Monday, December 30, 2013

Super-speciality block nearing completion - The Hindu

Super-speciality block nearing completion - The Hindu
Parasitic twin operated on in Trichy hospital
Dec 31, 2013, 01.18AM IST TNN?
TRICHY: The doctors at Mahatma Gandhi Memorial Government Hospital (MGMGH) here performed a complicated surgery on a parasitic twin for the first time in the history of the hospital. The male baby, which was born with extra organs, has now been put on ventilator as its condition was unstable.
"A team of five doctors including paediatric surgeons and anaesthetists performed the surgery on the five-day-old male parasitic twin born with parasitic phagus from 10am to 1.30pm on Monday. We successfully removed the additional legs, arms, penis and urinal bladder conjoined with the normal baby. The anaesthetists also played a major role in the operation," said paediatric surgeon Dr Baskaran, head of paediatric surgery department at the MGMGH, on Monday.
The case is considered to be rarest of the rare because the baby's intestines and spleen are still outside the body. The doctors have left the two organs outside after surgery because they cannot be pushed into the abdominal cavity. "The intestines and spleen cannot be inserted into the abdominal cavity as it will lead to major complications. So, we have adopted SILO technique by which the two organs will be covered by a bag to nudge the intestine into the abdominal cavity. As it will take three to four days, the baby is put on ventilator," said Dr Baskaran who had already said that the success rate is very low.
The baby is the fifth one born to Vijaya and Mamundy, both labourers, from Poigaipatti near Manapparai. The baby, which was born in a private hospital at Manapparai, was referred to the MGMGH on December 25. Since then the MGMGH doctors conducted numerous tests before deciding on operating the baby.
The MGMGH doctors have not estimated the surgery cost. "Normally, private hospitals don't take up this task. But it will cost about Rs 5 lakh for this operation," said Dr Baskaran.
Neurologist Dr MA Aleem, vice-principal of KAPV Government Medical College, said Vijaya did not take abdominal ultrasound test while carrying the baby. "It is a must for all pregnant women to undergo this test. The congenital deficiency could have been diagnosed and the fetus aborted to avoid such complicated births," said Dr Aleem.

Friday, December 27, 2013

Anxiety Increases Stroke Risk

High anxiety levels were associated with an increased risk for incident stroke independent of other risk factors, including depression.

"Anxiety is a modifiable experience that is highly prevalent among the general population. Its assessment and treatment may contribute to developing more effective preventive and intervention strategies for improving overall cardiovascular health.

"Everyone has some anxiety now and then. But when it's elevated and/or chronic, it may have an effect on your vasculature years down the road.

More anxiety symptoms at baseline was associated with an increased risk for incident stroke after adjustment for standard biological and behavioral cardiovascular risk factors.


Chronic anxiety could lead to excess activation of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system that may increase the risk for stroke.

Anxiety could also contribute to stroke or other cardiovascular disease by lowering the threshold for arrhythmia or by reducing heart rate variability

Wednesday, December 25, 2013

8 Limbed baby to be operated in Trichy

8 Limbed Baby to be Operated in Tiruchy

By Express News Service - TIRUCHY

Published: 26th December 2013 08:00 AM

Last Updated: 26th December 2013 08:02 AM

Dr M A Aleem and Dr D Baskaran checking the baby at MGMGH in Tiruchy on Wednesday | M K ASHOK KUMAR

In what is being seen as a major medical challenge, a baby who was born with eight limbs at a Manapparai private hospital two days ago has been admitted to Mahatma Gandhi Memorial Government Hospital (MGMGH) for treatment.

The medical officials were quick to form a team to perform a surgery next Monday. The medicos say that the case is rarest of rare and they are proceeding medical investigation to remove the extra limbs of the baby, who is sick to some extent.

According to officials, the woman, wife of Mamundi of Manapparai had developed labour pain on December 23 and was admitted in a private hospital in Manapparai. During the delivery, she gave birth to a baby boy with octo-limbs and the medical officials referred the case to the Tiruchy MGMGH.

D Baskaran, Pediatrician, MGMGH, said when a diagnosis was done, they found that the baby was affected by ‘Parasitic Pagus’, in which the baby has asymmetric legs and hands, but looked like one limb. “We will perform the surgery to remove the limbs,” he said, adding that the baby should be fine post operation.

Hospital officials said that this is the first case the MGMGH has received in its history. Tiruchy KAPV government medical college, vice-principal, Dr M A Aleem told Express, “One in a million would get this kind of case and it is also new to the MGMGH. A team has been formed to perform the surgery”.

The surgery would be performed under the Chief Minister’s Comprehensive Health Insurance Scheme (CCHIS), he added.

Conjoined twins to undergo surgery - The Hindu

Conjoined twins to undergo surgery - The Hindu

Parasitic twins

Trichy doctors to operate on parasitic twins

Dec 26, 2013, 01.40AM IST TNN[ R Gokul ]

TRICHY: Two-day old parasitic twins have been admitted to the Mahatma Gandhi Memorial Government Hospital (MGMGH) here on Wednesday. The doctors will conduct a risky surgery on them to remove their extra limbs on December 30. A surgery of this type will be the first in the history of MGMGH.

"It will be one of the rarest of rare surgeries. Their extra two legs and two arms are conjoined with chest. So, it will be a complicated surgery," said Dr D Baskaran, head of paediatric surgery department at the MGMGH.

The conjoined twins, which have the medical condition called 'parasitic pagus', were born to a poor couple Mamundy and Vijaya who are residents on the outskirts of Manapparai. This is their fifth baby.

Vijaya gave birth to the twins at a private hospital in Manapparai on Tuesday. Considering the complication, the babies were referred to the MGMGH on Wednesday. The two arms and two legs of the infants are conjoined with the chest. "We have decided to take up the rarest of the rare surgery on Monday. Such cases will happen in one in one-million babies," said Dr MA Aleem, vice-principal of KAP Viswanatham Government Medical College which is part of the MGMGH.

Dr Aleem also said that MGMGH doctors have never performed such a surgery. "We are proud to take up the challenge and our team of doctors will succeed in the task," said Dr Aleem.

The doctors said the MGMGH has all the facilities to conduct the planned surgery which will commence at 8am on Monday. "Many tests have to be conducted before the surgery. The costs cannot be calculated because we will be doing it for the first time. The doctors from our hospitals will only be part of the task because we have all the specialists as far as this surgery is concerned," said Dr Baskaran.

On the success rate of the surgery, Dr Baskaran said "The success rate is very low. Nevertheless, we will try our best to make our attempt successful."

"Medical conditions like 'parasitic pagus' is very uncommon anywhere in the world," said Dr Baskaran.

Saturday, December 21, 2013

Fast food and Kids

Children find themselves amidst a complex society that is undergoing breathtaking changes. Concepts, relationships, lifestyles are metamorphisised to accommodate the new jet-setting age. Food is no exception. Healthy nutritious foods have been replaced by the new food mantra - JUNK FOOD! Junk food comprises of anything that is quick, tasty, convenient and fashionable. It seems to have engulfed every age; every race and the newest entrants are children. Wafers, colas, pizzas and burgers are suddenly the most important thing. The commonest scenario is a child who returns from school and plonks himself in front of the television, faithfully accompanied by a bowl of wafers and a can of cola. Children suddenly seem to have stepped into a world of fast foods and vending machines, totally unaware of the havoc they are creating for themselves. 
The years between 6-12 are a time of steady growth; good nutrition is a high priority. Children must know that what they eat affects how they grow, feel and behave. Changes in our society have intensified the need for food skills, to the extent that they need to become a part of the child's basic education for good health and survival. The vast majority of working mothers with school age children are laboured with exhausting commutes, upswings in the households, and stress, leading to a situation where parents get to spend limited time with their children. Traditional food skills are not passed on automatically from parent to child. Most people have forgotten that the primary reason for eating is nourishment. In the not so distant past, food was treated with reverence because of its life sustaining quality. Enjoying a meal was sharing experience with the others. Today family dinners are rare. In many ways, our culture is structured to foster poor eating habits. Television commercials and supermarkets are propagating a wide variety of enticing junk foods, attractively packaged and often tagged with a tempting sop. We should be constructing an environment that protects our children. Instead we have a highly seductive environment that undermines eating habits. 
For children who have less vision of the heart disease, cancer, high blood pressure or diabetes that might befall them decades later, the tentacles of a junk food environment are virtually inescapable.  Studies reveal that as early as the age of 30, arteries could beginning clogging and lay the groundwork for future heart attacks. What children eat from puberty affects their risks of prostate and breast cancer.  Osteoporosis and hypertension are other diseases that appear to have their earliest roots in childhood when lifelong eating habits are being formed. Children are especially vulnerable. Poor diets can slow growth, decay new teeth, promote obesity and sow the seeds of infirmity and debilitating disease that ultimately lead to incurable disease and death or worse make life insufferable. 
Most of the times these junk foods contain colors that are laced with colors, those are often inedible, carcinogenic and harmful to the body. These foods and their colors can affect digestive systems, the effects of it emerging after many years. Studies have found that food coloring can cause hyperactivity and lapses of concentration in children. Children suffering from Learning Disabilities are often advised against eating food with artificial coloring. Chocolates, colas, flavored drinks and snack tit bits are full of artificial coloring. 
Not surprisingly, junk food not only has physiological repercussions, but also psychological ones - far reaching ones that affect the child's intellect and personalities. Coping intelligently with their dietary needs increases their self-esteem, and encourages further discovery. School days are full of educational challenges that require long attention spans and stamina. Poor nutritional habits can undermine these pre-requisites of learning, as well as sap the strength that children need for making friends, interacting with family, participating in sports and games or simply feeling god about themselves. 
Junk foods are often eaten in instead of regular food, an essential Indian diet that consists of wholesome chapatis and vegetables or snacks like upmas and idlis. Not surprisingly eating junk food leads to a sense of starvation both physically and mentally, as the feeling of satiation and contentment that comes after a wholesome meal is absent. There is simply no substitute for the feeling that descends, when you wake up and find that you are ready to take on the world and this primarily stems from GOOD HEALTH! There is no better time than now to build a supportive environment for nurturing our children and endowing them with a legacy of good health.

