Ramona (Name changed), a 30-year-old international patient, arrived at Wockhardt Hospitals, Mumbai Central, during her 6th month of pregnancy. She had been diagnosed with a large uterine fibroid measuring 15 x 12 cm and was advised in her home country to undergo a hysterectomy at the time of delivery. Concerned about this recommendation, particularly as this was her first pregnancy, the patient sought expert care in India under the supervision of Dr. Indrani Salunkhe, Consultant Gynaecologist at Wockhardt Hospitals.

Challenges Identified
Upon admission, Ramona was closely monitored through biweekly check-ups. The challenges in her case included:

·  Presence of multiple fibroids: The anterior fibroid measured 15 x 12 cm, while a second posterior fibroid of 5 x 6 cm was later identified during the cesarean.

·   Risk of preterm labor: The size and location of the fibroids restricted space for fetal growth, leading to increased risk of early delivery.

·  Nutritional concerns: The baby’s weight was initially below expected levels, necessitating protein supplements.

Treatment Approach
Dr. Indrani Salunkhe and her team adopted a proactive treatment strategy:

1.  Preventing Preterm Labor: The patient was started on biweekly injections to stop uterine contractions and additional injections to accelerate fetal lung maturity in case an early cesarean became necessary.

2.   Nutritional Support: The mother was given protein supplements to optimize fetal weight gain.

3.   Close Monitoring: Regular sonography ensured continuous assessment of both the baby’s development and fibroid growth.

Delivery and Outcome
At 32 weeks (8th month), Ramona developed severe pain and minimal vaginal discharge, indicating preterm labor. Despite attempts to control contractions, the team decided to proceed with a cesarean section. The challenges during surgery included:

· Fibroid obstruction: The fibroids prevented access to the lower uterine segment, necessitating a classical (vertical) uterine incision.

·  Placental positioning: The placenta was near the os, causing controlled bleeding during the procedure.

Dr. Indrani Salunkhe successfully delivered a 1.8 kg female baby. The newborn cried immediately at birth but was admitted to the Neonatal Intensive Care Unit (NICU) for 10 days due to mild respiratory distress and for weight gain. Post-surgery, the mother recovered without complications and did not require a blood transfusion.

Speaking about the case Dr. Indrani commented “This case was particularly challenging due to the presence of large fibroids, which obstructed the baby’s growth and complicated access during delivery. The decision to perform a classical cesarean section ensured the safety of both mother and baby. Post-delivery, the fibroids were not removed due to increased blood supply during pregnancy. However, we advised follow-up after 6 months to 1 year, as fibroids can be managed laparoscopically in most cases without open surgery.”

Postpartum Recovery and Follow-up
Ramona stayed in India for 2 months post-delivery to ensure both she and her baby were in stable health. The fibroids were closely monitored, and she was advised to undergo a follow-up sonography to assess their regression and decide on further treatment if necessary.

Key Learnings

1.     Fibroids during pregnancy can lead to complications such as restricted fetal growth and preterm labor, depending on their size and location.

2.     Proper monitoring and timely intervention, including advanced neonatal care, can significantly improve outcomes for both mother and baby.

3.     Surgical expertise plays a critical role in managing complex cases, as demonstrated through the successful delivery performed by Dr. Indrani Salunkhe.

Conclusion
This case highlights Wockhardt Hospitals’ commitment to providing world-class medical care for high-risk pregnancies. Through meticulous monitoring, nutritional support, and expert surgical intervention, the patient and her baby achieved a successful outcome, ensuring Ramona returned to her home country with her child in good health.

Dr. Aashish Chaudhry, Managing Director - Aakash Healthcare

Delhi's pollution has become an ongoing issue. We are seeing pollution levels rise earlier than usual in November, resulting in more illnesses. This year, however, a new pollution center has formed in the capital's relatively 'green' region - Dwarka, which has frequently reported greater levels of pollution than Anand Vihar.

This raises a crucial question: Could the growing aviation activity near the Indira Gandhi International Airport be a major contributor?

Aviation Emissions Under the Spotlight

Every month, six more aircraft are introduced to Indian airspace. In 2006-07, 60 million people traveled by plane in the nation, with half preferring other routes until five years ago. The aviation industry is increasing rapidly. 

According to a study conducted by the Massachusetts Institute of Technology (MIT) on the impact of aircraft on air quality, the most significant changes in air quality caused by aircraft are carbon dioxide (CO2), nitrogen oxides (NOx), and water vapour from condensation trails that are released when flying at cruising speeds. 

In addition to affecting air quality, aviation emissions contribute to climate change. With the present level of commercial air traffic in the world's skies, aviation emissions are projected to account for 5% of the gases contributing to anthropogenic climate change, which causes the planet to overheat as a result of human activity.

