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THE DILEMAS OF THE MEDICAL PROFESSION

2 May

There is a growing distance among the different sections of society, more so between the society at large and the inhabitants of the medical profession. This population is not only minuscule but is under- represented and inarticulate regarding its concerns, anxieties and problems. The spokesmen for the society are numerous and powerful with a ready audience. In this article I will try to be a spokesman for the other side.

The dilemma of choosing a branch of study is faced by all. Only a few choose the medical science as a profession, some out of choice, and many due to coercion by parents or by virtue of having to manage a nursing home to be inherited. Some few wanting to come onto the profession, but not succeeding opt for studies in foreign lands, mostly CIS countries likeRussia, Ukraine etc. Those coming out of choice do come in with a sense of dedication and willingness to serve, but the lengthy course and associated stress soon take their toll on their values. This is compounded when they find their friends and batch mates already into jobs, earning six-figure salaries, while they have to be satisfied with a measly stipend after a longer period of study. Add to that the fact that failure rates being so high, less than half complete their study in the stipulated 5 ½ years.

The next dilemma comes during internship; whether to work and learn during this period of a year (for whish it is intended) or to prepare for the post graduate entrance looming ahead. For in this branch only a student has to continue giving entrances for everything. Not doing a post graduation would leave him without a specialist degree and close further options, leaving him one of the nameless doctors wasting away in the hinterlands of the country for their sustenance. Yet preparing for the same has no guarantee of success, but one may have to spend some years to get through. And during that period, to be dependent on your parents, especially after being a doctor, is a mighty unpleasant experience.

The next dilemma facing the doctor choosing to do the PG is the choice of subject. Actually choice is only for the lucky few at the top of the rankings. For the rest it is only-take it or come back next year.

After completing the PG, the doctor is faced with choices of joining govt service, higher studies, joining pvt sector, or starting own practice. Each has good and bad points in its favour. A govt job gives security but with measly salaries. Of course, don’t count job satisfaction among the attributes, unless you are blessed. Keeping the govt tradition of putting round pegs in square holes, or vice versa, one may have to do works not even remotely connected to medicine. Yours truly had scrutinized scholarship forms and land records and measured areas of houses. Add to that posting in a god forsaken place, where you have to keep everyone happy starting from the local dada to the local leader so that you may survive to ply your trade. Or be prepared to get roughed up for some imaginary mistake you supposedly committed, starting from not attending to a patient to rape/molestation(so newsworthy events).Or better still, grease some palms to get a better posting. Now, this was not in the curriculum, was it? A pvt sector job gives you good salaries, but with no regards to anything else apart from profits. Please let go of your ethics, if you have any left by now. Higher studies entail the same problems described above, during post graduation. Starting your own practice involves a good investment and savings for the time till your practice starts looking up, which may be some years. You have to have an understanding father with deep pockets, so that he may support you, and by that time your wife (and may be kid) for some months(if you are lucky) or years(if not so).

Now assuming that our doctor has solved all this dilemmas, with his values wounded, but alive, he is faced with even more dilemmas. News like “doctor gives injection and patient dies” makes him feel like a cat caught in a car’s headlights. As if all the training he received in a decade and a half was for killing a patient .Also he comes under consumer protection act. Nothing wrong there except for some small points, like if patient is a consumer, why does he grudge you your fees? Oh! The doctor took Rs X for only writing three medicines. He cannot make them understand that the fees are for the expertise gained over years and not for writing only. The patient is always free to go to a ‘shop’ charging less. The other point is that why should other professions not be under copra? After all one can get killed when a bridge or building collapses, or by mosquito bites (dengue, malaria) and so many other causes. He is not sure whether he should attend to a patient brought to him when he is just about to die and try to revive him (which may not be possible medically)and risk being a breaking news for some TV channel, or first make an MLC ,so that his skin is saved, thereby losing a few vital minutes. Whether he should advise an investigation to rule out some problem. If he does, he risks being accused of taking commissions, and if not, then negligence, if the problem is discovered later.

