Samitivej Sukhumvit Hospital has conducted extensive research into and been involved in the development of this type of treatment, and first used it on July 12, 2010,

Current treatments for issues of infertility employ the use of ART to solve the problem. For some groups of patients – such as cases where the male has a very low sperm count, weak sperm health, or severe abnormalities, or if the female’s eggs have hard or thick shells – treatment is carried out with a procedure in which a single sperm is injected directly into an egg.

After incubation, eggs that are successfully fertilized become embryos, at which time the embryo transfer procedure is used to physically place the embryo in the woman’s uterus, where, if the treatment works, pregnancy will occur and the embryo will grow into a baby. We call this method Intracytoplasmic Sperm Injection (ICSI). Research has shown that only about three to five per cent of patients experience either fertilisation failure or a less than 50-per cent fertilisation rate, with the main cause of failure stemming from sperm abnormalities.

Once the sperm has been injected into the egg, the sperm must signal to the egg (the sperm factor) that it has arrived and should allow their nuclei to be fused together, after which the male sperm nucleus then fuses with the female nucleus.

If, however, the sperm has abnormalities, (problems with morphology or motility, for example) it will be unable to signal the egg properly. That means the egg pronucleus is unable to form and its genetic material is unable to arrange itself in order to fuse and combine with the pronucleus of the sperm. When it comes time for fertilisation to occur, therefore, only the nucleus of the sperm will be present, but not that of the egg,

The introduction of calcium ionophore can solve the problem. Using the technology, the egg that has been injected with the sperm is transferred to a medium containing calcium ionophore produced by Samitivej Sukhumvit Hospital and allowed to incubate for about 15 minutes.

The medium then enters the egg and acts as a signaler to the egg that the sperm has arrived. The egg is then activated for pronucleus formation and can begin the process of fertilisation. Finally, both the eggs and sperm, having begun the process of fertilization, are cultivated and matured according to the standard procedure.

This technique will be used in cases of:

l low fertilisation after undergoing ICSI |(< 50 per cent)

l very low sperm quality including low sperm count, weak sperm health, or severe abnormalities

l sperm morphology or abnormal sperm size and shape

l Sperm motility (the ability to move forward normally)

In solving problems of infertility using ART, it is important to consider carefully what kind of method is appropriate for each individual case. If an examination finds that the male’s sperm is abnormally shaped, that is, the sperm heads are very large, or in cases where ICSI has already been performed and was unsuccessful, the calcium ionophore technique will be used in treatment.

DR BOONSAENG WUTTHIPHAN is an obstetrician/gynaecologist specialising in reproductive medicine at Samitivej Sukhumvit Hospital. Call the Women’s Health Centre at (02) 022 2555-6.

Cow’s milk allergy is a common condition in infants and young children. The severity of the condition varies but it is important that parents keep an eye out for warning signs. By learning more about this condition and what it entails, parents can take the necessary steps towards providing their child with the right treatment, leading to a full recovery.

Cow’s milk allergy can develop early in life from the moment an infant comes into contact with cow’s milk. Even though only three to six per cent of all children suffer from this condition, parents should consistently observe their child’s diet, especially since the symptoms of cow’s milk allergy might not be apparent at first. Children can have an allergic reaction not only to the cow’s milk they drink, but also to cow’s milk in other food, shampoo, soap, or lotion.

The symptoms of cow’s milk allergy are divided into two categories – severe and mild. Mild symptoms can last a day or a few days, depending on how frequently the child comes into contact with cow’s milk. These mild symptoms can include:

•  Vomiting the milk he or she consumes. While vomiting or “spitting up” is a common occurrence in infants, it can point towards cow’s milk allergy if the symptom persist and if the baby only reacts this way to cow’s milk, not to mother’s milk.
•  Diarrhoea
•  Blood in stool
•  Rash
•  Snoring
•  Irritation and frustration when it is time to drink milk
•  Weight loss or inability to gain weight
• Most of the children who display severe allergic reactions to cow’s milk have parents with a history of high allergic levels, or high levels of immunoglobulin E (IGE). These severe symptoms can include:
•  Asthma attacks
•  Hives
•  Fainting
•  Low blood pressure
•  Seizures
•  Suffocation, shortness of breath or inability to breathe normally

In some cases, children can start becoming allergic after a severe case of diarrhoea. When there is trauma to the intestine, the body becomes more susceptible to proteins, therefore increasing the chance of the child developing an allergic reaction to cow’s milk.

