Pelvic inflammatory disease (PID) is a disease of the upper genital tract seen in women between 15 – 45 years of age and involves uterus (womb), fallopian tubes, ovaries and other areas within the pelvis. The infection affects the surface lining in all the above organs leading to damage with short and long term health implications.

The true prevalence of PID is unclear but it is known that nearly 1:50 women will see their GP with some symptoms due to the disease process. The common organisms associated with PID are Chlamydia trachomatis and Neisseria gonorrhoea. The other organisms that cause pelvic infection include Anaerobes, Mycoplasma genitalium, genital Tuberculosis etc.

Screening programmes have revealed that asymptomatic Chlamydial infection can be picked up in as many as 6% women seeking contraception advice and up to 5% women undergoing cervical smear test (PAP smear).  Overall screening programmes have shown a pick up rate of between 1-17% in asymptomatic women.

What are the causes of PID?

The commonest cause is sexual transmission of infection especially in those that indulge in unprotected intercourse with multiple partners. Other causes include retained tampons, instrumentation of the uterus through various procedures such as termination of pregnancy, tubal patency assessment test with dye, camera procedures for the uterus (hysteroscopy), sepsis or infection post abdominal surgical procedures, appendicitis/ appendicectomy, peritonitis, intrauterine contraceptive device use for long periods of time, etc.

What are the common symptoms of PID?

1. Lower abdominal pain which may be continuous through the month in some women
2. Pain at the time of intercourse – enough to disrupt sex life
3. Offensive and smelly vaginal discharge
4. Fever with abdominal pain

How does one diagnose PID?

The doctor will obtain a history and perform a clinical examination during which culture swabs will be taken from cervix (neck of the womb) and vagina to confirm the type of infective organism. This will be followed by blood tests, pelvic ultrasound scan and sometimes laparoscopy (camera procedure through the belly button).Genital Tuberculosis of the uterus can be confirmed following laboratory analysis of the endometrium (biopsy of the lining of the womb). Currently there is no single test that will accurately diagnose the presence of PID.

What are the risks associated with PID?

1. Risk Infertility x 14 times
2. Risk of ectopic pregnancy (pregnancy in the tubes) x 6 times
3. Risk of chronic pelvic pain x 10 times

Preventing The Diseases

1. Prevention – Safe sex education in schools and colleges, changing or modifying behaviour, programmes for screening of infection in the population
2. Oral drugs – prompt treatment for the infected individual with appropriate drugs for a prescribed time period
3. Contact tracing of sexual partners and treatment
4. Hospitalization, Intravenous drug therapy and surgery (laparoscopic / open) for severe cases and especially those that develop abscesses in the tubes and ovaries and also that fail to respond to standard oral drug therapy.
5. In the future vaccination for preventionEach year in the United States, it is estimated that more than 750,000 women experience an episode of acute PID. Up to 10-15% of these women may become infertile as a result of PID. A large proportion of the ectopic pregnancies occurring every year are due to the consequences of PID.

Frequently Asked Questions on Chikungunya

1. What is Chikungunya?
Chikungunya is a viral disease transmitted through Aedes mosquito bites. It is usually seen in tropical  areas.

2. Who can get infected with Chikungunya?
Anyone can get infected with Chikungunya virus. The virus infection can be serious in newborns and in
old people.

3. What are the symptoms of Chikungunya fever?

Chikungunya typically starts with one or more of the following symptoms  – congested eyes ,chills,  fever, vomiting, nausea, head ache and joint pain. The fever can reach up to 104 degree Celsius. The  attack is sudden and sometimes it is accompanied with rashes limbs & trunk. After the mosquito bite it  takes one to 12 days before the symptoms are seen.

Some of the physical symptoms of Chikungunya include, Redness in eye and difficulty in looking at light.  Severe fever with headache and joint pain. Rashes may also appear usually on limbs and trunks.
4. Is there any treatment for Chikungunya?

There is no antiviral drug or medicine specifically for Chikungunya. But since chikungunya is cured by  immune system in almost all cases there is no need to worry. Treatment usually is for the symptoms  and includes taking sufficient rest, taking more fluid and medicines to relieve pain (Paracetamol for example). **Aspirin & NSAIDs should be avoided.

Honey and lime mix is found to have soothing effect on the disease. Usually the disease starts to  decrease in intensity after 3 days and it may take up to 2 weeks for recovery. But in elderly the  recovery is very slow and may take upto 3 months. In some cases the joint pain can last even upto  6  months5. How can I prevent Chikungunya infection?

How is Chikungunya disease  Transmitted

is transmitted by mosquito. Taking various steps to minimize mosquito bite is the only  effective prevention technique.

6. Can I get Chikungunya from another person?

No. Direct human to human transmission is not possible. The disease is transmitted from one person  to another only through mosquito bites.

