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Category : All ; Cycle : December 2014
Medical Articles
I Assist knee replacement India
Tailor made knee replacement, now in Chennai

Knee replacement surgery can now give perfectly aligned knees, thanks to the new technology of movement sensors: A palm-sized electronic device, called ‘I-Assist’ is being used to personalize and support knee replacement intra-operatively. “This revolutionary device helps orthopedic experts align new knee joins more accurately and gives the best possible fit during surgery, “says orthopedic surgeon Dr.A.K.Venkatachalam, who performed this novel procedure on a fifty five year old woman in Chennai, India.
The ‘I-Assist’ is a surgical guidance system designed to improve the accuracy of a total knee replacement. It not just assists the surgeon in aligning knee implants to each person’s unique anatomy but also provides a personalized fit and truly tailor-made total knee replacement. The outcome is very predictable as perfect alignment is achieved intra operatively. The implants themselves are not custom built.
How it works:
This electronic device incorporates latest guidance technologies into a half palm sized electronic display. Some of these technologies are also inbuilt in latest smart phones. The LED lights on the display are similar to traffic signals. A green light means the position is acceptable and a red one indicates scope for improvement. Thus the surgeon can align and validate implant positioning during total knee replacement. As the device is anchored in the operating field itself, it doesn’t require shifting of the surgeon’s gaze. He doesn’t have to remove his visual focus from the operating field. Earlier navigation systems require the back and forth transfer of the surgeon’s gaze from the operating field to a computer monitor elsewhere, several times intra-operatively.
The device integrates into the operation by requiring no complex imaging equipment and additional surgical incisions. It is compatible with the company’s own product line of primary knee replacements.
History of navigation systems in total knee replacement
The goal of the surgeon during a total knee replacement is to get neutral alignment.. However, studies have shown that even experienced surgeons don’t always achieve this perfection.
Hence computer navigation systems were introduced about a decade ago to achieve perfect alignment. In this system, pins were drilled in the thigh and leg bones away from the knee. These pins were attached to sensors. The sensors relayed information to a processor located elsewhere. The monitor of the processor displayed the accuracy of the bony cuts and bony alignment. Based on these, the surgeon could intra-operatively fine tune the cuts and positioning to get perfect alignment. As mentioned previously the surgeon had to shift his gaze back and forth from the operating field to the computer monitor located elsewhere. This computer navigation system also requires intensive capital investment.
A different approach toward this goal was adopted with ‘Patient specific instruments (PSI) ’. This was pioneered by the author in Jan 2012 in Chennai. This required additional pre-operative imaging. The images were transferred electronically to engineers elsewhere. The engineers used Computer aided design to manufacture custom fit cutting tool for each patient. These patient specific instruments were shipped to the surgeon after an interval of a few weeks. Hence there is a time lag involved between the planning and execution in this process. Many patients don’t want to wait . This is where the new technology comes into picture.

The I Assist system improves on previous navigation technology.
The main component of the I-Assist knee guidance system is a disposable device that can be procured as needed. No capital equipment investment by the hospital is necessary.
Its features are
• It intuitively integrates with the surgeons’ conventional instrumentation for total knee replacement.
• No pre-operative imaging is required.
• No wait time for the patient and the hospital.
• Less invasive procedure to the patient.

Who benefits?

It benefits everybody involved :
• Surgeons’ benefit as it saves them more time unlike prior navigation technology.
• Hospitals save on additional costs by eliminating pre-operative imaging and capital investment.
• For the patient, it is less invasive and guarantees accuracy.

Which type of knee replacement patients’ benefit most from this technology?