These damages, together, make aviation a problem for future air mobility. To fulfill its commitment to sustainability, it must reach objectives for decreasing air quality contaminants and drastically reducing airplane noise. 

Why Dwarka?

Despite its green cover, Dwarka’s proximity to the airport makes it particularly vulnerable. The frequent takeoff and landing of planes mean constant exposure to pollutants. Combined with other factors like vehicular emissions and construction dust, the situation becomes more severe.

Should we fly less?

As it is currently difficult to cut emissions from this industry, traveling less is the only method to reduce emissions in the key decade preceding 2030. Flying less may imply adopting a more sustainable form of transportation, such as a train, or shifting your destination to one that can be reached by a less carbon-intensive method. 

During the COVID-19 epidemic, the ease with which many employees adjusted to being at home and flying less indicated that long-held beliefs about the necessity to fly for business were no longer valid. Reducing corporate travel is a simple approach to lower aircraft emissions. 

By lowering business travel to 50% of pre-COVID levels, we can reduce CO2 emissions by up to 32.6 MtCO2 in Europe by 2030, the equivalent of taking 16 million polluting automobiles off the road. 

Demand reduction should not be a taboo issue, regardless of how it is achieved. The sector's emissions are increasing at an alarming rate, and policymakers should at the very least refrain from foolishly promoting unending aviation expansion while also acknowledging how difficult it is to decarbonize the sector.

The Bigger Picture

Dwarka’s rising AQI levels are a stark reminder that even areas with better green cover are not immune to pollution. The role of aviation fuel cannot be ignored, but it is part of a larger ecosystem of urban challenges. The growing demand for air travel must be balanced with sustainability to ensure healthier living conditions for communities like Dwarka.

As we look to the future, the question remains: Are we prepared to make the changes needed to address this rising threat, or will we let our skies and cities become even more polluted? The time to act is now.

Dr. Aashish Chaudhry, Managing Director of Aakash Healthcare, is a leading orthopedic surgeon and Head of Orthopaedics at Aakash Healthcare Super Speciality Hospital, New Delhi. With over 15 years of experience, he specializes in robotic-assisted knee and hip replacements, using minimally invasive techniques for faster recovery.

Authored by Dr. Amit Jhala, Sr. Consultant Spine Surgeon, HCG Hospitals, Ahmedabad

The spine is the backbone of human anatomy. It provides structural support, enables flexibility, and protects the spinal cord, the main communication highway between the brain and the body. However, the spine often faces challenges due to poor posture, sedentary lifestyles, injuries, or age-related degeneration. Of many conditions, chronic pain in the spine tends to cause more discomfort, and conditions like herniated discs, spinal stenosis, or scoliosis can significantly impact mobility and quality of life. Various treatment options are available to manage chronic spinal pain, but spinal fusion stands out as a unique approach that often provides enhanced comfort and stability.

What Is Spinal Fusion?

Spinal fusion involves joining two or more vertebrae using bone grafts, screws, rods, or plates and the goal is to eliminate movement between the affected vertebrae, reducing pain and preventing further damage. Over time, the fused vertebrae grow into a single solid bone, offering enhanced stability.

What are the Common Conditions Requiring Spinal Fusion?

Spinal fusion is not a first-line treatment but is reserved for severe conditions, such as:

• Degenerative Disc Disease: When the cushioning discs between vertebrae break down, it can lead to pain and instability.

• Scoliosis: In cases of severe spinal curvature, spinal fusion helps realign and stabilize the spine.

• Spinal Stenosis: Narrowing of the spinal canal can compress nerves, causing pain, weakness, and numbness.

• Spondylolisthesis: This condition occurs when one vertebra slips over another, causing instability and nerve irritation.

• Fractures or Tumors: Severe trauma or tumors in the spine may necessitate spinal fusion to restore structural integrity.

When Is Spinal Fusion Necessary?

Spinal fusion is considered when:

• Non-surgical treatments Fail: Physical therapy, medications, and injections have not provided sufficient relief.

• Chronic Pain Persists: Pain significantly impacts the quality of life and daily activities.

• Spinal Instability Exists: Movement between vertebrae causes pain or nerve damage.

• Neurological Symptoms Appear: Weakness, numbness, or loss of bowel/bladder control due to nerve compression.

Risks and Considerations

Like any major surgery, spinal fusion poses inherent risks that patients should consider carefully. Potential complications include infection, blood clots, and nerve damage, which could result in numbness, weakness, or chronic pain. Another significant concern is adjacent segment disease, a condition where the vertebrae near the fused segment bear increased stress, potentially leading to degeneration over time. Recovery from spinal fusion is a gradual process, often requiring a prolonged rehabilitation period. Patients may need to undergo physical therapy to restore strength, improve mobility, and adapt to the changes in spinal mechanics. Adherence to post-surgical guidelines is crucial to achieving optimal outcomes and minimizing long-term complications.

