HEALTH & FITNESS

How telemedicine can help in health care
Dr S.K. Jindal
Telemedicine is the buzzword in today’s medical practice. It refers to the science and practice of disease management (medicine) from a distance (tele). A telephonic consultation, or medical queries discussed in radio talks on TV shows constitute some simple types of telemedicine.

Work-related sleep disorder
Dr C.S. Gautam
Ruchi, a young brilliant girl who wished to be on her own feet at a very young age, is now in a complete mess. She is continuing with her studies, but at night she works at a call centre against her parents’ wishes where alertness is desired from her.

EYESIGHT
Intrastromal corneal rings
Dr Mahipal Sachdev
Intrastromal corneal rings are an exciting new option for keratoconus patients between contacts and a corneal transplant that may be the best possible option to stabilise the cornea and improve vision.

Britain’s ‘cancer time bomb’
Sadie Gray
Soaring obesity rates have lumbered Britain with a "cancer time bomb" which, combined with an ageing population, will cause a massive increase in cases unless urgent action is taken, an expert has warned.

Health Notes
Green tea for treating inflammatory bladder diseases
WASHINGTON: A recent research has found that green tea could prove helpful in treating inflammatory bladder diseases. The study, conducted by The University of Pittsburgh School of Medicine, looked at the ability of herbal agents to protect bladder cells from inflammation.






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How telemedicine can help in health care
Dr S.K. Jindal

Telemedicine is the buzzword in today’s medical practice. It refers to the science and practice of disease management (medicine) from a distance (tele). A telephonic consultation, or medical queries discussed in radio talks on TV shows constitute some simple types of telemedicine. The more modern and practical application implies the transfer of complete patient data written in a specially designed software to the specialist doctors. This involves the use of computer and communication technologies along with the medical expertise.

Theoretically, the system can be used by doctors or even patients at remote peripheral places to seek opinions and consultations of specialists of referral hospitals. The person seeking advice is required to upload the data in the analogue software and send through the system to the consultant who will analyse and advise accordingly.

In practice, the direct patient-to-doctor consultation is very difficult and requires a costly infrastructure at the patient end. On the other hand, the doctor-to-doctor dialogue is more practical and meaningful. People working at the primary levels of health care can utilise the expertise of those at the secondary or tertiary levels, for example, at the medical colleges and other speciality hospitals. Obviously, it requires a compatible set-up at both ends. It is also time-consuming and taxing on the part of the medical consultants who are required to provide their inputs.

Advice is generally provided on a “store and forward basis” unless a programme is established with the on-site availability of consultants. This is feasible only when the activity is undertaken solely for this purpose and the personnel and the infrastructure are dedicated for telemedicine.

The service can be put to great use for the provision of medical help not only in the relatively remote areas but also at places like villages where qualified doctors are not easily available. It can also be effectively used for mobile services during fairs, camps and other large gatherings to provide on-site consultations for medical problems.

The advice thus provided by the senior consultant can be executed by the medical teams of the mobile unit immediately in case of an emergency. Such utilisation of services is also possible for on-site solutions in cases of disasters and accidents.

The system can in no way replace or substitute the direct patient-to-doctor contact. Distant medical management can only be advisory in nature for the doctor treating the patient at the local place. It also does not make it mandatory or legal for the medical personnel to ignore their own judgements in case there is a difference in approach. The final accountability rests with the doctors handling the patient on the spot.

More importantly in India, the technology processes have a great potential in the field of medical education and research. It is not only the classroom lectures and other teaching sessions of good medical institutes which can be transmitted to other centres, but actual case examples can also be shown and handled in an interactive fashion. This is especially relevant in modern times because of the limited availability of demonstrable case material and procedures.

Sham examples and models can immediately help in providing virtual on-hand practical experience to students. Medical education through telecommunication can also be targeted to other health professionals such as laboratory technicians, nurses and pharmacists.

