a flu vaccination. A flu vaccination once a year protects you against both flu and pneumonia.
• Getting a shot of pneumococcal vaccine for bacterial pneumonia
• Antibiotics for a speedy recovery
• Other treatments that can help treat pneumonia at home include a healthy diet, staying hydrated, oxygen therapy, medicines for pain, fever, and cough
With early identification and doctors’ consultation, pneumonia can be treated at home with few medications and precautions as part of daily routine.
The treatment of pneumonia depends on its type, but following these useful tips will help you prevent pneumonia and strengthen immunity:
• Add yoghurt to your daily diet. The probiotic supplement improves the defence system of the body against infection
• Eating fermented food increases the ability to fight viral and bacterial infections of pneumonia
• Zinc strengthens immunity and fights against lung infection. Some of the rich sources of zinc include red meat, seafood, tofu, nuts, whole grains, legumes, and dairy products
• Increasing the intake of Vitamin C acts as an antioxidant and enhances the functioning of immune cells. Vitamin C is abundantly found in fresh fruits and vegetables, sprouts, peppers, parsley, spinach, and other green leafy vegetables.
• Loss of vitamin D is the main cause of common cold and other respiratory tract infections. Including egg yolk, fish, red meat, and breakfast cereals provide supplementation of Vitamin D.
• Including garlic in food strengthens immunity with its antimicrobial, antifungal, and antiviral properties.
Apart from healthy food, one must avoid smoking, get vaccinated, maintain hand hygiene and be aware of general health practices. The early signs of pneumonia include respiratory problems such as cold, flu, mild fever, muscle aches, or fatigue. You must contact your doctor in case you are experiencing these symptoms. Bacterial pneumonia can adversely affect children and senior citizens. Therefore, timely intervention is prevention.
The writer is from the Department of Pulmonology at CK Birla Hospital, Gurgaon.
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