Tuesday, February 28, 2017

Life expectancy will approach the 90-year mark in some countries by 2030, with a persistent female advantage.

courtesy: Pathfinder.gr
Projection of life expectancies is necessary for healthcare policy planning, social services, social security and pension. It also reflects the patterns of health and disease prevailing in the society. A recent paper published online February 21 in Lancet aims to forecast future life expectancy in 35 industrialized countries using the Bayesian model.

Instead of using a single model, the researchers developed an ensemble of 21 forecasting models to  eliminate the uncertainty associated with a single prediction model.

The authors say "Taking model uncertainty into account, we project that life expectancy will increase in these 35 countries with a probability of at least 65% for women and 85% for men, although the increase will vary across countries.”

South Korean women are projected to have the highest life expectancy of more than 86·7 years in 2030 with 90% probability. This is equivalent to current highest life expectancy worldwide. The model also indicated that there is 57% probability that the life expectancy at birth for South Korean women will be higher than 90 years in 2030, "a level that was considered virtually unattainable at the turn of the 21st century by some researchers," the authors write.

Earlier gain in life expectancy in South Korea is due to decrease in infectious disease rate in infant and young adult but the increased longevity of the older groups is due to decrease in death rate from chronic diseases. Other contributing factors include improved nutrition, better access to health care, new medical technologies and control of many infectious diseases. South Korean and Japanese women also have lower BMI, and lower B.P than western counterparts.

South Korean women are followed by women from France, Spain, and Japan and are expected to occupy the top 3 spots in the 2030 list.

Men still lag in this projection with 95% probability of surpassing 80 years in 2030, and a greater than 27% probability that it will surpass 85 years in South Korea, Australia, and Switzerland. Similarly, Men in South Korea and many central European emerging economies like Hungry and Slovenia are going to make large gains in life expectancy by 2030 similar to men in Denmark, Ireland, and a few other western European nations. Currently Australia has the highest life expectancy for men.

In 2010, women had a higher life expectancy than men by 3·9 to 8·5 years. This gap will be narrowed and men will catch up with the female life expectancy by 2030 in every country expect Mexico where female life expectancy is predicted to increase more than male life expectancy.

Most of the projected gains in   life expectancy is due to enhanced longevity in older ages specially women, increasing the aging trends of industrialized countries. In 19 countries, one in two 65-year-old women have another 23 years to live and in other 11 countries 24 years to live.

Similarly, Male life expectancy at age 65 years is projected to surpass 20 years in 22 countries by 2030, “a level that has not been achieved so far” says the authors.

Of the 35 countries studied, the USA, Japan, Sweden, Greece, Macedonia, and Serbia have the lowest projected life expectancy both for men and women.

Currently USA, has the lowest life expectancy at birth than other high income countries and is expected to fall back further in 2030.  USA has the highest Maternal and infant mortality rate, Homicide index and BMI for any high-income country. The life expectancy in US has also stagnated or have declined for few population groups in recent years.  The authors quote "The USA is also the only country in the OECD [Organization for Economic Cooperation and Development] without universal health coverage, and has the largest share of unmet healthcare needs due to financial costs." 

In an accompanying editorial Dr. Santosa write “Forecasting life expectancy at birth and at age 65 years can help governments and health services to make the right investments in health, such as averting deaths due to infectious diseases and reducing maternal and child mortality. Achieving universal health coverage is worthy, plausible, and needs to be continued.”

Full text of the article here.
Full text of the editorial here.

Monday, February 27, 2017

Best Apps for Ob/Gyn healthcare provider 2016.

An interesting talk by Katherine T. Chen, MD, MPH, Icahn School of Medicine who has done extensive research on the best apps for doctors that are accurate, free and available from a phone’s app store.

Last few years have seen an overload of health app and it is difficult to choose the right and accurate one from the overflooded market.

Dr Katherine T. Chen narrows it down for the physicians. 

ACOG 2016 

FlexDex, a revolutionary laparoscopic technology that moves like surgeon’s hand.