Dr.Venkatachalam says that it is of great value primarily to young patients undergoing total knee replacement. The durability of a knee replacement is dependent upon among other factors, the alignment. As younger patients will survive longer after a knee replacement, it is crucial to get the first knee replacement right. This will reduce the need for a redo or revision knee replacement. Revision operations are difficult and expensive.
A sizeable number of young patients have additional complications in the leg that make a knee replacement difficult. Patients from Asia and Africa present with malunited thigh and leg fractures secondary to a previous accident. They have developed post traumatic knee arthritis as a result of these accidents. Bony deformities within the knee and outside preclude use of all previous modes of instrumentation.
• The use of conventional instruments which rely on intact straight bones is impossible.
• Conventional computer navigation is also inapplicable as it requires intact bone within the knee joint.
• PSI is also impossible to design with bone loss and extra articular deformities.
It is vital to get perfect alignment as there is a positive correlation between accuracy and long term survivorship of the implant.
The ‘I-Assist’ system is the only system that allows accurate alignment in these complicated and difficult cases.

About the author:
Dr.A.K.Venkatachalam performed this procedure on two knees in Chennai for the first time. He specializes in joint replacements and key hole surgery. He has performed knee replacement in several patients with durable materials and advanced techniques.

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Durable knee replacement India
I-Assist guided Verilast Knee replacement- Knee replacement that lasts for 30 years
Knee replacement in young patients can now last for a long time, thanks to the novel combination of a smart device, ‘I-Assist’ and a durable implant, the ‘Verilast knee’.A procedure involving an I-assist device to implant a Verilast knee, was performed for the first time in the world on a thirty two year old woman in Chennai, India by noted orthopaedic surgeon, Dr.A.K.Venkatachalam.
Case Report-
Ms Payal, a thirty two year lady from Gujarat was suffering from a rare condition called ‘Avascular necrosis’ of the knee and had suffered extensive damage. Although, she was very young for a knee replacement, the extent of the damage left no option for Dr.A.K.Venkatachalam. He had recently introduced the I-Assist device for another patient and was working with Verilast knee technology that had shown to reduce up to 81% of wear as compared to traditional materials.
He decided to go ahead with a knee replacement procedure for Ms Payal using the Verilast CR knee and the I-Assist. It was first time in the world that the I-Assist tool was used to implant a Verilast knee. The I-Assist tool uses electronic components in a palm sized device. With this, the surgeon can align and validate implant positioning during the knee replacement.
After the procedure, the patient was very happy with the results.
About the Verilast Knee Technology
The durability of the Legion CR knee with Verilast technology is based on laboratory testing.
In a laboratory, the LEGION CR knee with VERILAST Technology was compared with a similar knee made from conventional materials (cobalt chrome and standard plastic). The results showed that after five million cycles, or simulated steps, the LEGION CR knee reduced 98 percent of the wear experienced by the other knee made of conventional materials. After 45 million cycles,it was noted with the LEGION CR knee with Verilast technology, that the wear reduced to 81% in comparison to the conventional knee implant. That's equal to around 30 years of actual use.
VERILAST technology uses advanced, low-friction surfaces on both sides of the joint, the femur bone of the thigh, and the tibia bone of the leg. It combines Smith & Nephew’s award-winning OXINIUM™ Oxidized Zirconium metal alloy and a “cross-linked” plastic component (XLPE), which together has been proved in the laboratory to double the wear of a conventional knee.
OXINIUM™, Oxidized Zirconium is a tough, smooth metal with a ceramic surface 4,900 times more abrasion resistant and 20 percent lighter than the cobalt chrome metal used in conventional implants.
• The ceramic surface is created through a manufacturing process where oxygen is naturally diffused into the zirconium metal as it is heated in air. The original metal surface is transformed into a ceramic coating which is integrated with and part of the underlying metal ; It is not an externally applied coating
• With no detectable amount of nickel, the metal most associated with allergies, OXINIUM™ is a biocompatible material for implants.
• This proprietary material has been used in more than 250,000 knee implants.

About the I-Assist Smart Tool
‘I-Assist’ is a smart tool designed to improve the accuracy of a total knee replacement. It assists the surgeon in aligning knee implants to each person’s unique anatomy. The outcome is very predictable as perfect alignment is achieved intra operatively and raises the chances of favorable outcomes. Perfect alignment correlates positively with survivorship or durability of the implant.
Which type of knee replacement patients’ benefit most from this combined technology?