Dilemmas galore, yet these are not the only ones. So many more are experienced, yet untold. Due to the circumstances, under which a doctor has to work, and the negativity which has come to be associated to this profession, the number of students opting for the course has dropped appreciably. After all, why should a student spend the best decade and a half of his best years, toiling away only to do a thankless job. The money and time invested in this course, if invested differently will fetch much higher returns. And the days when a doctor wanted his children to be doctors are long gone. Now he wants them to be anything but a doctor, unless he has an established institution to give in inheritance.

This article is not to discourage anyone from entering this hallowed profession, but to make him aware of the pros and cons of the same. After all being a doctor has its advantages as well, least of them being a no retirement. The joy felt on seeing the thankful smile of a patient expressing his gratitude for his relief, compensates for many of the negatives. This branch of study requires utmost dedication, and concentration over a long period, probably throughout life. If you have it in you, then!

About the Author:

Dr B.K.Kundu,
Rheumatology Clinic,
Department of Medicine,
PGIMER, Dr RML Hospital
New Delhi-110001.
Email: bijit73@sify.com
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Micro Health Centre (µHC) Cloud enabled Healthcare Infrastructure

28 Apr

In India the healthcare delivery at the village level is constrained by lack of healthcare infrastructure, lack of doctors, lack of supply-chain and lack of appropriate monitoring of the existing healthcare infrastructure.

Most of the poor people living in remote areas are not able to access formal health care and many of them consult untrained local ‘private practitioners’ incase of any illness. Nearly one million Indians die every year due to inadequate healthcare facilities and 700 million people have no access to specialist care. About 75% of health care infrastructure, medical manpower and other health resources are concentrated in the cities or towns where only 27% of the population resides. There is a dual burden of disease with the rise in communicable and non-communicable diseases. There is shortage of human resources, poorly trained providers, poor quality of care, lack of drugs, equipment and ineffective referral systems. These are responsible for the lack of progress in reducing maternal mortality and in providing basic reproductive and maternal health services and act as a barrier for achieving millennium development goals. Recognizing this need to strengthen the Indian healthcare delivery system led to the conceptualization of the cloud enabled healthcare infrastructure – The Micro Health Centre.

This innovative and visionary affordable health care infrastructure can be rapidly rolled out to provide basic healthcare along with Tele-video medical consultation technology. It consists of a standard shipping container converted to a Micro Health Centre, that is connected to specialized medical personnel through Internet, to bring much needed preliminary healthcare to those in need. The first deployment will be in rural Haryana.

The objective is to equip the Micro Health Centre with basic diagnostic equipments that can be operated by paramedics or interns, along with specialist medical personnel providing expert interventions through remote medical consultation. It has a network connectivity varying from 256 KBPA (via satellite) to 2 MBPS (via leased line). Furthermore it can be easily transported to remote rural areas as all supply-chains such as trucks, trains, roadways etc are aligned to handling shipping containers. The Micro Health Centre has been designed to provide healthcare, health education as well as medicines, thereby providing the basic health facilities to inaccessible areas.

 

Micro Health Centre structure

 The solution helps in mitigating the following issues:

 

Identified Healthcare Issue Conceptualized solution
Lack of Doctors and specialists • Remote tele-health consultation
Absenteeism of assigned doctors • Cloud enabled biometric monitoring
Lack of Healthcare Infrastructure, no electricity • Rapidly deployable health infrastructure
Non Functioning medical equipment • Equipments integrated with Health Cloud
Inability to rapidly deploy and then maintain the

healthcare infrastructure

• Self sustainable infrastructure
Trained manpower to run the medical equipment • Interns/ para medical personnel can operate with

training in Tele-health services

No proper medical records • Centralized medical records

Easily deployable in remote areas

 

Key features:

  • Self contained medical solution that can be rapidly deployed and is usable from day one. Requires minimum skilled resources at site and only requires diesel to make it functional.
  • Satellite connectivity and built in electricity
  • Tele health services to provide basic healthcare and specialist medical care
  • Innovative and affordable health care infrastructure
  • Rapid roll out
  • Easy transportation to remote rural areas as all supply-chains such as trucks, trains, roadways etc are aligned to handling shipping containers.