FlexDex, a new minimally invasive surgical tool system developed by University of Michigan startup FlexDex Surgical has been in use for the first time in a series of operations. FlexDex has already begun shipping its product throughout the U.S. This new $500 surgical instrument is vying to take the place of a $2 million robot for certain minimally invasive procedures.

The FlexDex is very intuitive and ergonomic to use, provides greater precision and functionality. The new technology gives surgeons higher degree of dexterity and intuitive control than traditional laparoscopic instruments.

FlexDex is an all-mechanical platform that mounts to the surgeon's arms and precisely translates the surgeon’s hand, wrist, and arm movements that are performed outside the body into corresponding precise movements inside the patient’s body. The FlexDex concept is the result of two major innovations that has revolutionized the physical configuration of hand-held, mechanical tools.
  1. A mechanism around the surgeon’s wrist that geometrically projects a ‘virtual center’ of rotation at the same point as the surgeon's wrist.
  2. This ‘virtual center’ mechanism is placed between the tool handle and a tool frame, which is now attached to the surgeon’s forearm via an arm-brace.

Inventor of FlexDex

The movements of the surgeon’s hands are directly transmitted to the tool shaft and end-effector. The surgeon’s wrist is allowed to rotate freely and naturally while the working tip inside the body flexes in the same direction as the handle and it can be rotated 360 degree with the help of the handle.

There are no buttons or lever to press but only a trigger that always rests in the palm that is used to activate the instrument at the tip.

Geiger demonstrated: "If I move my hand up, the device tip goes up. Wherever I move my hand, the tip of this instrument follows." No other instrument currently on the market operates like this.

To stitch internally, for example, surgeons can opt for old-fashioned straight-stick instruments that make complex tasks like suturing and knot-tying ergonomically challenging and extremely difficult to learn, Geiger said. Or they can use the high-tech daVinci Surgical System, a robot-assisted approach that's not available at all hospitals due to its cost. It takes considerable training to learn how to use a robot-assisted system.

 This startup is the brainchild of Shorya Awtar, a University of Michigan (U-M) engineering professor who co-founded FlexDex with his U-M colleague and surgery professor, James Geiger, and entrepreneur Greg Bowles.

"FlexDex provides the functionality of robots at the cost of traditional hand-held laparoscopic instruments. We've disrupted the paradigm where surgeons and hospitals had to choose between high cost/high function and low cost/low function," said Awtar "It's kind of like the transition from mainframe computers to smartphones. You hardly need a manual to use it. It's just intuitive." 

To contact FlexDex surgical call 810-775-3352   Mail:info@flexdexsurgical.com

                                              FlexDex | A Revolutionary Surgical Tool

                                              FlexDex | A Revolutionary Surgical Tool

ACOG recommendations for management of suboptimally dated pregnancies.

The American College of Obstetricians and Gynecologists (ACOG) recently published its recommendations regarding management and delivery of pregnancies in whom the best clinical estimation of gestational dates is not confirmed in forthcoming March 2017 issue of Obstetrics and Gynecology Journal. 

ACOG has always strived to curb elective deliveries before 39 weeks of pregnancy and spread awareness among obstetricians about the negative effects of elective delivery before 39 weeks, which increases neonatal respiratory and nonrespiratory morbidities.[1] 

The article can be accessed here.

This topic was also debated at the ACOG Annual Clinical and Scientific Meeting 2016.[2]

The most accurate method of gestational dating is a first trimester sonography. As the woman advances into second and third trimester the reliability of USG for the purpose of dating decreases linearly.  Pregnancies without an USG performed to confirm or revise the gestational dating before 22 0/7 weeks are labeled as suboptimally dated.