It is of great value primarily to young patients undergoing total knee replacement. The durability of a knee replacement is dependent upon the alignment. As younger patients will survive longer after a knee replacement, it is crucial to get the first knee replacement perfectly aligned. There is a correlation between the alignment and survivorship of the implant. This will reduce the need for a redo or revision knee replacement. Revision operations are difficult and expensive.
In addition, a sizeable number of these young patients have additional complications that make a knee replacement difficult. Mal-united thigh and leg fractures secondary to previous accidents rule out the use of traditional instruments. Bony deformities within and outside the knee preclude use of all other modes of instrumentation and navigation.
Before this novel procedure, surgeons including Dr.Venkatachalam used “Patient specific instruments’ and ‘computer navigation’ to implant the Verilast knee. These are not applicable to difficult primary knees with bone loss.
The ‘I-Assist’ system is the only system that allows accurate alignment in these complicated and difficult cases.

In summary, the I-Assist tool allows the full survivorship potential of the Verilast CR Oxinium™ knee to be harnessed in primary and difficult cases. Young patients can return to their normal lives without the fear of a redo or revision surgery later on in their lives.

About the author:
Dr. A.K. Venkatachalam specializes in joint replacements and keyhole surgery. He has performed knee replacement in several patients with durable materials and advanced techniques. With numerous surgeries and years of experience combined with innovative and pioneering technologies, he has helped many patients to regain full mobility of knees and hips.

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Empowering Patients
There is an old Chinese saying “Give a man a fish and you feed him for one day. Teach him how to fish and you feed him for a lifetime”

From times immemorial, the practice of medicine has been a closely guarded secret. The physician is the “know all” and the patient is the “ignorant recipient” who was expected to blindly follow the orders. The medicinal concoctions were a secret. The prescriptions were in Greek or Latin.

I strongly feel that being a doctor-patient team and enabling patients is a better method of caring, curing and healing.

I deal with asthma. Asthma is a chronic disease which will stay with the patient. It can be controlled but it can’t be cured.

In chronic diseases, if a good outcome is desired, the doctor and the patient have to work as a team. The role of the doctor is more about teaching and less about doctoring. It is about empowering and enabling the patient to manage the disease himself/herself. Power must lie in the hands of the patient !!

Enabling patients does not make the doctor weaker. In fact he becomes stronger.

Can all patients be enabled and empowered ? Do all patients want to empowered ? Can all patients even comprehend the concept of empowerment? The answer is NO. Not all.

Some patients shy away from taking this responsibility. They like the doctor to hold their hand and lead the way. They do not want to be or find themselves incapable of being a part of the decision making process. Some may even think that the doctor is unsure/incompetent to be asking and wanting to know the patient’s preference.

I had a previous patient of mine bring her old mother from a village to come and see me for her medical problem. On my asking her “ Mataji, what is your problem” her response was “that is for you to find out”. And the look said it all: “You said he is a good doctor, but he seems to be an idiot. He’s asking me what the problem is.

Patients who claim they want to be empowered also become shaky when it comes to the crunch. I remember reading a very interesting study from the Mayo Clinics. They asked 100 healthy women in the age group of 50-60 years that if they were to be diagnosed with breast cancer, would they like the treatment modality (surgery, radiotherapy or chemotherapy) be explained to them and then they themselves decide what they want or would they like the doctor to decide what is best for them. As expected, a majority said they would like to decide for themselves. Another 100 recently diagnosed breast cancer patients were also posed the same question. Surprisingly, when the cancer was actually there, a majority of the women wanted the doctor to be the one to take this final call.

So, even though notionally the concept of self empowerment is attractive, when push comes to shove, many patients may still entrust this responsibility with the doctor.

No two patients think alike. So a doctors job is not only to diagnose the patients ailment, but also diagnose how mush to empower the patient. Herein lies the art and joy of medicine!!