A cow’s milk allergy is different from lactose intolerance.

Lactose is a form of enzyme that exists in almost all types of milk, such as cow’s milk, mother’s milk, and goat’s milk. A person should not consume more than 500cc of lactose per day, as the intestine cannot digest any more than that. If a child is allergic to lactose or has consumed too much of it, he or she can exhibit the following symptoms:

•  Flatulence
•  Gas
•  Diarrhoea
•  Constipation
•  Vomiting

A child can be allergic to lactose, but not to cow’s milk. If so, he or she can only drink cow’s milk which has no lactose. If parents suspect that their child might be suffering from lactose intolerance instead of cow’s milk allergy, the child can undergo a skin test or a lactose tolerance test, which can help diagnose the condition.

If your child is starting to show symptoms of cow’s milk allergy, remove milk from their diet. Do not let your child come into contact with any shampoo, lotion, or cream with milk. After the symptoms have subsided, the child can undergo a “skin prick test” at the hospital. The test introduces a small amount of the allergen into the skin. If the child is allergic to the substance, the skin surrounding the area will exhibit an allergic reaction.

If the test comes back negative, it is still advisable not to let your child drink cow’s milk for another month. Then, the child can come back for another test.

This time, the test starts with the consumption of one drop of cow’s milk. The child can drink another one millilitre of milk 15 minutes later, if there’s no allergic reaction, and the amount will be increased until it reaches 30 millilitres. The test can help determine the severity of the child’s condition.

Once the diagnosis has been made, the doctor will assist you and your child in further treatment and recovery.

PROFESSOR BOOSBA VIVATVAKIN is an expert in Paediatric Gastroenterology and Hepatology at Samitivej International Children’s Hospital, Sukhumvit Campus. Call (02) 022 2236-7.

Drivers slam on their car brakes, children want to play with it and impressed pensioners ask if it can carry their shopping. When delivery robot Robbie goes on test runs, everyone’s agog.

The six-wheeled delivery robot, designed by Estonian firm Starship and about the size of a lawnmower, is being tested in London, in two German cities and in the Estonian capital Tallinn.

There are already around 50 of the robots.

Reactions to the pilot project in Dusseldorf, Germany, at the end of September were overwhelmingly positive, says Media-Saturn spokeswoman Eva Simmelbauer.

The consumer-electronics retailer is the first company in Germany to use a Robbie.

Older people were especially impressed at bumping into the robot, according to supervisor Dino Dessi from Starship. Would it also do duty as a self-piloting shopping cart, they ask.

Children, on the other hand, wanted to play with it and even tried to climb aboard.

Rather than milk, bread or jam, the robot was used to deliver mail-order goods for Media-Saturn.

In another test in the northern city of Hamburg, the Robbie trundled around delivering mixed packages for parcels company Hermes to around 100 test households in high-rise flats.

During this test period, due to last until at least the end of the year, at least two people are always monitoring each Robbie.

On journeys outside of Estonia, it is accompanied by a “handler” who goes with it on foot, while in Tallinn an “operator” is constantly connected with the remotely controlled robot. Only in Tallinn have there been trials with no human tagging along, says Starship spokesman Philip Schroeder.If these tests go well, commercial use could follow next year, Starship says. Those deliveries would then only be monitored by the remote operator.

In Dusseldorf, the 100 test households had to ask for express delivery via robot, but were refunded the on-top fee.

Once the introductory phase is over, Starship insists the cost of the robot option when you order goods online will sink to around 1 euro (Bt38) per delivery. That would make the robot cheaper than mail or traditional parcel services.

Customers could book the robot via an app and choose the hour of their delivery.

The robot sets out at a faster than walking pace – around 6 kilometres an hour – from its station, which would serve addresses within a radius of several kilometres.

Only when the robot reaches its destination can it be opened by the customer; the delivery is also monitored by the operator, who can call the police if anyone tries to steal the payload or the robot itself.

Retail-trade experts like Boris Hedde of IFH, a Cologne think-tank, respond that instant delivery services like Amazon Prime are simply over-rated.

The majority of customers have got used to online orders arriving within two or three working days, and won’t pay extra for same-day delivery, he says. Premium delivery requires enormous organisational effort and extra cost.