The guidelines for management are:

  1. The decision about timing the delivery in a suboptimally dated pregnancy should be based on the best clinical estimate of the gestational age.
  2. There is no role for elective delivery in suboptimally dated pregnancies to avoid the neonatal morbidity because the pregnancy may be earlier in gestation than believed to be. Decision to administer antenatal corticosteroids should be based on the best clinical judgement if a woman with suboptimally dated pregnancy is identified to be at risk for preterm delivery.
  3. Amniocentesis to determine fetal lung maturity should not be used to decide the time of delivery in suboptimally dated pregnancies because  it is not reliable in predicting pulmonary maturity and other non-respiratory outcomes.
  4. A follow-up sonography after 3-4 weeks of the initial one is always advisable in women with suboptimally dated pregnancies. It helps to support the prediction of gestational dating as well as fetal well-being in terms of weight gain. If IUGR is suspected, a close surveillance with umbilical cord Doppler should be considered.
  5. It is always difficult to manage a presumably late-term pregnancy that lacks accurate dating because of the risk of overlooking post maturity and associated fetal morbidity and mortality. Therefore, is advised to begin antepartum fetal surveillance at 39–40 weeks of gestation and to deliver at 41 weeks using the best clinical judgement because it could be more postdated than it is believed to be.
  6. In women with suboptimally dated pregnancy with a previous history of low transverse C-section incision a trial of labor can be given based on the clinical assessment of gestational age. If a woman requests a repeat elective C-section, it should be planned around 39 weeks based on best clinical judgement.
  7. Women with suboptimally dated pregnancy should be well informed about the risks of neonatal morbidity and mortality because of inaccurate dating.

The full text of the  journal article can be accessed here.  

[1] https://obgynupdated.blogspot.com/2017/01/choosing-wisely-and-acog-advises.html
[2] https://obgynupdated.blogspot.com/2016/05/elective-induction-of-labor-iol-at-39.html

Sunday, February 26, 2017

The labor room of future: Light, Sound and Imagery providing a seamless experience.

Denmark hospital's first delivery room of future.

Philips developed a new and innovative concept to help women stay calm and improve the experience of a major life event. With the collaboration with Philips the simple delivery room is changed into a sensory room, with soothing lights and image formation that provides a stimulating ambience.   

The project was started in Denmark hospital. Katrine Hornum-Stenz, chief midwife at Nordsjællands Hospital says “The use of lighting, sound and imagery in delivery rooms is based on developments over many years. It is intended to help women in labour to experience calm and reassurance during the birth, thereby enhancing the experience of giving birth for both the woman and her family. We also expect the new sensory birthing rooms to help create a more pleasant working environment for staff.”[1]

The experience varies according to the woman’s stage of labor. In the early stages of labor, it consists of an app which help the women practice various breathing techniques. It includes a special audiovisual programme that supports the women breathing. The rhythm of breathing is displayed on to a large audiovisual panel through changing light and sound in the room. The app also helps woman and her family to change the colors in labor room according to her need.

As the women progresses in labor, the visualization grows and changes in response to data obtained from woman’s contraction. The animation is based on contractions monitoring data which is also simultaneously assessed by an obstetrician.

At the start of contraction, the animation on the wall changes to breathing coach to support contraction and also lend a point to focus on during the peak of contraction. For each contraction, a new flower grows up whose size and color is based on the intensity and duration of contraction. The distance between flowers indicate the interval between two successive contractions.

The visual pattern created provides the patient and her family a beautiful and simple idea about progress in labor, at the same time it helps to take her mind off the pain of contractions.

After the baby is born the visual design is also completed. The whole experience can be saved to visualize it later electronically and providing a beautiful experience.  

The Philips video is worth watching and explains it all.

[1] http://www.largeluminoussurfaces.com/content/dknordsj%C3%A6llands-hospital-and-wavecare-aps

Saturday, February 25, 2017

IVF in a shoebox: The Walking Egg Project

The Walking Egg (TWE) is a non-profit organization founded in March 2010 by four members: Annie Vereecken, Rudi Campo, Willem Ombelet and Koen Vanmechelen. It aims to bring fertility treatment within reach for all in developing and developed countries by a multidisciplinary and global.