 

 

Micro Health centre Functionalities

 

 Benefits:

•   Increasing the reach of healthcare

•   Affordable healthcare solution

•   Providing high quality care.

•   Provides primary healthcare

•   Remote medical consultation services

 

Cloud Enabled Micro Health Centre

 

The Micro Health Centre is able to leverage the revolutionary effect of cloud computing for Tele-health services, addressing the shortage of healthcare personnel in remote areas. The above diagram demonstrates the cloud computing functionality at µHC. The healthcare delivery at the Micro Health Centre can be monitored through the health cloud connectivity, thereby providing highly efficient and quality healthcare

The µHC- Health cloud advantage:

1.  Cloud computing for Tele-health is advantageous for remote consultations via video-conferencing; it can save the time and money spent by the patient.

2.  Real-time devices like tele-ECG at the µHC can transmit data to remote locations for instant analysis. Data is stored and forwarded to several sites at once or accumulated for further analysis at a later time.

3.  Patient registration, appointment scheduling and monitoring can all be performed

4.  Healthcare management and patient education are effectively handled by the µHC Health cloud, giving more complete care to the patient.

5.  Medical equipment integration with the health cloud such as with stethoscope, glucometer and equipments to monitor vitals to aid in remote consultations.

Thus it dramatically increases the reach of healthcare, bridging the Indian healthcare need gap.

 

REFERENCES:

 

1. John TJ. et al, 2011. Continuing challenge of infectious diseases in India. Lancet 15;377(9761):252-69.

2. Patel V, 2011. Chronic diseases and injuries in India. Lancet. 2011 Jan 29;377(9763):413-28.

3.Haines, A. et al, 2004. Can the millennium development goals be attained? BMJ. 2004; 329(7462): 394–397.

4.Travis, P. et al, 2004. Overcoming health-systems constraints to achieve the Millennium Development Goals. Lancet 2004; 364: 900–06.

5.Bhandari L. et al, 2007. Health Infrastructure in Rural India, India infrastructure report – 2007, 3inetwork, oxford publication, India. (Available at:  3inetwork.org/reports/IIR2007/11-Health.pdf)

6. Healthcare in India, Emerging market report 2007, Price Waterhouse Coopers. (Available at: http://www.pwc.com/en_GX/gx/healthcare/pdf/emerging-market-report-hc-in-india.pdf).

7. Krishnan A, 2010. Evaluation of computerized health management information system for primary health care in rural India. BMC Health Services Research 2010, 10:310

8. Siriginidi SR, 2009. Achieving millennium development goals: Role of ICTS innovations in India. Telematics and Informatics, 26(2):127-143.

9.Wang X. et al, 2010. Application of cloud computing in the health information system. In: Proceedings of the2010 International Conference on Computer Application and System Modeling (ICCASM). New York, NY: IEEE; 2010

  1. Technology firms and health care: heads in the cloud: digitising America’s health records could be a huge business. Will it? The Economist (US) 2011; 399(8727):63.
  2. Wootton R, 1997. The possible use of telemedicine in developing countries. J Telemed Telecare; 3(1):23-6.

About the Author:

Dr. Jaijit Bhattacharya
Adjunct Professor, Department of Management Studies
IIT – Delhi

Director, South Asia, Global Government Affairs,

HP India Sales Pvt. Ltd

email: jbhattacharya@iitd.ac.in

Bio: Dr. Bhattacharya is Adjunct Professor at IIT Delhi, and Vice President of Institute of Open Technology and Applications (IOTA), Government of West Bengal. Dr. Bhattacharya advises governments on e-governance strategies. Dr. Bhattacharya has developed business models and strategies for leading companies in the IT, media and computer hardware industries. He is the author/co-author of four books on e-Governance including the first book on e-Governance in India, ‘Government On-line – Opportunities and Challenges’.