Health effect of Fast Food in Indian children

Forty per cent of Indian parents admitted that they often give into their children's demands for junk food, according to a recent survey .But the next time you're thinking about buying dinner on the go, bear in mind the impact it will have on your kids before the day is over.

Fast food will encourage your child to eat more

The fats, sugar and salt in fast food draw kids like a magnet, largely because they appeal to a child's "primordial tastes". "From an evolutionary point of view, humans are hard-wired to crave high-calorie food as a survival mechanism, so each time we see, smell or eat junk food, many chemicals and neurotransmitters are released in our body$

"When your child bites into a burger, his brain reward system gets activated since dopamine, which is the main neurotransmitter responsible for pleasure and excitement, gets secreted. And then he will feel a complete lack of control and an intense demand from his brain for more.

If that isn't enough to convince you to ditch the takeaway, a study published in the Archives of Pediatrics & Adolescent Medicine (a medical journal published by the American Medical Association) found that once children have eaten fast food, they consume more calories and fewer nutrients for the rest of the day. On days when kids ate fast food, compared with days when they ate at home, adolescents and young children consumed an additional 309 and 126 calories, respectively.

Fast food will damage arteries immediately

Experts have known for years that long-term consumption of junk food clogs arteries, but recently they've recognised that this damage begins the same day. A study published in the Canadian Journal of Cardiology indicates that damage to the arteries occurs almost immediately after just one - that's right, one - junk food meal.

Fast food will cause school work to suffer

Diet has a significant effect on children's study habits. Junk food and foods with high-sugar content deplete energy levels and the ability to concentrate for extended periods of time. "If a kid is having sweets, chocolate croissants or sweetened beverages during the first break time at school instead of his fruit portion or his sandwich, he would definitely feel hungry within an hour and that would disrupt his concentration in class, and could affect his overall performance in school.

children who ate fast food four to six times within a given week tested significantly lower in maths and reading compared with children who did not.

Fast food will make your kid depressed

Eating foods rich in antioxidants, such as fruits and vegetables, and healthy fats, such as cold-water fish and nuts, leads to positive energy and moods - both of which derive from positive brain function. A diet high in fast food lacks these nutritional benefits, increasing the risk of depression.

Fast food will put your child off healthy food

The artificial taste of junk food is thought to be addictive and children used to spicy junk food may have trouble adjusting their palates to relatively blander healthy foods.

"Another problem is that junk food tends to replace other, more nutritious, foods. "When children are snacking on chips and cookies, they're usually not having enough fruits and vegetables, which will decrease their vitamin C and fibre intakes."

Fast food will cause constipation

Fast food typically lacks fibre. The less fibre children consume, the more likely they are to develop constipation, which can cause abdominal pain and discomfort. Will they know about it by the end of the day? Probably.

Fast food will make them irritable

"The high content of sugar in junk food causes fluctuations in children's blood glucose levels. "This makes them edgy, sleepy and irritable throughout the day and leaves them with no motivation to be active."

Fast food will ruin bedtime

Having sugary drinks or fruit juice with dinner even twice a week can affect children's sleep and wake-up cycle. The caffeine from sodas acts as a stimulant, keeping them awake longer and negatively affects their metabolism. "Studies have shown that moderate to high caffeine consumers [100 to 300mg of caffeine] have more disturbed and more interrupted sleep than low- or no-caffeine consumers.

Monday, December 16, 2013

Achievers Award 2013 to Dr.M.A.Aleem

Achievers award 2013 was given by st. Joseph college alumni Trichy to Dr.M.A.Aleem vice principal HOD and professor of neurology kapv Govt medical college. and MGM Govt hospital Trichy for his dedicated recognised service in the field of medicine-neurology by hon 'ble justice S. Rajaswaran judge Madras High Court on 14.12.2013 in the presence of st Joseph college Rector Rev Dr.S. John Britto SJ.

Friday, December 6, 2013

stem cell therapy under CM health insurence scheme

Though the state government has taken an initiative to promote cord blood banks to cell therapy affordable to the poor, awareness on the promising treatment method is low in tier-2 cities like Trichy, as was revealed during a seminar held here on Friday. Moreover, crucial facilities required to encourage the treatment is lacking.

Stem cell therapy is used in the treatment of several genetic diseases, cancers, and blood disorders. Blood harvested from umbilical cord is stored for retrieval for future use. Stem cells (undifferentiated biological cells) taken from the blood are injected into damaged tissue to treat disease or injury.

"Knowledge about the advantages of stem cell therapy is low in our city. At the same time, we have treated many patients, including six-year-old to 94-year-old, through stem cell therapy in a span of eight years," said Dr P Ramachandran, plastic surgeon at Maruthi Hospital in the city, while addressing the students of KAP Viswanatham Government Medical College.

As storing cord blood in private hospitals is not financially feasible to many, Mahatma Gandhi Memorial Government Hospital (MGMGH) has plans to set up a facility. Already, some private hospitals in the city are trying to persuade parents of new-born babies to store umbilical cord blood, though no such facility exists in Trichy unlike Chennai and Bangalore. In May 2013, the state government had announced Rs 9 crore grant to the cord bank of a private company in Chennai. As per the initiative the poor can store cord blood free of cost under the chief minister's comprehensive health insurance scheme. Unfortunately, many are not aware of the facility

However, oncologist Dr Arun Seshachalam, a member of the Indian Medical Association (IMA), is of the view that it will take a while before stem cell therapy picks up in the state. "A lot of research is on to make it useful for treating many complicated disease. Currently, stem cell therapy has proved to be a definite treatment for blood cancer and thalassemia. At the same time, the cost of treatment is very high," said Dr Seshachalam.

Interestingly, several doctors and medicine students are yet to regard the emerging field seriously and start learning about the therapy. "We organise workshops to make our students keep abreast of latest developments in stem cell therapy. If the facility is available in government hospital, many poor will be benefited," said Dr D Saminathan, head of department of paediatrics, MGMGH.

Commenting on the necessity of providing stem cell therapy at MGMGH, Dr MA Aleem, vice-principal of KAP Viswanatham government medical college, said a facility for it could be set up at the super-speciality block which is under construction on the MGMGH campus.

Thursday, December 5, 2013

Mission with Vision for a Healthy Tamilnadu

Mission to with vision to Create a Healthy Tamil Nadu

“When it comes to providing healthcare services to the citizens, Tamil Nadu is the first best performing state among the larger states in India says our chief minister J. Jayalalitha.
The aim of various health scheme in Tamil Nadu is to provide universal access to equitable, affordable and quality healthcare services. We seek to promote policies that strengthen public health management and service delivery effectively and handle the increased allocations as prescribed under the NRHM Guidelines. Efforts are being made to further strengthen the entire healthcare sector in the state by adding and operationalising new urban and rural PHCs (Primary Healthcare Centres) as per the needs. With NRHM providing support for strengthening secondary and tertiary care centres under certain categories, we expect to have a robust healthcare system with strong HR, infrastructure and equipments to meet any exigencies at all levels. In order to improve the quality of rural healthcare and in accordance with the standards of IPHS, all the PHCs are manned by two Medical Officers so that the quality of care is not different for the vast majority of rural population. New PHCs are established every year and we are also in the process of upgrading one PHC in each block into an Upgraded PHC with 30 beds and better infrastructure. One upgraded PHC in each Health Unit District is being developed into a comprehensive MCH Centre which can handle obstetric emergencies including caesarean section. These centres are adequately provided with manpower and equipments. In the entire country, only in Tamil Nadu almost 90 percent of deliveries take place in government institutions. NRHM has strengthened the infrastructure and provided high-end equipments in the Secondary Healthcare Sector, supplementing the inputs by the World Bank funded Tamil Nadu Health System Project. In the Tertiary Healthcare Sector, focus is provided more on very high quality MCH care and every year Two Medical Colleges are strengthened into RCH – Centre of Excellence with additional buildings, equipments and manpower.

Many young MBBS doctors do not like to work in rural places. What steps have you taken to encourage doctors to work in rural areas?
Tamil Nadu is one of the few states in the country where there is minimum vacancy in the healthcare sector even in rural areas. For this achievement, I would like to give credit to our recruitment system through which we have successfully encouraged doctors to work in rural places. We have set up the Medical Recruitment Board first of this kind in india by our CM which is an organisation entitled to recruit doctors by conducting examinations. Recently we have recruited more than 1,500 doctors. We have 19 medical colleges in the state and around 50 percent of post graduate seats are reserved for our government doctors. Any doctor who serves in rural area is entitled for two marks for every year of service in rural areas in his PG entrance exam. Moreover, the facilities and infrastructure available in rural PHCs are such that the doctors are able to provide quality medical care to the public. This gives them the satisfaction of putting to effective use what they have learnt through their five years of medical education. This encourages the doctors to opt for rural services.