Willem Ombelet, Belgium.
Infertility is a cause of distress across countries and in many countries very bad stigma is attached with-it. WHO quoted that about 10% of women have infertility and per Dr. Willem Ombelet there are 150 million infertile couples worldwide.

IVF and other Assisted Reproductive Techniques come at whopping cost that is affordable to selected few in developing and developed countries. Many couples have known to sell properties and other assets to go into treatment.

The standard price of an IVF cycles in most developed countries is around $12,000.

Walking Egg project was founded with the basic aim of optimizing fertility treatments in terms of effectiveness, availability and affordability. It also aims to raise global awareness regarding childlessness and the societal and psychological implication associated with it.

One of the biggest obstacle in making IVF affordable to all is the mammoth cost of basic setup of IVF lab where "in vitro" egg fertilization is brought around.

Well, the focal point of the Walking Egg's mission is a simplified system for egg fertilization and embryo transport. Measured quantity of citric acid and sodium bicarbonate are mixed in one test tube, the Carbon Dioxide created by the chemical reaction is led into series of test-tubes housing the culture medium for the embryo. The CO2 creates the alkaline medium required for the egg fertilization.

Aluminium heating block 
To maintain the perfect temperature for the gametes, Dr Van Blerkom tried many low-cost techniques like using a thermos or aluminium heating block which worked perfectly, eliminating high-end equipment like complex microprocessor-controlled incubators.

“The embryos didn't care if they were in an expensive triple walled incubator or a thermos flask,”said Professor Jonathan Van Blerkom, Embryologist, University of Colorado.

The next day, the test tube is visualized under a microscope to see if an embryo has been formed, which is transferred to the mother’s womb after 6 days.

This simplified system reduces the whole IVF lab to an aluminium heating block containing one pair of test tubes for each embryo, all inside a shoebox-sized container.

Trials began in Genk, Belgium in November 2012, and so far, 50 healthy babies have been born in Belgium
Self contained incubators 
using the system. “The technique works at least as good as regular 
IVF for a lower price, “says Ombelet.

Beyond Genk, Belgium the Walking Egg project have started laboratories in Ghana Porto, Kenya, Porto, London and Sicily. But IVF lobbyist are creating problems for setting up LCIVF labs across countries.

It took 2 years for Geeta Nargund, a senior consultant gynecologist and the medical director of the Create Health Clinics in London  to  navigate through  the stricter regulation in London for a trial of The Walking Egg project to begin. 

In Europe, this method can cut IVF costs by three-quarters bringing it down to less than 200 euros (£159) per cycle, says Willem Ombelet of the Genk Institute for Fertility Technology in Belgium.

Many international organizations have already expressed their desire to collaborate with the Walking Egg project including WHO, ESHRE and ISMAAR.

The W.E organization is working on education of the women in all aspects of fertility, advocacy and networking with global and local organizations.

Currently the project team and organization collaborates with members from the developing countries and help them set up low cost IVF laboratories in their countries, training and capacity building.

Dr Willem Ombelet also gave an hour talk about the Walking Egg Project at the The Best of ASRM and ESHRE held from 23-25 February,2017 at Paris, France.

The full information about the project can  be accessed here.

North American Menopause Society (NAMS) video series about important midlife health topics: February 2017.

The North American Menopause Society (NAMS) has started comprehensive video series for clinicians about important midlife health topics. All the interviews in the series are hosted by NAMS Board of Trustees Member and President Dr. Marla Shapiro, a Canadian physician, who led this exciting initiative.

In this monthly series, the  latest video is ‘ Sleep Disorders in Midlife’, Dr. Shapiro interviews Dr. Hadine Joffe, Professor of Psychiatry at Harvard Medical School, Director, Division of Women's Mental Health at Brigham and Women's Hospital and Director Psycho-Oncology Research at the Dana Farber Institute in Boston, Massachusetts. Dr. Joffe discusses how to diagnose and treat common sleep disorders in midlife women.