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Enjoy Painless Epidural Delivery with Rupal Hospital
All mothers who are on the verge of motherhood have one common fear. The fear is of acute labor pain during the time of childbirth. The quantum of pain varies from one mother to another mother. Some has very less labor pain and the pregnancy is easy and many have long delayed labor pain.

Labor pain is severe for most women who do not receive pain relief. With advent of modern medicine and availability of techniques with skilled practitioners, it is now possible to relieve the pain of labor. Management of pain is the most crucial thing in the delivery of baby and painless delivery techniques are providing respite from excessive pain, be it in normal deliveries or caesarean (that need operations). The technique of painless delivery called as Epidural Analgesia or Epidural Anesthesia is a popular technique used by women, if advised by the doctor, during labor. The technique is not only cost-effective, but also gives relief from unbearable labor pain during deliveries. Such deliveries have registered 6-7% rise in the past two-three years.

It is estimated that out of every 25 deliveries, there are around 8-10 painless deliveries. In fact most of those going for it are educated and come from well-off families. As threshold to bear labor pain among women has reduced, they prefer to go for epidural anesthesia. Most of patients come to us after knowing about it from friends and relatives. With women postponing motherhood till late thirties and conditions like obesity and hypertension, chances for normal delivery become less. As one grows old, threshold to bear pain also reduces but epidural anesthesia increases chances of having normal deliveries, doctors say. With women postponing motherhood till late thirties, with conditions like obesity, diabetics and hypertension becoming common, chances for normal delivery were becoming less.

In an Epidural procedure a small injection is placed in your lower back, through which a fine tube (epidural catheter), the size of a thread, is passed into your back. Drugs can be injected through this tube to relieve the pain of labor. These drugs are local anesthetics which cause numbing of the nerves and pain sensation without affecting the ability to move. These drugs are also very safe for the baby. With an epidural in place, you may feel the contractions, but they will not be painful. It provides respite to expectant mother from unbearable pain during delivery. The anesthesiologist and your nurse will check that the epidural is working well.

Pain is the reason to have epidural and whenever your pain is significant you can request for an epidural. All women in labor who need pain relief can have an epidural, except those on blood thinning drugs or abnormal blood tests. Epidural is not necessary for you to have delivery, but it can be beneficial in reducing the pain of labor. You only need to be in established labor, but there is no need to wait for a particular dilatation of the cervix. Also in those very anxious or keen to have an epidural, it can be placed at a convenient time before the labor pain is too bad, so that your cooperation is better.

Advantages: There are quite a few advantages of administering Epidural Analgesia. A few are listed below:

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Disadvantages: Disadvantages of epidural anesthesia include its potential for contributing to uncommon minor complications such as persistent positional headache afterwards, shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating. Epidural makes pushing more difficult and additional medications or interventions may be needed such as forceps or cesarean.

Who should have an epidural?

WHO should not have an epidural?

Can an Epidural Fail?

Get all the details and read more ...........

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Your obstetrician and anesthetist will discuss these with you.

Occasionally, epidural may not work as well as we would like it to. If this happens, the anesthesiologist will help by giving extra doses or changing your position or the catheter position. If it still does not work, the procedure has to be repeated (by placing the epidural catheter again).

Do epidurals increase the chance of a cesarean section?

A large amount of research has been done on this topic and it is clear that epidural per se does not influence the rate of cesarean section. A proportion of women planning normal delivery will end up having a cesarean section. This proportion remains the same with or without an epidural.

Seeking pain relief methods for child birth is mother’s choice. This is discussed beforehand only with the doctor in charge of delivery at the clinic. Moreover, a well informed patient is usually more cooperative and adaptive during labor and delivery. Hence, prenatal pain-relief education should work and mutually benefit parties, the patients as well as the care providers. Not every woman needs an epidural and not every woman wants an epidural. But women who are interested shouldn't wait. Rupal Hospital for Women in Surat is a one stop place for all Gynaec and Obstetrics problems and our expertise lies in providing affordable Laparoscopic surgeries and difficult cases of infertility. Rupal hospital is renowned for its comprehensive services under one roof for all your Obstetric need like Painless Normal Deliveries and Caesarean Deliveries and Post natal care and advice. We have one of the best facilities of painless delivery using epidural analgesia in Surat. For the backup, we have the most sophisticated sonography machines at our disposal.