7. Is Chikungunya fatal?
No. Human immune system is capable of recovery from this disease in almost all cases. But it might  take a while for the symptoms to disappear, especially the joint pains.
8. What is the impact of Chikungunya infection during pregnancy?
Pregnant woman can get Chikungunya infection at any stage of pregnancy. The chance of passing the
infection to fetus is very less. If the pregnant woman is infected at the time of delivery, the virus can  be transmitted to the new born child. If a new born is infected the risk is considerably higher. So it is  important to ensure that in Chikungunya areas pregnant woman is protected from mosquito bite.
9. Is it ok to breast feed if the mother is infected with Chikungunya?

Currently there is no evidence that Chikungunya virus is transmitted through breast milk. Again the
best defense for the child is to use mosquito nets and repellents to reduce the risk of mosquito bite.
Lab Tests :Chikungunya IGM(common test in lab)

10.Incubation Period of chikungunya

Time period between infected mosquito bite and onset of chikungunya symptoms, generally ranges from 1 to 12 days. But in some cases symptoms appear within 2 to 3 days only. Aedes aegypti mosquitoes bite only in the day time.
11.Diagnosing Chikungunya

Clinical appearance of dengue and chikungunya are similar, so it is essential to get a laboratory test done for diagnosing chikungunya. Chikungunya is diagnosed by a blood test named Enzyme-linked Immunosorbent Assay (ELISA).

12.Prevention from chikungunya fever

The best you can do to prevent from chikungunya fever is, do not get bitten by the mosquitoes. Try to get rid of fully grown mosquitoes and larvae in their breeding grounds itself. If you still notice any symptoms similar to chikungunya, immediately get tested and take plenty of rest. Infected individuals must be isolated from mosquitoes for avoiding transmission of infection to others.

Heart disease and stroke claims 17.1 million lives worldwide every year.

World Heart Day was devised by the World Heart Federation to help people realise that the majority of these deaths could be avoided.

Cardiovascular diseases are the world’s largest killers, claiming 17.3 million lives a year. Risk factors for heart disease and stroke include raised blood pressure, cholesterol and glucose levels, smoking, inadequate intake of fruit and vegetables, overweight, obesity and physical inactivity.

In partnership with WHO, the World Heart Federation organizes awareness events in more than 100 countries – including health checks, organized walks, runs and fitness sessions, public talks, stage shows, scientific forums, exhibitions, concerts, carnivals and sports tournaments.

This year is the eleventh year of the event and the theme this year is One World, One Home, One Heart. We will be targeted through our workplaces in order to establish more heart-healthy behaviors to benefit ourselves and our communities.

The World Heart Federation is urging us to become proactive about reducing heart disease and stroke. From individuals, right through to employers, health care professionals and governments, no one is exempt from the message.

What can I do to avoid a heart attack or a stroke?

Q: What can I do to avoid a heart attack or a stroke?

A: WHO estimates that more than 17.3 million people died of cardiovascular diseases such as heart attack or stroke in 2008. Contrary to popular belief, four out of five of these deaths occurred in low- and middle-income countries, and men and women were equally affected.

The good news, however, is that 80% of premature heart attacks and strokes are preventable. Healthy diet, regular physical activity, and not using tobacco products are the keys to prevention.

Eat a healthy diet: A balanced diet is crucial to a healthy heart and circulation system. This should include plenty of fruit and vegetables, whole grains, lean meat, fish and pulses, and restricted salt, sugar and fat intake intake.

Take regular physical activity: At least 30 minutes of regular physical activity every day helps to maintain cardiovascular fitness; at least 60 minutes on most days helps to maintain healthy weight.

Avoid tobacco use: Tobacco in every form is very harmful to health – cigarettes, cigars, pipes, or chewable tobacco. Exposure to second-hand tobacco smoke is also dangerous. The risk of heart attack and stroke starts to drop immediately after a person stops using tobacco products, and can drop by as much as half after one year.

Check and control your cardiovascular risk:

• Know your blood pressure: High blood pressure usually has no symptoms, but can cause a sudden stroke or heart attack. Have your blood pressure checked.
• Know your blood sugar: Raised blood glucose (diabetes) increases the risk of heart attacks and strokes. If you have diabetes it is very important to control your blood pressure and blood sugar to minimize the risk.
• Know your blood lipids: Raised blood cholesterol and abnormal blood lipids increase the risk of heart attacks and strokes. Blood cholesterol needs to be controlled through a healthy diet and, if necessary, by appropriate medications.

-~A special initiative by Fortis Cancer Institute Mulund recognizing the “can do” spirit in overcoming cancer~

In a unique event organized by Fortis Cancer Institute, International star and cancer conqueror Lisa Ray today honoured Dr Mary Francis with “Fortis Spirit of Life Award” for her courage battle against breast cancer. This initiative translates Fortis’ commitment towards creating a system of offering comprehensive care beyond medical treatment.