                                          Dr Hadine Joffe discusses sleep disorders

Friday, February 24, 2017

ACOG updates its guidelines on management of newborn with meconium-stained amniotic fluid.

Newborn resuscitation 

The American College of Obstetricians and Gynecologists (ACOG) updates its guidelines regarding resuscitation of newborn with meconium stained liquor.  The guidelines were published in the forthcoming March issue of Obstetrics and Gynecology. [1]

The committee opinion says that:

  • The resuscitation of infants with meconium stained liquor should follow the same principles as a newborn with clear fluids.
  • ACOG also advises against intrapartum suctioning irrespective of the fact that the newborn is vigorous or lethargic. At the same time, it mandates that a trained team of pediatrician or other medical personnel who are well versed with full resuscitation including endotracheal intubation should be present at the time of delivery.

The new recommendation against intrapartum suctioning whether a newborn is lethargic or vigorous is based on prevention of harm (the unnecessary delay providing bag-mask ventilation) because of precious time lost in suction.

The American Academy of Pediatrics and the American Heart Association first published the guidelines in 2006. Before the guidelines were formulated, delivery of all meconium stained newborn was managed by suction of the oropharynx and nasopharynx at the perineum before the delivery of the shoulders (intrapartum suctioning).

The guidelines did not support the practice of routine suction as it did not alter the incidence of meconium aspiration syndrome in vigorous infants. Non-vigorous newborns did undergo active incubation of trachea and suctioning of meconium and other aspirated from below the glottis.

The guidelines regarding management of lethargic and non-vigorous were again updated in 2015 which advised that if a non-vigorous infant has got good muscle tone, then the infant can be roomed in with mother after gentle cleaning of mouth and nose with a bulb syringe.[2]

If the infant lack muscle tone and breathing efforts he should be immediately shifted under a radiant muscle warmer and appropriate decisions should be individualized according to clinical condition. PPV should be initiated if the infant is not breathing or the heart rate is less than 100/min after the initial steps are completed. Routine intubation and suction is not recommended in all non-vigorous infants with meconium stained amniotic fluid.

If the airway is plugged by meconium, intubation and cleaning should be done.
ACOG practice committee updated its recommendation regarding timing of cord-clamping on December 22, 2016.
The article can be accessed here


[1] http://journals.lww.com/greenjournal/Fulltext/2017/03000/Committee_Opinion_No_689___Delivery_of_a_Newborn.45.aspx#P28
[2] http://circ.ahajournals.org/content/132/18_suppl_2/S543

Thursday, February 23, 2017

A C-section rate of approximately 19 percent seems to be ideal for the health of both women and newborns.

All generalization are false including the recent statement by India’s Union women and Child Development Minister about bringing down the C-section rate to 10%. The minister recently asked the health minister to issue a mandate to all the hospitals displaying the C-section rates. She took this action in response to a Change.org petition against hospitals and doctors profiteering by pushing women towards surgical deliveries instead of natural vaginal birth.

The petition has received 1.3 lakh signatures so far, a number that is not much looking at the total population of the country.

"We have entered into an area, very sorry to say, in the last 20 years, where doctors care more about money than about patients' health. We would like the hospitals to display data on how many cesarean section deliveries they have done," said the Minister.

"The normal Cesarean delivery rate in a country would not be more than 10 percent, because it is usually done as a last resort. In this country, it is extremely high because it brings the doctor more money," she further added.

Well, you cannot generalize and mandate a uniform C-section rate for all the hospitals in all the states across country. It all depends upon the healthcare infrastructure, geographical location, access to prenatal care and surgical expertise and the needs of individual woman.

Pointing a finger at the obstetrician and asking her to stop doing C-section is like treating a symptom instead of going into the root of problem. A hospital can have a C-section rate as high as 70% if it a tertiary care high risk hospital.

A review of trends around the world shows that currently about 18.6% of births take place by Cesarean section.  The rates vary from as low as 2% to as high as 50%. In U.S.A, about 1.3 million babies are delivered by Cesarean every year, which roughly equals to every 1 in every 3 children born in US(33%).