The rising cost of medicine is an area of great concern. What steps are being taken by our CM Jayalalithaa to regulate prices of essential medicines
Tami Nadu is one of the few states in India where medicines have always been provided free of cost at all levels of government healthcare facilities. We have been providing generic medicines to the patients in Tamil Nadu for the past fifteen years. We have also set up Tamil Nadu Medical Services Corporation Ltd (TNMSC) with the primary objective of ensuring easy availability of all essential drugs and medicines in the government medical institutions throughout the state. The TNMSC follows a very transparent and efficient procedure for the procurement, storage and distribution of medicines. The corporation is engaged in the procurement, storage and supply of 268 drugs and medicines, 84 suture items and 63 surgical items to the various Government Hospitals, Primary Health Centres and through them to the health sub-centres throughout Tamil Nadu. TNMSC is also engaged in procurement, storage and distribution of 114 veterinary drugs to the various veterinary dispensaries under the control of the Directorate of Animal Husbandry. Our Government of Tamil Nadu has taken a conscientious decision to provide quality medicines to the stake holder irrespective of the cost. The bulk purchase of medicines and other items through TNMSC brings down the prices considerably. At the same time the suppliers are aware that there should be no compromise in the quality of drugs and other supplies least they would be black listed from all supplies in future. We have ensured that there is no shortage of medicine in any government hospital throughout the state of Tamil Nadu. You will find a single medical store near any government hospital as we provide free generic medicines to patients in the hospital itself.

Our vision is to provide universal access to equitable, affordable and quality healthcare services

How would you rate the performance of NRHM in Tamil Nadu? What has been the organisation’s most significant achievement in past ten years?
Tamil Nadu is ranked among the high-performing states in India, in the area of human development. The state is noted for its low mortality rates and effective healthcare services for which NRHM has been catalytic in the last decade. The state has a long track record of innovations in the health care sector and has pioneered in making new approaches to enhance effective access to quality healthcare at low financial costs. NRHM have been instrumental in delivering the Health Care nearer to the community. The three staff nurse model in the primary health centre has changed the service availability of the PHCs. This has ensured that there is one skilled birth attendant at any point of time to provide quality service or appropriate referral to higher centres without delay. This along with the improved facilities and infrastructure has increased the number of deliveries in the PHCs from few thousands to three lakhs at present. This has also enabled us to make all 1614 PHCs as 24 x 7 centres for maternity care. This model is being emulated by other states also. NRHM has significantly contributed to the fall in IMR in the State. 47 NICUs (Neonatal Intensive Care Units) and 42 NBSUs (New Born Stabilisation Units) have been established and 17 NICUs and 114 NBSUs have been strengthened under NRHM. With support from NRHM the State has added 211 New PHCs and in the current year 118 New PHCs are in the pipeline. It is noteworthy to say 209 PHCs have been upgraded with 30 bedded facilities and we have planned to upgrade 60 more in the current year. 385 Mobile Medical Units are functioning as Hospital on Wheels at one per block. This caters to the people in the remote and hard to reach areas by providing health care at their door steps. Tailor made health care plans are being executed for the tribal population. Birth waiting rooms are provided in tribal areas where the pregnant mother along with one relative can stay well before her expected date of confinement. Their food and other expenses during the stay are being met from NRHM allocation. Other than the Maternal and Child Health care services the remarkable fields into which scrupulous actionable points has been taken till now are Provision of Emergency management services through “108” ambulances with the ‘response Time’ of less than 15 minutes in Urban and 20 minutes in Rural population ; making Inter-sectoral Coordination with the Departments of School Education, Sarva Shiksha Abhyan and SCERT; mainstreaming of AYUSH (Ayurvedha, Yoga & Naturopathy, Unani, Siddha and Homeopathy) services , Palliative Care services (next to the state of Kerala); hierarchal steps to reduce the prevalence of preventable blindness from 1.4-0.3 percent through involvement of Non Governmental Organisations ; entrusting the public with the increased awareness about Health related issues both Communicable and Non-communicable and many others.

Tell us about the Dr Muthulakshmi Reddy Maternity Benefit Scheme that you have implemented.
Dr Muthulakshmi Reddy Maternity Benefit Scheme is implemented by the Government of Tamil Nadu under which a financial assistance of `12,000 is given in three instalments to women from BPL families in order to compensate the wage loss during pregnancy and to get nutritious food so as to avoid low birth weight babies. A mother is eligible for receiving the first instalment of `4,000 after a minimum of three Ante-natal check-ups at the end of seven months; the second instalment of `4,000 after the baby is delivered in a government institution and `4,000 when the baby completes immunisation up to the third dose of DPT. The pregnant mother should be of age 19 years and above, and she should be in the BPL category for availing the benefit. The entire process is being done online and currently we are successfully transferring funds of about `600 Crores to more than three lakh beneficiaries every year. For this purpose we have linked all the primary health centres in the state with broadband connectivity We have trained all our doctors with private agencies and all our PSEs are connected through broadband.

Tell us about the key challenges that you face in managing the healthcare sector in the state of Tamil Nadu.
A huge infrastructure is required to provide efficient and effective healthcare to the people. At present we are having the capacity to admit about 70,000 inpatients in all the Government Facilities in the State. Every year we are constructing new buildings and also increasing the man power available in the Government Health Institutions to cater to the increasing needs of the General Public. Today the State has 19 Government Medical Colleges and every year we are improving our Medical Education by increasing the number of Medical seats in the colleges and also by opening New Medical Colleges. But our main challenge lies in addressing the gaps in effective coordination among all the health directorates. We are trying to provide comprehensive healthcare services to all the people of the State. There are certain areas of Health Provision which need to be strengthened and we also need to involve the private sector for better outcome in those areas. In fact, we are already partnering with many private organisations for implementing the Chief Minister’s Comprehensive Health Insurance Scheme for the people. Also we are involving the Private Sector, wherever necessary, in all high end requirements. We have made a detailed plan and hope to address the health needs of large number of poor people who live in urban areas and in urban slums through the forthcoming Urban Health Mission.