You can contact the team of our doctors at or at

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Type 2 Diabetes care
Lifestyle Advise
1.Lose weight if you are overweight
2. Exercise
3. Eat less salt
4. Stop smoking
5. Avoid alcohol
6. Follow your diabetes management plan
Diabetic Nephropathy complications & its symptoms
1.Swelling (edema), first in the feet and legs and later throughout your body.
2. Poor appetite.
3. Weight loss.
4. Weakness.
5. Anemia
6. Feeling tired or worn out.
7. Nausea or vomiting.
8. Trouble sleeping.
9. Puffiness face with. Swelling of eyelids.

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As we go on evolving; we begin to appreciate that a doctor’s prescription has to be HOLISTIC. It has to be aimed at healing an individual as well as a society; because; the health of an individual affects the health of a society; and the health of a society in turn; affects the health of an individual.

But this is not all!

The prescription can be holistic only if, it ensures complete and permanent health!

What is this complete and permanent health?

The complete and permanent health is actually an experience of ever effulgent benevolent bliss and vitalizing vitality! In other words; this is a state where there is no trace of pain, fear, worry, anxiety, insecurity, frustration, indolence, apathy, indifference, agitation, jealousy, hatred, viciousness, anguish, vindictiveness, revengefulness, selfishness, meekness, possessiveness and so on!

Hence ideally; the prescription should include all the guidelines about the preventive, curative and rehabilitative measures; applicable to; an individual’s health and also to; the health of a society. Thus the instructions should include all the international, national, regional and local policies, plans and programs; in every field of life!

This is especially essential as; the patient may be a lay person; medical student, a medical teacher, a practicing doctor, a paramedic. He or she may be even a policy maker, a leader or a health minister. He or she may be a scientist, a philosopher, a writer, an artist, whose thoughts, feelings, instincts and behavior influence; directly or indirectly; the international, national, regional and local policies, plans and programs in education, agriculture, industry, health care. All these are crucial determinants of the health of the society. The health of the society in turn; influences the health of an individual!
However; if we aim to include all such details in a prescription, then it would be impractical. A doctor is usually not trained in holistic health, holistic medicine and holistic medical practice. Moreover; even if a doctor is very well trained; and can include all such details, it would be extremely time consuming and the prescription would too huge!

In such a situation; how can we make a prescription holistic without having to train the doctors in holistic medicine? How can we make a prescription holistic, without having to write all the details? How can we make a prescription without spending excessive time? How can we make prescription holistic without making the prescription clumsily big and difficult for the patient; to read, understand and comply with?

The answer to this question is; to add an essential core to every prescription!

What kind of essential core?

The essential core should be such that it would add the holistic essence and make the prescription a holistic one! The criteria of such an essential core are;

1. It should nurture and evolve all the levels of consciousness.
2. It should be safe.
3. It should be noninvasive.
4. It should not involve technicality.
5. It should not involve skills e.g. singing.
6. It should not involve intellectual labor.
7. It should not involve learning a new language.
8. It should be inexpensive for the participants.
9. It should be acceptable to all cultures.
10. It should require minimum of classroom training
11. It should not interfere with daily routine.
12. It should be easy for compliance.
13. It should be accessible even to the individuals with handicaps such as physical, visual, auditory, vocal and so on.