What are the Advances in Spinal Fusion?

Modern surgical techniques, such as minimally invasive procedures, have improved outcomes and reduced recovery times. Innovations in imaging and navigation technologies ensure greater precision, enhancing the success rate of the surgery.

Conclusion

Spinal fusion is a highly effective solution for individuals suffering from debilitating spinal conditions. However, it is essential to weigh the benefits against potential risks and consider them only after exhausting non-surgical options. Consulting with a spine specialist is crucial for determining the best course of action based on individual needs and circumstances.

With the advancement in technology, every device has become smart - from smartphones and televisions to wristwatches. Smartwatches today are used across the globe to monitor one’s fitness, sleep habits, and health. We have recently observed how smartwatches are helping in saving peoples’ lives, which reflects on the usefulness of these devices.  Such smartwatches monitor heart rate rates as well and send an alert to the wearer if there is anything out of the ordinary.

Let’s take a look at what a smartwatch notification might indicate about irregular heart rates. While such notifications may sound alarming, it’s important to understand what these notifications mean and when and what action should be taken.

What Does a Smartwatch Detect?

Smartwatch are devices which comes with advanced sensors that monitor heart rates throughout the day. Also, the device analyses a person‘s heart rate when the person is at rest to detect irregularities. An irregular heart rate may signify a potential heart rhythm issue, such as atrial fibrillation (AFib). It also sends a notification to alert the user in case any unusual pattern or irregular beats are detected.

However, it is important to remember that a Smartwatch is not a diagnostic tool. Also, it cannot confirm AFib or any other medical condition. However, it does help identify irregular patterns that may require medical evaluation.

When Should Irregular Heart Rates Cause Concern?

If a smartwatch is repeatedly, sending alerts of is regular heart rate that might be an indication that it is time to consult a doctor. Even if the wearer of the Smartwatch feels fine, such consistent alerts should not be ignored. If there are additional symptoms like chest pain, dizziness, or shortness of breath along with frequent notifications from the Smartwatch device, it is crucial that an individual seek medical attention.

Steps to Take When a Smartwatch Sends an Alert

It is important that a doctor is consulted if there are frequent irregular heart rate notifications from a Smartwatch. One can keep a record of when these notifications occur and the type of activity that was being performed at that time, so as to provide any useful insights to the doctor.

It is important to rely on advice offered by medical experts who might suggest tests like electrocardiogram (ECG) in order to confirm or deny conditions like Atrial fibrillation (Afib).

Additionally, one can adapt lifestyle changes in their daily lives and try to incorporate healthy habits. This can include regular exercise, a balanced diet, and keeping a check on mental health in order to reduce any risk of heart problems.

It is important to remember that a Smartwatch is a helpful and valuable tool to monitor health and heart rate but it cannot have a final say in a person ‘s health. Consulting healthcare providers and medical experts is essential if in case a Smartwatch device sends out frequent notifications regarding one’s health.

By:- Dr Abhishek Singh, Consultant Cardiology, Manipal Hospital, Ghaziabad

Dr. Milind Shetti, Sr.Radiation Oncologist, HCG NMR Cancer Centre, Hubli

Our lifestyle choices play a significant role in determining our overall health and well-being. The food we eat, the exercise we get, and the habits we cultivate can all contribute to our risk of developing various diseases, including cancer. In recent years, research has shed light on the link between certain lifestyle choices and the risk of head and neck cancer. Two substances that have been extensively studied in this context are tobacco and alcohol.

The Role of Tobacco in Head and Neck Cancer

Tobacco is a well-established risk factor for head and neck cancer. Around 50% of all cancer are caused by tobacco and 75% in Head and Neck Cancer. The International Agency for Research on Cancer (IARC) has classified tobacco as a Group 1 carcinogen, meaning that it is considered to be carcinogenic to humans. Tobacco contains more than 70 known carcinogens, including polycyclic aromatic hydrocarbons (PAHs), nitrosamines, and volatile organic compounds (VOCs). When tobacco is smoked or chewed, these carcinogens are absorbed into the bloodstream and can cause damage to the DNA of cells in the head and neck region. This damage can lead to the development of cancerous tumors in the mouth, throat, voice box, and other areas of the head and neck.

The Impact of Alcohol on Head and Neck Cancer Risk

Alcohol is another substance that has been linked to an increased risk of head and neck cancer. The IARC has classified alcohol as a Group 1 carcinogen, and research has shown that drinking alcohol can increase the risk of cancer in the mouth, throat, and voice box. Alcohol can cause cancer in several ways, including by damaging the DNA of cells, increasing the levels of carcinogenic compounds in the body, and altering the way in which the body metabolizes nutrients. Additionally, alcohol can act as a solvent, allowing carcinogens to penetrate more easily into the tissues of the head and neck.