Co- Author:

Ms. Ritu Ghosh
Research Associate
IIT – DELHI

Specialist – Education Health Environment, Global Government Affairs,

HP India Sales Pvt. Ltd
Email ID: ritug054@gmail.com 

Bio: Ms. Ritu Ghosh is a research associate with Indian Institute of Technology, Delhi and has set up the Centre for Excellence in e-Governance at IIT Delhi campus with an objective to carry research activities and showcase the latest technology initiatives and innovation to the government. She is an ICT public policy expert with over 13 years of experience. She has been driving initiatives for the adoption of ICT as the transformation tool in emerging and developed economies.

Co- Author:

Dr. Anjali Nanda, B.D.S

Social Systems Specialist,

Hewlett Packard – India, Gurgaon

E-mail: anjalinanda0503@gmail.com

Bio: Dr. Anjali Nanda is a dental surgeon with rich clinical experience in both rural settings and urban areas in India. She has been a part of research projects involving urban poor and has a good understanding of their healthcare needs and the healthcare delivery process.

Useful Tips to Help You Prevent Itchy and Dry Scalp

19 Apr

It is very important to keep your hair and head clean if you want to maintain a healthy scalp. If you’re able to have a proper hygiene you can be rest assured of having a scalp that is far from being dry and itchy. Given below are some useful tips that will help you maintain a clean and healthy scalp. Majority of people have tried out these tips and have reaped benefits through them. Here are some of these tips:

1. It is important that you take a bath every day. When you don’t do so, dirt and other particles can get accumulated in your body; particularly in the regions surrounding your hair and scalp. Taking bath regularly ensures these particles are removed and are kept clean. When you don’t take bath daily, these particles will continue to remain in that area causing itchiness and dryness of scalp. Though you might have a valid reason for not taking bath on a particular day, you may not have any good reason in not taking bath regularly.

2. As far as possible, rely on organic products for cleansing your body and hair. When you use commercial products, the chemicals present in them could not only damage your skin but also your scalp. When chemicals are used on your hair, it can have an impact on hair as well as create dandruff. The natural properties of organic products will ensure your scalp will not get damaged and will remain healthy.

3. Its fine if you use shampoo and soaps on your head. But make sure you rinse them off thoroughly there are no occurrences of dandruff that can cause dryness and itchiness of your scalp.

4. Take some time out in massaging your hair and scalp. The best time to massage is while taking a bath. This procedure ensures that natural oils are released through scalp and this can help you prevent dryness and itchiness.

5.  If you’re having dandruff concerns, make sure to use a suitable anti-dandruff shampoo to help solve the problem. Though you may not see the desired results in a day or two, it will be visible within a few weeks. In addition to solving your dandruff problems, these products can also help you get rid of dryness and itchiness of your scalp.

6. You need to comb your hair frequently. In doing so, you’ll not only ensure natural shine of your hair, but also help scalp to release more oil. Combing also helps you get rid of dirt that gets trapped between hairs regularly.

7. Make it a habit to use clean scalp and hair cosmetics and tools. You should never use comb or any other material that is not cleaned properly.

8. Do not use combs and other accessories that are used by people who are dealing with problems relating to lice eggs and so on. In addition to facing this problem yourself, you might even have to deal with itchiness and dryness of skin.

Following all the above tips will go a long way in ensuring that you have a healthy scalp and hair. It will also help you in preventing itchiness and dryness of your scalp.

About the Author:

Nitin Ajwani enjoys networking with health care professionals and discussing nursing clogs and medical scrubs. He enjoys the challenges of creativity and attention to detail.

Eye Care Tips on Holi!

7 Mar

Holi is almost here. Dry Holi colours known as ‘Gulal’ and wet colours or ‘Rang’ were originally prepared naturally from the flowers and vegetables. However with time strong colours, chemical and artificial colours are being used.