The WHO recommends that the ‘ideal’ rate of C-section for optimum maternal and fetal outcome should be around 10-15%.This was  based on the  observation that some countries with the lowest perinatal mortality rates had cesarean delivery rates that were less than 10 per 100 live births. The study also has insufficient data and relied upon average C-section rate from multiple previous year.

However, new study recently examined the relationship between C-section rates and maternal and neonatal mortality in 194 countries around the globe concluded that C-section rate up to 19 percent is associated with lower maternal and neonatal outcome. C-section delivery rates above 19 percent showed no further improvement in maternal and neonatal mortality rates.[1] Researchers used mathematical modeling to impute C-section rates for countries where data was missing and to account for other contributing factors such as health expenditure.

Latin America and the Caribbean region has the highest CS rates (40.5%) while some countries in Africa have the lowest (7%). Brazil occupies the top slot with a rate that exceeds 50% (55.6%).

The  study  found out that in countries with very low C-section rate, people did not have access to basic healthcare and surgical facilities resulting in high maternal and neonatal morbidity and mortality. In fact, a study by WHO concluded that in countries with C-section rate < 10%, there is an additional need for 0.8 – 3.2 million CS every year to improve maternal and neonatal mortality and morbidity. [2]

Dr. Thomas Weiser, an assistant professor of surgery at Stanford School of Medicine says “As countries increase the number of C-sections they provide, mortality goes down— but only to a point, when the C-section rate tops 19 percent, benefits for maternal and infant health plateau.

Increasing C-section rates in recent years are due to modern technology of continuous FHS monitoring in labor room which is a two-way sword, practicing defensive medicine, rise in on-demand C-sections beside other maternal and perinatal factors that come into play.

According to ACOG " Safe reduction of the rate of primary cesarean deliveries, is the only way to  lower  the repeat  cesarean section rate and total cesarean rate."

To conclude, it is impossible to form a policy regarding relationship between delivery methods and birth outcomes. Each case must be decided taking into consideration social, medical, obstetrical and healthcare factors.

Our goal as an obstetrician should be to see that every woman who needs a C-section should get one and every woman who does not need a C-section should not get one.

[1] http://jamanetwork.com/journals/jama/fullarticle/2473490
[2] http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf

Wednesday, February 22, 2017

North American Menopause Society (NAMS) video series about important midlife health topics: January 2017

The North American Menopause Society (NAMS) has started comprehensive video series for clinicians about important midlife health topics. All the interviews in the series are hosted by NAMS Board of Trustees Member and President Dr. Marla Shapiro, a Canadian physician, who led this exciting initiative.

In the latest video Dr. Shapiro interviews Dr. Sheryl Kingsberg, Chief, Division of Behavioral and Professor in the departments of Reproductive Biology and Psychiatry at Case Western Reserve University School of Medicine and President-Elect of NAMS.

This video is titled" Tips of taking sexual history". 

                         North American Menopause Society (NAMS) video series

Air pollution identified as a possible risk factor for nearly 3 million preterm births every year.

Air pollution 
Outdoor air pollution has been identified as a possible risk factor for preterm births across the globe according to a study published in Journal of Environment International online February 10, 2017.[1] 

The 2010 study estimated that 2.7–3.4 million preterm births may be prevented if PM2.5 exposure is brought down.

It is estimated that 14·9 million babies were born preterm worldwide in 2010.

There exists a wide disparity between Preterm Births(PTBs) rates across the globe, European countries have the lowest rate at 4-5% vs. countries in Africa and South Asia with rates as high as 15–18%.

In South Asia, about 1 million   PM2.5 associated PTBs happened in India, followed by China which contributed another 500,000.
A pregnant woman in India or China will likely be exposed to 10 times more pollution as compared to a woman in Canada or UK.