Tuesday, December 3, 2013

12 kg tumour removed from woman’s uterus - The Hindu

12 kg tumour removed from woman’s uterus - The Hindu

Fibroid tumor of uterus

Fibroids affect at least 20% of all women at sometime during their life. Women aged between 30 and 50 are the most likely to develop fibroids. Overweight and obese women are at significantly higher risk of developing fibroids, compared to women of normal weight. Malignant (cancerous) growths on the smooth muscles inside the womb can develop, called leiomyosarcoma of the womb. However, this is extremely rare.
What is a Fibroid?
Fibroid is a non-cancerous (benign) tumors that grow from the muscle layers of the uterus (womb). They are also known as uterine fibroids, myomas, or fibromyomas. The singular of uterine fibroids is Uterine Fibroma. Fibroids are growths of smooth muscle and fibrous tissue. Fibroids can vary in size, from that of a bean to as large as a melon.
Types of Fibroid
There are four types of Fibroid:
Intramural: These are located in the wall of the uterus. These are the most common types of fibroids.
Subserosal fibroids: These are located outside the wall of the uterus. They can develop into pedunculated fibroids (stalks). Subserosal fibroids can become quite large.
Submucosal fibroids: These are located in the muscle beneath the lining of the uterus wall.
Cervical fibroids: These are located in the neck of the womb (the cervix).
Causes of Fibroid
A fibroid starts as a single muscle cell in the uterus. For reasons that are not known, this cell changes into a fibroid tumor cell and starts to grow and multiply. Heredity may be a factor. It is thought that a muscle cell in the uterus may be "programmed" from birth to develop into a fibroid sometime perhaps many years after puberty (the start of menstrual periods). After puberty, the ovaries produce more hormones, especially estrogen. Higher levels of these hormones may help fibroids to grow, although exactly how this might happen is not understood.
Symptoms of Fibroid
The symptoms of fibroids may include:
Heavy Vaginal Bleeding: Excessively heavy or prolonged menstrual bleeding is a common symptom. Women describe soaking through sanitary protection in less than an hour, passing blood clots and being unable to leave the house during the heaviest day of flow.
Pelvic Discomfort:  Women with large fibroids may feel heaviness or pressure in their lower abdomen or pelvis. Often this is described as a vague discomfort rather than a sharp pain. Sometimes, the enlarged uterus makes it difficult to lie face down, bend over or exercise without discomfort.
Pelvic Pain: A less common symptom is acute, severe pain. This occurs when a fibroid goes through a process called degeneration. Usually, the pain is localized to a specific spot and improves on its own within two to four weeks. Using a pain reliever, such as ibuprofen, can decrease the pain significantly.
Bladder Problems: The most common bladder symptom needs to urinate frequently. A woman may wake up several times during the night to empty her bladder. Occasionally, women are unable to urinate despite a full bladder.
Low Back Pain: Rarely, fibroids press against the muscles and nerves of the lower back and cause back pain. A large fibroid on the back surface of the uterus is more likely to cause back pain than a small fibroid within the uterine wall. Because back pain is so common, it is important to look for other causes of the pain before attributing it to fibroids.
Rectal Pressure: Fibroids also can press against the rectum and cause a sensation of rectal fullness, difficulty having a bowel movement or pain with bowel movements. Sometimes, fibroids can lead to the development of a hemorrhoid.
Discomfort or Pain with Sexual Intercourse: Fibroids can make sexual intercourse painful or uncomfortable. The pain may occur only in specific positions or during certain times of the menstrual cycle. Discomfort during intercourse is a significant issue. If your doctor doesn't ask you about this symptom, make sure you mention it.
Diagnosis for Fibroid
In most cases, the symptoms of fibroids are rarely felt and the patient does not know she has them. They are usually discovered during a vaginal examination. The following are the tests conducted for the diagnosis of fibroids.
Ultrasound: The doctor thinks fibroids may be present; he/she may use an ultrasound scan to find out. Ultrasound can also eliminate other possible conditions which may have similar symptoms. Ultrasound scans are often used when the patient has heavy periods and blood tests have revealed nothing conclusive.
Trans-vaginal scan: A small scanner is inserted into the patient's vagina so that the uterus can be viewed close up.
Hysteroscopy: This is a small telescope that examines the inside of the uterus. During this procedure, if necessary, a biopsy can be taken of the lining of the uterus (womb).
Laparoscopy: A laparoscope is a small device that looks at the outside of the uterus - where the doctor examines its size and shape. A laparoscope is a small flexible tube. During this procedure, if necessary, a biopsy can be taken of the outer layer of the uterus.
Biopsy: A small sample of the lining of the uterus is taken and then examined under a microscope.
Preparing for Fibroid Surgery
Your doctor/health practitioner should check whether you are pregnant, before he/she gives any treatment for fibroids. The fact that you have fibroids does not mean you are infertile; many women have had successful pregnancies with fibroids in their womb. Sometimes they are only diagnosed on for the first time during an ultrasound during pregnancy.  Surgery, of any kind, can cause a disruption of the normal functioning of the body's systems. The following measures should promote general good health, thereby helping the body to be in the best shape possible for surgery.  When planning for surgery, whether or not it requires a stay in the hospital, several steps can be taken to prepare both you and those around you for what is to come. Preparation can summed up in the following ways:
Doing things to promote health and eliminate unhealthy habits, such as cigarette smoking, recreational use of drugs, or excessive drinking of alcoholic beverages.
Providing your doctor with a full personal and family health history,
Deciding whether or not to donate some of your own blood for use during surgery,
Preparing your home to be as convenient as possible for your recovery,
Having some laboratory tests done, and
Doing some immediate preparation before surgery
Eat a well balanced diet, which includes plenty of fresh foods and vitamins and minerals. Vitamin C, in particular, is thought to play an important role in healing.
Provide the Doctor with information about all prescription and over-the-counter medications you have recently taken or are currently taking.
Ask friends or family to help out when you get home from the hospital. Check with your doctor about what you should or shouldn't eat before surgery
Some people choose to donate some of their own blood before surgery, which can be used to replace any blood lost during the procedure
Fibroid Surgery Procedures
When medications have not worked, the patient may have to undergo surgery. The following surgical procedures may be considered:
Hysterectomy: Hysterectomy is the surgical removal of the uterus (and usually of the cervix as well). It is the most common treatment for fibroids. Three out of every 10 hysterectomies in the United States are performed because of fibroids. Currently, hysterectomy is the only permanent cure for fibroids. However, a woman cannot become pregnant or carry a baby after having a hysterectomy. Hysterectomy is often considered when the uterus reaches the size it would be at 12 weeks of pregnancy. In the past, many doctors recommended a hysterectomy because they feared that such large fibroids could hide the presence of cancer of the uterus. A hysterectomy is usually performed through an incision in the abdomen. Sometimes the ovaries are removed in addition to the uterus and cervix. The decision to remove the ovaries depends on the woman's age and on whether the ovaries are diseased. Sometimes, for smaller fibroids, the uterus can be removed through the vagina. This is known as a vaginal hysterectomy. After a vaginal hysterectomy, the only stitches are inside the vagina. The body absorbs the stitches in four to six weeks.
Myomectomy: Myomectomy is the removal of fibroids without removing the uterus. This operation preserves a woman's ability to bear children. However, a successful pregnancy is not guaranteed. Only 4 or 5 out of 10 women become pregnant and give birth after a myomectomy. Heavy bleeding can occur when the fibroids are removed. A woman is more likely to need a blood transfusion after a myomectomy than after a hysterectomy. She is also at higher risk for problems such as infection and blood clots in the legs. Fibroids may grow back after a myomectomy, and another operation may be needed later to remove them. The risk of re-growth is related to the number, not the size, of fibroids removed. If more than three fibroids are removed, the risk of re-growth is about 50-50. Like a hysterectomy, a myomectomy is usually performed through an incision in the abdomen. The risks and recovery time are about the same as for a hysterectomy. Sometimes a myomectomy can be performed with the assistance of a laparoscope or hysteroscope.
UFE (Uterine Fibroid Embolization): Uterine fibroid embolization (UFE) is a minimally invasive treatment for fibroid tumors of the uterus. The procedure is also sometimes referred to as Uterine Artery Embolization (UAE), but this term is less specific and, as will be discussed below; UAE is used for conditions other than fibroids. Fibroid tumors, also known as myomas, are benign tumors that arise from the muscular wall of the uterus.  It is extremely rare for them to turn cancerous. More commonly, they cause heavy menstrual bleeding, pain in the pelvic region, and pressure on the bladder or bowel. In a UFE procedure, physicians use an x-ray camera called a fluoroscope to guide the delivery of small particles to the uterus and fibroids. The small particles are injected through a thin, flexible tube called a catheter. These block the arteries that provide blood flow, causing the fibroids to shrink. Nearly 90 percent of women with fibroids experience relief of their symptoms. Because the effect of uterine fibroid embolization on fertility is not fully understood, UFE is typically offered to women who no longer wish to become pregnant or who want or need to avoid having a hysterectomy, which is the operation to remove the uterus.
Endometrial Ablation: This involves removing the lining of the uterus. This procedure may be used if the patient's fibroids are near the inner surface of the uterus. This procedure is considered as an effective alternative to a hysterectomy. The entire lining of the uterus (the endometrium) is removed or destroyed. The standard endometrial ablation and resection techniques are equally effective in reducing bleeding. In general, either one reduces bleeding by about half. At least 90% of women find either procedure acceptable and about three-quarters are totally or generally satisfied with the treatment. Only about 15% of women require a hysterectomy later on. Since no procedure has any particular advantage, a woman's best option may be to select the procedure based on their surgeon's skill and experience with it.
Magnetic Resonance Guided Percutaneous Laser Ablation - An MRI (magnetic resonance imaging) scan is used to locate the fibroids. Then very fine needles are inserted through the patient's skin and pushed until they reach the targeted fibroids. A fiber-optic cable is inserted through the needles. A laser light goes through the fiber-optic cable, hits the fibroids and shrinks them.
Magnetic Resonance Guided Focused Ultrasound Surgery:  Is an MRI (magnetic resonance imaging) scan locates the fibroids, and then sound waves are aimed at them. This procedure also shrinks the fibroids. Most experts say Magnetic-resonance-guided percutaneous laser ablation and Magnetic-resonance-guided focused ultrasound surgery are both effective - however, there is some uncertainty regarding their benefits vs. risks.
Post Operative Care after Fibroid Surgery
Full recover will take about 2-4 weeks. When you return home, do the following to help ensure a smooth recovery:
Be sure to follow your doctor's instructions.
Wear sanitary pads or napkins to absorb blood. The first menstruation after the procedure may be heavier than normal.
Try to walk often. This will decrease the risk of blood clots.
Take medicines as prescribed by your doctor. If you had to stop medicines before the procedure, ask your doctor when you can start again.
Bathe or shower as normal. Gently wash the incision area with mild soap.
Ask your doctor when you will be able to:
Return to work and drive
Resume sexual activity
Resume strenuous activity (You may need to wait 2-6 weeks.)
Recovering after Fibroid Surgery
The recovery from fibroid removal may require a hospital inpatient stay of a few days and recovery can take several weeks. The following are the recovery for Hysterectomy and Myomectomy  
Recovery from Hysterectomy: An abdominal hysterectomy involves a large incision and has a recovery time of 4 to 6 weeks. Laparoscopic and vaginal hysterectomies utilize small incisions reducing recovery time to 3 to 4 weeks. All hysterectomies require 2 to 3 day hospital stays, painkillers, potentially a catheter to assist with the passage for urine, and moving around to prevent blood clots.
Recovery from Myomectomy: Recovery time after a single, large incision myomectomy lasts about 4 to 6 weeks. Laparoscopic and vaginal myomectomies have shorter recovery times of 1 to 3 weeks. All mymectomies require 2 to 3 day hospital stays, painkillers, and moving around as quickly as possible to prevent blood clots.
Advance Treatment Options for Fibroid Surgery
The following are newer treatment options for Fibroid Surgery:
Embolization: This procedure shrinks fibroids by cutting off their blood supply. Guided by an X-ray image, the doctor threads a small catheter (a thin flexible tube) through a tiny incision in the groin into the main arteries that supply blood to the uterus. He or she then injects particles of inert plastic through the catheter to block these blood vessels. The uterus itself is not damaged because smaller arteries continue to supply the nutrients and oxygen it needs. The procedure takes about an hour. It may be performed with local or general anesthesia. The woman must lie flat on her back for six hours afterward to stop bleeding from the incision in the groin. Cramps in the pelvis are common, and the doctor usually prescribes a pain medication for them.
Laparoscopic Surgery: Some procedures can be performed using a laparoscope, a pencil-thin surgical telescope similar to a hysteroscope. The surgeon inserts the laparoscope and tiny surgical instruments through one or more small incision in the abdomen. If the fibroids are small and easy to reach, the surgeon makes an incision in the uterus and removes them. This is called a laparoscopic myomectomy. It may require an overnight hospital stay. When the fibroids are larger or harder to reach, the surgeon may use a laser or an electric needle to destroy or shrink them. This procedure is known as laparoscopic myolysis. Women who have this procedure done can often go home the same day.
Hysteroscopic Resection: This procedure uses a hysteroscope, a thin telescope that is inserted through the cervix. It enables the surgeon to see inside the uterus. The surgeon may then remove the fibroids with a laser or an electrical knife, wire, or probe. No incision is made. The procedure may be done with local or general anesthesia. The woman may stay overnight in the hospital or be treated as an outpatient. Full recovery takes a week or two.
Fibroid Surgery in India
India has emerged as an option abroad for Fibroid Surgery and other medical treatments for the international patients looking for low cost solutions with high quality service. Surgeons performing Fibroid Surgery in India treat with best medical facilities and provide highest successful results to these patients.
India finds the infrastructure and technology at par with that in USA, UK and Europe. Fibroid Surgery is one the common treatments for global patients coming to India. The good facilities provided in India are certainly beneficial but also the skyrocketing medical costs and long waiting lists to get treated by the specialists in the western countries are helping Indian medical tourism industry.
India has highly trained doctors to appeal to the medical tourists with a large pool of professionally qualified doctors, nurses and paramedics. The world-class facilities and infrastructure is further supported by low cost airfare and other facilities related to their stay in India in the following cities:
Cost of Fibroid surgery in India
The cost of surgery less when it is compared with the other western countries, it is relatively cheap because that is the way the international economy runs. A cost comparison of various medical treatments can give you the exact idea about the difference:
Medical   Treatment
Procedure Cost (US$)
United States
Uterine Artery Embolization

