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 

This article highlights the factors behind rising lung cancer incidence in non-smoking women. It is the need of the hour for women to prevent lung cancer by avoiding secondhand smoke, and pollutants, getting screened regularly, and eating a nutritious diet. Read on to learn more about this article. 

Lung cancer is causing higher morbidity and mortality rates not only in India but across the world. This deadly cancer is commonly associated with smoking in men. However, a large number of women who are nonsmokers are now getting diagnosed with lung cancer which is taking a toll on their overall well-being. So, not only in those having a history of tobacco but even lung cancer rates are increasing in nonsmokers. According to reports, even though smoking rates are going down, lung cancer cases are rising at an alarming rate in women too.

Factors causing lung cancer in non-smoking women:  One of the major factors leading to lung cancer is secondhand smoking which involves toxic chemicals such as arsenic ammonia, benzene, and formaldehyde. Estrogen levels among menopausal women with lung cancer are usually higher than those in women without lung cancer. Hence, this also can be the cause of lung cancer. Genetic mutations and hepatitis B and C, human papillomavirus or HPV, and Epstein-Barr virus are also known to cause lung cancer in women.

The warning signs of lung cancer are constant coughing, chest pain, asthma, fatigue, breathlessness, poor appetite, chest pain, and recurrent respiratory infections that women shouldn’t notice and seek accurate diagnosis and treatment without any delay.

The treatment: Of lung cancer is based on the stage and location of the tumor. It will be essential for women to follow the guidelines given by the expert for successful outcomes. The treatment involves a tailor-made approach consisting of surgery, radiation therapy, and chemotherapy. Apart from this, one may also be advised targeted and immunotherapy for cancer management. Just like smokers, nonsmoking women will also have to be proactive when it comes to their lung health.  If you don’t smoke, that doesn’t mean you will not suffer from lung cancer.  Taking preventive measures goes beyond just avoiding smoking. Regular check-ups with experts can lead to earlier detection of potential issues. Women should eat a balanced diet rich in antioxidants, and ensure good indoor air quality through proper ventilation and air purification systems. Women need to stay vigilant regarding their health.

By:- Dr  Shahid Patel, Consultant Pulmonologist, Medicover Hospitals, Kharghar, Navi Mumbai

One of the most critical health issues in our country requires urgent attention to be applied and solved -  addiction to substances. Known for afflicting millions of people, substance abuse has emerged as a grave public health issue. Though tobacco and alcohol often grab headlines, we are globally increasingly facing the problem of drug abuse, which urgently needs attention.

Today, drug addiction in India has crossed alarming levels. As per the National Survey on Magnitude of Substance Use in India (2019), approximately 2.6 crore people (2.1% of the population) use heroin. Additionally, over 8.5 lakh people are estimated to be injecting drug users, with serious health risks including the transmission of HIV and Hepatitis C. These figures depict a worrisome trend, wherein drug use in the erstwhile rural hubs is significantly on the rise but now even more so in the districts. The most vulnerable victims are the youth, exposed to synthetic drugs and opioids that are equally potent and deadly. The social, economic, and health-related effects of drug addiction are severe, calling for intervention in both preventive as well as treatment measures. 

Dr. Swapnil Agrawal, Psychiatrist, Mind Clinic, Napier Town Jabalpur says, “Drug addiction is recognized as a chronic, relapsing disease that alters brain chemistry, making it difficult for individuals to break free from substance dependence. Opioids, in particular, bind to receptors in the brain, creating feelings of euphoria but also leading to tolerance, dependence, and eventually addiction. Heroin, one of the most commonly abused opioids in India, poses a significant risk of overdose and death.”

With addiction being a biological condition, treatment should be based on medical and behavioral interventions rather than morality or punishing the individual. In the recent past, immense advances have been in the treatment of drug addiction through medical therapies. Medications used in the treatment of opioid substitution therapy help people manage withdrawal symptoms and curb cravings without the euphoric effects associated with harmful drugs like heroin. Another critical treatment is through life-saving drugs that reverse opioid overdose, given by first responders and caregivers in time of need. This kind of treatment, accompanied by behavioral support, forms the foundation of advanced, evidence-based treatments of addiction and holds promise for millions fighting against substance dependence in India.

While advanced therapies are essential for those already in battle with addiction, prevention is the bedrock upon which a society free of drug dependency will be erected. The Indian government has made great strides under initiatives such as the National Action Plan on Drug Demand Reduction that serves not only to prevent drug abuse but also offers treatment to those in dire need of it. However, the scale of prevention has to be increased with more public awareness, education, and community outreach investment.