It is estimated that in 2010, out of 135 million livebirths globally 14.9 million babies (11.1%) were preterm, including both spontaneous and iatrogenic births. [2]

Exposure of mother to fine particulate matter(PM) has been identified as one of the many risk factors for PTBs as well low birth weight babies. The fine PM finds its way into blood stream through lungs and causes pulmonary and placental inflammation, coagulopathies, endothelial dysfunction and hematological responses.

Fine particles are produced from all types of combustion, including motor vehicles, power plants, solid cooking fuels, residential wood burning, forest fires, agricultural burning, and some industrial processes.

Desert dust also contributes to Particulate Matter ( PM) and in Sub Saharan Africa, Middle East and North Africa it is the major exposure. 

"Air pollution may not just harm people who are breathing the air directly - it may also seriously affect a baby in its mother's womb," said Chris Malley, lead author of the study which is based on data for 2010.

The study further demonstrated that majority of the PM2.5 associated preterm birth could be prevented by implementing strict emission control strategies in these regions except in in Sub Saharan Africa, Middle East and North Africa where nothing much can be done to change the geography of the area.

Johan Kuylenstierna, co-author of the study, and SEI's policy director said "In a city, maybe only half the pollution comes from sources within the city itself - the rest will be transported there by the wind from other regions or even other countries."

Nevertheless, the study demonstrated that reduction of maternal PM2.5 exposure through emission reduction strategies could bring down the global preterm rate, limit in utero exposure to PM2.5 bringing down postnatal and long term neonatal morbidity.

Exposure to PM2.5 is also responsible for 9–14% of total preterm births globally out of the total risk percentage. It should also be targeted along with other risk factors to reduce the incidence of preterm birth.

[1] http://www.sciencedirect.com/science/article/pii/S0160412016305992
[2] http://www.sciencedirect.com/science/article/pii/S0140673612608204

Tuesday, February 21, 2017

Clarius Wireless, Handheld Ultrasounds receives clearance in Europe.

Clarius probe and smart phone screen 

Clarius wireless ultrasound  gets European CE Mark approval for its wireless C3 and L7 ultrasound scanners.

Mobile Ultrasound developed by Clarius Mobile Health got the FDA 510(k) clearance for its C3 and L7 Clarius wireless ultrasound scanners on December 14, 2016.It has been rated as top technical innovation of 2016, that can change the medical device industry.

Founded in 2014 by Laurent Pelissier, Clarius Mobile Health merges the power of mobile phones, advanced technology, and decades of collective ultrasound experience to produce high quality, point-and-shoot mobile ultrasound devices.

Clarius is based at VANCOUVER, British Columbia.

                                Clarius wireless ultrasound scanners

The device uses just about  any iOS or Android phone or tablet as the display. A Clarius app is used to control the transducers and displaying the visualizations.

Clarius’ultrasound scanners are mobile devices compatible with Apple iOS and Google Android devices, the company said.[i]

The scanners are powered by a rechargeable battery that  will last for more than 45 minutes of scanning and up to 7+ days of stand-by power.

Two batteries and a charger are delivered with each Scanner. Built with a magnesium case, Clarius Scanners are designed to withstand challenging environments and are water submersible for easy cleaning and disinfection.

With automated gain and frequency settings it is as easy to use as a mobile camera.

"Physicians have been asking for a portable ultrasound system that works with their iPhone for some time," said Laurent Pelissier, Chairman and CEO of Clarius Mobile Health.  "The challenge has been to make an affordable device that is small enough to carry around and that also produces great images.  I'm happy to say we've succeeded in creating a product that will enable more clinicians to use ultrasound anywhere to improve patient care. It's as easy to use as a mobile phone camera."

                                     Clarius: The new stethoscope

2016 was the 200th anniversary of the stethoscope and every doctor will eventually hold a hand-held ultrasound that can be used in daily practice, just like a stethoscope  believes Laurent Pelissier, CEO of Clarius.