The essential core of a holistic prescription that fulfills all the above criteria and is practiced across the cultures for millennia; is called NAMASMARAN, the synonyms of which are JIKRA, SUMIRAN, SIMARAN, JAP and JAAP.
The concept of NAMASMARAN actually involves remembering the true self; as NAMA actually implies the true self. Remembering the NAMA is actually trying to reorient and reunite with one’s true self; because; this true self is usually inaccessible to one’s thinking, feeling and sensing!
This true self or innate core of an individual is traditionally referred to; as God or omniscient, omnipotent and omnipresent eternal truth.
From physiological point of view; NAMASMARAN involves:
1. Gradual central anchorage, control, regulation, progress, evolution and sublimation of the belligerent infatuations, whims, fancies, ideas, thoughts, feelings and instincts.
2. NAMASMARAN heals us by rectifying our physical needs, passions, feelings, motivations, thoughts; and vision (perspective) and behavior.
3. This is characterized by victory of over the dualities of thoughts, emotions and passions. But it does not stop here. There is triumphant ascent through the opposing nervous activities (e.g. sympathetic and parasympathetic), opposite thoughts, antagonistic emotions, conflicting passions; contra posed motivations and even the duality of anabolism and catabolism!
4. Later the NAMASMARAN is associated with the realization of being one, with the immortal and true self.
5. This is a difficult to conceive; as we are entrained to believe our beginning and end; in the end of our body. Moreover; the fact that we are immortal; is only experienced by only few; and we have no experience of it. Hence not only world consensus; but even the world literature in general; including scientific; does not uphold the idea of immortality.
6. Lastly; this is a protracted journey, but the most appropriate one! Moreover; while the other components of a prescription ensure prevention, cure and rehabilitation in concrete manner; NAMASMARAN ensures immortality! It is not concrete. It is not tangible. It is abstract! But what can be a more successful culmination than the state of immortality; of preventing, preempting or treating any disease?
7. NAMASMARAN is traditionally practiced for millennia and is centered on this state of immortality called Sat (True, Eternal) Chit (Vital, Living) Anand (Bliss); and normalizes the responses to internal and external stressors as one of the many byproducts. Hence it is safe as well as sure. It would prove to be central and crucial to a prescription; in preventing, preempting, or treating hundreds of other diseases and ailments; in terms of not either annihilating them, or overpowering and conquering; and thus getting freed from their sinister spell!

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Toiletry chemicals linked to male infertility
Know all about Male infertility - Male reproductive system -Male fertility - Male infertility causes - Male reproductive system and infertility - Causes of male infertility & Male fertility test - Male infertility symptoms and Male infertility treatment - Male infertility - male fertility supplements - male fertility drugs - How to increase male fertility - Male sterility - Male factor infertility

Causes of infertility or reproductive problems include disease and aging. Male infertility is as common as female infertility. Infertility or reproductive problems are often treatable with infertility drugs and high-tech procedures. A third of all cases of infertility involve problems solely with the male partner. Infertility in a man may be the sole reason that a couple can't conceive, or it may simply add to the difficulties caused by infertility in his partner. Early testing for male fertility can spare their partners a great deal of unnecessary discomfort and expense. It's also a good way to quickly narrow down potential problems.

Men can remain fertile for much longer than women. Even though male fertility also declines with age, it tends to happen gradually for men. While many men remain fertile into their 50s and beyond, the proportion of men with sperm disorders increases with age. The decline in male fertility is more gradual for men than women. The decline in male fertility can affect the health of the children they may go on to have.

While female age is well known to have negative effects on fertility, reproductive success and the health of offspring, the influence of male age on a couple's fertility has been largely neglected all over the world. It is well recognised that reduced sperm performance can affect pregnancy success, but it is less well known that the quality of the sperm, particularly DNA quality, could affect the development and health of the offspring. The consistency in its findings suggests that further awareness of the potential consequences of male age on reproductive outcomes is needed. The study also establishes that older males contribute to increased risk of obstetric complications, miscarriage, and offspring disorders such as autism, Down syndrome, epilepsy, and schizophrenia.

Male infertility is due to low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle choices and other factors can play a role in causing male infertility.

Lifestyle factors affect fertility. As most lifestyle factors can be modified, providing advice and support in making healthy lifestyle changes can promote fertility. The evidence relating to the effects on fertility of caffeine, alcohol consumption and smoking are discussed here. Recent Male Infertility study suggests some new facts which are must read and interesting for anyone trying to get pregnant or start creating family.