International day for people with disabilities 3.12.2013

Patients with disability due to Spinal cord injury

Every year, around the world, between 250 000 and 500 000 people suffer a spinal cord injury (SCI).

The majority of spinal cord injuries are due to preventable causes such as road traffic crashes, falls or violence.

People with a spinal cord injury are two to five times more likely to die prematurely than people without a spinal cord injury, with worse survival rates in low- and middle-income countries.

Spinal cord injury is associated with lower rates of school enrollment and economic participation, and it carries substantial individual and societal costs.

Understanding spinal cord injury

The term ‘spinal cord injury’ refers to damage to the spinal cord resulting from trauma (e.g. a car crash) or from disease or degeneration (e.g. cancer). There is no reliable estimate of global prevalence, but estimated annual global incidence is 40 to 80 cases per million population. Up to 90% of these cases are due to traumatic causes, though the proportion of non-traumatic spinal cord injury appears to be growing.

Symptoms of spinal cord injury depend on the severity of injury and its location on the spinal cord. Symptoms may include partial or complete loss of sensory function or motor control of arms, legs and/or body. The most severe spinal cord injury affects the systems that regulate bowel or bladder control, breathing, heart rate and blood pressure. Most people with spinal cord injury experience chronic pain.

Demographic trends

Males are most at risk in young adulthood (20-29 years) and older age (70+). Females are most at risk in adolescence (15-19) and older age (60+). Studies report male-to-female ratios of at least 2:1 among adults, sometimes much higher.


Mortality risk is highest in the first year after injury and remains high compared to the general population. People with spinal cord injury are 2 to 5 times more likely to die prematurely than people without SCI.

Mortality risk increases with injury level and severity and is strongly influenced by availability of timely, quality medical care. Transfer method to hospital after injury and time to hospital admission are important factors.

Preventable secondary conditions (e.g. infections from untreated pressure ulcers) are no longer among the leading causes of death of people with spinal cord injury in high-income countries, but these conditions remain the main causes of death of people with spinal cord injury in low-income countries.

Health, economic and social consequences

Spinal cord injury is associated with a risk of developing secondary conditions that can be debilitating and even life-threatening—e.g. deep vein thrombosis, urinary tract infections, muscle spasms, osteoporosis, pressure ulcers, chronic pain, and respiratory complications. Acute care, rehabilitation services and ongoing health maintenance are essential for prevention and management of these conditions.

Spinal cord injury may render a person dependent on caregivers. Assistive technology is often required to facilitate mobility, communication, self-care or domestic activities. An estimated 20-30% of people with spinal cord injury show clinically significant signs of depression, which in turn has a negative impact on improvements in functioning and overall health.

Misconceptions, negative attitudes and physical barriers to basic mobility result in the exclusion of many people from full participation in society. Children with spinal cord injury are less likely than their peers to start school, and once enrolled, less likely to advance. Adults with spinal cord injury face similar barriers to economic participation, with a global unemployment rate of more than 60%.

Existing data do not allow for global cost estimates of spinal cord injury, but they do offer a general picture.

The level and severity of the injury have an important influence on costs--injuries higher up on the spinal cord (e.g. tetraplegia vs. paraplegia) incur higher costs.

Direct costs are highest in the first year after spinal cord injury onset and then decrease significantly over time.

Indirect costs, in particular lost earnings, often exceed direct costs.

Much of the cost is borne by people with spinal cord injury.

Costs of spinal cord injury are higher than those of comparable conditions such as dementia, multiple sclerosis and cerebral palsy.


The leading causes of spinal cord injury are road traffic crashes, falls and violence (including attempted suicide). A significant proportion of traumatic spinal cord injury is due to work or sports-related injuries. Effective interventions are available to prevent several of the main causes of spinal cord injury, including improvements in roads, vehicles and people’s behaviour on the roads to avoid road traffic crashes, window guards to prevent falls, and policies to thwart the harmful use of alcohol and access to firearms to reduce violence.

Improving care and overcoming barriers

Many of the consequences associated with spinal cord injury do not result from the condition itself, but from inadequate medical care and rehabilitation services, and from barriers in the physical, social and policy environments.

Implementation of the UN Convention on the Rights of Persons with Disabilities (CRPD) requires action to address these gaps and barriers.

Essential measures for improving the survival, health and participation of people with spinal cord injury include the following.

Timely, appropriate pre-hospital management: quick recognition of suspected spinal cord injury, rapid evaluation and initiation of injury management, including immobilization of the spine.

Acute care (including surgical intervention) appropriate to the type and severity of injury, degree of instability, presence of neural compression, and in accordance with the wishes of the patient and their family.

Access to ongoing health care, health education and products (e.g. catheters) to reduce risk of secondary conditions and improve quality of life.

Access to skilled rehabilitation and mental health services to maximize functioning, independence, overall wellbeing and community integration. Management of bladder and bowel function is of primary importance.

Access to appropriate assistive devices that can enable people to perform everyday activities they would not otherwise be able to undertake, reducing functional limitations and dependency. Only 5-15% of people in low- and middle-income countries have access to the assistive devices they need.

Specialized knowledge and skills among providers of medical care and rehabilitation services.

Essential measures to secure the right to education and economic participation include legislation, policy and programmes that promote the following:

physically accessible homes, schools, workplaces, hospitals and transportation;

inclusive education;

elimination of discrimination in employment and educational settings;

Vocational rehabilitation to optimize the chance of employment;

micro-finance and other forms of self-employment benefits to support alternative forms of economic self-sufficiency;

access to social support payments that do not act as disincentive to return to work; and

correct understanding of spinal cord injury and positive attitudes towards people living with it.

Monday, December 2, 2013

Risk of hearing loss in teens

Less than 5% of parents think their child is at risk for high-frequency hearing loss despite the silent epidemic affecting almost 20% of adolescents.

Few parents believe that their teenager is at risk of hearing loss and most parents have a poor understanding of hazardous noise exposures for adolescents. However, the 19.5% prevalence of hearing loss among 12- to 19-year-olds is comparable to the 18.4% obesity rate, which gets much more attention.

When presented with a list of activities, most only recognized headphone use with an iPod as being high-risk factor. Many other common sources of hearing loss were overlooked, such as talking on a loud cell phone, band practice, shop work, summertime lawnmower operation, and motorcycle riding.

"Certainly, many of the hearing-hazardous activities in which adolescents partake are also important components of their education, growth, and development. The goal is not to eliminate these activities but to approach them with some knowledge of the potential hearing risks and take the appropriate steps for hearing conservation.

Risk of hearing loss in teens

Less than 5% of parents think their child is at risk for high-frequency hearing loss despite the silent epidemic affecting almost 20% of adolescents.

Few parents believe that their teenager is at risk of hearing loss and most parents have a poor understanding of hazardous noise exposures for adolescents. However, the 19.5% prevalence of hearing loss among 12- to 19-year-olds is comparable to the 18.4% obesity rate, which gets much more attention.

When presented with a list of activities, most only recognized headphone use with an iPod as being high-risk factor. Many other common sources of hearing loss were overlooked, such as talking on a loud cell phone, band practice, shop work, summertime lawnmower operation, and motorcycle riding.

"Certainly, many of the hearing-hazardous activities in which adolescents partake are also important components of their education, growth, and development. The goal is not to eliminate these activities but to approach them with some knowledge of the potential hearing risks and take the appropriate steps for hearing conservation.

Thursday, November 28, 2013

World AIDS Day 1/12/2013- HIV and Adolescents

. More than 2 million adolescents between the ages of 10 and 19 years are living with HIV, and many do not receive the care and support that they need to stay in good health and prevent transmission. In addition, millions more adolescents are at risk of infection.

The failure to support effective and acceptable HIV services for adolescents has resulted in a 50% increase in reported AIDS-related deaths in this group compared with the 30% decline seen in the general population from 2005 to 2012.