Public awareness campaigns, stricter implementation of existing regulations, and inclusion of addiction education programs are headed to reduce the burden of addiction. Such investments in prevention have been proven to greatly cut through the high healthcare costs and infrastructures that treat addiction and those accompanying health conditions, including cancer, heart disease, and liver cirrhosis. Education should also be directed toward schools, workplaces, and communities to prevent drugs, talk about the hazards of substance abuse, and present healthier alternatives. Furthermore, the stigma surrounding addiction should be lowered and help brought forward when the person who is suffering can be treated effectively, without fear, at an early stage.

Let us recapture the commitment to a drug-free India. By providing support to preventive efforts as well as to evidence-based treatments, we shall take giant leaps forward to eliminate the menace of drug addiction from our society.
 

As we celebrate the remarkable milestone of Southeast Asia’s 11 member states achieving a decade of being polio-free, it is with great pride and optimism that I extend my heartfelt congratulations to Bangladesh, Bhutan, Democratic People’s Republic of Korea, Indonesia, Maldives, Nepal, Sri Lanka, Thailand, Timor-Leste, Myanmar, and India. This achievement stands as a testimony to the power of collaboration, determination, and commitment to public health. The success stories of these nations serve as an inspiration, demonstrating that with the right strategies, the goal of polio eradication is attainable.

While five of six WHO Regions have successfully eliminated wild polio, Afghanistan and Pakistan are the two countries where wild polio periodically surges threatening the health of children and communities. With 12 cases of wild poliovirus (WPV) reported in the two remaining endemic countries in 2023 (six cases in Pakistan and six cases in Afghanistan), and 34 cases to date in 2024 (16 in Pakistan and 18 in Afghanistan), we have a renewed opportunity to stop wild poliovirus transmission epidemiologically.

Critical gaps in the proportion of children vaccinated against polio remain in both countries. In Afghanistan, this is largely the result of years of insecurity and a complex humanitarian crisis. In Pakistan, the main drivers are insecurity, community boycotts of vaccination activities, inconsistent access to populations on the move, and pockets of vaccine refusals. Cross-border transmission is also an ongoing challenge, and neither country will be protected from polio so long as it continues to circulate in the other. For example, in 2023, 96% of the environmental samples detected in Pakistan were linked to the cluster of poliovirus circulating in Afghanistan.

In Pakistan, the fight against polio has been ongoing for decades, with a dedicated team of frontline workers and community support, Pakistan remains committed to reaching every child with the polio vaccine.

Rotary’s PolioPlus program has been at the forefront of providing vital support to polio eradication efforts in Pakistan. Through initiatives such as the establishment of resource centers, team support centers, and Permanent Transit Points (PTPs), Rotary has helped create essential infrastructure to effectively target missed children and transient populations. This includes strengthening cold chain management and routine immunization by providing ice-lined refrigerators, vaccine carriers, and Permanent Immunization Centers (PICs). Most importantly, Rotary Clubs across the country have played an important role in engaging

Rotary members and clubs have also engaged communities by distributing fliers, Fatwa booklets, children’s books, vaccination information booklets, and advocacy items (tee shirts, hats, stickers, pencils, and more) to schools, advocacy seminars, ulema workshops, community centers in villages and remote regions. The premise of these activities is the understanding that as communities are engaged, interest in and support for polio immunization will increase, and the number of children who miss polio immunizations will be reduced.

In retrospect, one of the key learnings from this fight has been the Southeast Asia region's emphasis on data-driven decision-making. Regular monitoring and evaluation helped us identify gaps and challenges, allowing for adjustments to be made to vaccination campaigns and other interventions.

As we continue our efforts, it is important to acknowledge the invaluable support of organizations and individuals like Dr. Hamid Jafari, who led the WHO team that helped eradicate polio in India. Now leading polio eradication in the Eastern Mediterranean Region of WHO, Dr. Jafari appreciates the strong progress toward the eradication of polio in Pakistan. Similar to India, Dr. Hamid Jafari continues to count on the critical support that Rotary members in Pakistan provide, backed by the steadfast commitment of Rotary International to help end polio, not just in Pakistan but across the world.