It is imperative to adapt and design low-cost, indigenous programmes which address the local needs and cross the existing barriers. There is no doubt that one needs to make significant investments in intellectual, administrative and financial inputs to reap the benefits of telemedicine in improving the health scene.

The writer is Professor in charge, Telemedicine Centre, PGI, Chandigarh.

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Work-related sleep disorder
Dr C.S. Gautam

Ruchi, a young brilliant girl who wished to be on her own feet at a very young age, is now in a complete mess. She is continuing with her studies, but at night she works at a call centre against her parents’ wishes where alertness is desired from her. However, the following morning at 6 a.m. she would be back from her workplace and take a nap of three hours and leave for her college at 9.30 a.m.

Unable to get adequate sleep during the last six months, she has lost a few kg of weight; her bubbliness is replaced with the worry on her face. Her parents are really concerned about the sudden decay in her health. Even her performance in the college is gradually going down; she used to be among the first three students a few months back, performance-wise. After a thorough investigation, she has been diagnosed as suffering from shift work sleep disorder (SWSD), a newly recognised medical problem.

(SWSD) is a latest edition to mankind’s worries. Developed countries work in the daytime and entrust some of their work to young Indians in the form of medical or legal transcription. Because of the change in the time zone, individuals are bound to work in India during night-time. They are paid handsomely, but they put their health at great risk.

This recently recognised medical problem will make younger generations in the times to come to pay through their nose. It is recognised lately that such individuals are at an increased risk of cardiovascular problems, gastrointestinal tract problems like irritable bowel syndrome, peptic ulcer, reproductive problems, behavioural and psychiatric problems like anxiety and depression, even road rages and difficulty in concentrating at work. They are more vulnerable to infections because of the suppression of the immune system which is due to the deficiency of sleep.

Due to the continuous use of the computer they are more prone to eye strain and cervical spondylitis. Studies have even proved that the lack of sleep stops brain cell growth.

Invariably, the person coming back from the night shift would not be in a position to go to sleep immediately; even the glaring sunlight and noise around the house may increase either the time required for the onset of sleep or may decrease the total duration of sleep.

There is no approved medication yet for this new problem. Though sleep-inducing drugs are recommended in the day to induce sleep among night-shift workers, chances of drug addiction and tolerance are more with these. It is scientifically documented that shift workers at night should be exposed to the light of high intensity of 8000-12000 lux. It will improve their working capacity, alertness and concentration and may be instrumental in stopping the melatonin release at night, which automatically would be released on the following morning/day.

Research has also shown that taking naps during night shifts would increase work performance. However, scientific literature is silent about whether CNS-stimulant drugs like modafinil on long-term exposure would be free from harmful effects?

Shift work sleep disorder is not only limited to night shift workers but is also a recognised reality in the case of rotational shift workers. So, following proper sleep hygiene — avoiding coffee, tea at bed-time and creating an environment conducive for sleep, etc — would be beneficial in restoring the best physical and mental health in such workers.

Working against the law of nature is always harmful. It would not only reflect upon one’s health but also on many other things.

The writer is associated with the Department of Pharmacology, Government Medical College and Hospital, Chandigarh.

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EYESIGHT
Intrastromal corneal rings
Dr Mahipal Sachdev

Intrastromal corneal rings are an exciting new option for keratoconus patients between contacts and a corneal transplant that may be the best possible option to stabilise the cornea and improve vision. It is estimated that almost 21 per cent of keratoconus patients ultimately progress to an advanced stage of disease requiring corneal transplantation/grafting surgery to restore corneal architecture and improve eyesight.

Intrastromal corneal rings are available as Kera-rings and Intacs prescription inserts. These are indicated for patients with keratoconus, where contact lenses and glasses are no longer suitable.

To begin with, a person with early stage keratoconus will notice a subtle change in their vision. As the disease progresses, one’s vision tends to fluctuate and frequent changes to one’s glasses or contact lenses often occur. This occurs as a result of thinning and bulging of the weakened front surface of the eye. As the disease continues to advance, the light rays entering the eye become significantly distorted, called irregular astigmatism.