Addressing the specific needs of adolescents

The WHO recommendations "HIV and adolescents: Guidance for HIV testing and counselling and care for adolescents living with HIV" are the first to address the specific needs of adolescents both for those living with HIV as well as those who are at risk of infection. They are being released in advance of World AIDS Day 2013 (1 December).

“Adolescents face difficult and often confusing emotional and social pressures as they grow from children into adults, “Adolescents need health services and support, tailored to their needs. They are less likely than adults to be tested for HIV and often need more support than adults to help them maintain care and to stick to treatment.”

Across sub-Saharan Africa, many who were infected at birth are becoming adolescents. In addition to the many changes associated with adolescence, they also face the challenges of living with a chronic infection: disclosing the news to friends and family and preventing transmission to sexual partners.

“Adolescents need health services and support, tailored to their needs. They are less likely than adults to be tested for HIV and often need more support than adults to help them maintain care and to stick to treatment.”

“Adolescent girls, young men who have sex with men, those who inject drugs or are subject to sexual coercion and abuse are at highest risk. They face many barriers, including harsh laws, inequalities, stigma and discrimination which prevent them from accessing services that could test, prevent, and treat HIV,”. “About one-seventh of all new HIV infections occur during adolescence. Unless the barriers are removed, the dream of an AIDS-free generation will never be realized.”

Making it easier to know HIV status

Furthermore, many young people do not know their HIV status. For example, in sub-Saharan Africa, it is estimated that only 10% of young men and 15% of young women (15-24 years) know their HIV status and, in other regions, although data is scarce, access to HIV testing and counseling by vulnerable adolescents is consistently reported as being very low.

WHO recommends governments review their laws to make it easier for adolescents to obtain HIV testing without needing consent from their parents. The guidelines also suggest ways that health services can improve the quality of care and social support for adolescents. And they highlight the value of involving this age group to create an adolescent-centered approach to the services that work for people of their age.

Better equipping adolescents

“Young people need to be better equipped to manage their HIV infection and take ownership of their health care,”. “We have seen for example in Zimbabwe that, by developing adolescent friendly services, it is possible to achieve good treatment outcomes among adolescents. We urge others to be inspired by these examples.”

To help health workers put these recommendations into practice WHO has developed a new online tool which will be launched in January 2014. It uses practical examples from country programmes that are working closely with adolescents on HIV issues.

The guidelines provide recommendations and expert suggestions – mainly for policy-makers and national programme managers – on prioritizing, planning and providing HIV testing, counselling and care services for adolescents. Designed to be used with the recent WHO consolidated Antiretroviral guidelines, these new guidelines provide complimentary recommendations and guidance to support better provision of services to help adolescents remain in care and adhere to treatment.

The guidelines were developed based on scientific evidence, community consultations with adolescents and health workers, field experience of health workers and expert opinion. WHO led the development of these guidelines in collaboration with the United Nations Children’s Fund (UNICEF), the Global Network of People Living with HIV (GNP+), the United Nations Educational, Scientific and Cultural Organization (UNESCO), and the United Nations Population Fund (UNFPA).

World AIDs Day 2013

World AIDS Day - 1 December 2013

Getting to zero: Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths

World AIDS Day is celebrated on 1 December every year to raise awareness about HIV/AIDS and to demonstrate international solidarity in the face of the pandemic. The day is an opportunity for public and private partners to disseminate information about the status of the pandemic and to encourage progress in HIV/AIDS prevention, treatment and care around the world, particularly in high prevalence countries.

Between 2011-2015, World AIDS Day has the theme: "Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS-related deaths".

The WHO’s focus for the 2013 campaign is improving access to prevention, treatment and care services for adolescents (10-19 years), a group that continues to be vulnerable despite efforts so far.

WHO will release new guidance for HIV testing and counselling and care for adolescents living with HIV on World AIDS Day 2013.

Sunday, November 24, 2013

Role Of Music On Brain Function

There are new roles for musical training,which include fostering brain plasticity, providing an alternative educational tool, and treating learning disabilities, researchers say.

Playing a musical instrument is a multisensory and motor experience that creates emotions and motions — from finger tapping to dancing — and engages pleasure and reward systems in the brain. It has the potential to change brain function and structure when done over a long period of time.

These new findings show that "intense musical training generates new processes within the brain, at different stages of life, and with a range of impacts on creativity, cognition, and learning.

Start Music Lessons Early

Musical training at a young age may strengthen the brain, especially regions that influence language skills and executive function.
A formal musical training for at least a year, beginning sometime between age 3 and 15 help to improve brain function in later part of life
The volume of brain regions related to hearing and self-awareness appeared to be larger in those who began taking music lessons before age 7. This hints that early musical training could potentially be used as a therapeutic tool.

"Early musical training does more good for kids than just making it easier for them to enjoy music; it changes their brain and these brain changes could lead to cognitive advances as well. Early music training could change the structure of the brain's cortex.

"There is a lot of research showing that musical training has various cognitive benefits, such as better working memory, pitch discrimination performance, and selective attention.
It might be possible that some specified musical training could be applied to education in the future.

Childhood music lessons have neural benefit decades later. Older adults who took music lessons as children but haven't actively played an instrument in decades have a faster brain response to a speech sound than individuals who never played an instrument.

Music Training Influences Multiple Senses

Musical training improves the ability of the nervous system to integrate information from multiple senses.

Hemce there are broader role for musical training in improving the ability of the nervous system to integrate information from all senses

Sunday, November 17, 2013

New Lifestyle Guidelines to prevent stroke and heart attack

New lifestyle guidelines is to "reevaluate and update the concept of a healthy lifestyle," with the specific aim of preventing progression to cardiovascular disease in at-risk patients.

As such, the recommendations cover evidence related to dietary patterns, nutrient intake, and levels and types of physical activity that play "a major role in cardiovascular disease prevention and treatment through effects on modifiable cardiOvascular risk factors," namely high LDL
cholesterol and hypertension,

Eat a dietary pattern that is rich in fruit, vegetables, whole grains, fish, low-fat dairy, lean poultry, nuts, legumes, and nontropical vegetable oils consistent with a Mediterranean or DASH-type diet.

Restrict consumption of saturated fats, trans fats, sweets, sugar-sweetened beverages, and sodium.

Engage in aerobic physical activity of moderate to vigorous intensity lasting 40 minutes per session three to four times per week
The lifestyle and diet—namely calcium, magnesium, and alcohol intake; cardiorespiratory fitness; single behavioral intervention or multicomponent lifestyle interventions; the addition of lifestyle intervention to pharmacotherapy; and smoking. These may, however, have "potential benefits," .

The new guidelines, recommendations are broken out according to whether an adult in question has higher-than-desirable lipid profiles or higher-than-desirable blood-pressure levels, although the recommendations for both groups are very similar.

Low-Fat Diets Give Way to Mediterranean

The guidelines emphasize Mediterranean-style dietary patterns over a "low-fat dietary pattern," which is scarcely mentioned in the document, although "low-fat dairy products" are part of the dietary pattern advice. There are no specific recommendations to reduce overall fat consumption, only to reduce the percent of calories consumed from saturated and trans fats.

Also notable are the recommendations on sodium. The general recommendation to "reduce sodium intake" is given a level of evidence A (strong), in the NHLBI grading system or a class IA by the ACC/AHA grading system. By contrast, advice to further restrict sodium intake to 1500 mg/day as "desirable" .
The mean daily sodium intake in the US is about 3.5 g. "We're all consuming too much sodium . . . and it's absolutely critical to reduce it." However, she continued, "accurately assessing sodium intake is extremely difficult and probably clouds the whole issue, as does the [use of a] specific target.

Sunday, October 20, 2013

Marathon to create awareness on non-communicable diseases held

Oct 21, 2013, 02.43AM IST TNN

TRICHY: In an attempt to increase the awareness among people on non-communicable diseases (NCD), a mini-marathon was organised by the KAPV Government Medical College along with its students and medical fraternity.

People from all age groups including doctors participated in the mini-marathon that was flagged off by Dr M A Aleem, vice-principal and neurologist at the medical college. The mini-marathon that began from the medical college went through Aristo Roundabout, Central Bus Stand, Vestry School, collector's office and reached the medical college. Over 500 people took part in the run that started on Sunday morning. Prizes were also distributed to the winners. Talking to TOI while flagging off the marathon, Dr MA Aleem, said NCDs such as cardiac diseases, cancer, kidney and hyper-tension are on the rise these days. Due to the change in lifestyle, the food habits and the lack of exercise are making them prone to such kind of diseases. Hence, people must be made aware about them, he added. Meanwhile, breast cancer awareness was also conducted in the city by the Vishwanathan Speciality hospital at three locations. The breast cancer association, along with the private hospital conducted the awareness run, which was flagged off by the collector and the director general of police Amalraj. The awareness run ended at Anna Stadium.

Saturday, October 19, 2013

when and how to do sex after Heart Attack

Heart Attack and sex

A heart attack isa  dreadful experience which will make a person realize how fragile  life can be and make or break the euphoria associated with living. It will affect the mental state of a person far greater than the physical compromise with the potential for recovery by significant proportion. Thus, a subdued mental state will consider many activities of daily living such as physical exertion including sex, as unhealthy.

It’s interesting to know that in  research done among 17 married couples in which one of the pair had a recent heart attack; “a significant relationship was shown in the recovery of the patient with the spouse’s sexual comfort as well as marital satisfaction”.