To end polio in the face of today’s unique challenges, the GPEI is fine-tuning its tactics to reach every child, in every community, with polio vaccines and other life-saving interventions. The GPEI’s Polio Oversight Board (POB) has recently approved an extension to the timeline for eradication from 2026 to 2029. While the program has continually adapted its approaches to address new challenges and implement new tools, the extended timeline will allow it to build on this track record, adjust appropriately, and ensure that no child is paralyzed by polio again. To achieve this, the program will build on time-tested strategies in the endemics, to reach persistently missed children, through strong cross-border coordination, the delivery of broader health interventions alongside polio vaccines, and the investment in women as vaccinators, planners, and supervisors.

This is a powerful reminder that, with will and commitment, we can make the seemingly impossible task a reality. Pakistan hopes to soon join the world in celebrating its polio-free status. The last mile is always the hardest to cover, but if the whole world can eliminate a disease using vaccines, Pakistan can do the same. We must all play our part in increasing awareness and educating ourselves and others. I convey my best wishes to all the members for their continued efforts to ensure the region remains polio-free until polio is eradicated globally. Together, let us continue to strive for a world where every child can live free from the threat of polio.

An 80-year-old man who was recovering from a recent stroke and a complex medical history presented to us with a recent history of shortness of breath and wheezing for two days. He had undergone a tracheostomy during his stroke treatment due to prolonged ventilation, and it was initially suspected that he had a post-tracheostomy stenosis. He underwent evaluation by pulmonology and a scan revealed a mass in the mid-posterior tracheal wall, roughly 3 cm in length and obstructing the lumen by >80% with focal invasion of the cricoid ring, which forms the cartilaginous base of the voice box on which the vocal cords sit. Endoscopy showed that the tumor was obstructing the airway with each expired breath. It was suspected to be cancerous. After evaluation by the head and neck surgery and anesthesia teams, multiple plans were discussed to completely remove the tumor and re-establish the airway.

Complete resection of the upper trachea and the cricoid ring (the cartilaginous base of the voice box framework) would likely be too high-risk a surgery for the patient to withstand, and the previous tracheostomy scar would increase the likelihood of failure. A pure bronchoscopy approach where the tumor could be completely removed using an endoscope also would not be feasible since there was a risk of bleeding and airway obstruction, and the location of the tumor made complete removal unlikely. After extensive discussion, a hybrid approach was planned. Under local anesthesia, the previous tracheal scar was freed, an anterior tracheal opening was created, and the patient was administered general anesthesia. After that bronchoscopy debulking was performed to remove most of the tumor from the lumen. A carbon dioxide fiber laser was then used to completely excise the tumor from within the trachea up to the cricoid ring. The opening in the trachea was then carefully closed. The patient was safely extubated and was completely relieved of his airway obstruction, discharged home on day 5. This was a novel approach, not having been described before for the treatment of these tumors, which allowed adequate access and complete removal, with minimal side-effects of surgery and quick recovery.

Treatment of complex airway problems pose a major challenge to even experienced teams. Limited working space and complex anatomy make approaches difficult and working in the airway while allowing the patient to breathe pose numerous challenges. Hybrid approaches allows the best of both worlds – bronchoscopy approaches allow minimal access and quick recovery, while surgery allow definitive access and completeness of treatment. Newer technologies like laser and cryotherapy allow precise treatment with very little collateral damage to the surrounding normal tissue. Dr Vivek Gundappa, Consultant Pomologist notes, “Tracheal masses are rare; they present with severe respiratory distress whether cancerous or not, and a multi-disciplinary approach is essential to mitigate them”.

Coordinated approaches between airway surgeons, interventional pulmonologists, and anesthetists allow low complication rates and quick return to function. In addition to cancer, other problems include post-tracheostomy scarring and fibrosis, post-acid-ingestion injuries, and benign tumors. Dr Narayana Subramaniam, Senior Consultant and Director of Head and Neck Surgery and Oncology and Director of Clinical Innovation commented, “This gentleman had a complex tumor and a previous surgery in the same site which made treatment difficult. Additionally, he had a complex medical history that required a tailor-made approach that reduced the risk of extensive surgery while being effective. We were happy to offer him a good result with excellent coordination and planning between surgeons, pulmonologists, and anesthetists. The Sparsh Yelahanka Complex Airway Clinic offers multi-disciplinary care to patients with airway problems. With significant expertise in interventional pulmonology, surgery, anesthesiology, radiology, and pathology, as well as the best technology, we can offer the best quality care for people with these difficult groups of disorders.

By: Dr Narayana Subramaniam, Senior Consultant and Director Head and Neck Surgery and Oncology and Director of Clinical Innovation, Sparsh Hospital