The eyes are extremely at risk during Holi because of the use of harmful chemicals in synthetic colours which cause eye irritation / allergies and even temporary blindness.

The use of eco-friendly natural colours like herbal ‘gulals’ are now popular due to such reasons.

Some Helpful and Safety Tips: 

  • Ensure that your eyes remain protected at all times.
  • Use sunglasses or protective eye wear to protect your eyes from coloured water.
  • Use a hat or cap to protect your hair from strong chemical dyes.
  • Apply a thick layer of coconut oil on your body and hair so that the colour doesn’t stick and it can be washed

off easily later. While washing off the colour, use lukewarm water and keep your eyes tightly closed.

  • If you are travelling, keep the car windows tightly shut. Better still; avoid travelling on the day of playing

colours.

  • For children use non toxic colours.
  Leads to What to do?
 

Contact with eyes and skin

 

Irritation of eyes & skin, pain, swelling, photophobia [sensitivity to light]

 

Wash eyes with room temperature clean water. Remove contaminated clothing and wash exposed skin area thoroughly with soap and water.

 

If symptoms persist, see a doctor.

 

Eye injury with a high-speed balloon / stone

 

Severe injury, even rupturing the eyeball or causing a retinal detachment.

 

Do not attempt to clean the eye as the water may be contaminated and cause infection.

 

Shut the eye and rush to the nearest hospital.

 

Inhalation of the powders affects the respiratory tract

 

Irritation, cough or difficulty in breathing, bronchitis.

 

Move patient to fresh air. Administer oxygen if possible and assist ventilation as required.

 

If symptoms persist, see a doctor.

 

Encourage and motivate your friends to play a safe Holi this year!

Issued in public interest by Shroff Eye

 

About the Author:

Shroff Eye Hospital is India’s first eye hospital to be accredited by Joint Commission International (JCI), USA for excellence in patient care and health care delivery since 2006.

www.shroffeye.orgwww.lasikindia.inwww.pathologylabindia.com

Note:- To ensure that you receive our messages in your inbox, please add icare@shroffeye.org to your contact list, address book or safe sender list. If you do not wish to receive emails from Shroff Eye, please send us an e-mail.

Heart Disease Persists at Epidemic Levels in India

27 Jan

The high prevalence rate of hypertension, mostly among young and middle aged adult men and women has convinced the majority into adopting a normalized attitude towards disease progression. However, lifestyle and nutrition transition, linked to prosperity has unbelievably set India into the forefront of mind-boggling cardiac disease trends. Interventions at the national and individual levels are obligatory to curb cascading consequences of cardiac disease and complications arising from co-morbid conditions.

Disturbing Cardiac Disease Trends for India

According to global market research data published by Research and Markets, trends in cardiovascular surgery in Brazil, Russia, India, China, South Africa (BRICS) up to 2017 indicated incredible market growth opportunities for cardiac medical equipment suppliers and manufacturers. Their findings were based on trends in population growth, heart disease prevalence and inequities in access to cardiovascular medical care. India topped the list just after China, reinstating persistent loopholes in healthcare delivery on the cardiovascular front.

Epidemiological studies carried out by the University of California in San Francisco suggested that urban middle class was more prone to rising levels of CAD prevalence in a developing country like India. Secular trends in their twenty year long study showed a rise in BMI, decrease in smoking and systolic BP and no significant change in central adiposity, hypercholesterolemia, and diabetes. It was interesting to note that literacy levels were inversely proportional to trends in “systolic BP, glucose, HDL cholesterol and BMI”

The WHO Global Status report on non communicable diseases in 2010[[1]] focusing on the combined burden of cardiovascular disease, cancer, diabetes and lung disease, stated that nearly 80% of deaths due to cardiovascular disease occurred in low and middle income countries. According to report findings, CVD accounted for 17 million (48%) deaths from NCDs in 2008.