A prospective dad must consider his health as important in the journey of parenthood. The biggest cause of infertility in men is abnormal sperm. Sperm can be affected by lifestyle factors such as smoking, drinking alcohol and taking drugs.

1) Caffeine Consumption: Drinking too much coffee can radically reduce a man’s ability to father children, a study has found. Men who drank two or more cups of strong coffee a day had just a one in five chance of becoming fathers through IVF. However, for those who drank less than a cup, the chance of having a child rose to nearly 52%.

2) Alcohol: The studies also showed that men who drink around a pint and a half of beer a night could improve their fertility. The research found that men, who drank at least 22g of alcohol per day, or three units, were more than twice as likely to have children through IVF as those who abstained. Health experts say that moderate amounts of alcohol may reduce stress levels and that in turn help conception. The researchers say no definitive conclusions can be drawn about cause and effect, but young men should be advised that habitual high alcohol intake may affect their reproductive health.

High male caffeine consumption appears to reduce couples’ chance of achieving a clinical pregnancy, while male alcohol consumption appears to enhance their chances.

3) Smoking: Smoking tobacco decreases sperm size and movement and can damage the genetic makeup of sperm cells. It may also have a negative effect on seminal fluid (the fluid that is ejaculated along with sperm). It may take longer for your partner to become pregnant, particularly if you smoke heavily.

4,5,6,7 and more details...........

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Going to a doctor will help you determine the cause of any fertility problems you may have and give you a chance to talk to the doctor about what you can do to increase your chances of conceiving. Your doctor may refer you to a fertility specialist at a fertility clinic. Couples that are having difficulty getting pregnant may benefit from changing some lifestyle habits and taking help of fertility specialist in ascertaining the real cause of infertility.

Indira Infertility Clinic in Udaipur, has helped countless couples in achieving parenthood. As Indira IVF's Medical Director, Dr. Ajay is a highly skilled fertility specialist committed to patient advocacy with proven expertise in andrology. He brings extensive experience in assisted reproduction treatments like IVF, IUI, ICSI, MESA, TESA to the care of his patients. Apart from this team of doctors at Indira IVf also takes care of other factors contributing to infertility like unexplained infertility, increased age in men and women, lifestyle habits like alcohol, smoking, caffeine, overweight or underweight, sexually transmitted diseases, occupational or environmental factors and stress.

If you are experiencing infertility problems either due to PCOS, endometriosis, varicocele, abnormal sperm count, shape or motility, blocked fallopian tubes or increasing age or secondary infertility you can contact the doctors of Indira IVf at or at

Read and know more of IVF fertility treatments, IVF & Fertility Success Stories and your options for starting family at

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About twenty years ago I had sent a working hypothesis (a guesswork or conjecture) to a medical journal. In that hypothesis I had suggested stress as a root cause; in essential or idiopathic hypertension and ischemic heart diseases (apart from many others).

The hypothesis was rejected as baseless.

Today I wish to reiterate that hypothesis; in this article for free download; so that everyone can read and decide if it makes sense or not.
The hypothesis is:

The cardiovascular dysfunction; manifested in essential hypertensive pathophysiology and/or ischemic pathophysiology; is due to acute or chronic stress; either symptomatic (associated with; acute or chronic; restlessness, anxiety, conflicts, suffocation, fear, insecurity) or asymptomatic and without any symptoms. The underlying mechanisms of this stress could be:

a) Excess of adrenergic and nor adrenergic response or associated with tonic or phasic arteriolar spasms, increase in myocardial pumping, increase in all the catabolic products including those, which are produced by direct microscopic and molecular damage caused by increase in the catabolism/anabolism ratio!