Usually, early stage keratoconus is treated with contact lenses or glasses. In later stages, rigid gas permeable contact lenses are often recommended. These lenses are used to improve one’s vision as they act as refracting surface which is spherical and smooth. In advanced cases, where the patient can no longer achieve adequate functional vision with contact lenses, corneal transplant surgery may be necessary. Due to the progression of keratoconus, the weakened cornea loses its natural dome-like shape. As a result, the contact lenses don’t fit well for them.

Intrastromal corneal rings are specially designed inserts, made of medical plastic, which are surgically placed under the surface of the cornea. Due to their unique design, they are able to reshape the cornea, re-establishing a more natural spherical shape and improving one’s vision. The implantation of these rings does not require removal of corneal tissue. The recovery period is typically short, with visual improvement noticed almost immediately.

A corneal transplant is an invasive surgical procedure, requiring the removal of a disc of the cornea and having it replaced with a donor tissue. Although successful, it is a delicate procedure with a typically long recovery period.

The intrastromal rings improve the contact lens fitting in advanced keratoconus patients. They can be removed easily if required and even corneal transplant surgery is possible if it is required in future.

The implantation of these intrastromal rings can be combined with the C3R procedure. Cornea collagen cross linking using riboflavin (C3R) is the new procedure. Here, the corneas are cross-linked by the application of the photosensitiser riboflavin and exposure to UVA light (370 nm, 3 mW/cm2) for 30 minutes. Collagen cross-linking using riboflavin and UVA leads to a significant increase in the corneal collagen diameter. This alteration leads to an increase in biomechanical stability.

The placement of intrastromal corneal rings reshapes and reinforces your cornea, eliminating some or all of the irregularities caused by keratoconus in order to provide you with improved vision.

The writer is Chairman and Medical Director, Centre for Sight, New Delhi. Email: msachdev@bol.net.in 

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Britain’s ‘cancer time bomb’
Sadie Gray

Soaring obesity rates have lumbered Britain with a "cancer time bomb" which, combined with an ageing population, will cause a massive increase in cases unless urgent action is taken, an expert has warned.

Research has shown up to 40 per cent of cancers, particularly hormone-sensitive types such as breast and endometrial cancer (affecting the womb lining), can be prevented by adopting a healthy diet and taking regular exercise, said Dr Greg Martin, science and research manager at the World Cancer Research Fund. Obesity was also associated with cancer of the oesophagus and bowel, said Dr Martin.

"There has been plenty of attention recently on the problems of obesity, but a lot of people still do not realise how closely obesity is linked to cancer," he said. "People getting fatter will lead to an increase in the number of cancer cases as surely as night follows day.

Dr Martin, who was speaking at the start of his charity's Cancer Prevention Week, added: "You also have to add into the mix that cancer is largely an older person's disease, and the UK has an ageing population. So if you have an ageing population that is getting more obese, there could be really serious consequences in terms of the number of people getting cancer if people do not act now. It's a cancer time bomb."

Although the biological mechanics connecting obesity and cancer were far from clear, he said, adipose tissue, which makes up the rolls of fat that form around the belly, was not inert but produced oestrogen. The hormone is known to fuel certain cancers. For people with oesophagus cancer, which is especially deadly, obesity may increase acid reflux which in turn raises the risk of cancer.

In 2003 an estimated 4.3 million British men were obese, said Dr Martin. That figure was expected to rise to 6.6 million in 2010. "It's a huge chunk of the population," he said. "Each of these 6.6 million people are going to have an increased risk of cancer, but this is an avoidable risk factor.

"This kind of increase cannot be explained by anything genetic. It's almost certainly a function of behaviour. It's something we can do something about."

He said he expected cancer rates to follow the pattern of obesity. "When you look at a time series of maps it's really like an epidemic, a virus spreading,” Dr Martin added. — The Independent

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Health Notes
Green tea for treating inflammatory bladder diseases

WASHINGTON: A recent research has found that green tea could prove helpful in treating inflammatory bladder diseases.