Similarly, in a recent recommendation, The American Heart Association denounced the myths surrounding recovery after a heart attack by stating, “Many myths surround sex after heart disease and stroke. The most common one is that resuming sex often causes a heart attack, stroke or sudden death. This just isn’t true.”

Does it mean that you can have sex on the following morning after a heart attack? Probably not!

The introduction to physical exertion following a significant heart attack (MI) should be a gradual process which needs supervision and guidance by professionals. Often, following queries are made by patients on physical exertion and we will try to find answers to these queries one by one.

When to start exercising and what you should start on?

The expert recommendation is to stay put for few days before introducing yourself to mild activities such as walking. The process should be gradual and the main focus should be your comfort and as long as you are comfortable, the exercise will be safe.

How to increase the physical exertion?

The best option for a patient recovering from a heart attack is to enrol into a cardiac rehabilitation programme. The programme will lead you to a gradual build up towards an optimal level of exertion which is beneficial to the heart.

How often should it be done?

You should gradually increase your exercise sessions up to 3-4 times a week of at least 20-30 minutes duration. This amount of exertion should be reached by about 3-4 months rather than within few days or weeks.

When you should stop?

If you feel difficulty in breathing, chest pain, extreme sweating at rest, fainting or dizzy spells, leg swelling, nausea, vomiting and any other abnormality; then you should stop and refer yourself to your physician.

When can you go back to work?

A patient can get back to their normal daily work in about 3-4 months depending on the extent of the cardiac damage as well as other complications. This is best decided by your physician.

When and how should you engage in sexual activities?

Probably one of the important questions of all and one that surrounded by many myths is the sexual activity. It has been stated that the general depression following a heart attack can reduce the sexual interest and capacity in a significant manner. Therefore, love making and sexual engagement can be initiated as soon as you feel comfortable and this may be by about 3 – 4 weeks following a heart attack.

But, you should remember a few things in order to improve your comfort while engaging in sexual activities. These would be:

1. Choose the right time and a relaxed mood

2. Avoid having sex on a full stomach or soon after a hefty meal

3. Choose your most comfortable position; usually let the partner be on top to reduce your level of exertion.

4. Take medication, if prescribed, before such activities.

If these points are met, and if you look after your comfort, engaging in sexual activities would make you recover better as was mentioned at the beginning.

What changes should I do in my lifestyle to keep me active and healthy?

Engaging in exercises that feel comfortable to you, avoiding smoking, taking a healthy diet, practising relaxation methods such as deep breathing and yoga, and controlling the salt and cholesterol content in the diet are some of the lifestyle measures that you need to consider.

In conclusion, physical exertion including sex is not by any means prohibited or restricted in a patient following a heart attack as long as they stay within their comfort levels.

Friday, October 18, 2013

Prevent Lead Poisoning in Kids Through Paints-Lead poisoning prevention awarness week 20th to26 october 2013

Lead poisoning has devastating health consequences, in particular for children, with childhood lead exposure estimated to contribute to 600 000 new cases of children with intellectual disabilities every year. Overall, 99% of children affected by high exposure to lead live in low- and middle-income countries, says WHO on the occasion of International Lead Poisoning Prevention Week of Action, and calls on countries to strengthen national actions to eliminate lead paint.

Lead a major source of poisoning

Lead paint is a major source of potential lead poisoning for young children. It may be found in the home, on toys, furniture and on other objects. Decaying lead paint on walls, furniture and other interior surfaces creates lead-contaminated dust in the home that young children easily ingest. Mouthing lead-painted toys and other objects also exposes young children to lead. The sweet taste of lead paint means that some children even pick off and swallow small chips of paint.

“Lead poisoning remains one of the most important environmental health concerns for children globally, and lead paint is a major flashpoint for children’s potential lead poisoning. . The good news is that exposure to lead paint can be entirely stopped through a range of measures to restrict the production and use of lead paint.

It is estimated that 143 000 deaths per year result from lead poisoning and lead paint is a major contributor to this. Its use creates a health problem for many years into the future. Even in countries that have banned leaded paint decades previously, such paint continues to be a source of exposure until it is finally stripped and replaced. The cost of replacing lead paint means that people living in older, poorly-maintained housing are particularly at risk, and this disproportionately affects economically-deprived communities.

Phasing out lead in paint

WHO has identified lead as one of ten chemicals of major public health concern, and lead requires action by Member States in order to protect the health of workers, children and women of reproductive age. Such actions include adopting regulations and procedures to eliminate the use of lead decorative paints and provide information to the public on renovation of homes where lead paint may have already been applied.

Paints with extremely high levels of lead are still available in most of the developing countries where paint testing has been conducted as part of the efforts of the Global Alliance to Eliminate Lead Paint. In most of the countries with lead paint, equivalent paint with no added lead is also available, suggesting that alternatives to lead are readily available to manufacturers,.

At high levels of exposure, lead damages the brain and central nervous system to cause coma, convulsions and even death. Children who survive such poisoning are often left with intellectual impairment and behavioural disorders.

At lower levels of exposure, which cause no obvious symptoms and that previously were considered safe, lead is now known to produce a spectrum of injury across multiple body systems. In particular, lead affects brain development in children, resulting in reduced IQ, behavioural changes such as shortening of attention span and increased antisocial behaviour, and reduced educational attainment. These effects are believed to be irreversible. Adults are at increased risk of kidney disease and raised blood pressure.

International Lead Poisoning Awareness Prevention Week of Action

The International Lead Poisoning Awareness Prevention Week of Action runs from 20-26 October 2013. This year's theme – Lead-Free Kids for a Healthy Future – underscores the importance of avoiding the use of lead paint and using safe alternatives in order to prevent children coming to harm from lead poisoning.

Tuesday, October 15, 2013

திருச்சியில் எய்ட்ஸ் நோயால் பாதிக்கப்பட்டவர்களுக்கு சிகிச்சை அளிப்பதற்காக ரூ.20 லட்சத்தில் புதிய கட்டிடம்

திருச்சியில் எய்ட்ஸ் நோயால் பாதிக்கப்பட்டவர்களுக்கு சிகிச்சை அளிப்பதற்காக ரூ.20 லட்சத்தில் புதிய கட்டிடம் 

திருச்சியில் எய்ட்ஸ் நோயால் பாதிக்கப்பட்டவர்களுக்கு சிகிச்சை அளிப்பதற்காக ரூ.20 லட்சத்தில் கட்டப்பட்ட புதிய கட்டிடத்தை அமைச்சர் பூனாட்சி திறந்து வைத்தார்.
எய்ட்ஸ் சிகிச்சை மையம் 
எச்.ஐ.வி.யினால் பாதிக்கப்பட்டவர்களுக்கு (எய்ட்ஸ் நோயாளிகள்) ஆதரவு அளித்து சிகிச்சை அளிப்பதற்கான சிகிச்சை மையம் (ஏ.ஆர்.டி.) திருச்சி அரசு மருத்துவமனை வளாகத்தில் கடந்த 2005–ம் ஆண்டு முதல் இயங்கி வருகிறது. மேலும் எச்.ஐ.வி. தொற்று கண்டறியப்பட்டவர்களுக்கு இந்த மையத்தில் சந்தர்ப்பவாத நோய்கள் உள்ளதா என்றும் கண்டறியப்படுகிறது. தேவைப்படுபவர்களுக்கு ஏ.ஆர்.டி. கூட்டு மருந்து சிகிச்சையும் இலவசமாக அளிக்கப்படுகிறது.
ரூ.20 லட்சத்தில் கட்டிடம் 
எச்.ஐ.வி. தொற்று உள்ளவர்களின் எண்ணிக்கை அதிகம் ஆன காரணத்தினால் இந்த சிகிச்சை மையத்திற்கு ரூ.20 லட்சத்தில் தொண்டு நிறுவன உதவியுடன் புதிய கட்டிடம் கட்டப்பட்டு உள்ளது. இந்த புதிய கட்டிடத்தின் திறப்பு விழா நேற்று நடைபெற்றது. விரிவாக்கம் செய்யப்பட்ட இந்த புதிய மையத்தை அமைச்சர் டி.பி.பூனாட்சி திறந்து வைத்தார்.
அரசு தலைமை கொறடா மனோகரன், மேயர் ஜெயா, எம்.எல்.ஏ.க்கள் இந்திராகாந்தி, சந்திரசேகரன், துணை மேயர் மரியம் ஆசிக், கோட்ட தலைவர்கள் சீனிவாசன், ஞானசேகர், கவுன்சிலர் சகாதேவன், ஜெ. பேரவை புறநகர் மாவட்ட செயலாளர் ராமு, கி.ஆ.பெ. விசுவநாதன் அரசு மருத்துவ கல்லூரி டீன் வள்ளிநாயகம், துணை முதல்வர் டாக்டர் அலீம், ஏ.ஆர்.டி. மைய பொறுப்பாளர் டாக்டர் ராணி உள்பட பலர் கலந்து கொண்டனர்.
திருச்சி கி.ஆ.பெ., அரசு மருத்துவக்கல்லூரி மருத்துவமனை புத்தூரில் இயங்கி வருகிறது. இம்மருத்துவமனையில், 2005ம் ஆண்டிலிருந்து ஹெச்.ஐ.வி.,யால் பாதிக்கப்பட்டவர்களுக்கு சிகிச்சை அளிக்கப்படுகிறது. எய்ட்ஸ்க்கான மருத்துவ சிகிச்சை, 2004 ஏப்ரல் மாதம் அறிமுகப்படுத்தப்பட்டது. இம்மையத்தில் திருச்சி மாவட்டம் மட்டுமின்றி, புதுக்கோட்டை, கரூர், பெரம்பலூர் உள்ளிட்ட மாவட்டத்தைச் சேர்ந்த எய்ட்ஸ் நோயாளிகளுக்கு சிகிச்சை அளிக்கப்படுகிறது.
இம்மையத்தில், 6,427 பேர் ஏ.ஆர்.டி., மாத்திரையை உட்கொண்டும், தினமும், 200க்கும் மேற்பட்டவர்கள் சிகிச்சை மற்றும் ஆலோசனைக்கு வந்து செல்கின்றனர். 15 பணியாளர்களுடன், மூன்று பயிற்சி பெற்ற டாக்டர்கள் மற்றும் நான்கு ஆலோசகர்களுடன் இயங்கி வருகிறது. ஏ.ஆர்.டி., மையம் விரிவுபடுத்தப்பட்ட கட்டிட திறப்புவிழா நேற்று முன்தினம் நடந்தது.
அமைச்சர் பூனாட்சி திறந்து வைத்தார். அரசு தலைமை கொறடா மனோகரன், மாநகராட்சி மேயர் ஜெயா, எம்.எல்.ஏ., இந்திராகாந்தி, துணைமேயர் ஆசிக்மீரா, டி.ஆர்.ஓ., தர்ப்பகராஜ், அரசு மருத்துவக்கல்லூரி முதல்வர் டாக்டர் வள்ளிநாயகம், துணைமுதல்வர் டாக்டர் அலீம், மருத்துவ அலுவலர் சிவக்குமார் உள்பட பலர் பங்கேற்றனர்.