b) Excess of simultaneous adrenergic, noradrenergic, cholinergic, non adrenergic, non noradrenergic; and non-cholinergic response; leading to disruption of the synergy and/or complementarity (e.g. actions on GIT smooth muscles and sphincters) , and phased out opposing actions (+ ve and – ve inotrophic, bathmotropic, dromotropic and chronotropic actions on heart) and exhausting one another

c) Metabolic changes corresponding to catabolic excess and/or anabolic exhaustion in terms of increases in the fatty acids, cholesterol, triglycerides, glucose, amino acids

d) Constriction of the vessels of kidneys resulting in increase in rennin angiotensisn activity and subsequent increase in blood pressure

e) The root cause of spasms in coronary (heart) blood vessels is also acute and/or chronic over activity of sympathetic nervous system; due to acute or chronic stress.

f) The root cause of atherosclerosis; is the increased friction and mechanical damage and roughening of the constricting vessels; especially arterioles due to over activity of sympathetic nervous system.

It is agreed that some people would be genetically more prone to stress and subsequent ischemic heart disease and blood pressure. But that does not disprove or even create a doubt about the hypothesis of stress as a root cause of bad lipids, spasms and atherosclerosis and subsequent ischemic heart disease and essential (idiopathic) hypertension.

g) One can read the pathophysiology text books and then think about confirming or ruling out (through statistical surveys, clinical studies, experimental work etc.) this hypothesis.

h) However; till then; we can apply common sense and reason out; how stress and its inappropriate management can disturb the metabolic, endocrine, neuroendocrine, autonomic nervous and central nervous activities and influence various tissues including heart vessels and other blood vessels in body.

i) It is important to remember that the damaging stress is often subconscious; and is present even during sleep and embryonic life and hence goes unnoticed.

The conclusion of this brief hypothesis; is that the first line preventive as well as healing measure (treatment) for ischemic heart disease and essential hypertension (and several other diseases mentioned in my book on Total Stress Management); is the practice of NAMASMARAN, which is the core of Total Stress Management!

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1. SANSHAY (Doubt) refers to lack of complete belief that NAMA is the ultimate truth. Often, this is not merely an intellectual doubt, but a stronger force. It incorporates the dragging, distracting and destabilizing influences arising from the characteristic metabolic reactions, hormonal interactions and the autonomic nervous system activities, besides the central nervous activities. This force can overpower the intellectual clarity and conviction that NAMA is the ultimate truth!

2. The meaning of the word SANG (company) is our own attention, interest and involvement in anything, any situation or any person. Hence SATSANG means attention, interest and involvement in NAMA; or anything, any situation or any person helpful in this.

3. KUSANG is our own attention, interest and involvement in anything, any situation or any person opposing this.

4. NAMASMARAN ensures eradication of SANSHAY and consolidation of SANTSANG.

5. This realization, which preempts downfall in every respect; in personal, national and international life; is actually the victory (VIJAY) and grace (KRUPA) of Guru.

Since Guru is same as our innate (though usually inaccessible) self; I call this phenomenon;n VICTORIA INTERNA; and since this is the same as NAMA; I call this phenomenon; NAMAVIJAY.

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There are signals of serenity and happiness at personal level and holistic renaissance at global level; in the form of global unity and harmony.
Global conscience and consensus is being inspired and motivated towards it. In accordance the vision, policies, plans, programs and their appropriate implementation; are being shaped.

The mass movement of cleanliness; apparently initiated by Mr. Narendra Modi is actually a small reflection of this.

However; the degree of purity of body and mind; has direct implication; on our needs, requirements, whims and fancies; and their harmful or beneficial effects on; an individual, society and the environment. These effects are either direct or through the associated industries, trades and activities, which produce different types of wastes/pollution.

Hence this movement (SWACHATA ABIHIYAN) is bound to be far more successful; than what it is now; by integrating it with the idea of purity of body and mind. Even as it may not be feasible or appropriate; to enforce coercive measures of purity of body and mind; it would be more than advisable for the government to assist us in progressing towards the purity of body and mind.

This can be best done by the government and all the agencies associated with the SWACCHATA ABHIYAN; by simultaneously introducing and highlighting along with it; the principles and practice of NAMASMARAN.

This would not only help the SWACCHATA ABHIYAN to be far more effective; but also engender the serenity and happiness at personal level; and holistic renaissance at global level!

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