Despite that cost, Amazon and other large mail-order companies are putting the industry under pressure to speed up, according to Hedde. This explains the Robbie trials and underlines why robot delivery may perhaps end up being just a pipe dream.

German general workers union Verdi is also sceptical about the idea of delivery robots, pointing to all the fiddly technological issues that could go wrong and the modesty of the savings robots would yield in an industry already defined by low wages and job insecurity.

“We don’t think delivery robots will play a big part in shipping goods to customers in the future,” scoffs a spokeswoman.

Once Robbie’s charm has |worn off, shoppers may far prefer to have a friendly driver knock at the door.

In men, the inguinal canal functions to transport sperm to the testicles, and from the testicles to the penis. For women, ligaments supporting the uterus pass through the inguinal canal.

There are two types of inguinal hernias: indirect and direct. Indirect inguinal hernias are a result of abdominal abnormalities existent since birth, whereas direct inguinal hernias occur only in males with weak abdominal wall muscles. Direct inguinal hernias are more common in the young or middle aged. Many times, they occur as a result of a chronic cough brought on by bronchitis alveoli, a lung aneurysm or a pulmonary disease.

Symptoms of an inguinal hernia include:

•  Pain or discomfort in the groin region (increased when bending or exerting yourself)
•  A noticeable bulge on either side of the pubic bone
•  Weakness or persistent pressure in the groin
•  A pulling, straining feeling in the groin
•  An aching or burning sensation in the groin where the bulge protrudes

Diagnosis is based on an examination of the patient’s medical history, a physical exam and, where needed, imaging tests such as an x-ray or ultrasound

During the physical exam, the doctor will usually ask the patient to stand and cough to feel whether or not there is a noticeable moving bulge. In some cases, this bulge can simply be massaged back into its rightful place.

It is important that diagnosis is made as soon as possible, as lack of treatment can lead to serious complications such as incarceration or strangulation.

Incarceration occurs when fat or intestinal tissue becomes dislodged from the abdomen and resides in the groin or scrotum. Strangulation occurs when an inguinal hernia is left untreated. When the blood supply to the intestine is cut off, the parts of the intestine that do not receive blood can die. Both of these conditions require the immediate attention of a medical professional.

There is only one option for treatment of an inguinal hernia and that’s surgery. Surgery is necessary in preventing incarceration and strangulation. Two types of surgery are used: Open Hernia Repair or Laparoscopic Hernia Repair.

Open hernia repair entails providing the patient with anaesthesia and making an incision in the groin so that the hernia may be placed back into the abdomen, with stitching in the abdominal wall to strengthen the barrier. A laparoscopic hernia repair is a minimally invasive surgery (MIS) in which the patient is given anaesthesia and the doctor makes three small incisions. A laparoscope is inserted and a camera provides a magnified image of the hernia. The size of the incision for camera insertion via the abdomen is a mere centimetre. The doctor uses this improved image and a monitor system to view the surrounding tissues and repair the hernia with a synthetic mesh. The incision for the tools with which to perform this treatment is just 0.5 cm.

With MIS technology, incisions are smaller, cause less postoperative pain, less blood loss and a faster recovery for the patient. In many cases, a patient can undergo surgery one day and return to work the following day. The chances of infection are extremely low, reducing the need for further treatment and enhancing patient safety.

Though inguinal hernia repair surgery is quite safe, and complications are uncommon, a patient must return to the doctor if any of the following symptoms appear:

•  Elevated body temperature
•  Bleeding from the incision site
•  Inflamed incision site
•  Drainage from the incision site
• l Persistent pain, despite the help of medication

If your hernia is not causing you any discomfort or adversely impacting your life, immediate action is not required. In fact, there are those can live with a hernia for some time without experiencing any noticeable symptoms. However, it is important to be very aware of your body and to look out for symptoms of pain or discomfort. It should be noted that if you are someone who lives a very active life, more immediate action should be taken, as the added strain to the body can worsen the hernia.

While weakness in the abdominal wall cannot be prevented, certain measures can be taken to lead a healthier lifestyle, lessening the chances of developing a direct inguinal hernia.

•  Avoid lifting heavy objects
•  If you must lift, lift with your legs; do not put strain on your back.
•  Stay within your healthy BMI
•  Do not smoke

DR PAKPONG WATHANAORAN is a surgeon specialising in hernia surgery at Samitivej Sukhumvit Hospital. Call (02) 022 2555-6.