Cardiovascular disease has been rampant as the leading killer in India, accounting for the largest number of deaths, nearly 29% back in 2005[[2]]. Disease data has presented cumulative statistical trends consistently, year after year.

When experts in New Delhi analyzed disease burden in September last year on the occasion of World Heart Day, estimates revealed an overall increase of 34.5 million in heart disease population from 2000 to 2015. The year 2020 is expected to put India into the forefront of global heart disease. Around 19% deaths are expected from the killer illness and its comorbidities alone.

Causes of Disease Progression

Genetic predisposition and biological makeup account for causes related to triggers for CAD development. However, high blood pressure is often the precursor to a stroke, coronary artery disease or chronic heart disease among young and middle aged men and women. High blood pressure could result from certain medications including birth control pills, diet pills or certain amphetamines and antihistamines.

Disease burden created by stress, high carbohydrate diet resulting in overweight and obesity, smoking and alcohol not only raises morbidity and mortality ratios, but also threatens the existence of a healthy economy given the rising costs of healthcare involved.

Myocardial Infarction, directly associated with heart disease accounts for significant mortality rates among young men and women.  Egred, Viswanathan and Davis[[3]] have identified up to four causal agents for myocardial infarction in men and women under the age of forty five. Their review, motivated by the costs, psychological impact and significant morbidity related to the condition, suggests the application of secondary preventive measures to curtail mortality in the long run.

Low density lipoprotein cholesterol which is known to cause plaque formation in arterial blood vessels is a major contributing factor for hypertension.  The prevalence of dyslipidaemia among males between 31 and 40 years was identified early. One such study was carried out in 2006 in Mumbai[[4]]. Close to 9000 members participated in the Health check-up program at P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India. Researchers advocated increased physical activity and adoption of healthy diet besides clinical interventions for proper management of dyslipidaemia.

Clinical Insights for Disease Management

Researchers at the Fortis-Escorts Hospital in  Jaipur emphasize on the use of lifestyle and dietary interventions to reduce the risk of cardiovascular failure, besides just drug related therapy. Gupta and Gupta in their paper on Strategies for initial management of hypertension[[5]] recommend the use of dihydropyridine calcium channel blockers (CCB), angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARB) as opposed to beta-blockers or diuretics, based on international guidelines.

Anwer et al, at the Meerut Institute of Engineering and Technology, New Delhi identified that CAD in the diabetes backdrop had significant implications for drug prescription and use. In their research on “Hypertension management in diabetic patients”[[6]], the need for a “lower goal blood pressure” and “multiple antihypertensive drugs” was identified for increased efficacy in controlling the double dimensional spectrum of diabetes and hypertension.

It is interesting to note that people between the ages 35-65 years form the at risk population. Sharma and Ganguly from the Indian Council of Medical Research, New Delhi have explored the causes of premature coronary artery disease[[7]] among Indians. Researchers suggest focus on risk factors and relevant clinical guidelines, checking unhealthy nutrition and improving access to healthcare, especially among women, who seem to have been pushed into the neglected segment.

CAD and Indian women have been the focus of a number of studies earlier as well. The AIIMS study by Dave et al[[8]] for example suggested that diabetes, menopause and cholesterol were risk factors among women presenting a number of clinical forms of CAD.

According to Chow and Patel[[9]], outcomes in cardiovascular health of women are notably inferior to those in men, especially within the strata of lower socioeconomic status and education level.  The diversity in Indian population could be a significant factor contributing towards information deficit in prevention and care mechanisms of cardiovascular disease in India.

Finally, Setia et al[[10]] by shifting focus on families rather than individuals, have acknowledged the importance of diagnosing Familial Hypercholesterolemia, and its early identification. Whole family focus could result in better health outcomes, specifically life expectancy. Researchers suggest the use of DNA testing and cholesterol assay to achieve required results.

However, besides a role played by the genetic component involved in disease condition transition and development, heart disease is manageable in terms of preventing it and alleviating the overall impact on life quality.