"Clarius is the future of patient care. The image quality is amazing for any scanner, much less one that fits in my pocket," said Dr. Steven Steinhubl, Director of Digital Medicine at the Scripps Translational Science Institute.  "The ability to wirelessly connect it to any Apple or Android device means that anyone on my team can use it with whatever they already carry around in their pocket."

This mobile ultrasound startup is reshaping the $ 6 billion healthcare market. [ii]

In the United States, Clarius Ultrasound Scanners start at $6900.

Clarius will be available with Color Doppler on its premium offering, which will be priced higher than its entry-level black and white model.

[i] http://www.massdevice.com/clarius-wins-fda-510k-wireless-ultrasound-device/

[ii] http://www.forbes.com/sites/julianmitchell/2016/12/27/this-mobile-ultrasound-startup-is-reshaping-a-6-billion-healthcare-market/#4edb7bda4941

World’s first app receives approval as a contraceptive in Europe, could it replace the pill?

Natural Cycles app.

Natural Cycles- is world’s first fertility control app that got a clearance in European Union including U.K placing it alongside pills, IUDs and condoms. Natural Cycles is a certified and CE marked medical device of class IIb, intended to be used for contraception.

Elina Berglund Scherwitzl
The app was created by Dr Elina Berglund, 32, a physicist who was part of the team that found the Higgs boson at Cern in Switzerland, and her husband Dr Raoul Scherwitzl, a postdoctoral researcher.

“Natural Cycles can adapt to each individual woman’s body and, with a high degree of precision and accuracy, determine when she is ovulating.” says Dr Elina Berglund

Natural cycles is just like old times period tracker with some added features. Using sensitive thermometer and some mathematics the app claims itself “as good as the pill" at preventing pregnancy.

The app requires the women to input her daily basal body temperature recordings and the date of menstruation. LH test result is an optional entry point.

The safe and unsafe days 
The app’s calendar then labels fertile days as red (when you should abstain or use a condom) and the rest green, when you’re “safe”.

The app is primarily based on the fact that woman’s body temperature rises slightly (about 0.4)after ovulation and remains slightly elevated throughout the rest of the cycle. The app uses an algorithm that takes into account body temperature, cycle irregularities, sperm survival, length of menstrual cycle and cycle irregularities.  The algorithm learns from previously recorded cycles from the same woman and can provide predictions of her fertility status and upcoming ovulation, LH and menstruation days.

Initially the app shows nearly equal number of green and red day but, as women continue using the app and fed more data, the number of red days are reduced to 8 each month. The app is 99.95% sure before it assigns a day red or green. If in doubt it will go red.

It can be used by anyone, even women with PCOD or irregular cycles, only these women will have more red days on the calendar than green.

efficacy of the app 
A recent clinical study published in the peer-reviewed European Journal of Contraception and Reproductive Health Care recruited 4000 women between ages 18-45 to use this app.[1] The study results showed that for every 100 women who used the app, 7 women got pregnant each year (7% failure rate). CDC statistics quote the failure rate for pill is around 9%, for injectable contraceptive it’s 6%; for an IUD, it's 0.2% - 0.8%.

Kristina Gemzell Danielsson, from Swedish medical institute Karolinska Institutet. “The efficacy is far below that of intrauterine contraception or implants, but similar to that of the pill when used in real life. The pill which will celebrate its 56 birthdays in March 2017 was a breakthrough that liberated women and changed the way we look at sex.  

Could the app replace pill that has ruled for 56 years.

Natural cycles can help women to plan a pregnancy as well. It is specially useful for women with irregular cycles and PCOD. In fact it has already helped 5000 Swedish women to conceive under the # HappyPregnant project. Elina Berglund has already launched a similar project in U.K.

The app is currently used by nearly 100,000 users in 161 countries, paying £6.99 per month.

Natural Cycles was first launched in 2014, in Stockholm and across Sweden.

The company aims to expanding the team in the UK and internationally and to continue with more clinical studies and data analysis.

The app can be purchased here.

[1] http://www.tandfonline.com/doi/full/10.3109/13625187.2016.1154143