Commenting on the initiative Ms Lisa Ray said, “We wish to celebrate the spirit of life that exists within each of the cancer conquerors through this award. Overcoming cancer is not about healing the body; it’s about healing the mind. As a patient, I had to go through fear and isolation, it is human. I have learnt that conquering cancer is all about attitude. I was blessed to find immense support because I sought for it. When you need help, ask for it! Being a cancer survivor I can surely say that this initiative will bring to the forefront many cancer advocates who are great inspirers” added Ms. Ray.

Mr. Aditya Vij, CEO, Fortis India, said “At Fortis, our foray into Oncology was a few years ago. We have dedicated Oncology centers offering comprehensive cancer care services in several of our facilities. Taking this commitment forward we started the Fortis Cancer Institute in Mulund in 2010. We didn’t want to build just another Centre for Cancer treatment but a Centre of Excellence. With this in mind we assembled a fine team of surgeons, specialists and oncologists. We built a brand new block and we equipped it with the best machinery some of which are first in the city like VMAT (Volumetric Modulated Arc Therapy) & IORT (Intra Operative Radiation Therapy). Most of all we made sure that there were systems in place to  offer our patients the Fortis 3C (Comprehensive customized Care) that would embrace all forms of treatment modalities-  medical, surgical and radiations and take a patient from diagnosis to cure, follow up and counseling under one roof.  We created the perfect battlefield to support our cancer fighters in the formidable war they would fight. The emphasis was not just on survival but a glorious return to quality of life.”

Also present on the occasion Dr. Lloyd Nazareth, President & COO, Fortis said, “Fortis Cancer Institute is one of the few centres in India to offer end to end cancer care from diagnostic to rehabilitation. Focus is on interdisciplinary patient care that involves medical professionals from a variety of disciplines, including medicine, surgery, radiation, education, wellness and support services. Our institute has also attracted the best of medical talent to offer these treatments. These full time specialists, experts in their field are supported with sophisticated technology and trained technicians, physicists and nursing professionals to offer a complete care. We also have a fully integrated cancer control program that emphasizes prevention and early detection. Currently we are treating the largest number of cancer patients in the city with our widespread network.”

Mr. Varun Khanna, Regional Director, Fortis Hospitals (East & West) added, “Cancer is a disease which impacts the patient psychologically more than physically. The support from family members and the society keeps the spirit of the patient alive and help him fight the disease and live life to the fullest. It is important for society and family to uplift the spirit of the patient and help to battle the disease. We have inspirational stories of survivors and Lisa Ray, the epitome of bravery is here to honour another cancer fighter. Her attitude of taking the battle in the positive stride has inspired many and with this association we want to convey the message -“once you choose hope anything is possible”.

While unveiling “Fortis Lisa Ray Spirit of Life Award” Mr. Khanna states this initiative is a part of our 3C commitment. As we lead our innovative way to build a healthier community, we are also announcing the launch of – Fortis 3C support group… the 3 C translates into comprehensive, customised, care for our patients. The support group intends to reach out to patients through a support system which will help them fight the disease saying ‘you are not alone – we are there with you’.

Receiving the honour from Ms Lisa Ray, Dr Mary Francis who fought her battle against cancer said, “I faced cancer with confidence without letting the disease affect my zest for life. God has given me a new life and I would like to use it positively by spreading awareness about cancer and to urge people to face with the right spirit. If you have the will and determination, you can face this dreaded disease and come out victoriously”.

Dr. Mary Francis, who owns a clinical research company, is a born fighter. She bravely fought against the disease. While she was undergoing surgery and chemotherapy, she continued doing her routine activities both at home and at work. She even dared to travel to France during her battling phase.

Dr. Venkatesh S is a consultant cardiologist with over 11 years of clinical excellence to his credit. He combines a high academic record with a profound understanding of cardiac diseases and their management. A highly skilled interventionist, Dr. Venkatesh has performed numerous coronary angioplasties, including primary and complex angioplasties. He has worked as an interventional cardiologist at several renowned hospitals before joining Fortis Hospitals.

Professional qualifications
He is a topper and medal-holder in MD and DM from PGI.

Expertise
Dr. Venkatesh is exceptionally skilled in peripheral interventions and percutaneous valvuloplasties. His area of special interest is in percutaneous management of acute coronary syndromes.

Dr. Venkatesh is exceptionally skilled in peripheral interventions and percutaneous valvuloplasties. His area of special interest is in percutaneous management of acute coronary syndromes.

Fortis Hospitals Specialist EZine

Kolkata Fortis Hospitals, Walk The Talk , Patient Support launch