The study, conducted by The University of Pittsburgh School of Medicine, looked at the ability of herbal agents to protect bladder cells from inflammation.

The study being presented at the annual meeting of the American Urological Association (AUA) in Anaheim, Calif., found that constituents of green tea protected bladder cells from injury in culture.

Green tea, reported to have many health advantages, is rich in potent antioxidants that make it a potential cure for many medical conditions. It consists of catechins, plant metabolites that supply it with many anti-oxidative properties. — ANI

Statins may be useful for hepatitis C patients

WASHINGTON: A new study has demonstrated the potential of statins, used in important cholesterol management therapies, for improving the management of hepatitis C.

Statins or HMG-CoA reductase inhibitors form a class of hypolipidemic agents, used as pharmaceutical agents to lower cholesterol levels in people with or at risk for cardiovascular disease.

Two studies were conducted by a team of researchers led by Ted Bader at the University of Oklahoma in Oklahoma City to see the effect of statins.

As part of the first study, researchers conducted a 14-day study looking at the antiviral effect of fluvastatin (FLV) in vivo, in hepatitis C virus (HCV) patients who take statins, to see whether they experience any improvements in alanine transaminase (ALT, liver enzymes) levels. — ANI

Sleep apnoea patients face higher risk of accidents

WASHINGTON: A new study has found that the severity of motor vehicle crashes involving personal injury in people with obstructive sleep apnoea is higher than those who do not suffer from the disorder.

In obstructive sleep apnoea, the upper airway narrows, or collapses, during sleep. Periods of apnoea end with a brief partial arousal that may disrupt sleep hundreds of times a night. Obesity is a major risk factor for sleep apnoea.

The study as part of UBC Sleep Disorders Program in Vancouver, British Columbia, was conducted by a team of researchers led by Alan Mulgrew at the University of British Columbia.

As part of the study, researchers analysed 800 people with sleep apnoea and 800 without the night-time breathing disorder. — ANI

Apple and fish intake good during pregnancy

WASHINGTON: A new study has found that women who consume apples and fish during pregnancy may lessen the risk of their babies developing asthma or allergic disease.

The study, conducted at the University of Aberdeen, UK, found that the pregnant women who ate the most apples were most likely to protect their kids from asthma, as compared to the children of mothers who had the lowest apple intake.

The study also found that children of the mothers who ate fish once or more a week were at a lesser risk of eczema than children of the mothers who never ate fish.

The study did not find any defensive outcome against asthma or allergic diseases from many other foods, including vegetables, fruit juice, citrus or kiwi fruit, whole grain products, fat from dairy products or margarine or other low-fat spreads. — ANI

Nanotechnology paves way for nerve cell regeneration

WASHINGTON: Two group of scientists from the University of Miami and the University of California have shown that nanotechnology may help enhance the regeneration of nerve cells, and thereby reduce the effects of trauma and disease in a dramatic way.

The two presentations were made at the NSTI Nanotech 2007 Conference.

Developed by researchers at the University of Miami, the first method show how magnetic nanoparticles (MNPs) may be used to create mechanical tension that stimulates the growth and elongation of axons of the central nervous system neurons.

“By providing mechanical tension to the regrowing axon, we may be able to enhance the regenerative axon growth in vivo,” explains Dr Mauris N. De Silva.

Although the study is at a very preliminary stage, its findings may have significant implications for the treatment of spinal cord injuries, and it is a vital “next step” in bringing nanotechnology to clinical use. — ANI

No evidence of cancer transmission via transfusion

New York: People who receive a blood transfusion from a donor with undiagnosed cancer do not appear to be at increased risk of developing the malignancy themselves, new research indicates.

The findings, reported in The Lancet, were from an analysis of data entered in Swedish and Danish blood bank registers from 1968 to 2002. Blood donors diagnosed with cancer within five years of donation were considered to have had a subclinical malignancy at the time of donation. — Reuters

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