The Synergistic Effect of Tobacco and Alcohol

When tobacco and alcohol are used together, the risk of head and neck cancer increases significantly. This is because the two substances can interact with each other in ways that enhance their individual carcinogenic effects. For example, alcohol can increase the levels of carcinogenic compounds in tobacco smoke, while tobacco can increase the levels of carcinogenic compounds in alcohol. Additionally, the combination of tobacco and alcohol can lead to a greater degree of DNA damage and genetic instability in cells, making it more likely that cancer will develop.

Reducing the Risk of Head and Neck Cancer

While the link between tobacco, alcohol, and head and neck cancer is clear, there are steps that can be taken to reduce the risk of developing this disease. The most effective way to reduce the risk of head and neck cancer is to avoid using tobacco and alcohol altogether. For those who do use these substances, quitting or reducing consumption can significantly lower the risk of cancer. Additionally, eating a healthy diet rich in fruits, vegetables, and whole grains, and getting regular exercise can also help to reduce the risk of head and neck cancer.

The use of tobacco and alcohol is a significant risk factor for head and neck cancer. These substances can cause damage to the DNA of cells, increase the levels of carcinogenic compounds in the body, and alter the way in which the body metabolizes nutrients. By avoiding the use of tobacco and alcohol, quitting or reducing consumption, and adopting a healthy lifestyle, individuals can significantly reduce their risk of developing head and neck cancer.

Dr. R V Raghunandan, Senior Consultant - Radiation Oncology, HCG MNR Cancer Hospital, Ongole

Colorectal cancer, also known as bowel cancer, is one of the most common types of cancer worldwide, affecting millions of people each year. In India, it is estimated that over 50,000 new cases of colorectal cancer are diagnosed annually. While these statistics may seem alarming, the good news is that colorectal cancer is one of the most preventable types of cancer. By incorporating healthy habits into our daily lives, we can significantly reduce our risk of developing this disease.

Maintaining a Healthy Diet

A well-balanced diet plays a crucial role in preventing colorectal cancer. Foods that are high in fiber, such as whole grains, fruits, and vegetables, can help to keep the digestive system healthy and reduce the risk of cancer. It is recommended to consume at least 25-30 grams of fiber per day. A high-fiber diet can help to promote regular bowel movements, prevent constipation, and support the growth of beneficial gut bacteria. In addition to fiber, other essential nutrients that can help to prevent colorectal cancer include omega-3 fatty acids, antioxidants, and vitamin D. It is also essential to limit the intake of red and processed meat, which have been linked to an increased risk of colorectal cancer. The American Cancer Society recommends limiting red meat consumption to no more than 18 ounces per week.

Staying Physically Active

Regular physical activity is another important aspect of preventing colorectal cancer. Exercise can help to improve digestion, boost the immune system, and reduce inflammation in the body. Aim to engage in at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week. Moderate-intensity exercise includes activities such as brisk walking, swimming, cycling, and dancing. Vigorous-intensity exercise includes activities such as running, jumping rope, boxing or kickboxing, and high-intensity interval training (HIIT). In addition to regular exercise, incorporating physical activity into daily routines can also be beneficial. This can include taking the stairs instead of the elevator, walking to work or school, or doing household chores.

Managing Stress and Getting Enough Sleep

Chronic stress and lack of sleep can weaken the immune system and increase the risk of colorectal cancer. Practicing stress-reducing techniques, such as meditation or yoga, and aiming for 7-8 hours of sleep per night can help to mitigate this risk. Effective stress-reducing techniques also include deep breathing exercises, progressive muscle relaxation, and mindfulness meditation. In addition to stress reduction, getting enough sleep is also essential for overall health and wellbeing. Tips for improving sleep quality include establishing a consistent sleep schedule, creating a relaxing bedtime routine, avoiding caffeine and electronics before bedtime, and creating a dark, quiet sleep environment.

Getting Screened Regularly

Regular screening is essential for detecting colorectal cancer in its early stages, when it is most treatable. The American Cancer Society recommends that adults aged 45 and older undergo regular colorectal cancer screening. Common screening tests for colorectal cancer include fecal occult blood test (FOBT), fecal immunochemical test (FIT), colonoscopy, and computed tomography (CT) colonography. By incorporating healthy habits, such as a balanced diet, regular physical activity, stress management, and regular screening, into our daily lives, we can significantly reduce our risk of developing colorectal cancer.

While colorectal cancer is a serious disease, it is also highly preventable. By taking proactive steps towards a healthier lifestyle, we can reduce our risk of developing this disease. Let us prioritize our health and well-being, and take the necessary steps