Monday, October 14, 2013


Juvenile crimes rankle Trichy

Oct 15, 2013, 01.44AM IST [ R Gokul ]

TRICHY: Crimes of all sorts are reported and their perpetrators are varied, with even children being accused of heinous crimes. The growing number of juvenile crimes and other deviant acts are a concern for parents, law enforces and the general society. Experts say that the careless parenting is a significant factor behind children going astray. Trichy city is not immune to juvenile crimes and many here see it as an outcome of declining social values.

The statistics of the city crime record bureau (CCRB) reveal that as many as 45 minors were arrested in connection with 34 juvenile crime cases between January 2012 and December 2012. Among these minors, one was a girl. The cases registered against these minors include murder, attempt to murder, kidnap, theft, riot, causing hurt, accident and other petty offences.

The number of juvenile cases registered this year is yet to be compiled, but it is expected that juvenile crimes may only rise. A few days back, on October 11, the city police arrested three minors for pickpocketing. Two of them were sent to a government observation home. It was revealed that they were punished for their crimes earlier too and continued to repeatedly indulge in such crime.

"We are taking legal action against minors indulging in crimes in order to rehabilitate them. But they should realise that they are going on the wrong path," said Shailesh Kumar Yadav, the commissioner of police (CoP), Trichy.

Lack of good parenting is said to be one of the main causes for juvenile delinquency. "In the current scenario, it remains a big challenge to the society. Careless parenting, improper understanding of the children's mindset and some media have negative impact on the character of the children. Parents must realise that they should educate children about moral behaviour," said Dr RM Sam Deva Asir, assistant professor in the social work department of Bishop Heber College.

Asir recalled an incident in which a seven-year-old girl threatened her 27-year-old drunkard father with dire consequences for torturing the family. "The chances are very high for such children to indulge in criminal activities. So, good parenting is a must for a better society," he added.

Dr MA Aleem, vice principal of KAPV government medical college, said parents should be role models for their children. "Nowadays, the lack of role models in the family is also a problem. If the parents are embodiment of good behaviour, it will automatically have a positive impact on their children. The chances of children becoming criminal are high if their father is no more," he noted.

The desperation to earn money sidesteps care and protection of children, said advocate S Indra Gandhi, Chairman of child welfare committee (CWC), Trichy. "Even though parents have to deal with all sorts of problems, they should spare time to nurture their children. The real development of the country depends on the quality of the children."

Sunday, October 13, 2013

Antisocial Personality Features

In modern day, we encounter many instances where people behave against the rule of law and disregard many of the other social norms. Such encounters may put these persons in trouble and they will also disrupt the livelihood of the others who live in close association with them. These individuals may not be able to fulfill their duties to the family, work place or else to the society as a whole and would often resort to lies, violence and other such behaviors in carrying out these acts. In mental health, person who compulsively undertakes to so such antisocial acts can be termed under the category, ‘antisocial personality disorders in pschyiatry

A person with an antisocial personality disorder can be a good charmer as well as a liar. They will use their wit to manipulate people and lure them in order to achieve their objectives. These individuals will often show disregard to right or wrong and would perceive themselves as doing the right thing. The characteristic feature in such manipulation and lies would be its persistent nature than being isolated incidences.

Antisocial personalities often invade the rights of the others and they may resort to abuse of vulnerable groups of people such as children. They will not respect the rights of others and often would resort to intimidation of others in making their moves.

Another feature of this personality is their action based on impulsiveness and this would lead to many negative developments in one’s life. Their fondness to violence and aggression would make them resort to harming others in order to achieve what they want and due to the super imposed agitation in their life, the outcomes of such aggressive behaviors could become fatal as well.

When considering the relationships enjoyed by these individuals, it could be said that, they resort to abusive relationships as giving respect and performing their duties seems not to be part of their thinking process. Therefore, the relationships enjoyed by these individuals would be unstable and poor and often would end up in separation.

These individuals can be seen changing their jobs rather frequently as the employers may show unhappiness of their conduct of irresponsibility and disregard to work rules.

Apart from the above mentioned signs and symptoms, a person with antisocial personality disorder may often be found on the other side of the law and would frequently get in to trouble with the law enforcement authorities. The tendency to do drug and alcohol abuse would increase their vulnerability in performing antisocial acts and therefore, a intervention in correcting or rehabilitating such individuals would have to aim at relieving these elements prior to any constructive intervention.

Best Administrator Award To Dr.M.A.Aleem

Trichy district collector of government of Tamil nadu presented Best Administrator Award to Dr.M.A.Aleem vice principal head of the department and professor of neurology at Kapv Govt Medical College and MGM government hospital Trichy for his dedicated work as Vice-Principal and as a neurologist in doctors day celebration held at Kapv Govt Medical College auditorium on 10th OCTOBER 2013.

world congress of neurology 2013

Attended XXII world congress of neurology at Vienna Austria from 21to26th September 2013. That's very useful to update our recent advances in neurology.

Monday, October 7, 2013

Mental health of older people

Mental Health Of Older People
Dr M A Aleem
Professor of neurology
Kapv govt medical college and MGM govt hospital
Getting older and retirement both involve a change in lifestyle for most people and it's important to take care of yourself mentally as well as physically.
There's an assumption that mental health problems are a 'normal' aspect of ageing but most older people don't develop mental health problems, and they can be helped if they do. While a significant number of people do develop dementia or depression in old age, they aren't an inevitable part of getting older.
Get the statistics on mental health and older people.
Not everyone feels ready to retire at the same time. If work or career is a major part of your life, it can affect:
The social aspect of your life if your job also provided friendships
Your sense of self-worth and self-esteem if you felt valued at work
Your financial security.
But being retired (or semi-retired) can also be a busy life because friends and family can have plans for your time - anything from child care to DIY tasks. It can be a chance to try a new activity or learn new skills and do the things that you've always wanted to do but never had the time.
Depression describes a range of moods, from feeling a bit low in mood to feeling unable to cope with everyday life. It can affect anyone, of any culture, age or background but more older people are affected than any other age group. This is because older people are much more vulnerable to factors that lead to depression, such as:
being widowed or divorced
being retired/unemployed
physical disability or illness
loneliness and isolation.
The neurobiological changes associated with getting older, prescribed medication for other conditions and genetic susceptibility (which increases with age) are also factors.  There are a number of rarer mental health problems that affect older people too, including delirium, anxiety and late-onset schizophrenia.
Find out more about depression, how to prevent it and how to get help.
Dementia is a decline in mental ability which affects memory, thinking, problem-solving, concentration and perception. It occurs as a result of the death of brain cells or damage in parts of the brain that deal with our thought processes.
People with dementia can become confused and some also become restless or display repetitive behaviour. They may also seem irritable, tearful or agitated which can be very distressing for both the person with dementia and their family and friends.
Find out more about dementia, whether you're worried about memory problems or you're a trying to help someone with dementia.
Alcohol abuse
Although alcohol abuse is a problem for people of all ages but it is more likely to go unrecognised among older people. Reasons for alcohol abuse in older age include bereavement and other losses, loneliness, physical ill health, disability and pain, loss of independence, boredom and depression, which is also linked to the other factors. Retirement may also provide more opportunities for drinking too much.
Prescribed medications can cause symptoms associated with mental illness in older people. Most older people are taking some kind of medication, and many are taking several at the same time. There are risks associated with taking multiple medications, including confusion.
Mental capacity and caring for others
People with dementia or severe mental illness may be unable to make and communicate decisions. Very few people are completely incapable of making any choices or decisions, but some older people may have partial or fluctuating mental capacity and may need help.
People with dementia often need special support - they may take longer to make decisions, may need an advocate to speak on their behalf and their mental functioning may also vary by day, and time of day. Family members or carers are often useful sources of information but it is important to take account of the views of the person with dementia alongside those of their carer. Being a carer isn't always easy. Many find it demanding both physically and emotionally.