 The Zika virus is a member of the flavivirus family; patients can contract the virus by getting bitten by infected mosquitoes. It is related to other flaviviruses such as yellow fever virus, dengue virus, Japanese encephalitis and West Nile virus. The first large outbreak of the disease was reported on the island of Yap in 2007. In July 2015, Brazil reported a correlation between cases of Zika virus infection and microcephaly, a birth defect where a baby’s head is smaller than normal.

The Zika virus can be transmitted via the following:

•  The bite of an infected Aedes mosquito, which breeds in water and usually bites during the day
•  Sexual intercourse (including anal, vaginal and oral sex) with a person who is infected
•  Blood transfusions
•  Organ or tissue transplantation
•  Transmission from a pregnant mother to the foetus

There have been no reports of the Zika virus being transmitted through breastfeeding.

Am I at risk of contracting it?

You are at risk of contracting the Zika virus if you have travelled to endemic areas. Currently, these places include countries in Southeast Asia, the Pacific Islands, Africa and South America. Coming into contact with a person who’s been to these places also increases your chance of contracting the virus. A detailed list of all the countries with endemic Zika can be found at: http://wwwnc.cdc.gov/travel/page/zika-information

What are the symptoms and warning signs?

The incubation period is between three and 12 days. Symptoms of the Zika virus include:

•  Fever of around 37.8 to 38.5 Celsius in adults
•  Rash
•  Red eyes
•  Joint pain, especially in the hands and feet
•  Muscle pain
•  Joint swelling
•  Headache
•  Fatigue
•  Diarrhoea
•  Swollen lymph nodes

Some patients with Zika have also suffered from the Guillain-Barre syndrome (GBS), leading to paralysis. Others have problems with the brain or nerve issues. However, these cases occur very rarely. People who suspect they might have contracted Zika should see a doctor immediately so the spread of the disease can be contained.

How harmful is the Zika virus?

People very rarely die of Zika. Most people infected will only experience mild symptom lasting for two to seven days. However, it can cause major problems in infants who are infected before birth, leading to brain defects, hearing deficits, defects of the eye and impaired growth. Guillain-Barre syndrome (GBS) has also been detected in endemic areas.

How is Zika virus prevented?

Although there is no prophylaxis medication or vaccine for prevention of Zika, you can protect yourself by following these measures:

•  Avoid travelling to endemic areas, especially if you are pregnant.
•  Protect yourself from mosquito bites by wearing long trousers and long sleeves and using insect repellent. If you are pregnant, make sure that the repellent is safe for pregnant women and breastfeeding mothers. Do not use repellent on babies, but use mosquito nets instead. Stay in rooms with air conditioning or screens and cover water tanks so that mosquitoes cannot enter and breed.
•  Abstain from sexual intercourse or only engage in protected sex to prevent sexual transmission of Zika. Men who have displayed symptoms should not have sex for six months, women for at least eight weeks. Men and women with no symptoms, but who have been to endemic areas, should not have sex for eight weeks. Pregnant women who might have been exposed to the virus should only have protected sex or abstain from the act altogether during pregnancy.

How is the Zika virus detected?

If you have symptoms of the Zika virus, you should get tested. If you are a woman who’s travelled to an infected area and have experienced no symptoms, the test is still recommended. Zika infection can be diagnosed through a blood test or a urine test. For infants and children who might be infected, tests are carried out in the same way. Recent travel history, sexual history (in the case of adults) and symptoms will also be taken into account.

Pregnant women who display symptoms or have been living in endemic areas should get tested as soon as possible. Early testing, in cases of positive results, will allow for treatment plans to be made immediately.

How is Zika virus treated?

There is no specific medication for Zika. The doctor can only provide symptomatic treatment. It is recommended that you drink plenty of fluids and get lots of rest. You can take Tylenol to relieve aches and pains, but do not take aspirin or other non-steroidal anti-inflammatory drugs (NSAIDS). If you are taking medication for any other condition, let your doctor know first.

DR ON-UMAR BANPAMAI is an Internist specialising in infectious diseases at Samitivej Sukhumvit Hospital. Dr Tassanee Sookpranee, is a paediatrician specialising |in infectious diseases at the same hospital. Call (02) 022 2555-6