The Road Ahead

The World Health Organization country office for India in its 2011 summit on non-communicable diseases organized in New Delhi, identified cardiovascular disease as a dominant cause of mortality in rural as well as urban areas. Indian Health Minister, Shri Ghulam Nabi Azad, along with WHO representative Nata Menabde and potential stakeholders in Indian Healthcare rolled out an outline for “universal coverage, prevention and control of NCDs” to be rolled out during the 12th plan period, covering 640 districts. Concentration on Indian health policy framework in favor of better prevention and management of non-communicable diseases, alongside cross-sectorial support were significant in realizing their overall aims.

National and global research continually reiterates the importance of lifestyle and dietary interventions in controlling heart related chronic diseases. Given these research insights, it is high time for the large proportion of CAD diagnosed individuals to adopt healthy choices for catalyzing accomplishment of national initiatives and global collaboration attempts. This is true especially considering the fact that based on current trends in CVD progression, nearly seven out of ten CVD deaths are forecasted by the year 2020[[11]].

References


[[1]] WHO. “WHO Global Status Report on Non-Communicable Diseases – 2010.”. WHO Inda Office. World Health Organization, 2010.  Web. 2012. <http://www.who.int/nmh/publications/ncd_report_full_en.pdf&gt;.

[[2]] WHO. “Responding to the Threat of Chronic Diseases in India.” WHO Inda Office. World Health Organization, 2005. Web. 2012. <http://whoindia.org/LinkFiles/NMH_Resources_Responding_to_the_threat_of_Chronic_Diseases_in_India.pdf&gt;.

[[3]] M Egred, G Viswanathan, G K Davis. “Myocardial infarction in young adults”. Postgrad Med J 2005;81:741–745. doi: 10.1136/pgmj.2004.027532

[[4]] Sawant AM, Shetty D, Mankeshwar R, Ashavaid TF. “Prevalence of dyslipidemia in young adult Indian population.” The Journal of the Association of Physicians of India.. 2008 Feb;56:99-102.

[[5]] Rajeev Gupta and Soneil Guptha. “Strategies for initial management of hypertension”. The Indian Journal of Medical Research. 2010 November; 132(5): 531–542.

[[6]] Anwer Z, Sharma RK, Garg VK, Kumar N, Kumari A. “Hypertension management in diabetic patients”. European review for medical and pharmacological sciences.. 2011 Nov;15(11):1256-63.

[[7]] Meenakshi Sharma, Nirmal Kumar Ganguly. “Premature Coronary Artery Disease in Indians and its Associated Risk Factors” Vascular Health Risk Management. 2005 September; 1(3): 217–225.

[[8]] Dave TH, Wasir HS, Prabhakaran D, Dev V, Das G, Rajani M, Venugopal P, Tandon R. “Profile of coronary artery disease in Indian women: correlation of clinical, non invasive and coronary angiographic findings”. Indian Heart Journal. 1991 Jan-Feb;43(1):25-9.

[[9]] Chow CK, Patel AA. Cardiovascular healthcare for women in India. Heart. 2012 Jan 3.

[[10]] N. Setia, I. C. Verma, B. Khan, and A. Arora. “Premature Coronary Artery Disease and Familial Hypercholesterolemia: Need for Early Diagnosis and Cascade Screening in the Indian Population”. Cardiology Research and Practice Volume 2012 (2012), Article ID 658526, 4 pages doi:10.1155/2012/658526

[[11]] Khor GL. “Cardiovascular epidemiology in Asia-Pacific region”. Asia Pacific Journal of Clinical Nutrition 2001;10:76–80.

 

About the Author

Safia Fatima Mohiuddin is a Technical Writer in the Healthcare, Bioinformatics and Information Technology domains. Chronic Disease, specifically non communicable diseases accounting for epidemic proportions on a global scale is one of her primary interests. Safia blends scientific and health data to derive potential insights targeted at population health.

For questions, comments and feedback, please feel free to write to: safia.fatima@gmail.com


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